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Bridging the Gap Between Injury Research and Policy

By David A. Taylor

A physician treats a sore throat with antibiotics in a clinic. A biochemist devises a flu vaccine under a microscope in the laboratory. A surgeon removes a tumor with a scalpel in the operating room. But in the field of injury prevention, health solutions are most often devised on paper, in the halls of government. The result? Seatbelt laws, smoke alarm requirements, speed limits, fire-safe cigarette laws, rules governing playground design, even the establishment of legal drinking ages.

In Maryland, where injuries (including homicide and suicide) are the leading cause of death for people ages 1 through 44, approximately 100 bills related to preventing these injuries were considered in the last session of the state’s Legislature. But policymakers often function in the absence of sound research. “We make a lot of decisions in the Legislature with the best of intentions but not always the best data,” says Dan Morhaim, MD, the only physician in the Maryland House of Delegates.

Fortunately, two experts in the Bloomberg School’s Center for Injury Research and Policy (CIRP) are changing that. For the last three years, Keshia M. Pollack, PhD ’06, MPH, and Shannon Frattaroli, PhD ’99, MPH ’94, both assistant professors in the Department of Health Policy and Management (HPM), have been volunteering one day a week in Morhaim’s office during the 90-day legislative session. They gather data, translate injury and other health research literature into easy-to-understand policy briefs and provide testimony on health issues during committee hearings. Their goal, they say, is not to tell legislators what to do but to provide sound evidence on which to base decisions.

Frattaroli first worked with Morhaim about 10 years ago when she began taking doctoral students to Annapolis to shadow him and expose them to the real world of policymaking. When Pollack joined the faculty, she and Frattaroli began talking about their desire to engage more directly in the policymaking process. Morhaim, an HPM associate faculty member who also organizes the HPM Fall Lecture Series, was the obvious choice for collaboration. “Legislators have very limited staff and resources that don’t allow them to consider the public health ramifications of policies in the most evidence-based way,” says Frattaroli. “But we have the expertise and the access to literature.”

During the 2008 session, the Legislature increased the age for which children must ride in car booster seats to age 8. “Before that law was enacted, Maryland was not following the best evidence,” says Pollack. “We were able to provide testimony from a scientist who could speak to the literature as well as a practitioner who works with families through the [Johns Hopkins] Children’s Safety Center to install safety seats in cars.” In the committee hearings, theirs was the only testimony provided by a researcher.

Frattaroli and Pollack have been a known resource for other legislators as well. And when they don’t have the expertise themselves for a health issue, they know where to find it. Two years ago, the General Assembly was considering regulating pharmaceutical benefit managers, who administer prescription benefits for health insurers and employers. “Neither Keshia nor I do work with insurance benefits, but we knew [HPM Professor] Gerry Anderson did,” says Frattaroli. “We contacted him, and he brought the literature to the table.”

Maryland became the first state to pass comprehensive legislation to regulate this industry. “This is now model legislation,” says Morhaim. “All advocates—pharmaceutical companies, the Maryland insurance administration—now use the documents that Keshia and Shannon put together. I don’t think this bill would have been possible without their work.”