Public Health Insight

Road Safety: Leadership, Policies, & Best Practices

September 08, 2020 PHI Productions
Public Health Insight
Road Safety: Leadership, Policies, & Best Practices
Show Notes Transcript

Road traffic collisions are largely preventable, however, it consistently remains one of the top 10 leading causes of premature death every year. The Public Health Insight Podcast discusses the role of leadership and institutional management in preventing road traffic collisions and Vision Zero as a framework to address road safety. The conversation concludes with an overview of some effective best practices and evidence-based interventions, such as seatbelts, drink-driving laws, and helmets. 

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[00:00:00] Sully: Public health, as a population-based field of science focused on preventing disease and promoting health. Every week, we will be engaging in interactive discussions and analysis of the latest public health issues affecting you and your communities all around the world. This is the Public Health Insight podcast.

[00:00:24] Leshawn: My name is Leshawn, and I'm here with Ben, Sully, Linda and Gordon. 

[00:00:29] Ben: Before we move on is important to note that the views expressed in this podcast are our own and do not represent any of the organizations we work for or affiliated with. 

[00:00:38] Leshawn: In the previous episode, we looked at the global burden of road, traffic deaths and injuries.

[00:00:43] The next step after identifying a problem is taking action. However, global and national safety goals and targets are no easy feat. This requires sustained efforts in coordination and management to tackle the systems issue of road safety. In this [00:01:00] episode, we will look at the role of leadership and institutional management and some of the best practices that can be used to adjust this issue.

[00:01:08] So why do you guys think leadership and institutional management play a role in improving road safety 

[00:01:14] Gordon: Leadership plays a role in everything, man. 

[00:01:17] Ben: Can you define institutional management?

[00:01:19] Leshawn: Can you define it? 

[00:01:21] Ben: Is there an echo? (Laughter) 

[00:01:24] Gordon: Forgive the technical difficulties, everyone. There's an echo that sounds different than the person that originally said it. 

[00:01:29] Ben: Lets just talk, cause if what do you mean by institutional management? Are you talking about like infrastructure that we mentioned before? Are you talking about government funding because then that plays into leadership. 

[00:01:38] Linda: I think it's a combination of all of that. Institutional management is having a strategic plan, having targets, having measurable targets for a specific goal.

[00:01:48] So in this case, it would be like having a framework for road safety. That that there's funding there's targets. There's a timeline, that's a systems approach rather than [00:02:00] isolated and I think it encompasses all of it.

[00:02:02] Gordon: I think you can I'm not sure semantically, you can do this, but for the purposes of our discussion, institutional could mean a cross sectorial approach within government. So I think from our previous episode we've seen that prevention efforts and, the allocation of resources and, the health systems side of things, aren't really aligned. When we have a health and all policies, approach road safety should definitely benefit from that. 

[00:02:30] Leshawn: Right. So it seems like in the last episode we talked about how the UN incorporated traffic safety into the sustainable development goals. Now at the country level, whose responsibility is it to actually incorporate this and take measures towards achieving some of these goals and targets. 

[00:02:51] Ben: I think that's a good point cause we talked a lot about the governments being responsible and obviously governments would be releasing these reports or these deadlines or [00:03:00] goals. Another aspect of it is that we also have to consider private organizations and community organizations holding the government accountable for the goals that they set themselves. So I think leadership can play in both the private and the public sector.

[00:03:12] Gordon: In terms of the way I guess most countries are set up whether it's low, middle income or higher income countries, there is ministry of transportation, which is usually a branch within the whole government. So when roads are being built or, there's issues with road safety, I would imagine that falls under the jurisdiction of, the infrastructure parts of government or the transport branch of government, but I'm not sure how much of a role public health plays in the design of like highways or streets in urban areas or rural areas. I'm not sure how much of a cross sectorial approaches apply to those.

[00:03:55] Leshawn: So let me stop you there. So do you think public health should have a role [00:04:00] in this? 

[00:04:00] Linda: Within Alberta, we have a department of injury prevention. We're going all the way to health services and an injury prevention.

[00:04:05] We talk a lot about traffic safety and road safety, and we give guidelines for, things like carseats booster seats. So there's already a conversation within public health surrounding injury prevention in regards to road safety. To me it only makes sense that those same voices, but also just be at the table in terms of urban planning infrastructure in regards to designing roads, because they have the same goal. 

[00:04:32] Gordon: Right and in Ontario, The health units typically have a portfolio that looks at road safety and provides guidance to the local municipalities, some recommendations on how to bring down injuries and make the road safer. But I don't know how much that information is factored into decision making for the infrastructure sector.

[00:04:57] I don't know how much, I don't [00:05:00] know if telling them that. There's been, the rates have increased threefold since last year. I don't know how much that drives decision-making into. I've seen, I think everyone's seen bike lanes pop up recently, and even those barriers that now separate the car lanes from the bike lanes, I think that's helpful for, and making the cyclists feel safer in and some passengers feel safer.

[00:05:25] So maybe it has had an impact, but I'm not sure how much. It factors in, I think that's the heart of the discussion. Leshaun was bringing up that the institutional management of things. The kind of getting away from that siloed approach to, you're in a ministry of chance, what you deal with roles, public health and healthcare deals with people when they're sacred, prevent them from getting sick.

[00:05:46] And how do we marry the two together for the best results? 

[00:05:49] Linda: I guess it would depend too on who's building, it was talking specifically about roads. Who's building the road, how is it being funded? And I was looking into it and I found that in Canada, [00:06:00] Roads I've funded through a mix of options. So sometimes it's through federal or national funding other times it's provincial and other times it's public private partnerships.

[00:06:11] So there's not one set way. And so that would determine who's involved as well in the decision making 

[00:06:17] Gordon: process. Yeah. And I was even thinking with the goals. So the UN goals, the sustainable development goals that LaShawn mentioned in our previous episode, Cutting road, traffic deaths by half in such and such.

[00:06:30] I'm wondering if the kind of local municipalities in, in Canada, for example, in the different provinces I'm wondering if they also have those similar goals, when you're building sustainable cities or you're making modifications to make things more bike friendly, are there goals in mind that, the reason they're doing this.

[00:06:49] To reduce the fatalities that cyclists have by X amount. I don't think we hear that very much. I think. If one, one thing this has taught us is, and I've been always says is to [00:07:00] have things being goal-driven. We don't really hear much about what those goals are. So we can't really know if it's been successful or not.

[00:07:07] Leshawn: Yeah. It seems that from my experience, at least in Toronto, the local jurisdiction has a lot of power in terms of. Reducing speed limits and adding speed cameras or red light cameras. And so they have the power to do that, based on their municipalities. 

[00:07:28] It's 

[00:07:29] Gordon: true. I think that's an example though.

[00:07:31] Because in Canada and specifically the province of Ontario public health gets at least a portion of their. From the municipalities. So just based on the nature of that agreement there can be crosstalk happening and recommendations can be made and they might be more inclined to act upon them. But when we get into, like Linda said, the mixed funding, how much of a role does a federal government [00:08:00] play on the broader sense in Canada or other countries?

[00:08:04] I'm not 

[00:08:04] Leshawn: sure. So yeah, we'll get into a really cool example with Sweden in a second, but I also wanted to just get your thoughts on something I've been thinking about lately. So we've been discussing over this episode in the last episode, the significant burden countries face, especially the low and middle income countries.

[00:08:27] They might not have the same road infrastructure. They may not have access to the same safe vehicles as us. And at the same time, compounding these issues are the fact that maybe there are more prevalent issues in terms of what people deem is more important, such as certain diseases that may take priorities in governments or institutions.

[00:08:50] So my question. How do we highlight road safety as an issue that institution should come up with comprehensive plans with, especially in the context of [00:09:00] low and middle income countries, where there might be competing priorities. I 

[00:09:04] Gordon: think we mentioned it in a previous episode, if the kind of social argument with years of life loss and value.

[00:09:11] Yeah. Disability adjusted life years, which meaning that, the productivity that people lose when they sustain a permanent partial disability. And how that affects their productivity. If that's not a good enough argument for policy decision makers and considering that there is a finite resources are finite, no matter what country you are.

[00:09:32] If there's an argument made from the economic sense that the cost savings. Hopefully spur some action, but the problem with cost savings as we, and I might Bosch this because I, I'm not an economist, but we always talk about the problem in public health is that the dollar is valued more now than it will be valued in terms of cost savings.

[00:09:54] So while we can make an economic argument, You know that the economic burden [00:10:00] of road traffic deaths fatalities is $600 billion or whatever it is, the reality is by building a road today, you don't get that back right away. When people look at things as just like an investment too, if you have personal finance, If you have to wait longer to re reap those benefits, you're less inclined to do so on it.

[00:10:19] It's the same thing when you look at the government investments into public. 

[00:10:23] Ben: So I think another aspect of that is when we're investing in infrastructure for road development, like for example, speed bumps, et cetera, there's a lot of wear and tear. So an initial investment for a lack of a road safety measure, right?

[00:10:37] It's not going to have the same lifelong prevention as something else in public. So that road bumps put in or whatever other measure, it might be gone again, or just a Rolex or even just the roads, there's potholes, et cetera. That might all just be gone in five years. So now you're having that conversation again of, Hey, we need you to invest in this again.

[00:10:58] Gordon: Yeah. That's a great point then [00:11:00] w weather like the climate and the weather impacts like the longevity of those kinds of things you mentioned. And, I'm just remembering Jamaica. They, because it's so rainy all the time. They'd fix a road and by the next year it's gone back to, to think, and then we talk about how costly those materials are.

[00:11:20] And that will influence how long those materials can last. And, yeah, that's a great point that it's not like a permanent. You have to meet there's maintenance. How much is the maintenance cost? 

[00:11:31] Ben: Another aspect is if the policy window even open to have that conversation again, 

[00:11:35] Gordon: man's getting our sauce.

[00:11:36] Sad, man. Sorry, 

[00:11:39] Linda: that's going to say an incentive and incentive to get people onboard is to show that preventing road, traffic injuries and deaths. It is possible, and it's not an inevitable thing that someone will die or be injured on the road. It is a preventable thing. And so if we can show that,[00:12:00] seatbelts works, state roads works legislations around.

[00:12:04] Drinking and driving helmets, child restraints. Those things can have a positive effect then perhaps that can gain more support, more momentum people won't feel like, oh, I can't do anything about this, but actually wait, we all have a role to play 

[00:12:20] Gordon: in making.

[00:12:25] So yeah, that's a good point. I think the way we ended up looking at it is road roads or bus. And what you're saying is it's not relative bus, other things as well, that are you could say, maybe more cost effective in that they don't require this huge. That can have an impact on saving lives.

[00:12:42] So that's a great, 

[00:12:43] Leshawn: all right. So as I mentioned, we're going to be talking about Sweden, who is recognized worldwide as a global leader in road safety performance. And so with their case, they found that between 1990 and 2015, they were able to reduce the number of road [00:13:00] traffic deaths by 66%. So how did they do this?

[00:13:04] You may be asking a crucial aspect involved. Long-term. Evidence-based approaches to their interventions that they used and strong institutional delivery and leadership. So what were some of the things that they did? I know they in October, 1997, they adopted something that may be well known in other countries called vision zero.

[00:13:26] Gordon: Yeah. So I think it's simply put vision zero, just a systems thinking approach or. Wherever you might call it to that focuses on road safety. So we discussed some of the weak, the weaknesses of, the coordination of leadership in and how that kind of served as a barrier to getting things done in the space of road safety and vision zero simply.

[00:13:50] Puts all the crucial elements together to come together with the optimistic goal of achieving no road traffic fatalities. 

[00:13:58] Leshawn: So what are some of these [00:14:00] aspects? Vision zero kind of encompasses. 

[00:14:03] Sully: Yeah. From a framework perspective, looking at it compared to traditional approach. In a traditional approach, We say that traffic deaths are inevitable, whereas envision zero they're preventable in traditional approach.

[00:14:16] We're assuming that human behavior must be perfect, but in envision zero, we account for the human failings in our approach and our strategies. 

[00:14:26] Gordon: And another piece of vision, zero compared to traditional approach is that in the traditional approach, it's very centered on preventing collisions, but in vision.

[00:14:37] Just like the piece of integrating human failure. We recognize that some collisions might occur and it's about preventing fatalities and severe injuries from these crashes and harm reduction, more of a harm reduction more of a harm reduction systems based approach. To saving lives in a way that is less costly, 

[00:14:58] Linda: but I haven't had a [00:15:00] question or I guess a thought to dispose to the group.

[00:15:03] So Sweden I've never been to Sweden was I want to, but notoriously, I just had that thought like, oh, Sweden, higher taxes. One of those like Nordic countries, they pay a lot in taxes. So to me, something like vision zero. Perhaps they have more capacity to fund it because of just the cultural commitment to we pay for taxes to help fund social programs or, create a better society.

[00:15:30] So I was wondering, do you think because of the way their taxation system is set up, perhaps that is why they were able to be more successful in vision zero because I think it said that they were able to read. Road traffic deaths by 66% over a span of what, like from 1990 to 2015, that's a large increase and it shows it's successful, but is it because of the way their society is set up already?

[00:15:56] Gordon: I think I'm another piece of that, Linda to take it one step further, [00:16:00] if people are more generally okay. With paying higher taxes to get these programs and initiatives. That focus on public health or prevention, the uptake would be higher. So if you think of even just road safety education, then I'm not sure what the data is, but maybe they're even then more likely to wear a seatbelt, or less likely to drink and drive. Because there's that ownership piece that you're saying, Linda, that might help with the uptake and. Taking these things more seriously, 

[00:16:30] Linda: like we're paying into this. And I'm not here to say, you have to have a high taxation system for this to be effective, but I'm wondering, what do you think in terms of a place where it's set up differently?

[00:16:41] Could this still be 

[00:16:42] Gordon: successful? Okay. The scalability is like, what about Sweden that made this possible? Is it isn't it can't be just. Seatbelts or drink the driving laws or car seats because Canada's institutional management. 

[00:16:59] Leshawn: No, it's [00:17:00] definitely a true, if you have your leadership talking about these issues, like vision zero and having this plan and commitment to the reduction of road related traffic deaths and injuries as a, it, first of all, highlights this as an important issues to the citizens.

[00:17:15] And so they're more likely to. Just be aware of it. And as a result, I guess the ideal would be some sort of behavioral changes, but that's where the institutional commitment comes down to. For example, in Toronto, we see that mayor John Tory in 2016 announced the plan to reduce the number of people killed and injured in traffic by 20% within a decade.

[00:17:35] So even though. Yeah, even though they like, hopefully this is a realistic goal based on the data in Toronto, but to have this commitment and these goals and targets set is a great first step goals, 

[00:17:50] Gordon: strong leadership. What are some of those interventions that are considered. Best practices that countries and jurisdictions can [00:18:00] adopt to reduce these down to the target levels.

[00:18:03] Leshawn: So according to the global status report for road safety, from who there are three, there are five risk factors that were highlighted when it comes to traffic deaths. And. So basically having enforcement legislation on these key risk factors are said to be critical components of an integrated strategy to prevent road traffic deaths.

[00:18:25] So these risk factors are speed drinking and driving motorcycle helmet. The use of seatbelts and child restraint systems. So now at this point of our discussion, we're going to go through each ones and have a little discussion on each of these risk factors, starting off with managing speed. So why is speed important to consider and especially have.

[00:18:51] A legislative policy lens when looking at this issue of speed as 

[00:18:55] Gordon: a science always say speed kills. I think it just makes [00:19:00] sense the faster you're going. If you have a collision to something the less your chance of surviving and escaping without an injury. So addressing speed. Is an important part of the systems thinking approach to road safety.

[00:19:14] Leshawn: Okay. So I think first of all, it's very important to maybe just have a quick discussion on why it's bad to treat. 

[00:19:23] Ben: So obviously alcohol impairs, your decision-making abilities and your motor skills. And a lot of driving is hinged on both of those two factors being a key point of not being involved in the car.

[00:19:36] So if you're impaired on both aspects, you're basically asking for a 

[00:19:40] Gordon: collision. And I think even the response time element of it, when you go to driving school or you're practicing for your licensing test they emphasize defense and defensive driving, right? Part of defensive driving is to anticipate the errors of other drivers and.[00:20:00]

[00:20:00] In a timely manner to, to prevent any issues from happening. And if you're impaired, you're less likely to be able to do that effectively. So that's a huge element in terms of preventing death and injuries from collisions. For sure. 

[00:20:14] Leshawn: Yeah. And I think in terms of policy and legislation in terms of the best practices the who recommends that you have, that you focus on.

[00:20:25] You have a component of any sort of law that looks at your blood alcohol concentration? So in general they place a limit for the general population and the young and novice drivers. 

[00:20:37] Gordon: I think there's different limits for if you're a younger driver compared to, 

[00:20:42] Ben: I think it has to go with the development of the brain because we know that the brain is still developing up until you're 25 or around that age.

[00:20:48] So if you have your driver's license at 16, that's still a number of years before. In air quotes, fully developed. So I think that's why they have that distinction between [00:21:00] physiology. So 

[00:21:00] Gordon: you're saying at the same alcohol, our blood alcohol concentration, the younger person will pro will likely be more vulnerable to the effects of yeah.

[00:21:12] Yeah. So 

[00:21:12] Ben: That's one factor as well. And there's also the cultural factor of younger people being more riskier with alcohol, as we see in. So maybe that's why there's a difference there. And they're trying to make it more preventative for the younger population. 

[00:21:25] Leshawn: So what are some of, I guess the key interventions that governments or institutions can.

[00:21:32] Use to prevent drink driving from occurring mothers 

[00:21:36] Gordon: against drunk driving. Yeah. M a D have some good commercials. Shout out to that may 

[00:21:42] Leshawn: be D all those commercials. Like some of the commercials out there, very 

[00:21:48] Ben: intense. 

[00:21:50] Linda: Yeah. Media campaigns 

[00:21:53] Gordon: effected me the campaigns. And even if you think of, even when you go to a bar, Or even if you go to someone's [00:22:00] house the person or the host or whatever you want to call, it can be held liable.

[00:22:05] If the person leaving your event operates a car under the influence of alcohol. So that is one of, yeah, that is one of the intervention. If a bartender, to my knowledge, part of the liquor license is being understanding. Not to over-serve your clientele. And if they do go out and operate a vehicle and getting to an accident that establishment can be charged.

[00:22:30] So that's one of those maybe one of the more downstream interventions, but can be effective if the person serving knows they can be liable. If anything else people do or don't do things out of fear. So the fear of being of getting into trouble, even. You shouldn't be motivated by doing the right thing by being altruistic should drive your decisions.

[00:22:51] Reality is sometimes fear of consequence is a lot, is a way to go in a lot of cases. 

[00:22:57] Leshawn: Okay. So the third one is [00:23:00] increasing motorcycle helmet use. So why do you all think that's important 

[00:23:05] Gordon: motorcycle helmet? If you look at his motorcycle, and if you look at just, cyclists in general wearing helmets when they're white wearing a bike.

[00:23:14] Yeah. We talked about how one of the vulnerable groups of road deaths, fatalities and injuries are people on two and three wheelers. And we know that the primary cause of death after a collision is a head injury. So it then makes sense that measures to where. Some kind of protective thing on your head would be beneficial 

[00:23:40] Linda: and not to mention the cost savings because being treated in neuro rehab for a head injury compared to the customer, a helmet.

[00:23:50] Substantial 

[00:23:51] Leshawn: cost saving. So some of like the key interventions that were recommended were, laws enforcing, wearing helmet, which is very hard to do. I'll get to [00:24:00] that in a second standards for motorcycle helmet. So the specifications on specific helmets that you wear penalties for not using your helmet.

[00:24:09] And again, like we mentioned to that for the other risks, Kinda more informational educational campaigns. They'll help with the awareness of emotion I'm telling you exactly health promotion. And so that kind of leads me to talking about some, my experiences in Thailand. Even in the main city of Bangkok, where I spent a lot of time, those roads are wild.

[00:24:29] There's motorcyclists, everywhere, going in every which direction. A lot of them and especially their passengers who ride behind. Are not wearing helmets, which is very very sad, but there has been a lot of progress in this. In Thailand they actually passed a helmet wearing law, which basically found that individuals increased the use of helmets by five fold.

[00:24:56] And this resulted, as we all mentioned, A [00:25:00] decrease in deaths associated by injuries on bikes. 

[00:25:04] Gordon: Question four, I'm asking about Thailand, but we can open it up to other countries as well. In order to ride a motorcycle in Thailand, you have to have a license from the government to operate the vehicle. 

[00:25:17] Leshawn: I'm not sure about that, but from personal experience, it seems that in different areas of Thailand, especially the rural areas.

[00:25:27] There's not a lot of regulation or enforcement, so it's not uncommon that I've heard of a lot of, younger children, riding, riding bikes in their local areas. But the reason 

[00:25:38] Gordon: disorder, the reason I'm asking. So if we look at Canada and I'm pretty sure the United States, if you're a cyclist, so if you just have a bike and it's not, it doesn't have an engine, you do not need a formal license to operate. So I'm wondering how the enforcement comes in when you didn't necessarily have to pass some kind of tests to [00:26:00] show that you're competent to write up, a bicycle as opposed to a motorcycle, which you do need in licensed to operate legally. So I'm wondering if that makes enforcement more difficult when the vehicle that you're operating to transport is not necessarily, you don't need to be licensed to operate.

[00:26:19] And, and the specific example we're talking about is a motorcycle wearing a helmet. Why, while you're riding a motorcycle now, compared to wearing a helmet while you're riding a bike and you don't necessarily have to have a license to even ride a bike. And in young children we're ride bikes, right?

[00:26:35] So we're going to give eight year olds tickets to give their 

[00:26:39] Ben: parents. 

[00:26:40] Gordon: I support that. And then we get into the social equity piece with if lower income people are more likely to ride bicycles and can't afford helmets and you're ticketing. There's a social equity issue. 

[00:26:53] Leshawn: So another risk factor that was mentioned in the report was using seatbelts.

[00:26:59] [00:27:00] And I don't think I have to ask you guys why seatbelts are important, but I'll ask you guys anyways. Why seat belts? 

[00:27:06] Gordon: Yeah. Yeah. So seatbelts have been shown to reduce the risk of death amongst drivers in. The driver and the front seat passenger by up to 50% and reduce it by 25% from people in the rear seat occupants.

[00:27:22] That would be in terms of when you look at public health and prevention, those numbers are really good. In public health, if you get even a 10% reduction in anything that's considered pretty good. So considering that you can cut something in half by having a seatbelt. That is, that should be extremely desirable.

[00:27:42] Sully: Yeah. Cause all of that scales up. Because 10% of like millions of people that's a lot. 

[00:27:47] Leshawn: So what we're really talking about here at the end of the day is prevention. We were, we wear the seatbelts to prevent an incident or an adverse incident from happening to prevent us from flying through the window.

[00:27:59] And [00:28:00] I think have you guys. Like a huge prevalence of people not wearing seatbelts, like in certain populations. I'm not sure. I'm not sure, but oh yeah. Go ahead. Go ahead. Go. 

[00:28:12] Linda: This is not to generalize, but my experience in Ghana wearing seatbelts, I'd sit in a taxi and that'd be putting on a seat button.

[00:28:19] They'd look at me like, why are you putting on your seatbelt? Or it's. Sometimes if it let's say it's been used for a long time, it can stay in your clothing, the seatbelt. And so often people are like, oh, don't wear it. It's dirty the seatbelt. And so it just depends. The risk perception, it depends.

[00:28:37] What's the norm. It depends the type of vehicle you're in. And so yes, it's prevention, but if that's not something often people getting rejected from a car, you may not think the seatbelt is necessary. 

[00:28:45] Ben: Another aspect of that in the culture is. You wear a seatbelt, the driver might think, oh, you think I'm a bad driver?

[00:28:50] You think we're going to get into 

[00:28:53] Gordon: exactly. Just coughing 

[00:28:56] Ben: Straight up to ask you wait what do you think's going to happen while you're wearing your 

[00:28:59] Gordon: seat? [00:29:00] And that goes back to your earlier point, Linda too, about motivation. So we're motivated to follow the speed limits because we don't want to get pulled over.

[00:29:10] And unfortunately too, in a lot of cases with the seatbelt it's. Oh crap. I just pass the police and I don't have my seatbelt on. So it's unfortunately not motivated by preventing severe injuries and death. It's motivated by not being penalized, unfortunately, but that's true with all 

[00:29:28] Sully: aspects of road traffic.

[00:29:30] Really? 

[00:29:30] Gordon: Not really. I think that the helmet, one's an interesting example, right? It's you can if a helmet, if there is no law, To wear a helmet and you're wearing a helmet. It must mean that you recognize the value of the helmet. Yeah. 

[00:29:44] Linda: And I think like part of it is motivated by your safety and others, but like it's maybe not as much of a priority as your.

[00:29:54] As you not wanting to get a penalty right there. [00:30:00]

[00:30:00] Gordon: That's good because we have that, the what's it called the intervention ladder where 

[00:30:06] Linda: Nuffield or Newfield intervention letter. So at the base of the ladder, It's just, you do nothing or you simply monitor the current situation and then it goes up vertically on the levels of intervention.

[00:30:19] So it goes from doing nothing to providing information. Then you enable. And you offer a guided choice through changing the default. So for making healthier choices, the default option, and then the step above that is a guided choice through incentives. So you use financial or other incentives to guide people to pursue certain activities.

[00:30:40] So this comes to mind like when you give people money for recycling. 

[00:30:44] Gordon: And then another example too, is if you don't have any collisions. Your car insurance, then you can get like, 

[00:30:52] Linda: Yeah, relatable examples to road traffic, and then above that is choice through [00:31:00] disincentive. So like a speeding ticket to influence people, to not pursue a certain activity.

[00:31:05] And then above that is restricting choice where you regulate to restrict the options available and then the very last choice or the highest. Part of the ladder is to eliminate choice where you regulate to eliminate your choice entirely. And this all comes from the Newfield council on bioethics. 

[00:31:27] Gordon: I'm glad you brought up Linda because in the world health organization report that we're referencing throughout this discussion, they consistently indicated that typically stronger measures are more effective.

[00:31:41] And as we go up that. That policy ladder that you mentioned when there is no alternative. People are more likely to follow because they're motivated by having healthier behaviors or they're motivated by avoiding punishment. So that's a good, 

[00:31:56] Leshawn: so with that in mind, let's head on to the last [00:32:00] risk factor, which is child restraint use.

[00:32:04] What we know from the literature is that child restraints are highly effective in reducing injury, in depth to child, occupants, and the use of these restraints actually lead to a reduction of around 60% in deaths. So what are some of these. I guess laws that the, who recommends to implement in different.

[00:32:24] Linda: What I've been really interesting from this is that who recommends best practice is to have child restraints in place until the child is 10 years old or 135 centimeters in height. But in Canada, we do not enforce that. And. Yeah, and I saw this and I was like, I know I was not in a booster seat until 10 years old.

[00:32:45] Leshawn: I wasn't 10. Wow. 

[00:32:46] And 

[00:32:47] Linda: it's, but in Alberta, anyway, it's a recommendation, but it's not law. And so when people hear that, how many of us are even aware that this recommendation is in place until 10 years old? And [00:33:00] if you hear a recommendation versus an enforced law, how do you perceive the necessity? 

[00:33:08] Leshawn: Yeah.

[00:33:09] Linda: Or let's say you, you can't afford a booster seat. They're not cheap. I didn't know this 

[00:33:14] Gordon: at all, but even you think of the example, and I think going back to your examples of being in taxis, when you're in Ghana and similar experience for me, when I'm in Jamaica, first of all, cars have a limit to the amount of passengers it can have.

[00:33:30] Oftentimes in certain countries you end up with. Three or four more people and you should have in your car, right? Oh, way more.

[00:33:47] vehicles are built with the seat, the number of seat belts that you need for the number of passengers that should be in your car. So if you go beyond that, you can't have seatbelts. And in the example [00:34:00] with the. The child restraints or the child car seats, if you're having, and my experience in Jamaica too, when I, when my parents were carrying me around and maybe they've had to use taxis, if the taxi driver needs to pick up seven people in his midsize sedan, you can't take up two seats with a car seat.

[00:34:19] That's gonna infringe upon is, the return on investment. So to speak of what his trips that he makes. If you look at it too, in those developing countries where the gig economy or the informal work sector, where people rely on that form of transport to bring income to their family.

[00:34:37] You're not really willing to sacrifice two spots in your car to have one child in a car seat. 

[00:34:44] Linda: So is this profit over people are like, and not to bash people, but it's this is the society. 

[00:34:49] Gordon: Yeah. And, but then it goes, I think in terms of the social determinants of health, I think this is one where you just have to go more upstream to, they're doing.

[00:34:59] Economic [00:35:00] wellbeing, maybe, that the economic part of it has to be addressed rather than you shouldn't have a child, not in a car seat in your car. 

[00:35:07] Leshawn: So we wrapped up on talking about these five different risk factors, but there are different considerations. That go beyond this, that the, who did also recommend to look into.

[00:35:21] So one of those are reducing distracted driving and we know exactly what the increase of cell phone use and accessibility, more drivers, especially young and novice drivers are, being distracted by their phones, texting while driving. Calling people while driving FaceTiming while driving, so yeah. Why is this a concern? 

[00:35:46] Gordon: Yeah. Drafted, driving increases a chance just like being impaired. While driving, whether it's, we didn't really talk too much about cannabis in Canada and how that has changed the game for [00:36:00] enforcing laws of drivers being impaired in such and such. Yeah. That's definitely a factor, but 

[00:36:04] Narrator: that's 

[00:36:04] Linda: a hefty fine in Alberta.

[00:36:06] Anyway, if you're driving and you get caught using your phone, I think it's almost $300. Plus the merit point.

[00:36:16] Leshawn: Do you think that's well deserved 

[00:36:18] Gordon: to be even more? Yeah, it could be. I think the. In terms of the effectiveness of it, of the people that actually do it, maybe 10% of them are caught by police is limited capacity, right? So it's more sustainable to maybe the health promotion side of it to just communicate that it's just not a good idea and maybe make healthier choices, easier choice.

[00:36:43] So with that said, the point of public health is to create supportive environments for people to fill their potential, to be held. Another thing is to reduce the number of preventable deaths. And if technology has a role to play where the reality is cell [00:37:00] phones and that kind of social media connection has become a fabric of our society.

[00:37:04] Now it's going to stay here for the foreseeable future and it's about building an environment around that to make people safe while they're driving. 

[00:37:11] Leshawn: So we have discussed the importance of institutional management and leadership along with interventions and the ideas from a legislative perspective to reduce the burden of road traffic, deaths, and injuries.

[00:37:22] Remember to always wear your seatbelts and obey local traffic laws. Stay safe. 

[00:37:27] Narrator: Thank you for listening to the public Health Insight podcast, your go to space for informative conversations, inspiring community action. If you enjoy our content and would like to stay up to date, follow us on Instagram, Facebook, Twitter, and LinkedIn, to learn more about our community initiatives and how you can support us visit our website at thepublicofinsight.com joined the PHI community and let's make public viral.