Policy Advocacy in Public Health Setting

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Policy Advocacy in Public Health Setting

• Angela Cooper Brathwaite, RN, PhD.
• Lynne Gray, RN, BScN

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The Facts

• Injuries rank third account for 11 of the
  total economic burden in Canada (Health Canada,
  1997).
• Unintentional injuries account for 13 billion in
  Canada - 4.5 billion in Ontario (SMARTRISK,
  2006).
• The purpose of this presentation is to describe
  steps taken by the Durham Region Health
  Department in policy advocacy to influence the
  provincial government to amend the Highway
  Traffic Act and Off-Road Vehicle Acts.
• Four Es of Injury Prevention
• Effective strategies to reduce and prevent
  injuries involve the combination of Education,
  Engineering, Enforcement (of policy/
  legislation), and Evaluation

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• Enforcement of legislation is an important
  strategy to reduce injuries, but how do we get
  from problem identification to policy enactment?
• POLICY ADVOCACY

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Definitions

• Policy is a course or principle of action adopted
  or proposed by a government, party, business or
  individual. Policy defines a value or belief as
  well as defining what is acceptable by supporting
  certain steps or procedures.
• Advocacy is the deliberate and strategic use of
  evidence-based information, the media, experts,
  human and other resources to shape the injury
  prevention policy landscape (Vernick, 2006).
• Policy Advocacy involves the use of media
  messages, grassroots coalition building, letter
  writing campaigns and direct contact with
  decision makers or their staff to bring about
  change (Vernick, 2006).

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Steps in Policy Advocacy

• 1. Define the problem
• 2. Identify solutions
• 3. Find out who has the power to make the
  decision and who has influence
• 4. Identify resources
• 5. Create an action plan define strategies
• 6. Choose your timing
• 7. Implement and monitor
• 8. Celebrate your successes

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Defining the Problem

• A problem is
• A situation that creates hardship/difficulty
  for an individual or a group. A problem becomes
  an issue when brought to attention and becomes a
  public concern.

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Durham Region Health Department - Policy Advocacy

• During 2006, Durham Region Health Department,
  Injury Prevention Program, developed policy
  advocacy plans related to
• Motor vehicle safety (seatbelt use)
• All-terrain vehicle (ATV) safety

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Seatbelt Use

• STEP 1 The Problem
• A loophole was identified in the HTA in
  subsection 4 every personin a motor vehicle in
  which a seatbelt assembly is provided forshall
  wear the complete seatbelt assembly.
• There was no regulation to ensure that the number
  of passengers were restricted to the number of
  seatbelts.
• Canadian Safety Council issued a report calling
  the finding a loophole and a contradiction
  therefore resulting in a threat to public
  safety (2005).

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Seatbelt Use

• STEP 2 The Solution Amend the Highway Traffic
  Act to restrict the number of passengers to
  the number of seatbelts in a vehicle.
• Developed a resolution which read be it
  resolved that the Government of Ontario is urged
  to amend the Highway Traffic Act such that the
  number of passengers is restricted to equal the
  number of available seatbelts

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Seatbelt Use

• STEP 3 4 Identifying Decision Makers/Resources
• Presented by Dr. Robert Kyle, Medical Officer of
  Health, to Health and Social Services Committee
  (Feb 2006)
• Presented to Durham Regional Council
• Forwarded to Ministers of Children and Youth
  Services, Health and Long-Term Care, Health
  Promotion and Transportation, alPHa, OPHA and all
  Ontario Boards of Health
• Resolution presented and defended at Annual
  Meetings of alPHa, OPHA, RNAO
• All organizations supported this resolution

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Seatbelt Use

• STEP 5 Action plan/Strategies
• Dr. Robert Conn, SMARTRISK
• Teleconferenced numerous times to plan
  strategically
• Safe Kids Canada
• Toronto Area Safety Coalition
• Canada Safety Council
• RBC First Office for Injury Prevention
• Public Health Units/Departments throughout
  Ontario
• Local MPPs
• Letter with supporting documentation was sent to
  Transportation Minister Donna Cansfield

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Seatbelt Use

• STEP 6 7 Timing Implementation
• On October 14, 2006 four of ten people riding in
  a passenger van which was equipped with only 7
  seatbelts were killed in Caledon.
• On October 16, 2006 the McGuinty government
  introduced legislation to strengthen seatbelt
  laws, One Person, One Seatbelt.
• Two weeks later, the Bill passed.

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Seatbelt Use

• STEP 8 Success!!
• On December 1, 2006 the One Person, One
  Seatbelt Bill became law.

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ATV Safety

• STEP 1 The Problem
• Dramatic increase in ATV sales
• Ontario sales 5,704 in 1997 to 21,188 in 2004
  
• Increase in ATV-related injuries
• Almost 50 increase (1,693 in 1996/97 to 2,535 in
  2000/2001) while other types of injuries are
  decreasing (CIHI, 2003).
• Children, under age 16 account for 1/3 of the
  hospitalizations and 50 of the deaths (CPS,
  2004)
• Durham Region, rate of 7.6100,000 Ontario
  6.5100,000
• Problem is beyond Durham Region

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ATV Safety

• STEP 2 The Solution Amend the Off Road Vehicle
  Act to restrict children under 16 years old
  from driving ATVs
• Developed Resolution which read, be it resolved
  that the Government of Ontario is urged to strike
  a multi-stakeholder ATV Task Group to develop a
  comprehensive, evidence-based approach, including
  amendments to the Off-Road Vehicles Act, to
  promote ATV safety and prevent ATV injuries,
  particularly in children.

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ATV Safety

• STEP 3 4 Identifying Decision Makers/Resources
• Presented by Dr. Robert Kyle, Medical Officer of
  Health, to Health and Social Services Committee.
• Presented to Durham Regional Council.
• Forwarded to Ministers of Children and Youth
  Services, Health and Long-Term Care, Health
  Promotion and Transportation, alPHa, OPHA and all
  Ontario Boards of Health.
• Resolution presented and defended at Annual
  Meetings of alPHa, OPHA, RNAO.
• RNAO submitted a letter of support to Minister of
  Transportation and The Premier

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ATV Safety

• STEP 5 Action Plan/Strategies
• Canadian Paediatric Society
• Children under 16 years of age should not operate
  ATVs lack the knowledge, physical size and
  strength, cognitive and motor skills.
• Safe Kids Canada
• SMARTRISK
• Other Provinces considering legislation
• New Brunswick, Nova Scotia, Quebec
• Supporting reports and literature
• News reports of injuries, Coroners Inquests,
  Physician advocates, Consumers Report, research
  articles.

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ATV Safety

• STEP 6 7 Timing Implementation
• Continued with local ATV communication campaigns
  and education
• Requested that interest groups write letters to
  the government to support ATV policy change
• Mayors of rural communities in Durham Region
• Dr. Robert Conn (SMARTRISK)
• Safe Kids Canada
• Ontario Public Health Injury Prevention Managers
• Durham Region Chief of Police
• Toronto Area Safety Coalition

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ATV Safety

• Letters sent to Premier Dalton McGuinty to
  Minister of Transportation Donna Cansfield
• Information provided to MPPs at RNAO breakfast
  meeting
• Invitation to participate in Safe Operation of
  Off-Road Vehicles External Consultation Session
  at the Ministry of Transportation
• Participated in the two sessions
• Provided written information to support policy
• Coroners Inquests provided recommendations
• Activities paused for Provincial Election

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Next Steps

• Policy advocacy is a tool we can use to
  effectively improve safety in Canada.
• We can take simple actions as individuals, as
  organizations and in partnership to translate
  injury prevention knowledge into policy.
• Lets challenge decision-makers to make Canada
  the safest country in the world.

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Policy Advocacy

• Angela Cooper Brathwaite, RN, PhD.
• Lynne Gray, RN, BScN
• Connie Vail, RN, BScN