Health Policy: from Theory to Practice
María-Seguí-Gomez
MUARC Annual Lecture
Series 2013
Monash University Accident Research Centre
Friday, 15 novembre, 2013, Monash University, Melbourne
Outline
Theory!
Aligning of stars!
Practice!
scenario and actors!
real challenges
!!
targeting public health!
dealing with everything with humor!
Theory
•  First publication in 1996 on ED-based surveillance system using selected
ED rooms from Barcelona city!
•  Thesis work on airbag effectiveness published in 2000 at American
Public Health Association!
•  First publication with Mark Stevenson in 2001 on AIS and ISS uses and
misuses!
•  Tenured professor at Johns Hopkins Bloomberg school of public health
as first “Leon Robertson” Chair, preceding Adnan Hyder!
•  Tenured associated professor at University of Navarra while holding
visiting professorships at Hopkins and University of Virginia!
•  Currently under review process for full professorship tenure, h-factor 18!
Cont´d
•  Reviewer and editorial board member for Injury Prevention, Accident
Analysis and Prevention, etc!
•  Member and leadership at AAAM (Brian Fildes), chairing AIS center
(2009-2011)!
•  Member and leadership APHA, member EUPHA, SEE!
•  Researcher and deputy director Harvard Center for Risk Analysis,
researcher at Johns Hopkins Center for Injury Research and Policy,
founder and Director European Center for Injury Prevention!
•  Collaborators in broad international network (Rod McClure,Tony Bliss)!
•  Trying to settle back in Spain!
–  Frustrated with EU processes!
–  Good collaboration with Health ministry!
–  Difficult collaboration with DGT!
•  …in sum, like you!
And when you least expect it…
•  Would you like to Direct DGT?!
espana-gobierno-rajoy-jorge-fernandez-diaz-toma-posesion-como-ministro-de-hacienda$599x0.jpg 599×408 píxeles
14/11/13 21:38
BOLETÍN OFICIAL DEL ESTADO
Núm. 30
Sábado 4 de febrero de 2012
Sec. II.A. Pág. 10107
II. AUTORIDADES Y PERSONAL
A. Nombramientos, situaciones e incidencias
MINISTERIO DEL INTERIOR
1704
Real Decreto 313/2012, de 3 de febrero, por el que se nombra Directora
General de Tráfico a doña María Seguí Gómez.
A propuesta del Ministro del Interior y previa deliberación del Consejo de Ministros en
su reunión del día 3 de febrero de 2012,
Vengo en nombrar Directora General de Tráfico a doña María Seguí Gómez.
Dado en Madrid, el 3 de febrero de 2012.
JUAN CARLOS R.
El Ministro del Interior,
2012_02_02.jpg 340×230 píxeles
JORGE FERNÁNDEZ DÍAZ
Nov 2011
(#1 trending topic in twitter feb 3/2012)
14/11/13 21:3
But was it only 1 institution I became Director of?
Observatory!
Consulting
Co.
Other
offices….
Others!
Mob!
Some
provintial
and local
offices!
ility Sub.!
Police!
Spain as in pintoresque guides
mapa-españa.jpg 575×391 píxeles
13/06/1
Spain through the eyes of DGT
Spain (2011)
New drivers: 0,5 M
Renewed driver licenses: 3 M
Vehicle purchases: 1 M
Vehicle transfers & others: 5 M
travel permits:
complementary:50,000
special:5000
Spain (2011)
Population: 44 M
Tourists: 53 M
Public roads: 366.000 km
Trips on high capacity
public roads: 394 M
Population trips
(2007):42,000 M
Fines: 4 M
Spain in government terms
•  Unemployment!
•  Economy -severe budget cuts!
•  Education!
What is “Dirección General de Tráfico”?
The means
•  15000 people through the country!
–  5000 civilian workers!
–  10000 police (to add to other road police bodies)!
•  +475 buildings!
–  Central offices, province offices, local offices!
–  Exam areas!
–  Police-related buildings!
•  +7000 vehicles, 18 helicopters!
•  750 radars, alcohol/drug testers, etc!
•  ….metereology stations, !
!
With physical presence in all provinces and approximately 60 cities
(Jefaturas Provinciales y Locales y Oficinas Locales de Tráfico)
Traffic management Centers
Interurban road system (+80 owners, DGT
none)
Agrupación de Tráfico GC
The political structure
•  8.116 municipalities!
•  50 “Diputaciones”!
•  17 Autonomous
regions (including
Catalonia & Basque
country)!
•  1 Central Government
(DGT is within Ministry of
Interior)!
•  1 UE (27)!
!
The responsibilities
Grant/renew/revoque driver licenses
Grant/revoque vehicle licenses
Enact national laws and regulations on
mobility and safety (e.g., circulation code)
Monitor interurban roads
8000 of 20000 km of high capacity
+120000 km conventional
…and
•  Collect and report traffic safety data for national and international
comparison purposes!
•  Coordinate National Council on Safe Mobility!
•  Prepare and monitor strategic plan!
Budget (M€), DGT is an Autonomous Entity
170
What others had to say
(e.g.,Dacota “Road Safety Management Profile- Spain 2012 –based on 2010 data)
•  The lead agency and principle coordinator is under the Ministry of
Interior and therefore not well situated for inter-sectoral coordination!
•  Unclear specificacions of the role of the Prosecutor for road safety
with respect to road safety management!
•  Stakeholder consultation does not seem to include relevant NGOs or
businesses!
•  The national Road Safety Observatory does not seem to have the
complete set of data usually used for policy formulation and evaluation
(apparently no systematic data collection of behavioral data)!
•  No long term vision!
•  No identified budget for road safety!
•  No effective monitoring of implementation!
•  No strong multi-research team, some scattered research only!
•  No training plan for road safety actors!
Reality: pollution Spain 2011
•  5ª of the EU-27 emitting
bad gases!
–  37% of emissions are from
transport, 63% private cars!
1200000
1000000
1000 Tn Equivalentes de CO 2
•  No improvements on NO2
emissions and rise in
PM10!
•  800 M € paid in
environmental purchase of
emission rights!
•  Transport 1st or 2nd
emission
sourceª!
Fuente: Mº Agricultura, Alimentación y Medio Ambiente
Evolución de emisión de Gases de Efecto Invernadero
Media UE 27
800000
España
Alemania
600000
Francia
Italia
400000
Reino Unido
Paises Bajos
200000
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Reality: congestion Spain 2011
E.g., mean speed accessing Madrid,
spring 2012 at 8:00AM!
•  5.500 M€/año wasted on
jams!
•  Madrid & Barcelona
among top 20 congested
european cities!
•  DGT monitors access to
6 big cities (La Coruña, Madrid, Málaga/
Sevilla, Valencia, Valladolid y Zaragoza). !
Fuente: Estudios de Proespetiva Tecnólógica (IPTS), 2012
o de las Enfermedades Cardiovasculares. Valencia 24-26 Octubre 2013
ACTUAL
ARCHIVO
SUPLEMENTOS
COMITÉS
5. Mayo 2011 | Artículo siguiente
Overweight and obesity --sedentarism
ev Esp Cardiol. 2011;64:424-6. - Vol. 64 Núm.05 DOI: 10.1016/j.recesp.2010.06.010
e de la prevalencia de obesidad
: de 1,8 a 6,1 por mil en 14 años
Herramientas
Read in English
PDF
Beunzaa, Maira Bes–Rastrolloa, Estefanía Toledoac, Martín
Imprimir
onzáleza,
Enviar
a y Salud Pública, Universidad de Navarra, Clínica Universidad
a
nología), Hospital Reina Sofía, Tudela, Navarra, España
a y Gestión de Calidad, Hospital Virgen del Camino, Pamplona,
Exportar referencia del artículo
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Universidad de Navarra, Pamplona, Navarra, España
Contenidos relacionados
ta.
esidad mórbida, incrementa el riesgo cardiovascular y de
ivo es valorarSource:
las tendencias
la obesidad
en
Rev de
Esp
Cardiol.mórbida
2011;64:424-6
atos representativos de 106.048 participantes (Encuestas
n modelo de regresión de Poisson usando la presencia de
ependiente, estratificando por sexo y ajustando por edad.
Artículos publicados por:
F. Javier Basterra-Gortari
Juan José Beunza
Maira Bes–Rastrollo
Rev Esp Cardiol.
Estefanía Toledo
Martín García–López
Miguel A. Martínez–González
2011;64:424
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Fatalities
2012!
2011!
Diferencia!
1903!
2060!
-8%!
Motor vehicle deaths, 1965-2012
Fallecidos
10.000
1989= 9.344 Fallecidos
9.000
8.000
7.000
6.000
5.000
4.000
3.000
2.000
2012= 1.903 Fallecidos
1.000
0
Fatalities in EU-27
250
236
2001
2012
202
172
163
159
150
136
134
140
100
114
107
81
61
50
66
41
26
28
30
30
85
Aún 13
68
fallecidos
mas por
1M hab
32
36
41
146
140
125
145
145
130
121 119
82
48
7 ª
55
112
109
84
44
124
56
59
61
61
63
63
65
67
68
69
87
91
93
96
100
70
55
p o s i c i ó n
EU-27
Lituania
Rumania
Polonia
Grecia (1)
Letonia
Bulgaria (1)
Bélgica
Portugal (1)
Estonia (1)
Luxemburgo
Eslovenia
República Checa
Fuentes: Comisión Europea, Base datos CARE y Eurostat.
(1) 2012. Datos provisionales
Austria
Hungría
Italia (1)
Chipre
Francia (1)
Eslovaquia (1)
Finlandia (1)
Alemania
España
Irlanda (1)
Países Bajos
Dinamarca
Suecia
Reino Unido
0
Malta (1)
Tasa de fallecidos por millón de población
200
Fatalities by province, Spain 2012
5,2 deaths/day
≈2 august 2013
33
42
55
14
33
18
17
43
52
17
26
13
9
44
24
13
9
28
181
48
14
39
24
17
23
14
135
31
21
39
14
61
55
72
50
37
Total: 1.903*
*1.304 fallecidos a 24 h en vía interurbana nota
prensa 2 ene 2013
60
48
41
24
28
35
48
22
43
40
50
26
38
35
Ceuta
( 0)
Melilla
( 0)
Total nacional de fallecidos: 1903
Informe siniestralidad vial 2012; datos 2012 para España salvo que se indique otro criterio.
The vision
!
0!
Objetives Spain 2020 y 2050!
principal_134.JPG 350×233 píxeles
12/05/13 23:44
0 Contamination!
T_1_EVITAMIENTO.jpg 526×296 píxeles
12/05/13 23:46
0 Congestion!
0 (fatally) injured!
http://www.americatv.com.pe/portal/noticias/sites/default/files/imagecache/fi526x296/upload/images/T_1_EVITAMIENTO.jpg
http://images.nosotros2.com/images/sabiasQue/principal_134.JPG
0 debt +
competitivity!
Página 1 de 1
Página 1 de 1
Strategy
•
•
•
•
•
•
•
•
•
Permanence + territorial growth!
Reorganization to increase capacity!
–  Re-structure!
–  Integration functions: 1 informatics, 1 research unit, 1 international, 1
communication (internal and external)!
•  Coordination!
–  Convert administrative-oriented personnel into safety mobility people!
Improve efficiency: empower technical abilities personnel, use of technologies!
Strengthening human capacities: capacity and turn over!
Training, standardize messages, language, image!
Set priorities: international recommendations and specific opportunities!
Direction by objectives!
Propose use of extra income on road safety actions!
Augment competencies: victim attention units, information systems, safety road
audits, …. !
Reestructuring -Does it sound familiar?
Conocimiento del
problema
Identificación
de factores de riesgo
¿Qué funciona?
Decisión intervención
Y
Política Vial
Implementación
That is,
DIRECTORA
UNIDAD DE
APOYO
Comunicación,
Prensa y
Gabinete de
Dirección
SUBDIRECTOR
GRAL. DE
GESTIÓN DE
LA MOVILIDAD
SUBDIRECTORA
GRAL. DE
INTERVENCIÓN Y
POLÍTICAS VIALES
SUBDIRECTORA
GRAL. DE ANÁLISIS
Y VIGILANCIA
ESTADÍSTICA
SECRETARIO
GENERAL
(…)
DIRECTORA
UNIDAD DE
APOYO
(Comunicación,
Prensa y Gabinete
de Dirección)
SUBDIRECTOR
GRAL. DE GESTIÓN
DE LA MOVILIDAD
Formación
Agrupación de
Tráfico GC
SUBDIRECTORA GRAL.
DE INTERVENCIÓN Y
POLÍTICAS VIALES
SUBDIRECTORA GRAL. DE
ANÁLISIS Y VIGILANCIA
ESTADÍSTICA
Unidad de
Coordinación de la
Investigación
Unidad de
Normativa
Educación
Víctimas
Relaciones
internacionales
SECRETARIO
GENERAL
Unidad de
Informática
Priority Áreas
SISTEMAS
DE
INFORMACION
MODELOS
DE EVALUACIÓN
DE
CONDUCTORES
Y
PROGRAMAS
DE
REINCIDENTES
MODELOS
DE EVALUACIÓN
DE
CONDUCTORES
Y
PROGRAMAS
DE
REINCIDENTES
MOVILIDAD
SEGURA
ALCOHOL,
DROGAS DISCAPACITADOS
Y
MEDICAMENTOS
MOVILIDAD
SEGURA
-33-
Did not want to change (yet) Road Safety Indicators
2011-2020
Indicadores
1.
2.
3.
Drop fatality rate per million pop.
Reduce severe injuries by 35%
Zero children dead without restraint
system1
4.
25% fewer dead and seriously injured
drivers aged 18 – 24 on weekends
5.
10% fewer dead drivers > 64
6.
30% reduction dead pedestrians
7.
1 more million ciclist w/o increase death
risk
8.
Zero passenger cars deaths in urban
áreas
9.
20% fewer dead and seriously injured
motorcyclist
10. 30% fewer single vehicle exits deaths in
conventional roads
11. 30% work-related MV deaths
12. Decrese to less than 1% positive
alcohol random tests (0,05 mg/l2
13. Reduce by 50% el % of light vehicles
exceeding in more than 20 km/h speed
limits
2009
Target 2020
59
13 923
< 37
9 050
12
0
730
548
203
459
183
321
1.2?
1.2?
101
0
3 473
2 778
520
364
170
119
6.7%
< 1%
12.3% (autop.)
6.9% (autov.)
15.8%
(conv.90)
16.4%
(conv.100)
6.2% (autop.)
3.5% (autov.)
7.9%
(conv.90)
8.2% (conv.
100)
1. Information Systems
SISTEMAS
DE
INFORMACION
•  Eliminated consulting company empowering in house technical
experts (huge savings)!
•  After 20 years of delay in 6 months we had fixed how to nominally
identify death up to 30 days post crash, thus stopping the conversion
factor issue!
•  In 9 months we had secured access to medical discharge data and
national health interview data (with no identifiers yet), but recreated
pyramid of injuries!
•  Participated in high level EU meeting where decision to adopt AIS3+
as criteria for severe injuries was adopted. Leading the effort.!
•  Currently working on developing exposure indicators!
•  Augmented quality and quantity of data and analysis on annual report!
•  Created compendium of DGT own data sources (history, variables,
values, etc)!
Spain, 2012
*
Informe siniestralidad vial 2012; datos 2012 y 2011 para España.
New severely injured definition (UE requisite 2015+)
45000
40000
35000
30000
25000
22.102
20000
15000
11.347
10000
6.044
5000
0
2000
2001
2002
2003
2004
Altas Hospitalarias
2005
2006
2007
Datos Policiales
Informe siniestralidad vial 2012; España.
2008
MAIS>=3
2009
2010
2011
2. Evaluation models for drivers
MODELOS
DE
EVALUACION
….
•  Adapted all exam rooms in the country with tactile monitors!
for computerized testing!
•  Adapted new UE directive on practical tests with autonomous driving!
•  Started work on continuous production and testing of additional
questions!
•  Need to create program to evaluate driving schools and examiners!
•  Working on translating current medical condition lists into funcitonal
capacities needed for work!
•  About to complete paper on reincidents exploring types of repeat
offenses!
•  Evaluate renewal criteria!
•  Heavily regulated area -- Need to work and coordinate: driving
schools, professional driving schools, medical exam centers (not
within national health system)!
•  Need to engage health care sector!
Drivers ( N= 26.323.971)
Pop´ & Driver pyramids!
MV death risk (deaths per
1M
pop)!
140
Total
Tasa de fallecidos por millón de población
120
Hombres
121
Mujeres
126
100
80
66
71
76
69
67
79
59
68
60
40
20
44
9
7
0
45
50
41
22
15
6
0-­‐14
43
15-­‐24
25-­‐34
Informe siniestralidad vial 2012; datos 2012 para España
salvo que se indique otro criterio.
13
14
35-­‐44
45-­‐54
39
48
39
34
20
55-­‐64
65-­‐74
75-­‐84
85 y más
3. Alcohol, drugs and medicines
ALCOHOL;
DROGAS
Y
MEDICACMENTOS
•  Still some 3% random testing is positive for alcohol (50% deaths)!
•  Best estimates suggest 14% random testing is positive for illegal drugs!
–  TOLERANCE ZERO since feb 2012!
•  Developed legal framework to enforce no alcohol or drugs policies!
•  Increased monetary amount related to alcohol and drug offenses!
•  Trained and distributed drug saliva testers through the country!
4. Disabled
DISCAPACITADOS
•  Adapted manual driving exam and studiyng material to sign !
Language!
. Working on restraint systems for disabled people !
5. Safe mobility
MOVILIDAD
SEGURA
•  Put huge amounts of equipment and data to complementary uses:!
–  E.g. plate readers to monitor passing vehicles compliance with
Periodic Vehicle Testing or mandatory insurance!
•  Relocated mobile radars to secondary roads where most of fatalities
occurred!
•  Instructed police to monitor secondary roads more frequently!
•  Developed world novelty –a helicopter camara that serves as speed
radar (Pegasus)!
•  Created vehicle renewal plan!
•  Analyzed back and red spots on our roads to create maps and inform
owners and drivers!
•  Ecall and others!
•  Need to work with professional transports and special needs (e.g.,
autocaravans parking in cities)!
Vehículos motorizados (N= 32.962.502)
Letalidad según edad
turismo!
Edad media parque!
Tasa de Fallecidos por
100.000 Turismos!
12,32!
TODOS!
<1%
15%
9%
67%
Furgonetas!
CAMIONES >3500kg!
CAMIONES <=3500kg!
MOTOCICLETAS!
TURISMOS!
0!
12,72!
15,16!
16,72!
10,48!
15!
5,00!
4,00!
3,00!
2,00!
1,00!
Hasta 7 años!
12,00!
10!
6,00!
0,00!
14,01!
5!
Tasa de Fallecidos!
AUTOBUSES!
20!
De 8 y más años!
Todas las vías!
Autopista y Autovía!
Convencional!
Vías Urbanas!
Antigüedad Media!
Informe siniestralidad vial 2012; datos 2012 para España
salvo que se indique otro criterio.
504 Black spots; 8% accidents & 4% deaths
!
!
Informe siniestralidad vial 2012; datos 2012 España ( salvo Catluña y País Vasco).
And a few other things:
•  Research Unit!
–  Research Plan 2012-2016!
–  For the first time ever, managed to secure 1.6 M in research fund
(starting 2014)!
–  INTERESTED? We can offer free housing for up to 3 or 6 monts!
•  Attention Victims Units!
–  To collaborate & coordinate victims´ associations!
–  To coordinate non-medical post-trauma care attention!
–  To create a follow-up cohort for medium- and long-term sequelae!
Improving Communication!
•  Internally: scheduled meetings, intranet improvements,
visited sites, created bimonthly “letter from the Director”!
•  Externally: mobile application, twitter, facebook, revised web,
revised periodical!
–  And mantra messages!
•
•
•
•
•
•
•
!
Put your travels in order (number and duration)!
When there is a choice, use the safest road!
Use a safer vehicle!
Observe speed limits!
Use protection means in place: !
–  Helmets!
–  belts, child restraint systems!
Be aware: sleep, distractions (e.g., mobile phone)!
Zero tolerance with alcohol, drugs and medications that impair you!
Without loosing track of Road Safety Indicators 2011-2020
Indicadores
1.
Bajar la tasa de fallecidos a 37 por
millón de habitantes
2.
Reducción del número de heridos
graves en un 35%
3.
Cero niños fallecidos sin sistema
retención infantil1
4.
25% menos conductores de 18 a 24
fallecidos y heridos graves en fin de
semana
5.
10% menos de conductores fallecidos
mayores de 64 años
6.
30% reducción de fallecidos por
atropello
7.
1 millón de ciclistas más sin que se
incremente su tasa de mortalidad
8.
Cero fallecidos en turismos en zona
urbana
9.
20% fallecidos y heridos graves
usuarios de motocicleta
10. 30% menos de fallecidos por salida de
vía en carretera convencional
11. 30% menos de fallecidos en itinere
12. Bajar del 1% los positivos en aire
espirado en los controles preventivos
aleatorios. DRUID, punto de corte 0,05
mg/l2
13. Reducir en 50% el % de vehículos
ligeros que superan el límite de
velocidad en más de 20 km/hora
Cifra basal 2009
Cifra 2011
Cifra objetivo
2020
Cifra 2012
✓
10.444✓
9✓
59
45
41
13.923
11.347
12
5
730
598
406
548
203
179
202
183
459
367
355
321
1,2
1,1
1,6
1,2
101
75
71
0
3.473
2.966
2.760
2.778
520
357
369
364
170
128
--
119
6,7%
No disponible.
Estudio
periódico
No disponible.
Estudio
periódico
Inferior al 1%
12,3% (autop.)
6,9% (autov.)
15,8%
(conv.90)
16,4%
(conv.100)
12,8% (autop.)
7,0% (autov.)
21,2%
(conv.90)
15,5%
(conv.100)
(Datos 2010)
8,0% (autop.)
4,3% (autov.)
14,0%
(conv.90)
10,8%
(conv.100)
6,2% (autop.)
3,5% (autov.)
7,9%
(conv.90)
8,2% (conv.
100)
✓
✓
✓
Inferior a 37
9.050
0
On the administrative side
•  Transferring most administrative tasks to internet based protocols,
freeing people from having to go to office!
•  Implementing appointment system in offices to better schedule work!
•  Creating computer cross checks between databases to avoid
requesting documentation to citizens and improving quality and validity
of data !
•  Eliminating cash payment in office and on the road, thus saving
custodian costs!
•  Eliminating special treatment to external administrative collaborators!
•  ….!
Challenges
!
Like in my previous “life”!
•  Important vs. urgent!
•  Keeping on top of technical issues!
•  Respecting and valuing work of others!
•  Accepting that what you deem most valuable may not be so by others!
•  Building trust & credibility!
Unlike before!
•  Unity + strength + augmentation competencies (roads, some
professional driving issues)!
•  Coping up with the media and lobbying groups´ pressure!
•  To do injury prevention and control, now must also deal with
administrative transactions, unions, 44 million people watching my hair
on TV…. J!
Will I have time to finish it all?
Unlikely
•  But what an honor to be a part of this and practice Policy!!!
Thanks!!
Secretaria.directora@dgt.es!
www.dgt.es!
!