California Department of Health Services What? So What? Now What?

California Department of Health Services

What? So What?

Now What?

What? So What?

Now What?


What ?What ?

• Injuries remain the leading cause of death for children (and adults under 45 years old)

• Mortality from injuries has declined• along with almost everything else

• New approaches to analysis by age• analysis by periods less than years of age

• Infanticide rates vary by hours and days of age


What ?What ?

“In the October issue of Good Housekeeping, a revealing child safety report names California the safest state for child safety report names California the safest state for children in the United Stateschildren in the United States. Good Housekeeping arrived at the winning states by analyzing data compiled from the National Safe Kids Campaign, the Insurance Institute for Highway Safety, the National Conference of State Legislators, the National Association of State Boating Law Administrators and the National Program for Playground Safety. It was concluded that California's It was concluded that California's state laws top the list as the toughest in the nation in state laws top the list as the toughest in the nation in protecting our childrenprotecting our children.”


What ?What ?

• Are new threats emerging?

• Are we losing control over old threats?

• What important injuries continue in spite of what we are (or are not) doing?


Statistics Never LieStatistics Never Lie


What’s downWhat’s down


Homicides, Males, CaliforniansHomicides, Males, Californians

0

500

1000

1500

2000

2500

3000

3500

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


Homicides, Females, CaliforniansHomicides, Females, Californians

0

100

200

300

400

500

600

700

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


Suicides, CaliforniansSuicides, Californians

0

500

1000

1500

2000

2500

3000

3500

4000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


Suicides, Under 18, CaliforniansSuicides, Under 18, Californians

0

20

40

60

80

100

120

140

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


Fatal Child Abuse*, 0-18, CaliforniaFatal Child Abuse*, 0-18, California

0

20

40

60

80

100

120

140

160

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

* calculated* calculated



0

500

1000

1500

2000

2500

3000

3500

4000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


M V Occ., Hosp. Nonfatal, 0 - 5 years, Californians

M V Occ., Hosp. Nonfatal, 0 - 5 years, Californians

0

100

200

300

400

500

600

700

800

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000


M V Occ., Hosp. Nonfatal, Calif.M V Occ., Hosp. Nonfatal, Calif.

0

5000

10000

15000

20000

25000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000


Drowning, Age 0 to 5, CaliforniansDrowning, Age 0 to 5, Californians

0

20

40

60

80

100

120

140

160

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


Falls, Under 18, CaliforniansFalls, Under 18, Californians

0

5

10

15

20

25

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


What’s up?What’s up?


Homicides, Males, CaliforniansHomicides, Males, Californians

0

500

1000

1500

2000

2500

3000

3500

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


Homicides, Females, CaliforniansHomicides, Females, Californians

0

100

200

300

400

500

600

700

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001



0

500

1000

1500

2000

2500

3000

3500

4000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


M V Occ., Hosp. Nonfatal, Calif.M V Occ., Hosp. Nonfatal, Calif.

0

5000

10000

15000

20000

25000

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000


Falls, Age 55+ Years, CaliforniansFalls, Age 55+ Years, Californians

0

200

400

600

800

1000

1200

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001


By the wayBy the way

• One of the most commonly used flavorings in Chocolate...

...is Vanilla.

Think about it


Our Product Line...Our Product Line...• pool barriers• car seats• trigger locks• safety belts/air bags• flame-proof sleepwear• helmets• smoke alarms• child-resistant Rx,

disposable lighters

• Drug & Alcohol treatment• Rape Prevention Education• Batterers’ Treatment• Incarceration• after school “programs”• traffic enforcement• building code, enforcement• PHN home visiting• DV shelters


So What? Well, if “we” could...


• Reduce explicit violence in:• movies

• games

• TV journalism

• Reduce the divorce rate

• upgrade the worst tier of housing




• Reduce addiction in released prisoners

• reduce exposure to methamphetamine

• reduce flux of handgun commerce

• Improve access to quality education

• improve access to good jobs


Our Product Line...Our Product Line...• pool barriers• car seats• trigger locks• safety belts/air bags• flame-proof sleepwear• helmets• smoke alarms• child-resistant Rx,

disposable lighters

• Drug & Alcohol treatment• Rape Prevention Education• Batterers’ Treatment• Incarceration• after school “programs”• traffic enforcement• building code, enforcement• PHN home visiting• DV shelters


By the wayBy the way

• If the Clintons had converted to Buddhism during his Presidency…

• …we would have had an example of

the POTUS, the FLOTUS, and the Lotus.


Now What?Now What?

• “Programs” operate for hours at a time

• The structure of a community is on duty

24 / 7 / 365


Now What? Place mattersNow What? Place matters

• The Old


Now What? Place mattersNow What? Place matters

• The New


Create, Refine, Advance, ExecuteCreate, Refine, Advance, Execute

• We do a lot of creating, refining and advancing

• We don’t do enough executing

• What is feasible now?

• Now What?


What is feasible now?What is feasible now?

• Car Seats - and we’re doing it, mostly

• Bike Helmets - we’re not doing much

• Smoke Alarms - we’re doing almost nothing

• Pool Safety - law covers new pools only

• Trigger locks - totally unevaluated

• Sleepwear - new concern over toxicity


What is feasible now?What is feasible now?

• Drug & Alcohol - Prop 36, but little in-house Rx

• Rape Prev. Educ. - largely unevaluated

• Batterers’ Treatment - largely unevaluated

• After School - Prop.47, but no money for it

• PHN Home Visiting - growing under Prop. 10

• DV Shelters - largely unevaluated

• Suicide Prevention - largely unevaluated


What ain’t we got?What ain’t we got?

Don’t know how to do it• DV intervention• Sexual assault prev.• Elder falls prev.• Violent crime prev.• Suicide prevention

Know how, just don’t do it• Bike helmets• Smoke alarms• reduce impaired driving• truancy prevention• Suicide prevention• Playground improvement


Now what?Now what?

• What is worth doing?


Old problem, new package Old problem, new package

• Psychological Trauma from Disasters

• combination of “PTS” [post-traumatic stress] and TV journalism exposure

• Recent example; 8 hours of WTC collapsing on CNN, Fox, and everywhere else.

• Children 3,000 miles away react as if in NYC


• Created by the PL 107-188 Section 104(a), the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.

• A FACA committee (PL 92-463).

• See http://www.bt.cdc.gov/children for more background, and related documents and links.

National Advisory Committee on Children and Terrorism (NACCT)National Advisory Committee on Children and Terrorism (NACCT)


National Advisory CommitteeNational Advisory Committee

Charge

• Assess the nation’s preparedness w/ the physical and mental health needs of children

• Make recommendations to the Secretary

• Review the Strategic National Stockpile and make recommendations to the Secretary


National Advisory CommitteeNational Advisory Committee

Charge

• Oh, yes, and do it in the next 90 days !


4 Phases of an Emergency4 Phases of an Emergency

Planning

Response

Recovery

Mitigation


NACCT IssuesNACCT Issues

• The primary agent of terrorists is not a germ, a chemical, a bomb or a radioisotope.

• Rather, the primary agent of terrorists is terror.

• Children are more susceptible to terror than adults, but this has never guided us.



• Children are not small adults, but

• Planning has never effectively included children, schools, or pediatricians

• Neither have children’s special psychosocial and mental health needs been planned for



• Neither surveillance systems nor surveillance definitions have been developed for these needs

• The concept of first responders must include teachers, CBOs and clergy, who therefore need training, resources and a role in planning.



• Planning for health care and hospital capacity for adults has taken priority over that for children, but• children have higher risk from airborne,

waterborne, food-borne and soil contamination, • and their risk for being terrorized and having

post-traumatic stress disorders is higher.



• Research into the special needs of children is sorely needed if we are to learn how to mitigate the effects of future disasters.• For example, children all over the U.S. may

suffer from viewing events and hearing warning messages on television even though these events occur thousands of miles away


Now what?Now what?

• Assure that Education, Pediatrics, Mental Health and Public Health Surveillance sectors are fully involved in all 4 phases

• Require all local planning to do likewise as a condition of continued funding


Now what?Now what?

• Facilitate research to supply missing skills, knowledge and techniques, both before and during emergencies of all types, since the initial agent is often of least importance


The buck stops hereThe buck stops here

• Some of this has already begun to shape HRSA guidance

• Not clear which, if any, NACCT recommendations will be acted upon federally

• All politics, public health, and emergency response are local

• We have the opportunity to act if we choose to


The Future ?The Future ?

"The future. . . .is just one damned thing after

another" -- Churchill


Alex Kelter [email protected]

California Department of Health Services What? So What? Now What?

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