Tackling the health burden from household air pollution (HAP) : development and implementation of new WHO Guidelines

Household air pollution (HAP), arising mainly from the combustion of solid and other polluting fuels, is responsible for a very substantial public health burden, most recently estimated as causing 3.5 million premature deaths in 2010. These patterns of household fuel use have also important negative impacts on safety, prospects for poverty reduction and the environment, including climate change. Building on previous air quality guidelines, the WHO is developing new guidelines focused on household fuel combustion, covering cooking, heating and lighting, and although global, the key focus is low and middle income countries reflecting the distribution of disease burden. As discussed in this paper, currently in development, the guidelines will include reviews of a wide range of evidence including fuel use in homes, emissions from stoves and lighting, household air pollution and exposure levels experienced by populations, health risks, impacts of interventions on HAP and exposure, and also key factors influencing sustainable and equitable adoption of improved stoves and cleaner fuels. GRADE, the standard method used for guidelines evidence review may not be well suited to the variety and nature of evidence required for this project, and a modified approach is being developed and tested. Work on the guidelines is being carried out in close collaboration with the UN Foundation Global Alliance on Clean cookstoves, allowing alignment with specific tools including recently developed international voluntary standards for stoves, and the development of country action plans. Following publication, WHO plans to work closely with a number of countries to learn from implementation efforts, in order to further strengthen support and guidance. A case study on the situation and policy actions to date in Bhutan provide an illustration of the challenges and opportunities involved, and the timely importance of the new guidelines and associated research, evaluation and policy development agendas.

Linking the fifth pillar to the first in the UN Decade of Action

The UN Decade of Action outlines five pillars of activity within a safe system framework to achieve the goal of slowing and then reversing the global growth in road traffic fatalities, especially in low-income and middle-income countries. The first four pillars - road safety management, safer roads and mobility, safer vehicles, and safer road users – have a strong focus on prevention of road traffic crashes and mitigation of energy exchange when a crash occurs. The fifth pillar – post-crash response – is far more specific, focusing only on crash victims in the event of a safe system failure. The victims appear to be relevant to the first four pillars only insofar as their numbers can be used to evaluate the success of road safety programs and identify the target groups and contributing factors. This paper argues that a better understanding of the lived experience of long term disability from traffic crashes has the potential to provide a feedback loop from the fifth pillar to the first. Research conducted in Thailand with male crash victims with spinal injury demonstrates that patterns of attribution and social and cultural factors have important implications for road safety management and for interventions aimed at influencing behaviour. In addition, the mobility constraints experienced by people with long term disability can point to systemic issues that might otherwise go unnoticed. The UN Decade of Action can benefit from a more thorough exploration of the experiences and circumstances of people with long term disability as the result of a road traffic crash. Rather than being evidence of the failure of the safe system, they can inform the development of more effective road safety management on low-income and middle-income countries.

Reducing alcohol-related driving on China's roads : Traffic police officers' perceptions and practice

Alcohol-related driving is a longstanding, serious problem in China (Li, Xie, Nie, & Zhang, 2012). On 1st May, 2011 a national law was introduced to criminalize drunk driving, and imposed serious penalties including jail for driving with a blood alcohol level of above 80mg/100ml. This pilot study, undertaken a year after introduction of the law, sought traffic police officers’ perceptions of drink driving and the practice of breath alcohol testing (BAT) in a large city in Guangdong Province, southern China. A questionnaire survey and semi-structured interviews were used to gain an in-depth understanding of issues relevant to alcohol-related driving. Fifty-five traffic police officers were recruited for the survey and six traffic police officers with a variety of working experience including roadside alcohol breath testing, traffic crash investigation and police resourcing were interviewed individually. The officers were recruited by the first author with the assistance of the staff from Guangdong Institute of Public Health, Centre for Disease Control and Prevention (CDC). Interview participants reported three primary reasons why people drink and drive: 1) being prepared to take the chance of not being apprehended by police; 2) the strong traditional Chinese drinking culture; and 3) insufficient public awareness about the harmfulness of drink driving. Problems associated with the process of breath alcohol testing (BAT) were described and fit broadly into two categories: resourcing and avoiding detection. It was reported that there were insufficient traffic police officers to conduct routine traffic policing, including alcohol testing. Police BAT equipment was considered sufficient for routine traffic situations but not highway traffic operations. Local media and posters are used by the Public Security Bureau which is responsible for education about safe driving but participants thought that the education campaigns are limited in scope. Participants also described detection avoidance strategies used by drivers including: changing route; ignoring a police instruction to stop; staying inside the vehicle with windows and doors locked to avoid being tested; intentionally not performing breath tests correctly; and arguing with officers. This pilot study provided important insights from traffic police in one Chinese city which suggest there may be potential unintended effects of introducing more severe penalties including a range of strategies reportedly used by drivers to avoid detection. Recommendations for future research include a larger study to confirm these findings and examine the training and education of drivers; the focus and reach of publicity; and possible resource needs to support police enforcement.

Second Skin 2012 Workshop

The Second Skin 2012 Workshop Program consisted of a full-day intensive design immersion workshop run on Saturday 14 July 2012, at the QUT Faculty of Creative Industries Fashion Studios at Kelvin Grove Brisbane, Australia, for 30? self-selected high-achieving junior and middle school (year 5-9) students, as part of the Queensland Academies ‘Young Scholars’ Program. Inspired by a scientist researching the impact of sun on skin, and mentored by tertiary fashion design and interior design educators, and six tertiary fashion design and interior design students, the workshop explored science and design-inspired prototype solutions for sun-safety. This action research study aimed to facilitate an acute awareness in young people of the sun safety message (alternative to a scare campaign), the role of design in society and the value of design thinking skills in solving complex challenges, and to inspire the generation of strategies to address a systemic health issue. It also aimed to investigate the value of collaboration between junior and middle school students, tertiary design educators and students and industry professionals in targeting youth sun safety, and inspiring post-secondary pathways and idea generation for education. During the workshop, students developed sketching, making, communication, presentation and collaboration skills to improve their design process, while considering social, cultural and environmental opportunities. Through a series of hands-on collaborative design experiments, participants explored in teams of five, ways in which a ‘second skin’ can mirror elements of our skin – the ability to protect, divide, enclose, stretch, scar, pattern, peel and reveal – inspiring both functional and aesthetic design solutions. Underpinned by the State Library of Queensland Design Minds Website ‘inquire, ideate and implement’ model of design thinking, the experiments culminated in the development of a detailed client brief, the design and fabrication of a fashionable sun safe clothing range and then a team presentation and modelling of prototypes in a fashion parade, viewed also by parents. The final collections were judged by three prominent judges: Louise Baldwin - Executive Manager Public Health QLD Cancer Council, Shane Thompson - Architect and 2012 Queensland Smart Design Fellow, and Leigh Buchanan – Fashion designer and Project Runway Australia finalist. The workshop was filmed for Queensland television program ‘Totally Wild’ for dissemination of the value of design, the Design Minds model and the sun safety message to a wider target youth audience.

Reconceptualising policy integration in road safety management

Unless sustained, coordinated action is generated in road safety, road traffic deaths are poised to rise from approximately 1.3 to 1.9 million a year by 2020 (Krug, 2012). To generate this harmonised response, road safety management agencies are being urged to adopt multisectoral collaboration (WHO, 2009b), which is achievable through the principle of policy integration. Yet policy integration, in its current hierarchical format, is marred by a lack of universality of its interpretation, a failure to anticipate the complexities of coordinated effort, dearth of information about its design and the absence of a normative perspective to share responsibility. This paper addresses this ill-conception of policy integration by reconceptualising it through a qualitative examination of 16 road safety stakeholders’ written submissions, lodged with the Australian Transport Council in 2011. The resulting, new principle of policy integration, Participatory Deliberative Integration, provides a conceptual framework for the alignment of effort across stakeholders in transport, health, traffic law enforcement, relevant trades and the community. With the adoption of Participatory Deliberative Integration, road safety management agencies should secure the commitment of key stakeholders in the development and implementation of, amongst other policy measures, National Road Safety Strategies and Mix Mode Integrated Timetabling.

Empowering the school community for change : an evaluation of participation in the Ashgrove Healthy School Environment Project

The purpose of this study was to evaluate aspects of participation in a participatory action research project, the Ashgrove Healthy School Environment Project. Participatory action research is a form of research that creates change as an explicit part of the research process and requires the active participation of those by and for whom the research is being conducted. This study arose from concems by this researcher, who is also a co-facilitator of the project, that levels of participation were not as extensive as one might have hoped and that this seemingly low level would have a negative impact on the continuing participation of those already involved. Specifically. this evaluation sought to uncover the reasons that prompted participation, to identify structural barriers to initial involvement and to uncover participants' perceptions of the process, including barriers and opportunities. It also sought to record evidence of any shift in decision making and to draw implications about the findings that could assist the project, the school, other schools and the wider community. This evaluation involved focus group discussions and interviews with participants actively involved in the school project. The purpose was to uncover their views, feelings and perceptions about their participation and the participatory processes in use generally. It also included some examination of school documents and newsletters and as also drawn on the reflections of this 'insider' researcher, based on two years of involvement in facilitating the project. The findings that emerge from this study are heartening. Rather than feeling anxious about the long-term sustainability of the project, this researcher now feels more confident about its achievements, both in terms of the changes that have occurred in the school and about the participatory processes and levels of participation. Whilst the evaluation has identified a number of barriers, both institutional, personal and project related, it has also identified several key factors that serve to promote participation.

Sustainable infrastructure procurement in Australia : standard vs. project practices

The Australian Government and most Australian road authorities have set ambitious greenhouse gas emission (GHGe) reduction targets for the near future, many of which have translated into action plans. However, previous research has shown that the various Australian state road authorities are at different stages of implementing ‘green’ initiatives in construction planning and development, with considerable gaps in their monitoring, tendering, and contracting. This study illustrates the differences between procurement standards and project specific practices that aim to reduce GHGe from road construction projects in three of the largest Australian road construction clients, with a focus on the tools used, contract type and incentives for better performance.

"I drove after drinking alcohol" and other risky driving behaviours reported by young novice drivers

Background Volitional risky driving behaviours including drink- and drug-driving and speeding contribute to the overrepresentation of young novice drivers in road crash fatalities, and crash risk is greatest during the first year of independent driving in particular. Aims To compare: 1) the self-reported compliance of drivers with road rules relating to substance-impaired driving and other risky driving behaviours including speeding and driving tired, one year after progression from a Learner to a Provisional (intermediate) licence; and 2) the interrelationships between substance-impaired driving and other risky driving behaviours (crashes, offences, and Police avoidance). Methods 1268 drivers (373 males) aged 17-26 years were surveyed regarding their sociodemographics (age, gender) and self-reported driving behaviours including crashes, offences, Police-avoidance, and driving intentions. Results A relatively small proportion of participants reported driving after taking drugs (5.9% males, 1.3% females) and drinking alcohol (19.3% males, 11.6% females). In comparison, a considerable proportion of participants reported at least occasionally exceeding speed limits (85.7% novices) and driving when tired (82.7% novices). Substance-impaired driving was associated with avoiding Police, speeding, risky driving intentions, and self reported crashes and offences. Forty-four percent of illicit-drug drivers also reported alcohol-impaired driving. Discussion and conclusions The low self-reported prevalence of substance-impaired driving suggests official enforcement measures play a role in promoting compliance, in addition to social influences such as the broader community and the young novice drivers’ social networks including friends and family. Conversely, the prevalence of speeding appears to reflect the pervasive cultural acceptance of this behaviour. Given the interrelationships between the risky driving behaviours, a deeper understanding of influential factors is required to inform targeted and general countermeasure implementation and evaluation during this critical driving period.

Strengthening critical health psychology : a critical action orientation

The commentaries on my original article ‘The Emergence of Critical Health Psychology: Can it Contribute to Promoting Public Health?’ provided engaging views on what critical health psychology (CHP) actually is and does. Consideration of each commentary gave rise to numerous themes and generated my own further thoughts on CHP which I frame as five key areas of a continuing dialogue: (1) reflexivity and CHP; (2) health psychology: pluralist or not? (3) CHP as a moral project; (4) social action and change; and (5) strengthening critical approaches to health. Throughout I highlight concepts and issues that are integral to the capacity of CHP to create a shift towards a reinvigorated action-orientated agenda.

The Tashi project 2004-2010 : developing methods for creating theatre works that fully engage children aged between 3 and 10

Over a seven-year period, Mark Radvan directed a suite of children’s theatre productions adapted from the original Tashi stories by Australian writers Anna and Barbara Fienberg. The Tashi Project’s repertoire of plays performed to over 40,000 children aged between 3 and 10 years old, and their carers, in seasons at the Out of the Box Festival, at Brisbane Powerhouse and in venues across Australia in two interstate tours in 2009 and 2010. The project investigated how best to combine an exploration of theatrical forms and conventions, with a performance style evolved in a specially developed training program and a deliberate positioning of young children as audiences capable of sophisticated readings of action, symbol, theme and character. The results of this project show that when brought into appropriate relationship with the theatre artists, young children aged 3-5 can engage with sophisticated narrative forms, and with the right contextual framing they enjoy heightened dramatic and emotional tension, bringing to the event sustained and highly engaged concentration. Older children aged 6-10 also bring sustained and heightened engagement to the same stories, providing that other more sophisticated dramatic elements are woven into the construction of the performances, such as character, theme and style.

Children as change agents for sustainability : an action research case study in a kindergarten

At a time when global consumption and production levels are 25 percent higher than the Earth’s sustainable carrying capacity, there are worldwide calls to find ways to sustain the Earth for this and future generations. A central premise of this study is that education systems have an obligation to participate in this move towards sustainability and can respond by embedding education for sustainability into curricula. This study took early childhood education as its focus due to the teacherresearcher’s own concerns about the state of the planet, coupled with early childhood education’s established traditions of nature-based and child-centred pedagogy. The study explored the experiences of a class of kindergarten children as they undertook a Project Approach to learning about environmental sustainability. The Project Approach is an adaptation of Chard’s work which is situated within a constructivist theoretical framework (Chard, 2011). The Project Approach involves in-depth investigations around an identified topic of interest. It has three phases: introductory, synthesising and culminating phase. The study also investigated the learning journey of the classroom teacher/researcher who broadened her long-held co-constructivist teaching approaches to include transformative practices in order to facilitate curriculum which embedded education for sustainability. While coconstructivist approaches focus on the co-construction of knowledge, transformative practices are concerned with creating change. An action research case study was conducted. This involved twenty-two children who attended an Australian kindergarten. Data were collected and analysed over a seven week period. The study found that young children can be change agents for sustainability when a Project Approach is broadened to include transformative practices. The study also found that the child participants were able to think critically about environmental and sustainability issues, were able to create change in their local contexts, and took on the role of educators to influence others’ environmental behaviours. Another finding was that the teacher-researcher’s participation in the study caused a transformation of both her teaching philosophy and the culture at the kindergarten. An important outcome of the study was the development of a new curriculum model that integrates and has applicability for curriculum development and teacher practice.

Safety enhancement of water-filled road safety barrier using interaction of composite materials

Road safety barriers are used to redirect traffic at roadside work-zones. When filled with water, these barriers are able to withstand low to moderate impact speeds up to 50kmh-1. Despite this feature, Portable Water-filled barriers (PWFB) face challenges such as large lateral displacements, tearing and breakage during impact; especially at higher speeds. This study explores the use of composite action to enhance the crashworthiness of PWFBs and enable their usage at higher speeds. Initially, energy absorption capability of water in PWFB is investigated. Then, composite action of the PWFB with the introduction of steel frame is considered to evaluate its enhanced impact performance. Findings of the study show that the initial height of the impact must be lower than the free surface level of water in a PWFB in order for the water to provide significant crash energy absorption. In general, an impact of a road barrier with 80% filled is a good estimation. Furthermore, the addition of a composite structure greatly reduces the probability of tearing by decreasing the strain and impact energy transferred to the shell container. This allows the water to remain longer in the barrier to absorb energy via inertial displacements and sloshing response. Information from this research will aid in the design of new generation roadside safety structures aimed to increase safety in modern roadways.

How to improve pupils' literacy? A cost-effectiveness analysis of a French educational project

The Action Lecture program is an innovative teaching method run in some nursery and primary schools in Paris and designed to improve pupils’ literacy. We report the results of an evaluation of this program. We describe the experimental protocol that was built to estimate the program’s impact on several types of indicators. Data were processed following a Differences-in-Differences (DID) method. Then we use the estimation of the impact on academic achievement to conduct a cost-effectiveness analysis and take a reduction of the class size program as a benchmark. The results are positive for the Action Lecture program.

Critical reflection on the SIA’s professional project and the body of knowledge

Over the last few years the Safety Institute of Australia (SIA) has developed and implemented a number of strategies to gain professional status for the ‘generalist occupational health and safety professional’. Two of the most significant developments have been the publication of the ‘Core Body of Knowledge for the Generalist OHS Professional.’ and the accreditation of university OHS courses. Despite a considerable amount of work aimed at gaining professional status there has not been any public debate or reflection about how the professionalisation project may impact on OHS and how the project is being conducted. Professionalisation has been vigorously promoted as a sign of maturity for the SIA and which will provide unmitigated benefits for workplace health and safety. The aim of this paper is to critically reflect on the processes of professionalisation (the professional project) and discuss some of the ways in which this project may shape the field of occupational health and safety. The implications for the role of universities will also be discussed.