Reducing Injury Through Safer Design
R. David Pittle, Ph.D.
Senior Vice-President for Technical Policy
17th Annual California Conference on Childhood Injury Control
Los Angeles, CA
September 23, 2003
Theme: “It should not take staggering statistics from the emergency room to change corporate behavior in the boardroom.”
First of all, on behalf of Consumers Union, let me join the chorus of congratulations to the state of California for being named the safest state in the union for children by the Good Housekeeping Institute. For those of you who missed the October issue of Good Housekeeping magazine, this is how they sung the state’s praises.
No. 1 California From requiring pool enclosures to setting standards for playground equipment, California has the most laws on the books to protect kids. And it was out in front early on—California was the first state to make helmets mandatory for cyclists, in-line skaters, skateboarders, and scooter riders, and one of the first to require that seat belts be installed on the school buses. This state’s laws are often the toughest: Bike helmets are necessary for anyone under age 18, the oldest cutoff (only 19 states have bike-helmet laws, most of which extend to age 15).
And I recognize that this was no accident (pardon the pun). Many of these laws are on the books to protect kids because many of you in this room worked hard to get them there. There will be thousands of kids each year who will escape injury or death because of your work. But they won’t know who they are, and they won’t know who you are, so they can’t thank you—but we can. We all owe you our thanks.
I speak to you today not only as a former commissioner of the Consumer Product Safety Commission, but also as a former professor of electrical engineering & public affairs, a former president of a large, citizen-action consumer group, and as the former Technical Director and now Senior Vice-President for Technical Policy of Consumers Union (CU).
CU, as many of you know, operates the largest consumer-dedicated product-testing laboratory in the world and publishes Consumer Reports magazine and ConsumerReports.org. The guiding principles, indeed the cornerstones, of our published research on products and services are to be accurate, fair, unbiased, and independent. To maintain those attributes, we never accept gifts, advertising, grants, free product samples, or anything else of value from manufacturers, distributors, retailers, and other commercial entities. We do whatever we can to make sure we have no stake in the outcome of our testing and research. We are supported almost exclusively by the sale of our information products for consumers, such as CR, CRO, Special publications, CRTV, Auto Price Service, and by donations from consumers.
Our tests focus on performance, quality, safety, and reliability. Our engineers often use portions of relevant mandatory and voluntary industry standards, and several of them sit on standard-setting bodies and committees such as the American Society for Testing and Materials (ASTM) and Underwriters Laboratories (UL). But many times we find it necessary to develop our own tests when we feel an existing standard is inadequate or a hazard is not covered. We develop our test protocols based on a variety of sources, including surveys of readers (re: use patterns), outside injury databases, mandatory and voluntary standards, industry practice, trade associations, university researchers, technical literature, test protocols of other consumer magazines, outside consultants, outside labs, and from more than 65 years of testing products and publishing the results.
I must say here that after nearly three decades of research and advocacy in the product safety field, I have grudgingly come to the conclusion that too often it takes the surfacing of staggering statistics from the coroner’s office and the emergency room to change corporate behavior in the boardroom. But it should not work that way. Many of you, I’m sure, understand my frustration, since you are on the frontlines everyday dealing with serious public safety and health problems.
The Ford/Firestone debacle of 2000 is a perfect example. It was not until the spotlight of the media was shone on both these companies in the evening news every night for months, highlighting the patterns of death and injury from tires coming apart at high speeds that finally forced a recall—and generated unanimous support in Congress for sweeping legislation to improve the safety standards for tires, vehicle rollover, and child safety seats. But it shouldn’t have taken a tragedy. Even worse, those injury data existed for many months before corrective action was even contemplated. This was a system in disarray.
At this point, I want to share with you a few fundamental tenets of risk reduction that have evolved for me over the years.
First lesson: It is far easier, and cheaper in the long run, to manufacture products whose design has been thoroughly evaluated for all manner of possible hazards. It is essential that the product be designed to incorporate predictable consumer behavior—even what some would call predictable misuse. This is especially true when it comes to children. Kids will pretty much act the way they act, which is predictably unpredictable. Their everyday behavior cannot be altered very easily, if at all. Moreover, we should not depend on changing consumer behavior to compensate for or protect against a dangerous product design involving a child. Said more succinctly, it is easier to change the product than it is to change the consumer.
Second, manufacturers must be ready to change their designs when safety problems surface. They should do their best to avoid the temptation of defending their products by blaming the victims for poor use behavior. Obviously, consumers shoulder major responsibility when they use any product, but when a pattern of injury begins to emerge, that is a signal that something is wrong. There can be no comfort in the manufacturer convincing itself that it is “right” while its customers continue to be added to the casualty list.
Next lesson, you can’t sticker over a safety problem with gummed labels and instruction books that require consumers to change their regular behavior patterns or act in a counterintuitive manner. For example, labels on toxic products that warn “Keep out of reach of children” have not been effective. That’s why CPSC requires special packaging, which prevents children from accessing the contents of OPDs and other toxic substances in the first place.
And manuals that advise parents to watch their children at all times are not always effective, either. The cost for a momentary distraction by a parent dealing with the chaos of daily life should not be a tragic fatality. If a safer product can be manufactured at a reasonable cost that will protect children when their parents are predictably unable to keep constant surveillance to prevent an accident, then it should be.
Before I get into the areas I think need our attention, I want to highlight some of the more recent success stories in the world of childhood injury control.
1. Bunk beds—In response to the more than 34,000 children who were taken to emergency rooms with bunk-bed-related injuries in 1998, the Consumer Product Safety Commission (CPSC) issued new regulations requiring all beds manufactured or imported to meet safety specifications to minimize risks.
2. Baby Walkers—In 1994, after injuries had reached 28,000 a year, the CPSC voted to initiate mandatory standards for baby walkers. In response, manufacturers moved to develop designs voluntarily that made baby walkers safer. By 1999, baby walker injuries had dropped almost 50 percent.
3. Child-resistant packaging—The CPSC voted unanimously in October 2001 to require child-resistant packaging for cosmetics and household products that contain at least 10 percent hydrocarbons. These include sunscreens and baby oils; makeup removers; nail-enamel dryers; massage oils; some types of hair, body, and bath oils; and certain spot removers and metal cleaners. If a child ingests even small amounts of these materials, it can enter the lungs and bring on a potentially fatal case of chemical pneumonia.
4. Ongoing state bans of ephedra (including just recently in California)—Illinois and New York have banned the sale of ephedra, and there is a bill right now sitting in the California Governor’s office waiting to be signed, which bans the drug. California already has a law on the books banning the sale of ephedra to minors. This herbal supplement may be the most hazardous of the major sports supplements, which are popular among young athletes and teenagers seeking an energy boost. Some states still do not prohibit the sale of ephedra to minors, so that should be the first step in those states.
5. Child safety seats, increased awareness about use, especially boosters—Representing Consumers Union, I stood alongside of National Highway Traffic Safety Administration’s head Dr. Jeffrey Runge in June when he announced new ease-of-use ratings for child-safety seats. We were very pleased to hear him say that NHTSA will be meeting with both the vehicle and child restraint manufacturers to address some of the vehicle-to-seat compatibility issues Consumers Union and others have found in recent tests of LATCH seats. Consumers Union is also happy to see greater awareness being spread about the importance of children remaining in booster seats until they are about eight years old. As you know, children should remain in booster seats until they can sit in a vehicle’s rear seat with their back comfortably against the backrest, their knees bent comfortably over the edge, with the vehicle shoulder belt crossing mid-chest and the lap belt snug across the top of their thighs.
As I highlighted earlier, all these successes sprang from long-term patterns of injury where citizen and government action forced change. I want to turn now to areas we need to focus on next to reduce death and injury to children.
1. Pre-market testing of children’s products
One of the most staggering statistics I have come across in the last year deals with nursery products. According to the July 5, 2002 CPSC Nursery Product-Related Injuries and Deaths to Children under age 5 Annual Memorandum, an estimated 69,500 children under age five were treated in hospital emergency rooms for injuries associated with nursery products. An average of 65 children, according to this CPSC report, have died annually in such incidents from 1997-1999. We believe the number of injuries and deaths from using such products is far too high—indeed, it is unconscionable.
It is particularly troublesome given the fact that over the last decade, each of the top five juvenile product manufacturers has had at least nine product recalls. In my view, it is unacceptable for any company, especially one that specializes in making products for use by children, to have so many recalls. Consumers Union is supporting legislation that would require pre-market testing of all durable children’s products by an independent entity. This legislation was initiated by a leading child safety advocacy organization, Kids in Danger, based in Illinois, whose founders’ son was killed in a recalled portable crib provided at his day-care center.
2. Better response to recalls
Add this lax record of introducing products into commerce that must be recalled later to the fact that only 10-30% of product recalls are effective to begin with (i.e., the product is successfully repaired, replaced, refunded and/or destroyed) and you have a recipe for needless and serious danger. And that danger is to children, our most vulnerable consumers.
Consumers Union has met with parents whose children have died using products that were recalled but who were unaware of the recall. Many express the same sentiment: I bought or used the product never dreaming it could be anything but 100 percent safe. I would never have knowingly placed my child’s life or any child’s life in danger.
The truth is that consumers expect manufacturers to design products—especially products for children—with safety as an inherently high priority, not as a luxury add-on for high-end models. And when a serious safety problem arises, manufacturers should work to remove the product from the market and the homes of consumers with the same level of vigor and effort as was used to promote its sale in the first place.
3. Product registration cards
Manufacturers of children’s products could go a long way to being more effective when a serious safety problem arises by including Product Registration Cards with their baby products. This would allow parents the opportunity to fill the cards out with simple contact information, so they could be informed right away in the event of a recall. The industry argues that the costs of such cards are not worth the benefits they might provide. We strongly disagree.
We were very disappointed that the Consumer Product Safety Commission rejected a petition that would have required companies to provide registration cards for higher cost “durable” baby products. We believe we would then see greater registration percentages and, hence, greater chances of saving young lives when a safety recall is underway.
There is precedence for this approach. The National Highway Traffic Safety Administration (NHTSA) began requiring such cards with the sale of each child restraint in 1993 and the numbers of consumers registering went from 3% to 27% in 10 years.
The bottom line in recalls, in my opinion, is that consumers pretty much understand the real world. They understand that honest mistakes can happen; they don’t expect manufacturers to be perfect. But they do expect companies and federal safety agencies to protect their interests when decisions are made implementing a safety recall. Sitting on injury data and doing nothing is not acceptable.
At a time when companies diligently track all our purchasing habits and send daily marketing solicitations, it is simply unconscionable that they don’t invest in these registration cards and the overall maintenance of information that could literally save lives.
4. All Terrain Vehicles (ATVs)
Between 1993 and 2001, the number of injuries associated with ATV-related accidents more than doubled, with 111,700 ATV accidents occurring in 2001. The number of injuries suffered by children under sixteen increased 94% to 34,800 in 2001. Pursuant to a petition filed by the Consumer Federation of America, CU supports a ban on the sale and use of ATVs by children under the age of 16 (and other safety measures). We think the American Academy of Pediatrics Model Statute is an excellent and comprehensive approach to the ATV safety problem, providing for training and licensure of ATV riders and requiring safety gear like helmets and protective clothing.
5. Baby bath seats
CU feels strongly that this baby product should have been banned long ago, and indeed, we supported the Consumer Federation of America’s 2000 petition to ban these seats. Baby bath seats have been involved in 104 infant drowning deaths since January 1983. The procedural tragedy, we believe, is that the Commission voted to proceed with a mandatory rule on these seats in August 2001, but to this day still has not acted to ban or improve their design. During those two years, 10 more babies have died.
6. Crib bumper safety
Despite the fact that the CPSC recommends that infants under a year old should be sleeping in a crib that’s nearly bare—with just a mattress and fitted sheet—retailers are still displaying cribs made up with all the trimmings. These include bumpers, quilts, pillows, and stuffed toys. The problem is that soft bedding can suffocate infants. Some 900 die that way each year in cribs, play yards, and the like according to the CPSC.
7. And just to give you a quick list of issues that our West Coast office in San Francisco is working feverishly to translate into success:
California just banned PBDEs, which are showing up at alarming levels in breast milk and appear to be a possible cause of the dramatic increase over the last decade in the number of children with developmental, learning or behavioral disorders.
CU is working on a bill in California to require that children up to 6 years of age, or up to 60 pounds in weight, be secured in a back seat of a vehicle, when available. This is to remedy the problem of air bag deaths of children sitting in front seats. Passed the Senate and is going to the Governor.
We’re supporting a bill in Congress that would require the addition of a bitter-tasting ingredient to ethylene glycol antifreeze in an effort to prevent the accidental ingestion by children and animals. CU supported a similar measure in California, which is now law in California (also law in OR and pending in NV). Ethylene glycol smells and tastes sweet, which makes it attractive to small children and pets. The problem of accidental poisoning among children resulting from the ingestion of toxic antifreeze is serious. According to the American Association of Poison Control Centers database, there were 4,392 unintentional “poison exposures” associated with ethylene glycol in 2001. Sixteen percent of those poisonings were in children under 6 years of age. No doubt, a parent or caregiver was not paying full attention. But who is taking the risk, and who is paying the price for that risk. There must be a more effective response than simply “train the parents.”
8. Kids, cars, and safety
Since the subject of a workshop this afternoon is entitled “Short, Sweet, and Vulnerable: Preventing Backover Injuries and Death to Young Children,” I just want to give all of you a brief overview of the work Consumers Union has been doing in this critical area. Last year, 58 children died because drivers did not see them while backing up. This is an unbelievable—yet avoidable—tragedy. We have been working closely with Janette Fennell from Kids ‘n Cars to bring widespread attention to this issue. We have worked with all the national news networks to demonstrate the problem of vehicle blind spots, using test vehicles at our auto test facility.
What we show shocks reporters and viewers alike, which is that the size of the blind spot behind some vehicles such as the Chevy Avalanche, a pick-up truck can be more than 30 feet for an average-height driver and more than 50 feet for a short driver. While CR reminds drivers that it’s best to always look carefully behind the vehicle before you get in and again before you put the car in gear, and always back up slowly, consumer education is only part of the equation.
The other part is what the industry and the government could be doing. We are pushing the government to test back-up warning devices and to track injuries and fatalities in non-crash non-traffic incidents and prepare a report for the public addressing causes and solutions. And we’re targeting the industry directly to increase the number of vehicles providing or offering back-up warning devices.
Along similar lines, we are asking the government to require a national performance standard for power windows. At least 25 children have died during the past decade from injuries involving power windows in cars. Typically, the child has his or her head out the window of a parked car and accidentally leans on the window switch. The glass moves up forcefully, choking the child.
Two types of switches are inherently risky, especially if they’re mounted horizontally on the door’s armrest. There are safer choices that we believe should be used in all passenger vehicles.
This list is a long and challenging one, telling us there is still a lot of work ahead—not only on our part, but on the part of government and manufacturers. They all must take into account the way parents and children are likely to use products and make them the most forgiving they can be, consistent with technology and reasonable cost. I can’t say this enough.
In closing, let me reiterate a critical point in the debate about injury reduction. There is no question that parents have a huge responsibility for their children’s safety—but the cost of a fleeting moment of inattention or poorly-followed directions should not be a serious injury or fatality to a child. This is simply not acceptable. And blaming the caregiver only prolongs the cycle of death and injury while the numbers pile up. At some point, those who can correct the problem will no longer be able to hide their inaction behind the hollow argument of consumer misuse. They will be forced to assume a higher level of responsibility. But by then, a lot of damage will have been done, damage that could have been avoided.
It shouldn’t take a tragedy. And our challenge is to make sure it doesn’t.