The public policy approach to injury prevention.

Despite widespread application of the public health approach to injury prevention, its facilitation of the translation of injury research to practice is limited. This paper describes a public policy approach to injury prevention, derived from Kingdon’s streams approach, which may circumvent the research-to-practice block, specifically for use by practitioners. The central premise of the proposed public policy approach is that policy action is a consequence of windows of opportunity created by the convergence of three streams: (1) problem recognition; (2) development of injury prevention policy; and (3) political will. The role of the injury prevention practitioner is to encourage a convergence of these elements, and thus maximise the opportunity provided to galvanise policy action. Effective injury prevention relies on creating windows of opportunity and focusing resources on achieving prolonged engagement from all aspects of society. It is not intended that the public policy approach replace the existing public health model, which remains a critical paradigm within which researchers from all disciplines can develop the evidence base for practice. Rather, the role of the public policy approach to injury prevention is to facilitate the implementation of effective countermeasures. The gap between available research evidence and effective implementation of this research by practitioners (the research-to-practice block) is an important issue that remains to be adequately addressed within the field of injury prevention. The issue is complicated by the fact that many people would consider themselves both researchers and practitioners, and there are many who do injury prevention but may not explicitly identify themselves as injury prevention practitioners. In this paper we use the term ‘practitioner ’ to refer to any person or body with a role in injury prevention. The purpose of the paper is to explain the basis for the research-to-practice block inherent within the public health approach, and to propose an additional model derived from public policy, specifically for use by practitioners, to facilitate implementation practice. THE PUBLIC HEALTH APPROACH TO INJURY PREVENTION The public health approach to injury prevention is usually described in four stages: (1) defining the problem; (2) identifying causes; (3) developing and testing interventions; and (4) implementing prevention programmes (figure 1). This is an ordered process that begins with the delineation of the nature and extent of the injury problem through the systematic collection of information about its magnitude, scope, characteristics and consequences. The process then involves a determination of the risk and protective factors that can be modified through intervention. Countermeasures, and strategies for implementing the countermeasures, are then generated to address the modifiable factors. The efficacy of both the countermeasures and strategies are quantified, and effective interventions are then scaled up into programmes for implementation and dissemination at a population level. The public health approach is well developed in terms of injury surveillance, risk factor identification, and quantifying the efficacy of countermeasures. However, it is underdeveloped in its characterisation of the means by which research evidence is implemented to achieve improved outcomes at the population level. 7e10 The first three stages of the public health approach to injury prevention follow an epidemiological method of scientific enquiry. The fourth stage also relies on scientific enquiry, which is not limited to epidemiology, to determine methods of implementation and intervention effectiveness. This is derived from gaining an understanding of societal values and decision-making processes within government and non-government (both not-for-profit and for profit) organisations. To achieve this, injury prevention practice necessarily takes place in the public domain. The public health approach thus entails a ‘research-to-practice’ shift that occurs between the third and fourth stages (figure 1). The term ‘translation’, used to describe the process of moving ideas from the research paradigm into the public domain, reflects the extent of this shift in perspective.