In this podcast, Gail Greatorex talks with Professor Joan Ozanne-Smith, Head of the Prevention Research Unit at Monash University’s Department of Forensic Medicine. The interview took place at the Victorian Institute of Forensic Medicine where the department is co-located.
Joan has just been made an Officer of the Order of Australia (AO) in the 2016 Australia Day Honours List. This award is in recognition of Joan’s extensive and pioneering work in injury prevention. She is an internationally acclaimed epidemiologist and advocate for injury prevention strategies, including consumer product safety. Congratulations Joan!
You can read more about Joan’s award and her career in The Maze blog article A well deserved award – Professor Joan Ozanne-Smith.
In the interview, Joan discusses the value of research and evidence in addressing product hazards, using the children’s product sector to illustrate some successes. Gail and Joan then discuss how to improve product standards and the need for innovative thinking on products, such as ladders. And Joan finishes by describing the challenges of her work on road safety in China.
Product safety podcast
Gail: Joan, you’ve been working in the field of injury prevention for a long time now. Can you tell us what first got you interested in it?
Joan: Yes, it was working in hospital emergency departments as a doctor, and seeing injuries where people were perfectly normal and healthy just a short time earlier and then came into hospital with these terrible injuries. And patching them up just didn’t seem the best solution, and I became very interested in a prevention approach to injury.
Gail: People often use the term accident, but how do you feel about that term?
Joan: I think the term accident suggests that fate has had a hand, or that the injuries aren’t preventable. And really an evidence base shows that injuries do fall into patterns of mechanisms and causes and that they can be prevented.
Gail: So you were actually witnessing the results of injury incidents and decided that you were perhaps better spending your time working on the preventative side.
Joan: That’s right. I was working at the Children’s Hospital in Melbourne at that time and that coincided with the International Year of the Child in 1979, when a Swedish paediatrician was brought to Australia to talk about their success in Sweden in child injury prevention. And their results were dramatic. I learnt from that lecture that Sweden had reduced its child injury death rate from rates that were about what we were having in Australia at the time to something dramatically lower. And it became obvious to me that Australia could do something similar. So those two things happened more or less at the same time and convinced me that prevention was the way to go for my career.
Gail: That’s a good story. It’s a nice little coincidence of events. And so you’ve spend a lot of time working on injury data?
Joan: Yes. Having recognised that we had a big problem that could be prevented – the problem then was that we didn’t have good data sources where we could really understand the problems. So it was never my intention to become a data person, but in order to get to the prevention stage it was necessary to set up data systems. So in fact a lot of my career has been about setting up hospital-based injury surveillance systems, helping to refine hospital admissions databases, and then developing and directing for a period the National Coronial Information System. So I have had a lot of experience with databases in order to get to the point where I could study injuries and help to prevent them.
Value of research and evidence
Gail: So what role do you think data can play in improving the safety of products?
Joan: I think data is really essential to understand product safety issues. Products can be involved in injuries in a multitude of ways, and also a multitude of products are involved in causing injury. And it’s quite complex to understand not only which products are involved, but how they’re involved.
And then the next step being – well, how could that involvement be prevented? And it’s not as simple as ‘some products fail’. That’s true, but it’s only a small proportion of product related injury that’s related to product failures as such; where the product collapses or breaks or something. It’s much more about the human/product interaction. That’s where most product related injuries occur.
Gail: You’ve seen the data systems progress over the time that you’ve been involved, but Queensland University’s recently published a study examining the current situation with injury data and product safety (in Australia). What do you think needs to happen now, at this stage, to improve the quality and the availability of data?
Joan: Well, it’s hard to know where to start on this one because it’s such a big issue. I think starting at the most severe end: the National Coronial Information System should, and could, be used more. But the system also needs investment and strategic development to improve to provide better and more consistent information on product involvement in deaths.
The hospital admissions system has gradually improved over time so that more and more products have actually been entered into the coding system, at least in Australia; it varies between countries. There’s still a lot of products that can’t be identified in hospital admissions injury data, and products as a category can’t be identified overall.
There’s no collective category for products in the hospital admissions data system. So that’s a blind spot; it’s part of the reason why product related injury isn’t better recognised at the global level. Because it relates to the coding system and this blind spot around product related injuries.
Gail: So you’re saying that if we could capture incidents and the relationship of the product to the injury then we might have a better chance of understanding the problem with the product, and recognising the need to make some other strategies to improve the products.
Joan: Yes. And the emergency department surveillance systems that operate, just in two Australian states I think now, are very helpful. And they’re probably fairly representative of the whole country’s issues with products, with just a few differences between states on the edges, more or less. I think these systems are very good, and again investment would be needed to better extract the information from these systems. Similarly, with the death data; there needs to be a regular analysis and reporting process, and some strategic investigation of the data to identify ongoing or existing and emerging product related issues in the data.
Gail: Okay, well we’re just coming up to the tenth anniversary of the Productivity Commission study into consumer product safety, and the system that’s associated with that field. That did bring about a number of changes. How much do you feel has changed in the last decade, associated with the report and the systems that have changed as a consequence?
Joan: I can’t say that I’m an expert on all of the things that have come out of that report. On mandatory reporting, for example, I don’t really know how that’s affected the rate of (identifying) product related injuries. I think that there were some missed opportunities with the Productivity Commission Review. Certainly one of my recommendations at the time was that Australia needed a product safety directive similar to that in Europe. And that wasn’t accepted and didn’t seem to be thought to be needed at the time.
I still think there’s a need for that because I think our system is still far too reactive, and that a product safety directive would start to turn things into a more proactive system. And that could only be a good thing, I think. And I wouldn’t like to see us go too far in the US direction of being very litigious in the way we conduct product safety. And again that’s reactive.
With other issues, like drugs for example, these are carefully tested before they’re released into the population and into the community, whereas new products or redesigned products, we really find out when people are injured, that there are problems with the products. So I think the system still needs to be turned on it’s head quite frankly.
Gail: Of course some five years after the Productivity Commission’s report, which did of course bring in a number of systemic changes, the actual legislative changes (which came through in 2010-2011), introduced mandatory reporting and a number of other changes. These included the consumer guarantees, which obliged for the first time companies to supply safe products. It’s not as explicit as a directive. But I think slowly the government, through the ACCC and its state counterparts, and also the supplier community, has recognised that it’s a form of directive in a way, that does provide that incentive – or prompt – to make products safe in the first instance. And since the Australian consumer law is being reviewed now, after a five-year period, all of that will hopefully go back into the mix.
Joan: Another problem I had with the Productivity Commission Review was that there was an undertone of blaming the victim, and as I said before, I don’t think product safety can really be solved until we properly recognise that most of the injuries happen as a result of the human/product interaction and so there still needs to be further recognition that products need to be designed in such a way that it’s less possible to misuse them and I’m not sure how that can be reflected in legislation.
Need for innovative thinking
Gail: Well, no. And that’s certainly a good question, but we don’t want to have to rely on the government for all of the solutions. Product safety is a tripartite consideration. It’s government, it’s suppliers, and it’s the consumers, and everybody needs to play their role.
In terms of – you mentioned victim blaming and the fact that injuries are often associated with the way that people and the users interact with the product – it’s sometimes the case that the suppliers, when confronted with a complaint or the fact that an injury has occurred, their first recourse is to say that obviously the person wasn’t using it properly. But in many cases with products there’s ways of designing the product so that even if a person isn’t using the product the way it was originally intended and marketed, you can design that hazard out of the product. So suppliers really need to understand who’s going to be using their product, in what environment, and who else might be affected in terms of bystanders or other people in that environment.
I know that you did do some work at Monash with the engineering side of things, trying to get product designers to understand some of the technical and engineering – physics aspects, if you like – of products. Do you know whether that sort of work has been going on in Australia much?
Joan: Yes, there has been a certain amount of innovation, particularly related to research studies that have been founded on identifying problems in the data and then redesigning products or designing new products to deal with those issues.
Nursery furniture is an example where once we had good data systems we realised that there were a horrific number of injuries to infants and young children associated with nursery products that we could never have known about except when we saw the data.
Most nursery products, I’d say, have been redesigned since those days, including the very clever designs of baby walkers that were very dangerous in the early days when they could just be rolled around anywhere; down steps and into fireplaces and all sorts of dangerous places with the early designs. And the new designs that emerged from America in relation to their new standard were very exciting and still allow children to have interesting stations for play that could no longer, very cleverly, could no longer fall down steps and get into other dangerous situations.
Gail: So that was a redesign of baby walkers that meant that there was a kind of brake that was applied if one wheel dropped down from the level surface. So if a child happened to wheel their baby walker across to a set of stairs and one wheel fell down the first step then the brakes would come on and the rest of the baby walker, and the baby with it, wouldn’t continue down the stairs.
Joan: And moving on to a more modern example, one that I discussed with engineers just a couple of weeks ago. A study that has recently been funded by the Victorian Health Department looked at domestic ladder falls in Victoria. It found that there are more than 2,500 hospital treated domestic ladder falls each year, and an average of about nine deaths each year.
A number of recommendations emerged from this study, some of which were about public awareness and safe use of ladders. But also we discovered that most people were accessing ladders to clean gutters, to reach the roof for other reasons or to pick fruit. And in speaking to engineers it seems as though it would be a very easy design solution to make roof gutters that could be hinged so that they could easily empty debris. Or they could be designed to lower to the ground for cleaning.
So sometimes the solution, the engineering solution, isn’t in the product itself, but in ways that the product can be used, or become no longer necessary, for tasks.
And for the pruning and picking of fruit and so on, which was so often related to ladder falls, maybe a domestic cherry picker could be designed. So I think in the new political climate of innovation that there’s a lot of possibility around designs, new designs, for products – that could be commercialised.
Gail: Perhaps if we attach a pair of secateurs to a drone, or something like that? Because I was listening to a talk on drones being used for agriculture recently, and how they can be used, with a camera attached, to detect what’s a weed and what’s crop, and so just target the weed for treatment. That limits the chance of any pesticides or whatever contaminating crops, or if there’s any GM crops next door, that sort of thing. I understand there’s plenty of opportunities in agriculture for new technology.
Joan: Yes, and I think the other thing about product related injury is that some of the solutions cross portfolios or jurisdictions. That’s an ongoing problem that I’m not sure whether a review of the legislation can deal with in any way. But it seems that agencies or jurisdictions are only interested in recommendations that fit into their powers and that other recommendations that might need to involve some other government departments, for example, are too hard.
Gail: And that’s always been the case, hasn’t it? That things fall between the gaps and so even mobility scooters, we mentioned before. You’ve done a project on motorised mobility scooters. That was one that crossed a number of different federal agencies.
Joan: Absolutely. And it still seems too hard for different jurisdictions to coordinate their action to develop a strategy. I think we’ve done that in road safety; that we have state and national road safety strategies, where all concerned parties work together from different parts of government and industry. But it doesn’t seem that we’ve got to that point with product safety as yet.
Gail: Well, you know, it seems to me that where you’ve got those specific sectors, like road safety and agriculture and veterinary, food and therapeutic and pharmaceuticals, they at least have their own stream in terms of their networks and the key players in that sector. With product safety across the board that is the remit of the ACCC and its state consumer affairs counterparts, the range of products can be so broad that it really does add that extra level of challenge, I think, to just work out what’s the best space to operate in and gather together your allies and develop a good strategy.
Joan: Yes. It’s true.
It may be we need to think of new ways of doing things. Maybe some sort of task group – inter-governmental task group – is necessary to solve a particular problem like motorised mobility scooters, that really do take in therapeutic goods, road safety, product safety, ACCC, and various health issues related to ageing and frailty, et cetera.
Gail: Yes. So something a bit more formal perhaps? I know that the ACCC did some really good work a few years ago on motorised mobility scooters, and gathered together a couple of – two or three other agencies to do some work on it. And it was only after they’d gone a fair way down the track that they discovered that there was another agency again that had some regulation that was relevant, and they hadn’t kind of bubbled up to the surface and revealed that they had a role and so, you know, that was just happenstance.
Joan: Yes. There’s no question it’s a complex area.
Improving product standards
Gail: Joan, do you have any thoughts on the trade offs associated with aligning standards across countries and regions. We want standards to be the same from one nation to the next, and it would really help if that could be the case to allow our efforts in product safety to have more traction; but to harmonise a standard requires some compromises. How do you see these dilemmas? And how do you think they should be approached?
Joan: Yes. I think it’s important that they shouldn’t be used as policy tools by government in terms of non-tariff barriers to trade and that sort of thing and I think that’s a pity, they’ve become a political football. I think that the underlying thing is that we should use evidence to guide policy at all levels, including the international level. And I think that we… I don’t think we should therefore compromise on serious safety issues. But perhaps be willing to compromise a little more on lesser issues.
I understand that there will always be trade-offs in harmonisation, but I think we certainly should stand firm on important issues. And I think that internationally the whole system would be further assisted by further development of horizontal standards so that compliance is a little more straightforward for a wider range of products.
Gail: And so, when you say horizontal standards, you’re talking there about standards that can apply to a range of different products?
Joan: Yes, and are more hazard-based – so standards around entrapment, for example, or stability.
Gail: Well, the toy standard is actually quite a good example of a horizontal standard, because for all of the hundreds and thousands of toys that are different types of toys, we’ve got a single standard that tends to deal with – as you say – entrapment or sharp edges or whether it’s robust and doesn’t break into small parts and so forth.
Gail: So you think that a horizontal standard would be more helpful more generally?
Joan: Well, I think it could help to solve some of these harmonisation problems. And it would involve a lot of work, and a lot of negotiation no doubt. But I think that that is probably the way to the future.
Gail: One of the key things I think could help with improving harmonisation of standards is to include more rationales in the standards, because quite often the specification will be sitting there in the standard and people can’t work out why it’s there, what’s the point of it, what it’s trying to achieve. The toy standard is one case that does have a whole separate annex that talks about why the specifications are written as they are.
As you say, evidence base can be included into that rationale to demonstrate what the objective is and what the standard is trying to achieve. And then if somebody else wants to come along and harmonise their standard with that one, then they’ve got a better chance of being able to persuade their own stakeholders that it’s the way to go.
Joan: Yes – it‘s all about evidence of one sort or another.
Road safety in Asia
Gail: If I can perhaps just close the interview by asking you a little bit about your work in China. It’s an area that not many of us have gone toward to take on such a different culture, and a country with such a large population. You’ve done some work on road safety, it seems like a massive task. What approaches have you been involved in to date? Particularly in the context, perhaps, of the product safety side of things?
Joan: Yes. Well a lot of my work has been on road safety in recent years in China.
I’ve been a long-term China goer. I’ve been there about 45 times I think, over the years.
Joan: So I’ve watched it grow from a low income country to a middle income country. And in terms of road safety China is still rapidly motorising. It’s in the same situation we were in in the 1950s in Australia when we were rapidly motorising and dealing with a lot of new problems.
One of the new problems that’s emerged in China is electric bikes. These are not – well, there is a category of pedal-cycles, that also have a little motor – but there’s a whole enormous productivity of motorbike/moped type motorised bikes, that often don’t even have pedals anymore. But these have come onto the market in their hundreds of thousands in a virtually unregulated way.
So these have become a massive new threat to safety on the roads in China, for the rider in particular. There have been no regulations about learning to ride. Most of these electric bikes are registered, but there’s no sort of licensing requirement in terms of knowing road rules for example. And I’ve done some work with some Chinese researchers and we’ve learned, not surprisingly, that head injuries are very common and the major serious injury that occurs.
Gail: And so, what’s the proportion of helmet wearing ?
Joan: There’s no helmet law.
Gail: Does anybody wear them despite the law?
Joan: Yes, we have done some observational studies and found that about nine percent of these electric bike riders do wear helmets.
Gail: What about on pedal bicycles? Do they wear helmets?
Joan: No. It’s extremely uncommon to see pedal bicycle riders wearing helmets in China, as in some European countries.
Gail: Yes. Well, it’s a different approach, isn’t it? Especially like the European countries that are so bicycle oriented, they choose not to wear helmets a lot of the time.
Joan: So in China, I think electric bikes (mopeds) are a good example of a new product on the market that’s emerged ahead of any laws and regulations and now China’s in a catch up situation of needing to legislate and develop better standards, sort of retrospectively. And it’s a very complex situation. So I’ve been involved in some of the ground work in helping to understand the problem looking at injury, or sourcing injury data. And I’ve been involved in some observational studies of how people ride these electric bikes and some of the problem behaviours that exist in traffic.
Gail: So is it essentially a behavioural issue, or could you change the design of the product to improve the safety?
Joan: Yes. The product needs to have clear standards and the speed needs to be regulated mechanically and the weight of the bikes needs to be regulated, for example. And there need to be road rules and enforcement as well as training for the riders.
It’s a whole complex new product safety situation. But these electric bikes are made in China and they’re being exported to other developing countries now, so the problem is being exported.
Joan: And for the first time low income people can actually afford to be motorised, and so it’s very attractive. And once people have mobility it can’t really be taken from them.
Joan: So new products can be a very complex issue, and we need to learn from these emerging problems as well, I think.
Gail: Is the Chinese government involved in examining these things or is it work from universities and the like?
Joan: Yes. The work I was involved in was conducted for the World Health Organisation with funding from Bloomberg Philanthropies, and it was local Chinese who initiated the research. The Chinese government is definitely very concerned and is looking at legislation and ways . . . and the Chinese police – traffic police – are very concerned, and some of them have been quite innovative in trying to find ways to set up local enforcement to deal with the problems.
Gail: Even if it’s a large problem, it sounds like there’s some good work going on to help address that . . . and well done you for being part of it I think.
Joan: Yes, it’s been very interesting.
Gail: Thank you so much for your time. I appreciate your taking time about of your busy day.
Joan: Thank you for your interest. It’s a subject dear to my heart.
Read more about Professor Joan Ozanne-Smith at her Monash University Researcher Profile page and you can read more about Joan’s award and her career in The Maze blog article A well deserved award – Professor Joan Ozanne-Smith