Policy Advocacy on Road Safety Dr. Angela Cooper Brathwaite, PhD, RN. Betsy Jackson, RN, MScN

The Facts Motor vehicle collisions are the leading cause of injury, death and morbidity in young adults in Ontario. Teenage drivers are 3.5 times more likely to be involved in a fatal collision. Motor vehicle collisions contribute to the total economic burden in Canada. Research has shown that Education, Engineering, Enforcement of policy and Evaluation must be combined to reduce the rate of unintentional injuries. Enforcement of healthy public policy is an important strategy to reduce injuries but how do we move from problem identification to policy enactment? The missing step is policy advocacy. Notes: Today we would address one of the four E’s of Injury Prevention: Policy Advocacy. In order to advocate for healthy public policy, we must identify a health problem or gaps in legislation to address that problem.

Purpose to this Presentation This paper describes the steps taken in policy advocacy in order to influence the provincial government to amend the Highway Traffic Act, Counteracting Distracted Driving and Passenger Safety Acts.

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

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).

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

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.

Policy Advocacy Between 2006 and 2009, in collaboration with an Injury Prevention Program in Public Health, we developed policy advocacy plans related to: Motor Vehicle Safety (Seatbelt Use) Distracted Driving (Bill 118) Passenger Safety (Bill 126) Bill 118 deals with cell phone use, texting on a mobile devices and computer Bill 126 deals with passenger safety and includes the driver’s level of blood alcohol, driving impaired and impoundment of a vehicle for speeding or driving over the alcohol limit of 0.05.

Seatbelt Use STEP 1: The Problem A loophole was identified in the Highway Traffic Act in subsection 4 “…every person…in a motor vehicle in which a seatbelt assembly is provided for…shall 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).

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…”

Seatbelt Use All organizations supported this resolution STEP 3 & 4: Identifying Decision Makers/Resources The Medical Officer of Health presented the problem to the following Committees: Health and Social Services Committee (Feb 2006) Municipal Government (Feb 2006) Ministers of Children and Youth Services, Health and Long-Term Care, Health Promotion and Transportation, OPHA and all Ontario Boards of Health. Angela presented and defended the Resolution at OPHA & RNAO Annual Meetings. The resolution with background information was… RNAO – April 2006 alPHA - June 2006 OPHA - Oct 2006 All organizations supported this resolution

Seatbelt Use STEP 5: Action plan/Strategies Teleconferenced Dr. Robert Conn of SMARTRISK numerous times to strategically plan our actions. Collaborated with Safe Kids Canada Collaborated with Toronto & Area Safety Coalition Collaborated with Canada Safety Council Collaborated with Royal Bank of Canada First Office for Injury Prevention Collaborated with Public Health Units/Departments throughout Ontario Informed Local MPPs & submitted a letter with supporting documentation to Transportation Minister Donna Cansfield Support was sought and received from numerous organizations into implement the Advocacy plan. All the organizations listed above had a vested interest in preventing injuries in children and adults.

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. On October 16, 2006 the Provincial Government introduced legislation to strengthen seatbelt laws, “One Person, One Seatbelt”. Two weeks later, the Bill passed 3rd reading.

Seatbelt Use STEP 8: Success!! On December 1, 2006 the “One Person, One Seatbelt” Bill became law in Ontario.

Counteracting Distracted Driving, Bill & Passenger Safety STEP 1: The Problem Cell phone use and texting while driving increase the incidence of motor vehicle collisions. In 2004-2005, motor vehicle collisions were the leading cause of major trauma and hospitalization (44%) of all major trauma in Ontario (ON), Canada. In ON, for every 10 driver fatality, approximately 5 passengers were killed. The economic and social cost of motor vehicle collisions for ON was $17.9 billion or 3.5% of Ontario’s 2004 GDP (Transport Canada, 2007). Counteracting Distracted Driving is Bill 118 85% of cell phone owners used their cell phone while driving (Stayer et al., 2003). Drivers using a cell phone can exhibit greater impairments than in toxicated drivers. Passenger Safety was Bill 126

Bills 118 & 126: Distracted Driving and Passenger Safety STEP 2: The Solution: Pass the Distracting Driving and Passenger Safety. Developed an advocacy Letter and brief, which was submitted to Standing Committee on General Government, Legislative Assembly of Ontario. Hearings on evidence to amend the law occurred throughout ON between January 2009 and April 2009.

Counteracting Distracted Driving & Passenger Safety STEP 3 & 4: Identifying Decision Makers/Resources Medical Officers of Health in ON. Boards of Health or Municipal Regional Councils Ministers of Transportation, Health Promotion, Health and Long Term Care Ontario Public Heath Association and Registered Nurses Association of Ontario. Advocacy letter and Brief submitted to Standing Committee, Legislative Assembly at Parliament. Hand held devices include, cell phones, iPhones, smartphones, blackberries, iPods, MP3 players, DVD players, laptop computers, eBook readers, portable games. In addition to submitting an Advocacy letter and Brief to the Standing Committee at Queen’s Park (Provincial Parliament). We attending several hearings at Queen’s Park to give input and counteract opposing evidence to amend the law.

Counteracting Distracted Driving & Passenger Safety Acts STEP 5: Action Plan/Strategies Collaborate with coalitions and professional organizations (Safe Kids Canada, RNAO) to develop and distribute reports and fact sheets Educate politicians (MPs, MPPs and municipal) and the community about the problem Submit a Advocacy letter and Brief on Distracted Driving and Passenger Safety to the Standing Committee at the Legislative Assembly. Attended three hearings at Queen’s Park to give input and counteract opposing views on this legislation. The Ontario Government held numerous hearings across the province to get evidence to either support or opposed the proposed legislative changes to the two Acts.

Counteracting Distracted Driving & Passenger Safety STEP 6 & 7: Timing & Implementation During the hearings by the Committee in Standing at the Legislative Assembly, we attended several meetings to influenced the amending the two Acts. Educated Medical Officers of Health and collaborated with them to influence the Regional Government to provide support at their level. Collaborated with community partners, key stakeholders by distributing reports and fact sheets to them. Aligned our advocacy plan with stakeholders’ plans in order to have a united case for amending the acts.

Counteracting Distracted Driving & Passenger Safety STEP 8: Success!! Bill 118, Counteracting Distracted Driving and Bill 126, Passenger Safety received Royal Accent in April 2009 and were amended. They became effective in September 2009. Implementation of these acts were introduced by phases commencing September 2009 to 2010. Bill 126 deals with impounding a vehicle if the driver was impaired (Blood Alcohol level of 0.05 or over meant that the drive license can be suspended, the vehicle was impounded with a fee for impoundment. It also include that young adults with G1 license could not drive at nights.

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. Let’s challenge decision-makers to make Canada the safest country in the world.

Policy Advocacy on Road Safety Angela Cooper Brathwaite, RN, PhD. Betsy Jackson, RN, MScN