Airplane!

"It’s important not to define safety as the absence of accidents." - Captain "Sully" Sullenberger

(Found this RyanAir infograph
hilarious in 2006; I forget why)

We are still technically on hiatus, but an article in the Times this morning tempted me to write a few quick sentences.  Citing data from the Aviation Safety Network, the article reports that flying in airplanes has literally never been safer.  The US has not had a fatal plane crash in 4 years.  And the risk in death for passengers in the US is now 1 in 45 million.  How do you like them apples?



Medical quality and safety, which I had just begun discussing as a public health problem a few weeks ago, is often compared to aviation safety.  Both professions require a combination of human skill and maneuvering of ever-changing technology.  Protocols and "acts of God" matter for both.  And in both industries, lives are at stake.  Lots of them.  This article is remarkable not only for illustrating what can be done when an industry is committed to reducing accidents and how to do it-- 

After another series of accidents in 1996, federal officials set a goal of cutting accident rates by 80 percent over 10 years. ... Since then, the F.A.A., airlines and pilot groups have stepped up efforts to share safety concerns through a series of voluntary programs. Airlines agreed to participate after obtaining assurances that the information would not be used to discipline them.  -- Jad Mouawad and Christopher Drew for the Times

--but also how much more is to be done.  As Captain Sully's quote above illustrates, this report should be an encouragement for public health rather than a reason for complacency.  Shirley Surely, there are miles to go before we sleep.

Academia Done Right

I remember the first day of my Principles of Suicide Prevention course, we went around the room to talk about why we were taking the class.  Over and over again, from the 2 instructors to the students, though we were in different programs, there was the same refrain, "When I took DHem's class-," "DHem-," "DHem-."  When I got to Hopkins last fall, there it was again.  That one name everyone mentioned when they talked injury prevention, that one name that inspired them to care and see the world differently.  Except at Hopkins, it wasn't DHem.  It was Sue Baker.  She even predates DHem.

So when I saw a feature on her this Sunday, I thought: how could I not mention an article that a. features a hero in injury prevention and b. mentions the very title of this blog?

By 1973, she was teaching Hopkins’s first class in injury prevention. Baker’s decision to champion what was at the time a virtually nonexistent discipline was a mystery to some of her colleagues. One of them, a public-health professor, asked what she was working on. “The connection between alcohol and highway safety,” she replied.  “Oh,” the professor said, “is that public health?” (emphasis added)

--Robert W. Stock for the New York Times 

The world outside is raining and storming, you might as well take the time to enjoy this piece and be inspired by a woman who sees public health everywhere.  The article not only has some neat stories from the Annals of Safety History (any good student of Baker and DHem should recognize some of these), but also shows how a research career forms and grows and relates to the people and world around us.  It's that second part that makes me like the piece so much.  I don't yet know if I can talk about so many research projects without being boring.  But examples like this is exactly what I'm gearing up to do here when I grow up.

Le Head Strong

The last time I was on a bike, I did not wear a helmet.  Neither did anyone around me.  I was in Seoul, Korea, visiting friends (3 public health masters on 1 trip).  We rented bikes and rode on an easy path along the river.  There were families walking, skating, and riding all around us.  Afterward, we had a fried chicken picnic delivered to us at the park (people of Korea, outdoor chicken delivery is genius).  Then wandered around a night market where I bought Che Guevara socks.  The day was so perfect that I didn’t even realize my helmet oversight until I was looking at pictures the next day.  Whereupon I immediately confessed my transgression to DHem via email*.  

(Photo Credit: Esther Kim/Alex de Rubira via facebook)

 In this past Sunday’s Times opinion pages, Elizabeth Rosenthal makes the case for repealing helmet laws to encourage biking.  Rosenthal uses the example of European cities where biking is prevalent and helmet laws rare to argue that helmet laws discourage people from riding bikes and the health benefits of riding far outweigh those of helmet wearing.  Mayor Michael Bloomberg is noted as rejecting calls for a mandatory helmet law when New York’s bike share program rolls out next year. 

Despite my idyllic Seoul ride, Rosenthal’s piece misses the point.  As our bikers noted last month, the type of safe, biker-only, slow-speed riding environment I encountered (and Rosenthal alludes to) is rare in the US.  Bikers, especially commuters, ride at high speeds among cars.  The 20-to-1 cost-benefit analysis Rosenthal touts depends on 2 assumptions that aren’t readily met in much of the US: safe riding environments and the belief that people view biking as a mode of commuting rather than exercise (and thus will not make up for not biking with other exercise).  Bike accidents may be rare events, but riding with a helmet is always safer than riding without one.

Rather than repeal helmet laws, there are better solutions using principles this blog has covered (like looking for ways of reducing the ‘cost’ of helmets and barriers to use through helmet giveaways, making rentals available, and creating biker-only lanes).  Rosenthal also missed an opportunity to push for changing the riding culture in the US the way we have with cigarette smoking.  Though warning labels may be larger in Europe, the US has been more successful at transforming perceptions of smoking and lowering cigarette use.  The US is raising up generations of non-smokers (the recent college bans in the news being one indicator of this success) who grow up in smoke-free environments and we can aim for the same for bike safety.

Policy Implication:  Making bikers safer begins with improving the riding environment, not repealing helmet laws.

*One of these days, I will stop mentioning DHem and/or bike safety in every post.  Just not today.

This Is So Not Public Health- Firearm Handling Edition

Even if we sidestep the right-to-carry gun issue and just focus on the problem at hand, this is still the opposite of a public health job well done.  From the New York Times:

Invariably, according to the T.S.A., travelers at airports with guns in their carry-on bags say they simply forgot they had them. “It’s almost always inadvertent rather than intentional,” said David Castelveter, a spokesman for the agency...  [That] was exactly the excuse offered by a 27-year-old flight attendant who was stopped at a checkpoint at the Philadelphia airport on Sunday... A Philadelphia police officer who responded tried to unload the 38-caliber handgun weapon but instead accidentally fired it. No one was hurt, and the flight attendant was issued a summary citation for disorderly conduct.

It's a well-told story of public health gone wrong.  Guns cannot be tossed in carry-on bags.  And guns cannot be accidentally fired when trained law enforcement officers try to unload it.  Even if the law allows people to have guns, our discourse around it should emphasize how carefully they must be handled and how well trained people must be to handle them.  These 2 missteps in 1 demonstrate missing pieces in our stories of gun use.

Red Light District

(special thanks to Priscilla for inspiring this post)

Is running red lights public health?  Randy Cohen, the New York Times "Ethicist," recently justified it as ethical practice for cyclists in an opinion piece.  Since I once incurred ridicule from peasant farmers in China for forgetting how to ride a bike ("like riding a bike" my foot), I thought it best to turn this question over to 4 great public health minds for their diverse and expert perspectives.  Hit the comments below for your own take.

To start off, their glittering credentials (more complete bios available on their respective post pages):
David Hemenway: Commuter cyclist; PhD in economics, Harvard; currently a big deal in injury prevention
Oliver Hsu: Serious 'gearhead;' MS in Health Policy, HSPH; currently works in healthcare consulting
Amy Lee: Commuter cyclist; MPH in Public Health Practice, UW; currently works in clinical research

Cass Kercher: Non-cyclist, MPH in Occupational Health, Drexel; PhD student in injury prevention & policy at Hopkins

(apologies for my lack of tech savvy, they don't teach this in public health school)

David:  Ride (and run lights) safely and sensibly 

I am most concerned about safety.  In Boston I often run red lights as this turns out to make me safer—for example  if, as is common, there is a car illegally parked up ahead and I will be forced into the motorists lane, so I want to do that when there is no car behind me.  If there were a safe bike lane I would rarely run a red light.  I also, on a rare occasion, will actually use the sidewalk if it is especially dangerous on the street, and it doesn’t affect any pedestrians. ... (Read more) 
 

 Oliver: Respect the rules, or risk causing harm

I'm definitely one of those cyclists who does not run red lights and stop signs. I am an avid gearhead so that may bias my response. I get annoyed when cyclists flaunt the rules, especially, in the back roads of California where vehicle speed is much higher and there are more blind corners. The environment is more dangerous yet that there is less regard for the rules just because traffic is infrequent.  I would disagree that just because a bike is not moving as fast or is as heavy as a car that it is somehow less dangerous than a car. There is still roughly 200 pounds of rider plus bike traveling at 20 miles per hour. ... (Read more)

Cass: Our imperfect laws keep you from hitting me  

As a frequent active commuter (until very recently I didn't own a car and walked nearly everywhere I went in Philadelphia and Baltimore), I am concerned with transportation safety. On more occasions than I can count I have witness cyclists putting pedestrians and motorists at risk while they occupy a lane of travel but ignore traffic laws. Of course, I will admit to crossing the street against a light, but always in the crosswalk of a very empty intersection. ... (Read more)
 

Amy: Rules keep me in check while the right environment makes rule-following easy

I do not run red lights when I'm biking.  Although I think some lights are ridiculous to sit through (especially during rush hour when I'm breathing in car exhaust), I follow the rules because I believe that this is public health.  I am a fairly experienced biker, but I can make mistakes.  Following biking rules helps reduce the temptation for me to make a poor decision when I'm in a rush because it is habit for me to slow down and stop when I see a red light or a stop sign.  This is true for drivers, too, which is why we don't allow drivers to make illegal turns when the roads are completely clear. ... (Read more)

Their individual practices may differ, but David, Oliver, Cass, and Amy all point to the need for better bike infrastructure.  They also recognize that while traffic regulations are designed to keep cyclists from endangering themselves and others but given imperfect regulations, cyclists must also rely on individual discretion in deciding what is safest for them.

Policy Implications: Altering bike infrastructure (e.g. better lanes, more vigilant and sensible enforcement, tolerant bike culture) can improve road safety and behavior for drivers, cyclists, and pedestrians alike.

Photo credits for this post: Kent Dayton via UVM.edu (DHem), and Oliver Hsu, Jim Kercher, and Sasha Tan via facebook (Oliver, Cass, and Amy).