In Support of Mandated Safety Regulations
According to the Centers
for Disease Control (CDC), violence and injuries are the number 1 killer of
citizens between the ages of 1 and 44 in the United States, and the literal cost
is as precipitously steep as the cost in terms of lives lost- an estimated $465
billion annually in medical care and loss of productivity. Of course, not all of
these deaths can be reduced, prevented, or even anticipated- but some of them
can. For instance, mortality due to violence is unpredictable and therefore hard
to regulate. We do, however, know that morbidity and mortality numbers increase
when bicyclists/motorcyclists get into accidents and are not wearing helmets,
and that people involved in motor vehicle accidents also suffer higher incidents
of bodily injury when they are not wearing their seatbelts than of those who
do. Therefore it is the responsibility of public health practitioners to
influence the implementation of policies that reduce morbidity/mortality
wherever possible.
Policies and regulations
aimed at reducing serious head injuries by requiring riders to wear helmets is a
great example of why the involvement of public health practitioners in guiding
such legislation is so important. An article published in The Lancet in April
2013 declared that in the midst of falling traffic collision fatalities in the
United States, motorcycle crash deaths continued to increase, prompting a
national inquiry into why. However the answer to “why” was revealed very
quickly- simply put, there are no universal laws relating to the use of
motorcycle helmets in the United States. Many states have either no helmet law,
or have what are termed “partial” helmet laws (those which require only certain
riders, such as young riders) to wear helmets. Oftentimes motorcycle helmet laws
are enacted, only to be repealed and, according to Rebecca Ivers, one of the
world’s leading injury experts, “states that repeal compulsory helmet laws
completely or partially experience sharp drops in helmet use and increases in
motorcycle-related deaths” (Kirby, 2013, pg XXXXXXXXXXAnd the numbers bear this
out- in the two year period between 2008 and 2010, upwards of 14,000 people were
killed in motorcycle crashes in the United States. In states with enforced
universal helmet laws, 12% of motorcyclists killed were not wearing helmets. In
states with partial helmet laws, 64% of those killed were not wearing helmets,
and in states with no helmet laws, 79% of those killed were not wearing
helmets. Since 2000, motorcycle crash deaths have risen a staggering
55%.
The role of epidemiologists in the
generation of data to support changes in health policy is extremely
important. In the above example, Dr. Ivers is leading team out of the George
Institute for Global Health in Sydney, Australia, and working with the CDC on a
“systematic review of motorcycle safety to guide America’s policy” on motorcycle
helmet use by examining epidemiologic studies of helmet use legislation from all
over the world. The results of their review will “guide the US Community
Preventive Services Task Force in the recommendations they make” (Kirby, 2013,
pg. 1171).
In addition to the
generation of the data that helps shape and influence public health policy,
epidemiologists and other health practitioners are also integral to the
development of tools/instruments that facilitate changes in policy. In their
article
The Spectrum of Prevention: Developing a Comprehensive Approach to
Injury Prevention, Cohen and Swift discuss what they term the “spectrum of
prevention” – a tool which is “framework for multifaceted approaches to injury
prevention” (Cohen, & Swift, 1999, p XXXXXXXXXXThe spectrum of prevention has 6
levels with an outward progression that begins at the individual level, and ends
at the policy level. Specifically these include: “strengthening individual
knowledge and skills, promoting community education, Educating providers,
fostering coalitions and networks, changing organizational practices” and,
finally “influencing policy and legislation” (Cohen, & Swift, 1999,
203). According to the authors, the influence of policy and legislation has the
greatest implications- where there is the broadest opportunity for improvement
with regard to health outcomes. They believe that communities will continue to
expend energy being reactive- that is, “devising new services and programs in
response to injuries” until they dedicate themselves in earnest to proactively
promoting accident/injury prevention (Cohen, & Swift, 1999, 207). As an
instrument, the spectrum of prevention has not been formally evaluated; however
it has been applied to some health problems globally with encouraging measures
of success.
Epidemiologists play a
key role in both justifying changes to existing public health policy and/or
developing new policy through the generation of data from epidemiologic studies,
as well assisting legislators with the facilitation of implementation those
policies. Their work provides guidance for lawmakers who may not necessarily
have the knowledge or expertise required to be able to design effective,
evidence-based policy themselves. The relationship between epidemiologists and
legislators may therefore be considered symbiotic, neither of which would be as
successful without the other.
ReferencesCohen, L., & Swift,S XXXXXXXXXXThe Spectrum of
Prevention: Developing a Comprehensive Approach
to Injury Prevention.
Injury prev
evention, 5(3), XXXXXXXXXXdoi:
10.1136/ip XXXXXXXXXX
Kirby, T XXXXXXXXXXUSA Reviews Motorcycle Safety
Laws as Crash Deaths Increase.
The Lancet, XXXXXXXXXX), XXXXXXXXXX.
doi:10.1016/S XXXXXXXXXX
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