HP Strategies & Tactics

Chapter 11

Law, Policy, and Injury Prevention

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Injuries

Injuries are a tremendous public health problem, killing more people during the first four decades of life than any other cause

Injuries are not accidents—they are predictable and preventable

Because the word “accident” implies an unexpected and unintended event that happens by chance or fate, it should not be used when referring to an injury

Injury is the medical outcome of an unintended event like a crash or a fall

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Injuries

Policies (statutes, ordinances, or other adopted measures) regulations adopted by government agencies, and procedures, incentives, voluntary practices implemented via institutions = most important tools to reduce injuries and save lives

Can apply injury prevention policies to the three levels of prevention

Primary

Secondary

Tertiary

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Identifying the Problem: Injuries

Primary prevention policy

Prevent an injury before it happens

Deterring drunk driving by defining the legal limit for blood alcohol concentration while operating a vehicle

Secondary prevention policy

If injury occurs, reduce or eliminate the injury damage from an event

Installation of airbags and requirements to use seatbelts

Tertiary prevention policy

Can improve the likelihood that a person will survive an injury

Policies that assure qualified emergency medical services (EMS) responders and community emergency response capability to deliver pre-hospital care to the injured

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Laws and Legal Tools for Addressing Injury Prevention

Effective approaches to saving lives from injury:

Policies

Legislation (i.e. statutes and ordinances)

Regulations

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Laws and Legal Tools for Addressing Injury Prevention

Organizational Policies

School districts

Antibullying or violence prevention

Hospitals

Requiring car seats at discharge for newborns

Community-based organizations

Ensuring safe sporting environments

Business, industry, or corporations

Workplace hard-hat and safety-goggle

Professional associations

Policies against serving alcohol at association events

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Laws and Legal Tools for Addressing Injury Prevention

Regulatory Policies

At the State level

Regulations pertaining to child day-care facilities

At the Federal level

Consumer product safety regulations; vehicle safety regulations

At the local level

Building and fire codes

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Laws and Legal Tools for Addressing Injury Prevention

Local government policies

Speed limits on local roads

Limitations on bar and liquor-store hours

Local enforcement of bicycle helmet use

State government policies

Seat belt

Child-safety seat

Motorcycle helmet laws

Vehicle inspection requirements

Speed limits on state roads

Blood Alcohol Concentration [BAC] laws

Federal government policies

Occupational Safety and Health Act of 1970 to protect America’s workers

Public Health Service Act

Maternal and child health block grants

Highway construction and road building standards

Airbag warning labels

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Legislative policies

Injury Prevention and the Role of Policy

Laws and policies can affect the occurrence of injuries in at least three ways

Modifying the physical and social environment

Changing the social meaning of risk behavior

Changing individual behaviors by requiring persons to either refrain from a behavior (e.g., driving too fast) or to undertake a preventive action (e.g., wearing a seat belt)

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Laws and policies can affect the occurrence of injuries in at least three ways

Changing behavior is always the most difficult to achieve

Noncompliance can take place because an individual may not feel that an action carries a risk

Chances that an individual may die in a car crash on any individual trip in 2005 is 1 in 19,000

This is low enough that the everyday experience of many people might not prompt a perception of risk or preventive action

However, under the legal requirement to wear seat belts, perception of risk may shift from the risk of being injured in a crash to the risk of being punished for breaking the law—a far more relevant and immediate threat

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Policies that Modify the Physical and Social Environment

Polices that make the physical environment safer can benefit all of society

Schools that modify playground equipment by installing soft surfaces under equipment will protect many children from injury

Municipalities that require regular safety and hazard assessments of playing fields, parks, and public spaces to identify and fix dangerous play environment protect all users

None of these changes require behavior change on the part of children or playground users

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Policies that Modify the Physical and Social Environment

Success in changing the physical environment requires large-scale changes that are costly and can compete with other municipal priorities

Reducing the number of lanes on a highway to reduce the speed of vehicles entering a city might lower the severity of traffic injuries, but also may be a lower priority than reinforcing bridges or conducting asphalt paving

Remember, we need to design policy that makes the healthy (or safe) choices the easy choices

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Using Policy to Change the Social Meaning of Risk Behavior

When compliance with a law or policy is seen as an official or widely accepted view, compliance is more likely

Attitudes about right or wrong and about desirable and undesirable behavior can be influenced by policy

Individuals may obey the law not only because they fear detection and punishment, but also because they wish to comply with stated social norms

A child safety seat law that is viewed by the culture as acceptable because it is something that protects children, who cannot protect themselves = increased compliance

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Using Law & Policy to Change Individual Behavior

Just because a policy is in place does not guarantee compliance

The public may be unaware of a law, or enforcement of a law may be inadequate or imperceptible

Laws sometimes accomplish individual behavior change by removing a person’s ability to offend in the first place

Ignition interlock devices in cars to prevent alcohol-impaired driving

OR The public is aware of a law but does not perceive any benefit from it, or perceives the law to be rarely enforced

OR sanctions to be minimal or tolerable, or sees it to be too harsh, burdensome, or an excessive infringement on personal liberty (e.g., motorcycle helmets)

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Using Law & Policy to Change Individual Behavior

Laws can be an effective mechanism for inducing individuals to adopt safer behaviors, provided they are:

Widely known

Fair and acceptable to the public

Designed so that the probability of being caught is substantial

Enforced so that punishment is perceptibly swift and certain

Perceived to be of more benefit than harm (e.g., social benefits vs. harm; health benefit vs. costs)

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Using Law & Policy to Change Individual Behavior

Public education is an important addition to implementation of the law

Assures that the public is prepared and persuaded, and that it accepts the law or policy as meaningful and contributing to the public good, or sees it as a way to improve health

Individual behavior change to prevent injuries are more successful when the behavior was easily observable (this is key) and required by law

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Importance of Enforcement

Effectiveness of a law is directly related to its enforceability

Recent examples are the state-level policies to enhance the use of prescription drug monitoring programs (PDMPs) for controlling the prescription drug overdose (PDO) and abuse epidemic

49 states have responded by developing PDMPs

State-run electronic data- bases used to track the prescribing and dispensing of controlled prescription drugs to patients

Only 22 of the 49 states with PDMPs now legally mandate prescribers to query the system before writing a prescription for a controlled substance with potential for abuse or dependence therefore they are not effective

Without mandated registration or even mandated use, PDMPs have limited potential for impacting public health outcomes.

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Importance of Enforcement

Effectiveness of a law is directly related to its enforceability

Enforcing state-level policies that regulate pain clinics or “pill mills” have shown positive results

Florida

2010: Policy was implemented to regulate pain clinics and stop healthcare providers from dispensing prescription painkillers from their offices

By 2012, more than a 50% decrease in oxycodone overdose deaths was documented

New York

2012 regulation requiring prescribers to check the state’s PDMP before prescribing painkillers resulted in a 75% drop in patients seeing multiple prescribers for the same drugs

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Importance of Enforcement

Increasing the level of enforcement or increasing the penalty for violations can have a positive effect on behavior

A local ordinance in a rural town in Georgia requiring children to wear a bicycle helmet, had virtually no effect on helmet use because enforcement was either low or nonexistent

When police began vigorously enforcing the ordinance by confiscating bicycles from any child who was not wearing a helmet, rates of helmet use increased dramatically

Confiscation was a visible, dramatic, and well-publicized outcome of violating the law

Resulted in a 70% helmet-use compliance rate after targeted enforcement

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

Effectiveness of Laws and Policies Related to Injury Prevention

With the right policies, effective implementation, and strong enforcement, injuries can be prevented and lives can be saved

But, the laws must be effective

If people know that a particular law is effective, the knowledge alone can improve enforcement

Ineffective laws:

Are of no (or even negative) utility to public health and, in some cases, can be unconstitutional

Can breed cynicism among lawmakers and the public about injury prevention

May drain scarce enforcement or advocacy resources away from more fruitful pursuits

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

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Injury Prevention and the Role of Policy

What is the future of injury prevention & policy?

Depends on the extent to which policies are successful in changing injury-related behaviors, environments, and products in ways that improve public health, and on the extent to which those successes are carefully documented and made known to policy makers

*Assemble into 5 groups

*Review case study Box 11.1 p.225 in the text

*Come back and summarize your section

Eyler, Chriqui, Moreland-Russell & Brownson, 2016

Link to Video: MADD – Interlock Device AB : http://www.fox5atlanta.com/good-day/madd-supports-house-bill-for-dui-ignition-interlocks

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