Risk And Misfortune by Judith Green

Author:Judith Green [Green, Judith]
Language: eng
Format: epub
Tags: History, Modern, 20th Century, Medical, Emergency Medicine, Research, Social Science, Sociology, General, Disease & Health Issues
ISBN: 9781000672923
Google: 1dHVDwAAQBAJ
Barnesnoble:
Goodreads: 4755802
Publisher: Routledge
Published: 1997-05-01T00:00:00+00:00

Evaluating success

Others, most eloquently Adams (1995), have argued that these engineering and enforcement strategies are also inherently limited because they do not take into account the way in which human behaviour changes in response to reduced risk. Adams refers to the idea of a “risk thermostat’: a psychological mechanism that sets the level of risk with which an individual feels comfortable (Adams 1995: 20). If the environment is made safer (by, for example, providing soft safety surfaces on playgrounds, or by enforcing seat belt use) then individuals increase the amount of risk they face by, for instance jumping from a higher rung of the climbing frame, or by driving faster. Adams argues that this “risk compensation” undermines efforts to reduce accidents: making environments safer is likely to lead to more risky behaviour. In addition, risk may be redistributed to the most vulnerable members of society Thus if car drivers (secure in the knowledge that they are protected by air bags, seat belts and a crash-resistant car chassis) drive faster, they endanger pedestrians and cyclists. Although seat belt use might reduce fatal injuries to drivers, it may increase those to other, less well-protected, road users. The implications of Adams’s argument for accident prevention are interesting. If making cars safer means drivers drive less carefully, then making cars more dangerous would lead to more careful driving. His most radical suggestion is for the “driving column spike” (Adams 1995: 155) to replace the air bag, which would undoubtedly increase the care taken by most drivers. Adams’s arguments are convincing, and his reanalysis of the “successes” of accident prevention certainly undermine any faith in engineering or enforcement strategies as routes to reducing accident rates. However, Adams admits that his arguments have been peripheral to the planning process and have had little impact on public health policy. In terms of the research consensus, and the information available to health promotion experts in the early 1990s, there remains a question about why education was prioritized as a strategy despite the apparent strengths of other approaches.

The “success” of any accident prevention programmes is of course extremely difficult to evaluate. Any individual accident event is “caused” by many environmental, cultural and personal factors, and age-specific mortality rates for particular causes are usually too small to gauge significant change. This is what Adams refers to as the problem of “not enough accidental deaths” (Adams 1995: 69). Even when reduced mortality rates can be observed, they are not in themselves evidence of unqualified success, even in terms of health gain, as Roberts (1993) has highlighted in his analysis of the decreasing number of pedestrian deaths in road traffic accidents. In England and Wales between 1968 and 1987 pedestrian deaths fell by 67 per cent for those under four years old, and by 39 per cent for five- to fourteen-year-olds. This represents, argues Roberts, neither the success of road safety campaigns nor improved road designs, but rather the reduced exposure of children over this period to traffic, as they are no longer able to play in the streets or walk to school safely.

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