“Pundits Are Saying This Is ‘Anti-poor’”: Competing Framing Strategies for Child Road Safety Policy in the Philippines

Document Type : Original Article

Authors

1 Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

2 Department of Global Health, School of Health, Georgetown University, Washington, DC, USA

3 Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines

4 Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany

Abstract

Background 
Child restraint systems (CRS) can lead to a 60% reduction in child deaths, yet few low- and middle-income countries (LMICs) have comprehensive policies to enforce best practice standards. In 2019, the Philippines established such a policy: the Child Safety in Motor Vehicles (CSMV) Act.
 
Methods 
Drawing on framing theory, this study aims to understand the social dimensions of policy change to identify the Act’s origins, design, and implementation. Three sources of data – 25 articles, 27 key-informant interviews, and field notes – were collected and thematically analysed.
 
Results 
We present the findings according to two features of the framing process: storytelling and naming. The policy process can be sharply distinguished into two sections: the Act’s passage into law (which was swift and successful) and its implementation (which to date has not been). The Act’s implementation was stymied by three overarching frames – that it is “anti-poor,” “unnecessary,” and a “strategic political distraction.” A media backlash at the time of implementation solidified these frames, leading President Duterte to indefinitely defer enforcement of the Act.
 
Conclusion 
The CSMV Act emphasises that passing a law is insufficient. The trajectory of the act highlights the combined importance of (a) the framing of policy, (b) framing processes operate throughout a policy’s lifecycle, and (c) the media in creating a narrative. Our findings offer valuable insights for other LMICs implementing evidence-based road safety measures, suggesting that successful implementation requires not only strong legislation but also strategic communication and frame management throughout the policy process. Understanding framing dynamics can help policy-makers anticipate and address potential resistance to life-saving public health interventions.

Keywords


  1. World Health Organization (WHO). Global Status Report on Road Safety 2018. WHO; 2018.
  2. World Health Organization (WHO). Global Health Observatory Data Repository, Road Traffic Deaths, Data by Country. https://apps.who.int/gho/data/node.main.A997.
  3. United Nations Philippines. UN Secretary-General’s Special Envoy for Road Safety returns to Southeast Asia (5-19 April) to call for more investment in road safety. UN; 2023. https://laopdr.un.org/en/226141-un-secretary-general%E2%80%99s-special-envoy-road-safety-returns-southeast-asia-5-19-april-call-more.
  4. Land Transportation Office Republic of the Philippines. LTO Road Safety Action Plan; 2019.
  5. World Health Organization (WHO). Save LIVES: A Road Safety Technical Package. WHO; 2017.
  6. Jakobsson L, Isaksson-Hellman I, Lundell B. Safety for the growing child: experiences from Swedish accident data. In: Paper Number 05-0330. ESV Conference; 2005.
  7. Nazif-Munoz JI, Blank-Gommel A, Shor E. Effectiveness of child restraints and booster legislation in Israel. Inj Prev. 2018;24(6):411-417. doi:1136/injuryprev-2017-042458
  8. Zaza S, Sleet DA, Thompson RS, Sosin DM, Bolen JC. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med. 2001;21(4 Suppl):31-47. doi:1016/s0749-3797(01)00377-4
  9. Brown J, Keay L, Hunter K, Bilston LE, Simpson JM, Ivers R. Increase in best practice child car restraint use for children aged 2-5 years in low socioeconomic areas after introduction of mandatory child restraint laws. Aust N Z J Public Health. 2013;37(3):272-277. doi:1111/1753-6405.12070
  10. Moulton AD, Mercer SL, Popovic T, et al. The scientific basis for law as a public health tool. Am J Public Health. 2009;99(1):17-24. doi:2105/ajph.2007.130278
  11. Regulation No 129 of the Economic Commission for Europe of the United Nations (UN/ECE). Uniform Provisions Concerning the Approval of Enhanced Child Restraint Systems Used on Board of Motor Vehicles (ECRS). 2014. Available from: http://data.europa.eu/eli/reg/2014/129/oj.
  12. Republic of the Philippines Congress of the Philippines. Republic Act No. 11229: An Act Providing for the Special Protection of Child Passengers in Motor Vehicles and Appropriating Funds Therefor, "Child Safety in Motor Vehicles Act". Republic of the Philippines Congress of the Philippines; 2019.
  13. Stone D. Chapter 3 of Policy Paradox: The Art of Political Decision Making. In: Policy Paradox: The Art of Political Decision Making; 2012.
  14. Fischer F, Torgerson D, Durnová A, Orsini M. Handbook of Critical Policy Studies. Edward Elgar Publishing; 2015. doi:4337/9781783472352
  15. McInnes C, Kamradt-Scott A, Lee K, et al. Framing global health: the governance challenge. Glob Public Health. 2012;7 Suppl 2:S83-S94. doi:1080/17441692.2012.733949
  16. Hyder AA, Hoe C, Hijar M, Peden M. The political and social contexts of global road safety: challenges for the next decade. Lancet. 2022;400(10346):127-136. doi:1016/s0140-6736(22)00917-5
  17. Hoe C, Taber N, Champagne S, Bachani AM. Drink, but don't drive? The alcohol industry's involvement in global road safety. Health Policy Plan. 2021;35(10):1328-1338. doi:1093/heapol/czaa097
  18. Gusfield JR. The Culture of Public Problems: Drinking-Driving and the Symbolic Order. University of Chicago Press; 1981.
  19. Koon AD, Hawkins B, Mayhew SH. Framing and the health policy process: a scoping review. Health Policy Plan. 2016;31(6):801-816. doi:1093/heapol/czv128
  20. Schön D, Rein M. Frame Reflection: Toward the Resolution of Intractable Policy Controversies. New York: Basic Books; 1994.
  21. van Hulst M, Yanow D. From policy “frames” to “framing” theorizing a more dynamic, political approach. Am Rev Public Adm. 2016;46(1):92-112. doi:1177/0275074014533142
  22. Dewulf A, Gray B, Putnam L, et al. Disentangling approaches to framing in conflict and negotiation research: a meta-paradigmatic perspective. Hum Relat. 2009 Feb;62(2):155-193. doi:1177/0018726708100356
  23. Aukes E, Lulofs K, Bressers H. Framing mechanisms: the interpretive policy entrepreneur’s toolbox. Crit Policy Stud. 2018;12(4):406-427. doi:1080/19460171.2017.1314219
  24. Pentecost M. Field notes in the clinic: on medicine, anthropology and pedagogy in South Africa. Med Humanit. 2018;44(4):e1. doi:1136/medhum-2018-011473
  25. Republic of the Philippines Congress of the Philippines Senate. Committee on Public Services (Subcommittee on Special Protection of Child Passengers) Joint with the Committee on Women, Children, Family Relations and Gender Equality; 2018.
  26. Republic of the Philippines Congress of the Philippines. Republic Act No. 4136: An Act to Compile the Laws Relative to Land Transportation and Traffic Rules, to Create a Land Transportation Commission and for Other Purposes Therefor the "Land Transportation and Traffic Code". Republic of the Philippines Congress of the Philippines; 1964.
  27. Republic of the Philippines Congress of the Philippines. Republic Act No. 8750: An Act Requiring the Mandatory Compliance by Motorists of Private and Public Vehicles to Use Seat Belt Devices, and Requiring Vehicle Manufacturers to Install Seat Belt Devices in All Their Manufactured Vehicles Therefor the "Seat Belts Use Act Of 1999". Republic of the Philippines Congress of the Philippines; 1999.
  28. Republic of the Philippines Congress of the Philippines. Republic Act No. 10586: An Act Penalizing Persons Driving Under the Influence of Alcohol, Dangerous Drugs, and Similar Substances, and for Other Purposes the "Anti-Drunk and Drugged Driving Act of 2013". Republic of the Philippines Congress of the Philippines; 2012.
  29. Republic of the Philippines Congress of the Philippines. Republic Act No. 10054: An Act Mandating All Motorcycle Riders to Wear Standard Protective Motorcycle Helmets While Driving and Providing Penalties Therefor "Motorcycle Helmet Act of 2009". Republic of the Philippines Congress of the Philippines; 2009.
  30. Abueva JV. Filipino democracy and the American legacy. Ann Am Acad Pol Soc Sci. 1976;428(1):114-133. doi:1177/000271627642800111
  31. Lam H, Atienza WA, Adovich Rivera MS, et al. Child Restraints in the Philippines: A Baseline Study on the Availability, Affordability and Acceptability of Child Restraints in the Philippines. 2017.
  32. Miguel RT, Atienza WA, Rivera AS, et al. A financial forecasting exercise on the child restraints market in the Philippines. Acta Med Philipp. 2018;52(5):466-472.
  33. Republic of the Philippines Congress of the Philippines Senate. Bicameral Conference Committee on the Disagreeing Provisions of Senate Bill No, 1971 and House Bill No. 6938 (Child Safety in Motor Vehicles Act). Presented at: November 26, 2018.
  34. Land Transport Office, Department of Transportation. Implementing Rules and Regulations of Republic Act No. 11229 or the "Child Safety in Motor Vehicles Act. Land Transport Office, Department of Transportation; 2019.
  35. Borras SM, Carranza D, Franco JC. Anti-poverty or anti-poor? The World Bank's market-led agrarian reform experiment in the Philippines. Third World Q. 2007;28(8):1557-1576. doi:1080/01436590701637409
  36. de Ungria MC, Jose JM. The war on drugs, forensic science and the death penalty in the Philippines. Forensic Sci Int Synerg. 2020;2:32-34. doi:1016/j.fsisyn.2019.11.002
  37. Biana HT. The matter of class: COVID-19 in the Philippines. Soc Ethics Soc J Appl Philos. 2020;6(2):17-36.
  38. Ratcliffe R. Philippines Accused of Being ‘Anti-Poor’ with Public Transport Ban on COVID Unvaccinated. The Guardian; 2022.
  39. Binay JC. Anti-Poor. Manila Bulletin; 2021. https://mb.com.ph/2021/5/26/anti-poor.
  40. Mongaya K. Philippines’s New Vaccine Mandate Decried as Punitive and Anti-Poor. Global Voices; 2022.
  41. Koon AD, Hawkins B, Mayhew SH. Framing universal health coverage in Kenya: an interpretive analysis of the 2004 Bill on National Social Health Insurance. Health Policy Plan. 2021;35(10):1376-1384. doi:1093/heapol/czaa133
  42. Koon AD, Mendenhall E, Eich L, Adams A, Borus ZA. A spectrum of (dis)belief: coronavirus frames in a rural midwestern town in the United States. Soc Sci Med. 2021;272:113743. doi:1016/j.socscimed.2021.113743
  43. Lam H, Atienza WA, Rivera AS, et al. PW 2524 Determining availability, accessibility, affordability, and acceptability of child restraints to support legislation on mandatory child restraint use in Philippines. Inj Prev. 2018;24(Suppl 2):A140. doi:1136/injuryprevention-2018-safety.390
  44. Katikireddi SV, Bond L, Hilton S. Changing policy framing as a deliberate strategy for public health advocacy: a qualitative policy case study of minimum unit pricing of alcohol. Milbank Q. 2014;92(2):250-283. doi:1111/1468-0009.12057
  45. Khan MS, Meghani A, Liverani M, Roychowdhury I, Parkhurst J. How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan. Health Policy Plan. 2018;33(2):215-223. doi:1093/heapol/czx145
  46. Fischer SE, Strandberg-Larsen M. Power and agenda-setting in Tanzanian health policy: an analysis of stakeholder perspectives. Int J Health Policy Manag. 2016;5(6):355-363. doi:15171/ijhpm.2016.09
  47. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet. 2007;370(9595):1370-1379. doi:1016/s0140-6736(07)61579-7
  48. Lwin KS, Koon AD, Rasanathan K, et al. Framing health taxes: learning from low- and middle-income countries. BMJ Glob Health. 2023;8(Suppl 8):e012955. doi:1136/bmjgh-2023-012955
  49. Matland RE. Synthesizing the implementation literature: the ambiguity-conflict model of policy implementation. J Public Adm Res Theory. 1995;5(2):145-174. doi:1093/oxfordjournals.jpart.a037242
  50. Nilsen P, Ståhl C, Roback K, Cairney P. Never the twain shall meet?--A comparison of implementation science and policy implementation research. Implement Sci. 2013;8:63. doi:1186/1748-5908-8-63
  51. Hapal K. The Philippines’ COVID-19 response: securitising the pandemic and disciplining the pasaway. J Curr Southeast Asian Aff. 2021;40(2):224-244. doi:1177/1868103421994261
  52. Dressel B, Bonoan CR. Southeast Asia's troubling elections: Duterte versus the rule of law. J Democr. 2019;30(4):134-148. doi:1353/jod.2019.0057
  53. Cairney P, Oliver K. Evidence-based policymaking is not like evidence-based medicine, so how far should you go to bridge the divide between evidence and policy? Health Res Policy Syst. 2017;15(1):35. doi:1186/s12961-017-0192-x
  54. Hoe C, Weiger C, Minosa MK, Alonso F, Koon AD, Cohen JE. Strategies to expand corporate autonomy by the tobacco, alcohol and sugar-sweetened beverage industry: a scoping review of reviews. Global Health. 2022;18(1):17. doi:1186/s12992-022-00811-x
  55. Weiger C, Hoe C, Cohen JE. Seven-year tobacco tax plan in Ukraine: a case study of the actors, tactics and factors motivating policy passage. BMJ Open. 2022;12(2):e049833. doi:1136/bmjopen-2021-049833
  56. Vasudevan V, Nambisan SS, Singh AK, Pearl T. Effectiveness of media and enforcement campaigns in increasing seat belt usage rates in a state with a secondary seat belt law. Traffic Inj Prev. 2009;10(4):330-339. doi:1080/15389580902995190
  57. Siddiqui E, Ejaz K, Waheed S, Kazi GI, Khursheed M. Attitudes towards child restrains and seat belts usage in the learned population of Karachi, Pakistan. World J Emerg Med. 2014;5(3):223-228. doi:5847/wjem.j.issn.1920-8642.2014.03.012
  58. Haynes A, Loblay V. Rethinking barriers and enablers in qualitative health research: limitations, alternatives, and enhancements. Qual Health Res. 2024;34(14):1371-1383. doi:1177/10497323241230890

Articles in Press, Corrected Proof
Available Online from 16 June 2025
  • Received Date: 11 May 2024
  • Revised Date: 05 April 2025
  • Accepted Date: 11 June 2025
  • First Published Date: 16 June 2025