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V V iolence andiolence and I I njurynjury P P reventionrevention Core curriculum

Lesson 20

The materials in this lesson are based on an injury prevention and

control curriculum originally developed by the World Health

Organization and a global network of injury experts.

Injury prevention: policy development

and advocacy

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Global burden

Disease burden (DALYS) for the 10 leading causes1999

Disease or injury2020 (projected)Disease or injury

1. Lower respiratory infections 1. Ischaemic heart disease

2. HIV / AIDS 2. Unipolar major depression

3. Perinatal conditions 3. Road traffic injuries

4. Diarrhoeal diseases 4. Cerebrovascular disease

5. Unipolar major depression 5. Chronic obstructive

6. Ischaemic heart disease pulmonary disease

7. Cerebrovascular disease 6. Lower respiratory infections

8. Malaria 7. Tuberculosis

9. Road traffic injuries 8. War

10. Chronic obstructive 9. Diarrhoeal diseases

pulmonary disease 10. HIV DALY = Disability-adjusted life year WHO, 2000

Policy development and advocacy

“Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful. Health promotion aims at making these conditions favourable through advocacy for health.”

WHO, 1986

Who are the actors?

Government

Parliament

Media international national regional local

Professionals

Industry

NGOs, special interest groups

Users/citizens

Injury prevention

policy

Factors in policymaking

• what opposition groups think

• how far ‘free market’ as opposed to

interventionist policies are pursued

• the framing of debate

• editorial and media coverage

• public opinion

• political leadership

Political decisions depend on:

• To narrow the gap between what is known to be effective, acceptable and practicable and what is practised.

• To overcome barriers to the timely implementation of effective measures.

Why do we need advocacy?

• Injuries are preventable

• Importance of evidence-based measures

• Ineffective measures - waste of resource

Injury prevention policy

Narrowing the gap

Injury prevention policy

Injury prevention policy

WHO, 1998

Narrowing the gap

Policymaking tools

Injury prevention visions, targets and strategies, independent research and data analysis, performance indicators, public opinion survey

• Policies and practices of governments and large institutions

• Laws and regulations

• Commercial marketing practices of industries

• Activities of counter-health lobbies

The targets of advocacy?

What are the barriers?

Opposition from powerful sources

• Political philosophies that undermine health at the expense of economic considerations

• Commercial interest and the marketing or manufacturing of unsafe and unhealthy products

• Vociferous minorities perceiving state interference with civil liberties

“a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and system support for a particular goal or programme.”

WHO (1995)

“taking a position on an issue, and initiating actions in a deliberate attempt to influence private and public policy choices.”

Labonte (1994)

What is advocacy?

Meeting the demands of brevity and the nature of newsworthiness by transforming facts and arguments into metaphor, label and symbol in order to allow them to be told as news stories.

Chapman and Lupton, 1994

Framing the issues

What is framing?

Public debate about the mandatory installation of domestic swimming pool fences to prevent infant drowning:

For - Concern about protecting children from drowning in domestic pools

Against - Concern about the aesthetics of garden landscaping

Chapman and Lupton, 1994

Framing the issues

Pool fencing in Australia

Use of expertise

For - pubic health professionals, retired judges

• used data and evidence as core argument• used supportive public opinion information

Against - PFAG, pool owners

• sought to show disagreement amongst experts• sought to discredit public opinion information

Chapman and Lupton, 1994

Media discourse analysis

Pool fencing in Australia

“Pool owners heard a number of expert speakers who said (the new regulations) would not make outdoor swimming pools any safer for children.”

(North Shore Times, 30.6.90)

A PFAG spokesman said, “The fact is that the survey is so flawed as to be useless and indeed a waste of taxpayers’ money …. opinion surveys ... should be conducted according to the highest professional criteria. This survey was not so conducted.”

(Sydney Morning Herald, 12.3.92)

Chapman and Lupton, 1994

Use of expertise

Pool fencing in Australia

Who initiates?

Enlightened governments ?

Well-informed parliamentary committees ?

Pro-active professional or citizen networks ?

Advocacy planning process

•Identify likely sources of opposition•Anticipate their likely framing•Identify barriers (other than direct

opponents)•Identify (and engage) likely

supporting partners•Identify (and engage) likely

political/opinion leader “champions”•Develop an advocacy strategy

e.g. Royal Australasian College of Surgeons

Parliamentary Advisory Council for Transport Safety (UK)

New York Coalition for Safety Belt Use

European Transport Safety Council (ETSC)

Injury Prevention Advocacy

Top down - professional experts/organizations

Injury Prevention Advocacy

“Acts as a non-political authoritative counter to political inertia and public ignorance and apathy.”

“Has played a major role in Australian traffic safety progress by acting as a powerful advocate.”

Australia occupant restraint legislation

Trinca et al (1988)

www.racs.edu.au

Role and achievement:

Helped to achieve:

• compulsory front and rear seat-belt wearing• legislation on speed humps• ring-fenced funding for low-cost safety engineering schemes

• founder member of the European Transport Safety Council

Injury Prevention Advocacy

www.pacts.org.uk

e.g. Mothers Against Drunk Driving (MADD)

Campaign against Drinking and Driving (CADD) RoadPeace

Injury Prevention Advocacy

Bottom up networks - grassroots/local citizens

Helped to achieve:

• enactment of over 300 excess alcohol laws between 1980 and 1986

• introduction of random sobriety checkpoints

• elimination of plea bargaining for excess alcohol

• mandatory prison sentences

• 21 years as minimum drinking age

Mothers Against Drunk Driving

www.madd.org

• Formative - current injury level or current target population opinion?

• Process - how much media coverage?• Outcome - did it change policy?• Impact - did it prevent deaths and

injuries?

Loue et al (2003)

Evaluation methods

Evaluating advocacy actions

Group exercise

• Divide into 3 groups

• Take one of the assigned topics:

• Bicycle helmet legislation

• Risk Compensation

• Evaluation of injury prevention programs

• Answer the questions