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How Policy Impacts Health Outcomes: A Look at Youth Concussion Laws

Julie Potyraj is the community manager for MHA@GW and MPH@GW, both offered by the Milken Institute School of Public Health at the George Washington University. For several years, she served as a community development specialist in Zambia coordinating youth empowerment programs and reproductive health education. She is currently an MPH@GW student focusing on global health and health communications.
Effective health policy plays a vital role in fostering healthier communities—we’ve seen it countless times throughout history. A case in point is the youth concussion safety laws created back in 2009 after 13-year-old Zackery Lystedt suffered a debilitating brain injury on the football field—an injury he likely would not have sustained had he stayed out of the game following his initial blow to the head.

Zackery’s tragic story prompted his home state of Washington to introduce the "Zackery Lystedt Laws,” known collectively as “return-to-play” laws. This legislation mandated, among other things, that student athletes suspected of having a concussion be immediately removed from play. It also prohibited return to play without written medical consent from a licensed healthcare provider. By 2014, legislatures in all 50 states and the District of Columbia had enacted some form of return-to-play laws.

The Impact of Return-to-Play Legislation

Although there are still gaps that must be addressed, the policies outlined in return-to-play laws have had a positive impact. A recent University of Michigan study on the effect of these laws discovered the following:

  • A 92% increase in 12-18 year olds seeking medical treatment for head injuries in states with concussion laws. States without concussion laws showed a 75% increase.

  • Compared with pre-legislation trends, rates of concussion treatment in states with return-to-play laws were:
    • 7% higher in 2009-2010
    • 20% higher in 2010-2011
    • 34% higher in 2011-2012

  • By 2012, concussion-related office visits rose 78% in states without return-to-play laws and 17% in states with concussion laws.

Within the scope of the study, treatment for concussion-related injuries ranged from physician office and emergency department visits to specialist care and inpatient admissions. The rates of computed tomography scans were also measured.

Other Public Health Achievements

The apparent success of return-to-play laws is encouraging, but not entirely surprising. After all, each of the 10 major public health achievements of the 21st century identified by the CDC was catalyzed by policy change. Some examples are listed below.

  • Tobacco use. The implementation of policies and interventions at the federal, state, and local levels has significantly reduced tobacco use. By 2009, 20.6% of adults and 19.5% of youths were smokers, compared with 23.5% of adults and 34.8% of youths 10 years earlier. For comparison’s sake, note that in 1965, 42.4% of adults were smokers.

  • Vaccine-preventable diseases. The early part of the 21st century saw major declines in incidences, deaths, and costs related to vaccine-preventable diseases. Newer vaccines were introduced, bringing the number of diseases covered by United States immunization policy to 17. A recent analysis found that vaccinations help prevent 42,000 deaths and 20 million cases of disease, with net cost savings in the billions.

  • Motor vehicle safety. Between 2000 and 2009, although the number of miles traveled on roadways increased, the death rate related to motor vehicle travel dipped from 14.9 deaths to 11 deaths per 100,000 population, and the injury rate decreased from 1130 to 722 per 100,000 population. This can be attributed largely to seat belt and child safety seat legislation as well as safer roadways and vehicles.

These examples are proof positive that policy and awareness can improve both individual behaviors and health outcomes for entire populations. Leveraging the legal system in a sensible way—via regulatory action or mechanisms like taxation—can help public health practitioners respond effectively to the many health-related challenges facing our country today.

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