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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