Building the Case for Prevention is Not Easy

By Ted Bruce

The debate over the mandatory use of bike helmets has predictably heated up with the arrival of ideal biking weather. And there is an abundance of population level data being tossed around to buttress both sides of the argument. On one side is the position that mandatory bike helmet use discourages ridership and it is high ridership that creates safer riding environments – thus mandatory helmet laws might impede reductions in injury rates. This argument also suggests that by discouraging cycling, society does not achieve the benefits of more people participating in active transportation. On the other side, there is data showing the lower injury rates associated with helmet use and little evidence that mandatory laws have dampened the uptake of bicycling as form of transport.

There has been an impressive array of data to bolster both sides of the debate. The importance of epidemiology to good policy making cannot be underestimated. But the debate highlights the challenge in securing the quality of evidence we need to advocate for prevention strategies.

Of particular concern is the considerable lag time between a prevention intervention and the measureable benefits it is intended to produce. This is compounded by the reality that the intervention is only one of many interventions that co-exist in a messy policy world. How does one assess the benefits of a specific intervention in a complex, real world, uncontrolled environment where there are many confounding variables that are affecting the measured outcome? In addition, prevention interventions have an underlying problem with generating data since if they are impactful they have prevented an occurrence and there may be limited mechanisms to collect data within our routine normal data collection systems.

The Canadian Best Practices Portal is a source of best practice reviews.

The Canadian Best Practices Portal is a source of best practice reviews.

There are a number of research methods such as cross jurisdictional studies that can assess the benefits of prevention interventions as we see in the case of the debate on bike helmet laws. Rates of injury and disease, for example, can be compared between jurisdictions that implement a prevention strategy and those that don’t. In spite of more innovative methods, many of these studies are still open to challenge because of the differences in real world contexts that are being compared. Fortunately there is an ever increasing body of quality evidence available to argue the case for prevention. Check out this source of best practice reviews: Canadian Best Practices Portal (Public Health Agency of Canda).

While it is never wise to base decisions on individual cases that are not representative of the larger population, the importance of case studies and narrative analysis can be quite informative and convincing. As we all know, it is the “stories” of real people that often influence decisions whether good evidence is available or not.

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Embrace the wisdom of investing in children

By Dr. Brian O’Connor

In a recent blog (‘It Doesn’t Have to Be this Way’, March 27th), Trevor Hancock, in a tribute to Clyde Hertzman, reviewed the policy platform of the Human Early Living Partnership (HELP) as contained in the 15×15 document.  Much of this speaks to the importance of ensuring adequate incomes for families and some of the key aspects of a poverty reduction plan.

One of Clyde’s colleagues at HELP, Professor Paul Kershaw, has put a unique twist on early child development and the need for adequate resources for families in terms of income, time and services.  Young people and young families have unique challenges in today’s social environment that present huge impediments in terms of the ability of children to develop optimally.  Professor Kershaw refers to the young families of today as the squeezed generation or GenSqueeze (www.gensqueeze.ca).  His thesis is that today’s young families, quite unlike their predecessors (boomer, gen x, etc.) are severely under resourced in terms of

1) the time they have available for optimal parenting

2) the lack of supportive services – the consequences of a paucity of sound social policies in support of today’s families such as universal, quality, affordable for all, day care – Professor Kershaw proposes a $10/day solution, a solution also promoted by the Coalition of Child Care Advocates of BC (CCCABC.bc.ca) and

3 ) income issues arising from discrepancies in wages and the cost of living over time leading to two working parent families with very long hours

Professor Kershaw has contrasted the social policy supports that as Canadian society, we have put in place for seniors as an example while at the same time we have not been as generous in our support for young people and young families.   While he is not trying to pit one generation against another, he does point out that our social spending on seniors comes to $45,000 per Canadian over 65, while a similar young family today is afforded social policy spending of only $12,000 per Canadian under 45.   He does not support reapportioning  spending  (maintain funding to existing social programs) but adding a mere $1000 per Canadian in additional spending which will as an investment bear vast return in mitigated costs from things such as reduction in costs from crime, education, avoidable absenteeism and improvements in human capital, and competitiveness.

It is interesting that our society has not fully embraced the wisdom of investing in children, the future of our province, by ensuring optimal early child development for all BC’s children.  While our universal Medicare program is a defining national characteristic and the support we provide seniors is never questioned, we can hear the negativity that arises when one proposes $10/day child care – “why do I have to pay for their child’s day care?”

So Professor Kershaw comes at the poverty reduction question in a slightly different way.  But it is anchored in the recognition that optimal child care development if not addressed through policy options that provide more resources, will perpetuate the continuum of poverty, poor child outcomes and increased health inequity.

Brian O’Connor is the Co-Chair of the Population Health Committee, Health Officers Council of BC

Additional Reading:

15 by 15: A comprehensive policy framework for early human capital investment in BC | Human Early Learning Project | 2009

Poverty is Bad for Your Health – Backgrounder and Q&A info series | PHABC 2012

Public Health is ROI

By Dr. Marjorie MacDonald

Earlier this week, I posted a blog on this website about the economic benefits of prevention. After writing the blog, I realized that in the US, it is National Public Health Week with the theme “Public Health is ROI” (return on investment). Since this deals with the focus of my earlier blog, I thought I would post a weblink from APHA on this very theme.

National Public Health Week — Public Health is ROI: Save Lives, Save Money (video by the American Public Health Association)

–  Marjorie MacDonald is the President of Public Health Association of BC