Car manufacturers and global road safety: a word frequency analysis of road safety documents

Dynamic evolution of policy mix in response to COVID-19: Practice from China

COVID-19 is a global pandemic. In response to this unprecedented crisis, Chinese government formulated a series of policies. This research is dedicated to exploring the dynamic evolution of China's policy mix in response to COVID-19 in different crisis response stages from a network perspective. First, a three-dimensional analysis framework of "policy subject-policy target-policy instrument" was developed. Then, based on the data sets collected by textual analysis, the dynamic evolution of policy subject, policy target, policy instrument in China's policy mix in response to COVID-19 was discussed by using the method of SNA. This study concluded that the core policy subject, policy instrument, and policy target of China's response to COVID-19 changed with time. National Health Commission (NHC), Ministry of Finance (MOF), Ministry of Transport (MOT) and Ministry of Human Resources and Social Security (MHRSS) have important influences in the network of policy subjects. Other subjects are more at the edge of the network, and there are few joint issuances among policy subjects. The study also found that the core policy target was adjusted over time, with phased dynamic characteristics. At the initial stage of China's response to COVID-19, "reduce infection and mortality" and "steadily carry out economic and social work" were the core policy targets. With the COVID-19 under control, "enterprise development and work resumption" becomes a new core policy target. In addition, this study also revealed the dynamic evolution and unbalanced use of China's policy instruments in response to COVID-19 in different stages. The combination of policy instruments is mainly composed of "mandatory administration instruments" and "economic incentive instruments", and supplemented by "health promotion instruments" and "voluntary plan instruments". These findings may enrich the literature on COVID-19 policy to help researchers understand the dynamics of policy from a network perspective. Moreover, these findings may provide several valuable implications for policymakers and other countries to formulate more effective policies for epidemic response.

Policy Instruments for Health Promotion: A Comparison of WHO Policy Guidance for Tobacco, Alcohol, Nutrition and Physical Activity

BACKGROUND

Policy is an important element of influencing individual health-related behaviours associated to major risk factors for non-communicable diseases (NCDs) such as smoking, alcohol consumption, unhealthy eating and physical inactivity. However, our understanding of the specific measures recommended in NCD prevention policy-making remains limited. This study analysed recent World Health Organization (WHO) documents to identify common policy instruments suggested for national NCD prevention policy and to assess similarities and differences between policies targeting different health-related behaviours.

METHODS

Evert Vedung's typology of policy instruments, which differentiates between regulatory, economic/ fiscal and soft instruments, served as a basis for this analysis. A systematic search on WHO websites was conducted to identify documents relating to tobacco, alcohol, nutrition and physical activity. The staff of the respective units at the WHO Regional Office for Europe conducted an expert validation of these documents. The resulting documents were systematically searched for policy instruments. A word frequency analysis was conducted to estimate the use of individual instruments in the different policy fields, followed by an additional in-depth coding and content analysis by two independent reviewers.

RESULTS

Across all health-related behaviours, the following policy instruments were suggested most frequently in WHO guidance documents: laws, regulations, standards, taxes, prices, campaigns, recommendations, partnerships and coordination. The analysis showed that regulatory and economic/fiscal policy instruments are mainly applied in tobacco and alcohol policy, while soft instruments dominate in the fields of nutrition and especially physical activity.

CONCLUSION

The study confirms perceived differences regarding recommended policy instruments in the different policy fields and supports arguments that "harder" instruments still appear to be underutilized in nutrition and physical activity. However, more comprehensive research is needed, especially with respect to actual instrument use and effectiveness in national-level NCD prevention policy.

Association between Perceived Neighborhood Built Environment and Walking and Cycling for Transport among Inhabitants from Latin America: The ELANS Study

Purpose: This study aimed to examine the associations of the perceived neighborhood built environment with walking and cycling for transport in inhabitants from Latin American countries. Methods: This cross-sectional study involved 9218 participants (15–65 years) from the Latin American Study of Nutrition and Health, which included a nationally representative sample of eight countries. All participants completed the International Physical Activity Questionnaire-Long Form for measure walking and cycling for transport and the Neighborhood Environment Walkability Scale-Abbreviated. Furthermore, perceived proximity from home to public open spaces and shopping centers was assessed. Results: Perceived land use mix-access (OR: 1.32; 95%CI: 1.16,1.50) and the existence of many alternative routes in the neighbourhood (1.09 1.01,1.17) were associated with higher odds of reporting any walking for transport (≥10 min/week). Perceived slow speed of traffic (1.88 1.82,1.93) and few drivers exceeding the speed limits (1.92; 1.86,1.98) were also related to higher odds of reporting any walking for transport. The odds of reporting any cycling for transport (≥10 min/week) were higher in participants perceiving more walking/cycling facilities (1.87 1.76,1.99), and better aesthetics (1.22 1.09,1.38). Conclusions: Dissimilar perceived neighborhood built environment characteristics were associated with walking and cycling for transport among inhabitants from Latin America.

Road traffic injuries measures in the Eastern Mediterranean Region: findings from the Global Status Report on Road Safety - 2015

Background:

The Eastern Mediterranean Region has the second highest road traffic fatality rate in the world. This article presents the epidemiology of road traffic injuries and the preventive measures in Eastern Mediterranean Region taken by the different World Health Organization member states compared to the rest of the world.

Methods:

This is a secondary data analysis addressing the Global Status Report on Road Safety published by the World Health Organization in 2015. Data are from 180 countries covering 6.97 billion people of the world’s population, of which 21 Eastern Mediterranean Region of World Health Organization member states with about 595 million population were included and were analyzed. From 22 countries in the region, 21 are presented and Syria has not reported any data on road traffic injuries.

Results:

Eastern Mediterranean Region member states contribute to 9.69% of all global fatal road traffic injuries (19.9 per 100 000 population compared to the same rate in the European region with 9.3), while these countries account for 7.4% of the world’s population and have about 5.6% of the world’s vehicles on their roads. More than 90% of the Eastern Mediterranean Region countries have passed mandatory seat-belt laws for both front-seat and rear-seat passengers and making helmet use obligatory; and only 27% have child restraint laws; half percent have an emergency room injury surveillance system. All countries have a national drink-driving law; and certain speed limits but there is no distinction between rural and urban areas, and the latter lack adequate speed restrictions.

Conclusions:

Although the Eastern Mediterranean Region member states have some important preventive measures recommended by World Health Organization, considerable efforts are still needed to optimize the enforcement of existing road safety laws. The maximum urban speed limit should be reduced in many countries. Sufficient attention should be paid to the needs of pedestrians, cyclists and motorcyclists, who together make up about 50% of Eastern Mediterranean Region road traffic deaths.

Revisiting the Corporate and Commercial Determinants of Health

We trace the development of the concept of the corporate determinants of health. We argue that these determinants are predicated on the unchecked power of corporations and that the means by which corporations exert power is increasingly unseen. We identify four of the ways corporations influence health: defining the dominant narrative; setting the rules by which society, especially trade, operates; commodifying knowledge; and undermining political, social, and economic rights. We identify how public health professionals can respond to these manifestations of power.

Is road safety being driven in the wrong direction?

BACKGROUND

Road traffic crashes are a major cause of death and injury worldwide and are set to increase as low- and middle-income countries motorize. United Nations (UN)and World Health Organization (WHO) road traffic injury prevention efforts depend on support from external organizations, many of which have commercial interests in increasing car use. Because of concerns about conflict of interest, this study objectively assessed the activities of a key WHO collaborator, the Global Road Safety Partnership (GRSP).

METHODS

We conducted a quantitative content analysis comparing GRSP publications and the 2004 WHO World Report on Road Traffic Injury Prevention. Dictionaries of terms were constructed for each of the evidence-based interventions detailed in the World REPORT. Text analysis software was used to generate word frequency counts of those terms to compare the World Report and GRSP documents.

RESULTS

Education, information and publicity featured far more commonly in the GRSP publications than in the WHO World Report [word frequency ratios and 95% confidence intervals: GRSP Newsletter 3.09, 2.53 to 3.78; Around GRSPs World 4.69, 3.76 to 5.87;GRSP Project summaries 3.42, 2.59 to 4.51] On the other hand, compared with the World Report, reducing car use [GRSP Newsletter 0.36, 0.27 to 0.48], minimizing exposure to high-risk scenarios [GRSP Newsletter 0.04, 0.02 to 0.09] and encouraging the use of safer modes of travel [GRSP Newsletter 0.02, 0.01 to 0.08] rarely featured in GRSP publications.

CONCLUSIONS

The GRSP focuses on educational interventions, for which there is no evidence of effectiveness. Furthermore, the GRSP does not appear to consider the full range of WHO interventions. As motorization growth has serious negative implications for health, including those associated from physical inactivity, climate change and air and noise pollution, it is imperative that the UN and WHO do not allow business interests to dominate public health interests.

A population approach to transportation planning: reducing exposure to motor-vehicles

Transportation planning and public health have important historical roots. To address common challenges, including road traffic fatalities, integration of theories and methods from both disciplines is required. This paper presents an overview of Geoffrey Rose's strategy of preventive medicine applied to road traffic fatalities. One of the basic principles of Rose's strategy is that a large number of people exposed to a small risk can generate more cases than a small number exposed to a high risk. Thus, interventions should address the large number of people exposed to the fundamental causes of diseases. Exposure to moving vehicles could be considered a fundamental cause of road traffic deaths and injuries. A global reduction in the amount of kilometers driven would result in a reduction of the likelihood of collisions for all road users. Public health and transportation research must critically appraise their practice and engage in informed dialogue with the objective of improving mobility and productivity while simultaneously reducing the public health burden of road deaths and injuries.

Bicycling and walking for transportation in three Brazilian cities

BACKGROUND

Physical inactivity plays a role in the acquisition of heart disease, type 2 diabetes, and breast and colon cancer. The impact of such noncommunicable diseases on low- and middle-income countries is a major global health concern, but most studies in this area have focused on high-income countries. A better understanding of the factors that may influence physical activity in low- and middle-income countries is needed.

PURPOSE

This study describes the prevalence of cycling and walking for transportation and their association with personal and environmental factors in adults from three state capitals in Brazil.

METHODS

In 2007-2009, a random-digit-dialing telephone survey was conducted with residents (aged ≥18 years) of Curitiba, Vitoria, and Recife, sampled through a clustered multistage sampling process. Walking and cycling for transportation, perception of the environment related to physical activity, and demographic and health characteristics were collected. Poisson regression was used to examine associations between cycling and walking for transportation with covariates stratified by cities. All analyses were conducted in 2011.

RESULTS

The prevalence of bicycling for transportation was 13.4%; higher in Recife (16.0%; 95% CI=13.7, 18.4) compared to Curitiba (9.6%; 95% CI=7.8, 11.4) and Vitoria (8.8%; 95% CI=7.34, 10.1); and 26.6% for walking regularly as a mode of transportation. The adjusted analysis showed that cycling is positively associated with being male (prevalence OR [pOR]=3.4; 95% CI=2.6, 18.4) and younger (pOR=2.9; 95% CI=1.8, 4.9) and inversely associated with having a college degree (pOR=0.3; 95% CI=0.2, 0.4). Walking for transportation is inversely associated with having a college degree (pOR=0.6; 95% CI=0.5, 0.8). No strong evidence of association was found of environmental indicators with walking or bicycling.

CONCLUSIONS

The prevalence of active commuting was low and varied by city. Personal factors were more consistently associated with bicycling than with walking, whereas perceived environmental features were not related to active commuting.

Are cars the new tobacco?

BACKGROUND

Public health must continually respond to new threats reflecting wider societal changes. Ecological public health recognizes the links between human health and global sustainability. We argue that these links are typified by the harms caused by dependence on private cars.

METHODS

We present routine data and literature on the health impacts of private car use; the activities of the 'car lobby' and factors underpinning car dependence. We compare these with experience of tobacco.

RESULTS

Private cars cause significant health harm. The impacts include physical inactivity, obesity, death and injury from crashes, cardio-respiratory disease from air pollution, noise, community severance and climate change. The car lobby resists measures that would restrict car use, using tactics similar to the tobacco industry. Decisions about location and design of neighbourhoods have created environments that reinforce and reflect car dependence. Car ownership and use has greatly increased in recent decades and there is little public support for measures that would reduce this.

CONCLUSIONS

Car dependence is a potent example of an issue that ecological public health should address. The public health community should advocate strongly for effective policies that reduce car use and increase active travel.

Household motor vehicle use and weight status among Colombian adults: are we driving our way towards obesity?

OBJECTIVE

To determine the associations between household motor vehicle ownership and weight status among Colombian adults.

METHODS

Secondary analysis of data from the 2005 Demographic and HealthSurvey of Colombia. Height, weight and waist circumference were objectively measured in 49,079 adults, ages 18 to 64 that resided in urban settings. Abdominal obesity was defined as a waist circumference >80 cm in women and >90 cm in men.

RESULTS

Prevalence was 19.9% for motor vehicle ownership in household, 33.1% for BMI between 25 and 29.9 kg/m(2), 14.4% for BMI>30 kg/m(2), and 46% for abdominal obesity. Males reporting any household motor vehicle ownership were more likely to be overweight or obese, and to have abdominal obesity (p for genderexposure variables interaction=<0.001).

CONCLUSIONS

Household motor vehicle ownership is associated with overweight, obesity, and abdominal obesity among Colombian men but not women.

Headlines and Discourses in Newspaper Reports on Traffic Accidents

Building on the existing social and health sciences knowledge base, we explore the ways in which traffic accidents on South African roads are constructed by the media and how these constructions are related to the media's role in supporting hegemonic interests, producing public consensus and promoting public agency. Discourse analysis was used to analyse 52 South African newspaper articles that reported on traffic accidents during the Easter weekend and the festive season in 2005/6. The analysis suggests that well-crafted headline messages and multiple discourses, predicated by a range of news-values and specific framing modalities, are interwoven to project the dominant view that over the holiday season South African roads are war-zones. Irresponsible and reckless drivers, in particular taxi drivers, are typecast as ‘unworthy’ citizens and habitual perpetrators of the ‘carnage’ on the roads. Motorists and occupants of public transport vehicles feature prominently as the primary victims of traffic deaths. Pedestrians and motorcyclists are among the less frequently mentioned victims. In contrast to the villains of the road, traffic safety officers are presented as the protectors of law-abiding citizens and emergency care workers, characterised as altruistic and angelic, are described as the rescuers who heal the wounded. Whereas the non-dominant discourse alerts the reader to pedestrian vulnerability, certain contextual determinants of traffic deaths, some successes in traffic safety promotion, and the dominant discourses suggest that the panacea for traffic safety is primarily rooted in proper road behaviour and law-enforcement. The analysis points to silences related to societal, institutional, and corporate responsibility in road safety and highlights the need to engage the print media toward assuring evidence-led reporting of traffic accidents.

Cars, corporations, and commodities: consequences for the social determinants of health

Social epidemiologists have drawn attention to health inequalities as avoidable and inequitable, encouraging thinking beyond proximal risk factors to the causes of the causes. However, key debates remain unresolved including the contribution of material and psychosocial pathways to health inequalities. Tools to operationalise social factors have not developed in tandem with conceptual frameworks, and research has often remained focused on the disadvantaged rather than on forces shaping population health across the distribution. Using the example of transport, we argue that closer attention to social processes (capital accumulation and motorisation) and social forms (commodity, corporation, and car) offers a way forward. Corporations tied to the car, primarily oil and vehicle manufacturers, are central to the world economy. Key drivers in establishing this hegemony are the threat of violence from motor vehicles and the creation of distance through the restructuring of place. Transport matters for epidemiology because the growth of mass car ownership is environmentally unsustainable and affects population health through a myriad of pathways. Starting from social forms and processes, rather than their embodiment as individual health outcomes and inequalities, makes visible connections between road traffic injuries, obesity, climate change, underdevelopment of oil producing countries, and the huge opportunity cost of the car economy. Methodological implications include a movement-based understanding of how place affects health and a process-orientated integration of material and psychosocial explanations that, while materially based, contests assumptions of automatic benefits from economic growth. Finally, we identify car and oil corporations as anti-health forces and suggest collaboration with them creates conflicts of interest.