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TEACH-VIP

TEACH-VIP. T raining, E ducating, A dvancing C ollaboration in H ealth on V iolence and I njury P revention.

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TEACH-VIP

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  1. TEACH-VIP T raining, E ducating, A dvancing C ollaboration in H ealth on V iolence and I njury P revention 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. Core curriculum Lesson 20

  2. TEACH-VIP Injury prevention: policy development and advocacy

  3. Global burden Disease burden (DALYS) for the 10 leading causes 1999 Disease or injury 2020 (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

  4. 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

  5. Who are the actors? • international • national • regional • local Media Professionals NGOs, special interest groups Injury prevention policy Government Users/citizens Parliament Industry

  6. Factors in policymaking Political decisions depend on: • 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

  7. Why do we need advocacy? • 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.

  8. Injury prevention policy Narrowing the gap • Injuries are preventable • Importance of evidence-based measures • Ineffective measures - waste of resource

  9. Injury prevention policy

  10. Injury prevention policy Narrowing the gap  WHO, 1998 Policymaking tools Injury prevention visions, targets and strategies, independent research and data analysis, performance indicators, public opinion survey

  11. The targets of advocacy? • Policies and practices of governments and large institutions • Laws and regulations • Commercial marketing practices of industries • Activities of counter-health lobbies

  12. 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

  13. What is advocacy? “acombination 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)

  14. Framing the issues What is framing? 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

  15. Framing the issues Pool fencing in Australia 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

  16. Pool fencing in Australia Media discourse analysis 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

  17. Pool fencing in Australia Use of expertise “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

  18. Who initiates? Enlightened governments ? Well-informed parliamentary committees ? Pro-active professional or citizen networks ?

  19. 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

  20. Injury Prevention Advocacy Top down - professional experts/organizations 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)

  21. Injury Prevention Advocacy www.racs.edu.au Role and achievement: “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)

  22. Injury Prevention Advocacy www.pacts.org.uk 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

  23. Injury Prevention Advocacy Bottom up networks - grassroots/local citizens e.g.Mothers Against Drunk Driving (MADD) Campaign against Drinking and Driving (CADD) RoadPeace

  24. Mothers Against Drunk Driving www.madd.org • 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

  25. Evaluating advocacy actions Evaluation methods • 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)

  26. Divide into 3 groups Take one of the assigned topics: Bicycle helmet legislation Risk Compensation Evaluation of injury prevention programs Answer the questions Group exercise

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