The Costs of Injury

From Winter 1995
Volume II, Number 1

Injury problems are often described with rates or numbers of people killed and injured. While these measures are important, injury problems can be expressed in other ways. Ted Miller, director of the CSN Economics and Insurance Resource Center, speaks to this issue.

Cost is often a more understandable measure of the size of an injury problem than incidence. Suppose you were a governor and I was trying to sell you on continuing an injury program with a $1 million annual budget. Suppose I walk in and say, "Governor, we've done an evaluation and found that our program reduces injuries in the state by 1 percent per year. That's statistically significant." You're going to throw me out of your office. How about if I say that our program saves 28 lives a year? You're going to say, "I've got 4.6 million people and 38,000 deaths. What are you talking about?" Suppose I say that our program saves $390 million dollars a year? Now you can understand why you should be funding that program. It's a way to sell safety. If we can say, "Here's the likely Medicaid savings from motorcycle helmet use," we can start convincing a legislature, because they are used to thinking in dollars.

I implemented an injury prevention program that targeted preschool-age children. One of our concerns was child occupant safety. We distributed low-cost child safety seats, implemented loaner programs in law enforcement agencies, provided training and the "Buckle Bear" curriculum to daycare centers, and held classes for new parents on the proper use of child safety seats and other child safety issues. The law in Florida calls for a $155 fine and three points levied against your license if you get caught with an unrestrained child under the age of four in your car. I went to the records and looked at the child occupant protection citations given by all of the law enforcement agencies in the 19th Judicial Circuit, which includes four counties. They weren't writing many tickets. I went to the law enforcement agencies and asked why. They said their officers felt the fine was too much, particularly for low-income people. The fine was levied per child. So if someone was stopped with two or three kids unrestrained, well, you're talking about a lot of money and possibly a suspended license.

I proposed an administrative order to the 19th Judicial Circuit, which was approved. If a violator attended a two-hour class on child occupant protection, the three points would be waived and the fine would be reduced by $94. Part of the remaining $61 was used to cover court costs and rental of the facility where the classes were held [and] $30 was used to buy child safety seats, which were offered at low cost to people who attended the class. Excess seats were offered to participants in the new parents class and to the loaner programs. This system gave law enforcement officers an incentive to write tickets and provided a permanent revenue source for child safety seats for the low-income population.

I did presentations for law enforcement chiefs and the state's attorneys. But there wasn't any increase in writing tickets. My salary was funded by a grant. The funders were tracking my measurable objectives, one of which was to get this administrative order passed and achieve a 10 percent increase in citations. But the numbers were going down rather than up. We obviously had to do something to convince the police that it was important to enforce the Child Restraint Law.

I attended a NHTSA teleconference in Miami on child occupant protection. The conference packet included CSN cost analysis fact sheets. They were invaluable. I extrapolated the numbers to the local level, included them in a law enforcement information sheet, and started doing law enforcement workshops on child occupant safety. The information sheet explains what law enforcement can do--they can write the ticket--and the educational option available in lieu of the fine and points. But it also includes CSN's breakdown of injuries to occupants age 0 to 4, which cost $7.5 billion in 1991. I wanted to show the impact locally. So I did a separate sheet for each county, using their local statistics. There were 45 injuries to unrestrained children in St. Lucie County in 1992 and 1993. Using the CSN numbers, I calculated that the costs associated with these injuries were $2.7 million. I put information sheets in every mailbox in every law enforcement agency in the four-county area. I did trainings. I was able to say that we have an infrastructure in place that will save children's lives if law enforcement writes tickets. We've got an opportunity to save people's lives and reduce the tax payers' burden of the costs of preventable child occupant injuries. I think this made a difference.

The law enforcement folks were impressed by the statistics. At the last session I held, the second in command from one of the sheriffs departments said, "How can we argue with you? You've got the facts. I guess we're not doing enough. We didn't realize we were that bad."

The law enforcement people were the key component. If they don't write the tickets, the program won't work. They can make it or break the program, even if everything else is in place. We reached the 10 percent goal before I left to take a job in another county. I am sure that the next evaluation will show that the program continues to have a positive impact.

Building Bridges Home Page

http://www.edc.org/HHD/csn/buildbridges/bb2.1/cost.html
Revised: October 22, 1996

©1997 Education Development Center, Inc.