Kelly Larson

Public Health Detailing: A Strategy to Improve the Delivery of Clinical Preventive Services in New York City

To promote use of essential clinical preventive services, the New York City Department of Health and Mental Hygiene developed the Public Health Detailing Program, a primary care provider outreach initiative modeled on pharmaceutical detailing. Department representatives conducted topical campaigns, making unscheduled visits to health care practices and meeting with providers and office staff members. Representatives distributed “action kits” containing practice tools, provider information, and patient education materials; nicotine replacement therapy was distributed during the smoking cessation campaign. More than 2,500 interactions with practice staff members were completed by six health department representatives at approximately 200 sites. Physician visits lasted 10 minutes or longer, and by provider self-report, use of office systems for prevention and adherence to recommended practices increased. Public health detailing is an effective method of reaching providers to deliver key prevention messages, feasible for public health agencies and acceptable to practices. The effectiveness of this intervention in improving clinical prevention services requires further evaluation.

The Importance of Data for Global Road Safety

The epidemic of deaths and injuries on roads throughout the world is not a new problem; poor infrastructure, lack of enforcement of road safety laws and sub-standard vehicles are just a few of the factors that have contributed to traffic-related mortality and disability for decades (Peden et al. 2004). However, it is only more recently that issues surrounding road safety have began to receive the attention they deserve. Aware of the growing burden of road traffic injuries, the World Health Organization (WHO) and the World Bank released the “World Report on Road Traffic Injury Prevention” in 2004. By 2008, WHO predicted that road traffic injuries (RTIs) would become the 5th leading cause of death by 2030 (World Health Organization [WHO] 2008). This fact, combined with 2004 report led to several recommendations and United Nations (UN) resolutions calling on governments to do their part in reducing road traffic deaths and injuries. In 2009, WHO also published the first “Global Status Report on Road Safety,” which was the first assessment of the road safety situation in 178 countries around the world (WHO 2009). And in 2010, the UN General Assembly officially proclaimed 2011–2020 as the Decade of Action for Road Safety, which aims to save 5 million lives during the 10-year period (WHO 2011a). The Decade of Action is an opportunity for governments around the world to work with their partners in public health, transport, law enforcement, civil society and the private sector to halt the upward trend, and ultimately reduce the number of deaths and injuries due to road traffic crashes. Many countries have already expressed their commitment to the Decade, held national launch events, and drafted national action plans (Global plan for the Decade of Action for Road Safety 2011–2020; WHO 2011b).

Implementing proven road safety interventions saves lives.

Today road traffic injuries are the 8th leading cause of death globally, killing 1.24 million people each year.1 Unless action is taken, the World Health Organization estimates that road traffic injuries will become the 5th leading cause of death by 2030. Ninety-two percent of road traffic deaths occur in lowand middle-income countries. Vulnerable road users pedestrians, cyclists and motorcyclists are at greatest risk accounting for half of the 1.24 million deaths. WHO recently published the Global Status Report on Road Safety (2013) showing that road traffic fatalities have not increased since the last report in 2009, but 1.24 million deaths each year is unacceptable. In 2010, the United National General Assembly adopted resolution 64/255 which proclaimed a Decade of Action for Road Safety (2011-2020).2 The goal is for governments to prioritize road safety and stabilize the number of road traffic deaths, saving 5 million lives over the course of the Decade. In order to reach this goal, governments must prioritize adoption and/or improvement of road safety legislation and support implementation and enforcement of proven road safety interventions. This requires political will and an integrated approach involving the collaboration of many sectors including, but not limited to Health, Public Security and Transport. We know what works to reduce fatalities and injuries on the world’s roads. Proven interventions include increasing helmet and seat-belt use, reducing speed, and eliminating drinking and driving:3,4 • Wearing a seat-belt reduces the risk of fatality among front seat passengers by 40-50% and 25-75% for rear seat car occupants • Helmet use decreases risk of injuries by 70% and deaths by 40% • Research on effective speed management indicates that speed limits on urban roads should not exceed 50 km/h • Global standards for drinking and driving laws set acceptable blood alcohol content (BAC) limits at less than 0.05% for adult drivers. Bloomberg Philanthropies has committed

Public Health Detailing of Primary Care Providers: New York City’s Experience, 2003–2010

125M over 5 years (2010-2014) to address these proven interventions in ten lowand middle-income countries that make up almost half of road traffic fatalities globally. The Bloomberg Global Road Safety Programme is currently focusing on Brazil, Cambodia, China, Egypt, India, Kenya, Mexico, Russia, Turkey and Vietnam. Through strong social marketing campaigns combined with increased enforcement and improved local and national laws, we’ve seen progress in many focus countries. In Afyon, Turkey seat-belt use has increased from 4% in 2010 to 73% in 2013. Similarly, seatbelt use in Ivanovo, Russia has increased from 45% to above 90%. Following implementation and enforcement of a comprehensive 2007 helmet law in Vietnam, helmet use among drivers and passengers remains steady at about 90%, up from 40% prior to the 2007 law. The Johns Hopkins Bloomberg School of Public Health International Injury Research Unit (IIRU) has monitored and evaluated the implementation of these activities since 2010. Monitoring is critical to demonstrate the enormous returns both in injury prevention and lives saved such investments in road traffic injury prevention can have. This supplement issue provides important data that can help us generate new knowledge for the road safety field and highlights the potential gains with strategic investments.