To Ban or Not to Ban
Just Say No? / The Three Es of Safety / Prohibition or Precaution?
Whenever a child is killed or seriously injured, the question of how to prevent a similar mishap in the future must be addressed. An increase in injuries and fatalities from a specific cause indicates safety measures are needed.
However, evidence of a safety problem does not necessarily point to the solution. Moreover, similar evidence may lead to very different responses. Should the priority be to eliminate the hazard, or to reduce the harm? What is the role of education, legislation and enforcement, and engineering?
Baby walkers are a case in point. In the mid 1990s, data showed more children were being injured with baby walkers than any other nursery product. This prompted the U.S. Consumer Product Safety Commission to work with manufacturers on a voluntary product standard to prevent stair-falls. The standard was put into place in 1997, and a 2005 study reports a 63 percent drop in emergency department injury rates.1 Canada, taking more drastic action, banned baby walkers from importation, advertising and sale effective November 2004.
Whereas Canada legislated a product ban, our American neighbours worked with stakeholders to make the product safer.
Just Say No?
With a potentially dangerous product, especially a new product, a precautionary ban can prevent a problem from developing. An example is the Alcohol Without Liquid (AWOL) vaporiser, which purports to enable users to get drunk without calories or a hangover. In 2004, the Canada Safety Council asked Canadian jurisdictions to prohibit the sale of this device in Canada. Its potential to impair driving ability while still allowing the user to pass a breathalyser test posed a serious threat to safety. Waiting for the evidence to mount before taking preventive action would be foolhardy.
However, when the goal is to change a common practice, Just Say No can be the wrong approach because it ignores the complexity of human psychology and the need to encourage voluntary compliance.
In 2004, based on an increase in sudden, unexpected deaths of infants in adult beds, the Canadian Paediatric Society stated it is dangerous for parents to sleep with their baby.2 In February 2006, recognizing that some parents will sleep with their infants in spite of a doctor’s advice, the Society said it would consider a harm reduction approach in place of the recommended ban. While discouraging bedsharing, pediatricians may suggest precautions for parents who choose to sleep with their baby.3
The Three Es of Safety
The safety discipline is built on three pillars: education, engineering and enforcement. Safety educators help people prevent mishaps. Regulators develop safety legislation, which the police enforce. Engineers design safer products and environments. The underlying premise of safety practitioners is that risks can and must be managed.
After World War II, with more and more traffic on the road deaths and injuries began to rise. The problem had to be addressed, but banning cars was not an option. Engineers developed safer cars and roads. Governments put safety regulations into place, and police enforced them. The public became aware of the need to take care in traffic.
The Elmer the Safety Elephant™ Traffic Safety Program is a success story of evidence-based safety education from that time. A Toronto police officer started the program in 1947 to address community concerns over an alarming increase in collisions involving children.
Elmer’s original six rules were based on a study of collisions involving children five to nine years of age. The vast majority of mishaps were linked to six key factors. As well, the children may have been taught the necessary safety rules, but momentary excitement often made them forget to be careful. These findings led to the slogan “Elmer and I never forget” and Elmer’s famous safety rules.
During the program’s first year, traffic mishaps among Toronto school children dropped 44 percent while motor vehicle registration in that city rose by more than 10 percent. Elmer has remained Canada’s best known and best loved safety character, and continues to teach young children how to stay safe.
Prohibition or Precaution?
The debate about whether children should be allowed to ride all-terrain vehicles (ATVs) illustrates two distinct perspectives on the type of legislation than can best protect the public.
A cursory review of the evidence4 reveals that injuries and fatalities have risen as these vehicles have grown increasingly popular for recreation, and identifies common factors in the mishaps.
Between 1996 and 2001, ATV sales in Canada tripled. In that same period there was a 50 percent increase in ATV-related hospitalizations. Children between the ages of five and 19 accounted for more than one-third (36 percent) of the injuries. Boys aged 15 to 19 were most at risk. Speed, inexperience, improper apparel, non-use of helmets and alcohol were common factors. A significant number of injured children were passengers, though most ATVs are designed for one rider.
Some medical professionals believe the best way to prevent injuries is simply to prohibit all children under age 16 from riding ATVs of any size. On the other hand, safety practitioners advocate measures to manage the risks, recognizing that the young people most at risk are likely to ride ATVs anyway. They advocate a combination of enforceable regulations, training and public education, and mandatory use of vehicles engineered for children.
The Canada Safety Council maintains to ban the use of ATVs by children under age 16 would be a mistake. Enforcement would be difficult (if not impossible) on private property and in northern and rural communities where ATV use is common, and not just for recreation. Child-size machines with reduced speed capability and a device to stop the vehicle remotely could be removed from sale. Children who ride in spite of a ban will develop a disrespect for the law — an unacceptable attitude to take into adulthood.
Evidence clearly shows that graduated licensing has led to a drop in road fatalities and injuries by giving young drivers the opportunity to gain experience under controlled conditions. It makes sense to apply a similar preventive strategy to ATV safety.
The criminal activity spawned by Prohibition in the 1920s serves as a lesson that prohibiting a common practice can backfire. However, if the risky behaviour is not widespread and is easily controlled, a ban targeting those at highest risk may be the most effective way to prevent harm.
In 2003, four of Hockey Canada’s 13 branches allowed checking for boys as young as nine years old. At that time, the Canada Safety Council maintained that bodychecking should continue to be banned in minor league hockey. A study5 published in 2006 showed the move led to more injuries, including concussions which can lead to life-long disability. Pressure from safety groups, medical professionals and insurers may force Hockey Canada to re-institute its ban on checking for players up to age 14.
While a ban may be appropriate in specific situations, it should not be used as a universal quick fix. To improve safety in the long term, imposing precautions is often much more effective than prohibiting the activity.
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