That Movie Magic

In the late 1980s, the term “designated driver” began popping up all over pop culture.  The bar in Cheers had a poster and on L.A. Law, Harry Hamlin asked a bartender to call his designated driver.  This was the work of Dr. Jay Winsten of the Harvard Alcohol Project.  Using movie magic for good, he asked Hollywood studios and TV networks to spread the word on designated drivers.  The point wasn’t to change behavior over night but to bring the idea into public consciousness and shape social norms. 

As someone who grew up in the 1980s, I can attest to the success of the campaign.  What was new back then is now a given among my friends today.  As someone who has never owned a car (or a suit— despite my age, I’m barely a grown up), I have ridden shotgun countless times while generous friends drove.  Consequently, I’ve gotten to observe the driving patterns of many conscientious, risk-averse, public-health minded friends— who always buckle up, would never drive drunk, and would otherwise never put our lives at risk.  That is, except for one thing: futzing with the damn smartphone (aka “distracted driving). 

We’ve read the risks.  Signed Oprah’s pledge like Sandra Bullock.  And cried through super sad PSAs.  Yet we stubbornly assume that we are safer, smarter, and luckier drivers than others and whip out phones to send messages, find that one song, and check Facebook when we think traffic is slow. Many states are enacting distracted driving laws to deter phone use, though the policies haven’t stopped many of us.  We need Winsten's movie magic to change social norms.  He is working on replicating his campaign with distracted driving.  Until it becomes widespread though, I offer 3 personal tips to reduce distracted driving:

•  “Look, Ma, No Hands!”  Bossing someone around is more fun anyway.  Take advantage of bluetooth technology (or even Siri) to make calls and navigate via verbal cues rather than fumble with the phone.
•  Cede/Commandeer Control.  As a driver, let whoever rides shotty co-pilot.  As a rider, I offer my phone and navigation skillz so the driver can focus on well, driving. 
•  I Don’t Want To Die Today. As a rider, when I feel particularly uncomfortable with how much a driver is looking down on the phone, I shout “Eyes on the prize!” or other variants.  It’s usually funny enough that I don’t get kicked out immediately, yet alerts the driver to the issue.

Unlike Winsten’s campaign, my suggestions are not quite public health. They are one-on-one interventions whose successes I have personally witnessed.  But until policy initiatives catch up, I hope you’ll give these a try.

Read more: On Jay Winsten, on distracted driving, on Eyes on the Prize.

Talking Sh*t About Safety... Done Right

My apologies- this blog is overdue for a resurrection.  My best explanation for this seven-month-and-counting break is that I'm not very good at preparing a dissertation proposal and maintaining a blog at the same time.  It's lame but true.  I promise we'll mount a comeback soon and in the meantime, let me share this with you: absurd, observation comedy about injury prevention, preventive medicine, and medical research.  It's everything I love, it's everything I know you'll love, and more.

Safety Done Pretty Well

(Special thanks to Sarah Riddle for bringing this to my attention.)

Like many in Boston, when I lived in that fair city, I had a love/hate relationship with the public transit system-- the Massachusetts Bay Transit Authority, or MBTA.  The heat lamps by the Silver Line bus shelters?  A nice touch.  The fact that Green Line doors get stuck and passengers are asked to move to the left side of the train to offset the weight?  Absurd in 2013.  So I was heartened to see this solid effort from the MBTA on transit safety and "distracted riding."  I love it when Boston displays Good Public Health.

Admittedly, the dancing is pretty awful.  The song could be better.  And I'm not certain what exactly the safety bounce entails.  This is no Dumb Ways to Die.  But the video raises the issue of rider safety and invites the public in with a goofy song.  And given Boston's high transit ridership (5th in the country), I liked that the video incorporated 3 languages and at least tried to incorporate faces reflective of Boston's demographics.

If you're taking notes, MBTA.  Here are some other videos to work on: accessibility, noise pollution (cough, Boylston Street station), and sanitation.

Death Done Right (aka Safety Done Right Part 2)

(To make up for the 2-week gap in posting, we have a 2-post week ahead of us)

Let a psycho killer inside,
scratch a drug dealer’s brand new ride,
take your helmet off in outer space
use a clothes dryer as hiding place-

Good job, Melbourne Metro.  I have not stopped singing this song since I first heard it a few days ago (thanks, Louise, for making sure that I saw it).  It does right everything we found heavy handed about the last cutesy public health animation I shared.  The message is simple and catchy and best of all, it’s a campaign with actionable steps for the viewer to take.  I’ve embedded the youtube video so you can see the song here, but you should really check out the Dumb Ways to Die site.  It’s happy; it’s funny; it’s informative.  It is wicked public health.  

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.

Mistakes (Don't Have to) Happen

Part of how public health works "while we were sleeping" is to take away opportunities for making the wrong decisions.  Figuring out what decisions to target isn't always easy.  Banning cars will drastically reduce the number of car accidents on the road.  But it would also prevent people from giving me rides.  Public health succeeds then, when it strikes the right balance between what's good for the individual and the public.  Here are a couple of clever examples:

Haizhu Bridge

(source: http://news.163.com/09/0826/02/5HK0I4SF00011229.html)

Maybe "clever" was too generous a term.  This wacky idea might not score an A in design, but it is reportedly successful.  If you're the officials of a crowded city with a growing bridge-jumping suicide problem, how might you combat an issue?  Making the bridge harder to jump off of is a good place to start.  The traditional approach is to put up barriers, but officials in Guangzhou had another idea: grease up the bridge with brown oils to make it difficult to climb.  Weird?  Yes. Unsightly?  Yes.   Effective in curbing the number of jumpers?  Also yes. 


Children's Aspirin*
This is one of my favorite stories of While We Were Sleeping.  In the 1940's, children's aspirin first came onto the market.  They were a commercial success.  Pink and flavored, they were attractive to children.  Some literally ate them “like candy” such that 200 children each year were dying from ingesting aspirin.  It took the work of a Duke pediatrician, Jay Arena, and the head of a small pharmaceutical company, Abe Plough, to stop these deaths.  They made the bottles more difficult for children to open.  Safety enclosures are routine for our pill caps now, but back then, no other company was willing to do so.  Plough took the risk.  “If it if it saves the life of one child," he said, "I’ll do it.”  They didn’t stop there.  Arena and Plough also worked to cut down the dose and number of tablets per bottle, so that even if all the other measures failed and a 2-year-old somehow ate an entire bottle of aspirin, the dose would not be toxic.   The child could still be safe simply because Arena and Plough adjusted the bottles. 

Policy Implication:  "It is possible to protect children without changing their or their parents' behavior.*"

*While We Were Sleeping pp 30-31, 37-39 (I swear I'll stop quoting DHem every other post.  But it's a hard habit to break.

P.S.  Those of you who like good long form non-fiction or want to read more about bridge jumpers, check out this excellent New Yorker piece on the Golden Gate Bridge.

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).

Spices Done -- ?

I will return to posting intellectual content later this week.  For the time being, let's ponder:

(Photo Credit: The AP, via The Daily Mail UK)

Where were the seat belts?   Where were the helmets?  Speeding around the top of London cabs in really tall shoes is definitely not public health.  The Spice Girls reunion at the Olympics closing ceremony was, admittedly, a little bit awesome.  But was there enough awesome to outweigh these safety hazards?  You tell me.  (I couldn't embed a video, but you can watch it here for the time being)

(Photo Credit: The AP, via The Daily Mail UK)

What if Posh's train had gotten caught in heavy machinery?

Safety Done Right (and Wrong)

(since this 'Done Right' segment comes earlier and longer than usual, I'll be taking it easy next Monday)

Jacqueline Brooks and D Niro are ranked 18th after the opening day of Dressage competition on August 2 at the 2012 London Olympic Games. © Cealy Tetley, www.tetleyphoto.com

Almost everything I have learned about dressage, I have learned from Stephen Colbert.  Mostly, he taught me how to pronounce the word (it does not rhyme with 'message').  But Jacqueline Brooks of Canada has taught me that even horse ballet can be a gutsy sport.  She became the first competitor in the discipline to wear a hard hat during Olympic Competition instead of the customary top hat.. Three other riders, including the gold medalist Charlotte Dujardin, also donned hard hats.  Jan Ebeling, who rode the Romney horse, did not wear a hard hat.  (Ebeling was eliminated earlier today.)

(DuJardin, left, and her fellow Team GB riders. Photo Credit: The Telegraph 2012)

The tension over helmets, between safety experts and players, occurs in every sport at every level.  Like I've said before, it often takes a tragedy for our behaviors to change.  The United States Equestrian Federation required safety helmets for dressage riders only after an Olympian was seriously injured in a horse accident in 2010.  Even then, it took a year between accident and policy change.  (In fact, I'm not sure why American riders aren't wearing hard hats at the Olympics-- perhaps the ruling only applies to U.S. competitions?  Can anyone help me out?)  What Jacqueline Brooks has shown, however, is that we don't always need tragedies or policies to force us to choose tradition over safety.  We can make the choice ourselves.  There are no special Muppets, music, or comedy to this public health story.  Brooks simply embodies it head on.

(Of course, of course, I am as impressed with making it through without a single horse pun as you are.)

You Can't Count on Me

I graduated from college in 2007 and enjoyed 6 brief months of employment in the pre-recession era.  It was a time when the research office flowed with free food.  I especially remember one celebration (Flag Day?) when we had a tall, gorgeous cake covered in chocolate shavings and studded with fresh fruit.  As it was being cut, a giant strawberry fell onto the conference room table.  I instinctively reached for it.  Only to have my supervisor gasp and swat my hand away.  It was a compromised strawberry; I wasn’t to touch it.

I wash my hands 83 times a day, cough into my elbow, and always buckle up.  Public Health needs us to do these things for our own good and the good of others, but it can’t solely rely on our caution and wisdom.  Because I draw the line at fallen strawberries.  You might draw the line at sunscreen.  We’re all idiot snowflakes in our special ways, misjudging our risk in everyday situations.  This is why while most traffic accidents occur during the winter months, when road conditions are poor, most traffic fatalities occur during the summer months, when conditions are clear*.  We drive carefully when the roads are slick but carelessly when they are not, leading to deaths. Though 15% of all motor vehicle crashes in 2009 occurred in rain, snow, and sleet, they only accounted for 10% of traffic fatalities*.  

(when my car was totaled** on I-495 one fine May morning and spun off of the road, I was able to recover, stop the car, and avoid all those thick trees thanks to this nice patch of grass)

Thus Public Health strives to make our environments safer so that even when we make the wrong call, we and those around us are protected.  Rather than resigning road safety to the whims of individual drivers, trees can be cleared from the side of the road so that cars that spin out can be slowed down by grassy patches rather than slamming into trees.  Airbags and collapsible steering columns prevent cars from becoming death boxes once crashes occur and minimize secondary injuries.  These measures make crashes less lethal and lift the onus off of individuals but aren't always easy to come by-- they require conscientious planning and lobbying to win government and manufacturer support.  These measures are necessary and reassuring when we aren't always reliable or rational.  Because never mind the conference room table, I would have eaten that strawberry off of the carpeted hospital floor. 

Policy Implication:  Making products and the environment safer can be easier and more effective than changing human behavior.   

*From the NHTSA's Fatality Analysis Reporting System, via David Hemenway slides

**Not my fault.

What We Talk About When We Talk Public Health

I had known for years that mopeds were dangerous and helmets crucial.  I’m a public health student, specializing in health policy.  I'll be a 'health services researcher' when I grow up and these are the kinds of things we believe.  Plus, I grew up in motorcycle-dense Taipei.  I remember crowding around the safety campaign posters after school to gawk at photos of helmet-less, headless bodies.  Then again, I grew up in Taipei.  So I’ve also felt the thrill of whizzing up a mountain on the back of a motorcycle, tilting from side to side, and I know the convenience of mopeds. It wasn’t until the death of the kindest ER doc I know that these safety beliefs became real.  Afterward, my mentor made me promise that I’d never ride a moped.  He didn’t have to.  I knew it by heart by then:  Mopeds are dangerous.  Helmets are crucial.  

We are shaped by the stories close to us.  Yet public health, by its nature, looks at people from a distance, focusing  on populations rather than individuals faces.  This is useful in spotting trends and making policy recommendations, but it also means that despite solid research, public health findings often don’t seem convincing.  Sometimes, it takes a death to shake us.  Other times, a happy ending will do just fine.

While I am still learning the art of public health storytelling, Professor David Hemenway at the Harvard School of Public Health has compiled a collection of compelling public health success stories he may or may not have shamelessly shilled in multiple classes.  In it, he uses a neat concept to describe public health: it is lifesaving work that often happens behind the scenes, "while we were sleeping."  It moderates the air we breathe, the cars we drive, and the drugs we take, even as we are blissfully unaware.

In the coming weeks, months, and years, as I sharpen my public health research skillz, I hope to use this place to articulate just what exactly public health is, why you should care, and what great, non-creepy, things are happening while you're asleep.

Policy Implication: Public health protects your life in ways that are often unnoticed; better awareness of its successes/tragedies can enhance the public’s reception.

Declaration of Competing Interest  Neither While We Were Sleeping, nor DHem (as the cool kids call him), nor anything else that will be mentioned here sponsors this blog in anyway.  I just like his book, message, and the grades he gave.  My views do not represent those of any of my institutions.