INJURIES AS A PUBLIC HEALTH PROBLEM zWhat are injuries? zWhat are unintentional injuries? zWhat are...
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Transcript of INJURIES AS A PUBLIC HEALTH PROBLEM zWhat are injuries? zWhat are unintentional injuries? zWhat are...
INJURIES AS A PUBLIC
HEALTH PROBLEM
What are injuries?
What are unintentional injuries?
What are intentional injuries?
Injury Prevention and Control:“Accidents” and “Safety”
The term accident has fallen into disfavor and disuse with many public health officials Accident suggests a chance occurrence or an unpreventable
mishap Many, if not most, accidents are preventable The term unintentional injury is now used in its place
Similarly, the term safety is rather vague Safety has been replaced by injury prevention or injury
control -- inclusive of all measures to prevent injuries, both unintentional and intentional, or to minimize their severity
Unintentional Injuries
Injuries judged to have occurred without anyone intending that harm be done
E.g., injuries resulting from car crashes, falls, drownings and fires
Intentional Injuries
Injuries judged to have been purposely inflicted, either by the self or another person
E.g., assaults, intentional shootings and stabbings, homicides, and suicides
Deaths
147,891
Hospital discharges
2,591,000
Emergency department visits
36. 961,000
Episodes of injuries reported
59,127,000
Burden of Injury, United States -- 1995(National Center for Health Statistics, 1997)
Injury Deaths, United States -- 1995
Unintentional64%
Suicide21%
Homicide15%
Undetermined0%
Note: Injuries account for 6.4% of all deaths among U.S. residents
Injury Deaths among Young People
Injuries are an especially important cause of death in young people
In 1995, injuries caused -- 43% of deaths in children aged 1-4 52% of deaths in children aged 5-14 76% of deaths in children aged 15-24
[New slide]
Injury Rates: Race, Gender and Socioeconomic Status
Males are more likely to sustain injuries than females, with a fatal injury rate 2.5 times higher than that for females for all age groups combined
African-Americans have higher rates of injury mortality than whites Much of the excess mortality among African-Americans is due to the
high rate of homicide in the 15-24 age group -- 12 times the rate for white youth
Injury rates, like other indicators of poor health, are higher in groups of lower socioeconomic status
[New slide]
Injury Rates: Race, Gender and Socioeconomic Status (cont’d.)
Injury rates, like other indicators of poor health, are higher in groups of lower socioeconomic status The death rate from unintentional injury is twice as high in low-
income areas as in high-income areas House fires, pedestrian fatalities, and homicides are all more common
among the poor Low-income individuals are more likely to have high-risk jobs, low-
quality housing, defective and old cars, and such hazardous products as space heaters -- all of which contribute to higher injury risks
[New slide]
Emergency Department Visits byPlace of Injury, U.S., 1994
Home1%
School/day care7%
Other13%
Work21%
Street/highway23%
Unspecified35%
Occupational Injuries
Workplace injuries have been a significant public health problem since the Industrial Revolution Many states implemented occupational safety laws in the late 19th and
early 20th centuries 1970 -- federal law created the Occupational Safety and Health
Administration, empowered to set standards, inspect workplaces, and impose penalties for workplace hazards
The OSHA law also created the National Institute for Occupational Safety and Health (NIOSH) to conduct research, recommend standards, and conduct hazard evaluations
[New slide]
Occupational Injuries (cont’d.)
In 1996, 6,112 workplace fatalities were reported by the Bureau of Labor Standards In part, reflects mandated safety measures and workplace safety
education programs In part, reflects an economy less dependent on heavy industry
In 1996, an estimated 2.8 million Americans suffered an injry that led to lost workdays
[New slide]
Four Characteristics of Unintentional Injuries
They occur following an unplanned eventThey are usually preceded by an unsafe act or
condition (hazard)They are often accompanied by economic loss or
injuryThey interrupt the efficient completion of a task
Costs of UnintentionalInjuries to Society
Death Rate: 34 per 100,000 population (1997)Cause of Death Rank (5th)Motor Vehicle Fatality Rates: 16 per 100,000
population (1997)Motor vehicle deaths are the leading cause of death
in the U.S. for people aged 14-24
Costs of UnintentionalInjuries (cont’d)
Ranked 1st in Years of Potential Life Lost Before Age 65 (YPLL65 )
Over 2,000,000 YPLL65 (1995)Each injury death represents as much as 36 years of
potential life lost ($334,000 in lost productivity) By way of comparison, only 12 years of potential life are
lost for each death from CVD (heart and stroke combined), and 16 years for each cancer death -- $51,000 in lost productivity for CVD and $88,000 for cancer
Motor Vehicle Crash Deaths and Seat
Belt Use, U. S., 1988-1994
19.2 18.4 17.916.4 15.4 15.6 15.6
42
4749
5962
66 67
0
10
20
30
40
50
60
70
80
90
1988 1989 1990 1991 1992 1993 1994
De
ath
s p
er
100,
000
Po
pu
lati
on
Seat Belt Use
Motor Vehicle Crash Deaths
Percent Distribution of Injury-Related Emergency Department Visits by Place of Injury, U. S.,1994
Home -- 39% Street/Highway-- 22% Work -- 13% School/Day Care -- 4% Other -- 8% Unspecified-- 22%
Source: National Safety Council, Accident Facts, 1997 Edition.
Deaths from Unintentional Injuries: Leading Causes United States
Motor Vehicle Crashes More people die from unintentional injuries associated with motor
vehicle crashes than any other types of injury
Falls Leading cause of deaths from non-motor vehicle injuries
Poisonings Fires and Burns Drownings Suffocation by Ingested Object
Injury Prevention and Control Tactics, Based Upon the Epidemiological Model of Energy as the
Injury-Producing Agent
Prevent the accumulation of the injury-producing agent, energy E.g., reducing speed limits to decrease motor vehicle injuries, lowering the height
of children’s high chairs and dividing boards to reduce fall injuries, lowering the settings on hot water heaters to reduce the number and seriousness of burns
Prevent the inappropriate release of excess energy or modify its release in some way E.g., flame retardant fabric that will not ignite, such the current legal requirement
that such a fabric be used in the manufacture of children’s pajamas E.g., use of automobile safety belts -- i.e., excess energy (movement of a human
body) is released into the safety belt instead of the into the car’s windshield and/or dashboard
E.g., prevent fall injuries by use of handrails, walkers, and non-slip surfaces in bathtubs that prevent the inappropriate release of kinetic energy resulting from falls
Injury Prevention and Control Tactics, Based Upon the Epidemiological Model of Energy as the
Injury-Producing Agent (cont’d.)
Place a barrier between the host (human) and agent (energy) E.g., insulation around electrical wires and the use of potholders and nonheat-
transferring handles on cookwares E.g., use of sunscreen lotion and the wearing of a hat in summertime to place a
barrier between the sun’s energy and the individual
Sometimes necessary or useful to completely separate the host (human) from potentially dangerous sources of energy E.g., locked gates and high fences around electrical substations and swimming
pools E.g., at home, locking up guns and poisons to provide protection against the
likelihood of unintentional injury to children
Four Broad Strategies for the Preventionof Unintentional Injuries
Injury Prevention Education The process of changing people’s health-directed behavior in such a way as
to prevent unintentional injuries
Regulation Enactment and enforcement of laws to control conduct as a means of
reducing the number and seriousness of unintentional injuries E.g., speed limits, state laws requiring safety belts and motorcycle helmet
use, and child restraints in automobiles In a “free society,” such as the U.S., there is a limit to how much can be
accomplished through legislation The strategy of prevention through regulation can be difficult to implement
-- i.e., the idea of regulating health behavior grates against the individual freedom that Americans have come to expect
Four Broad Strategies for the Preventionof Unintentional Injuries (cont’d.)
Automatic Protection Combining engineered changes with regulatory efforts -- i.e., automatic (or
passive) protection E.g., Child-proof safety caps on aspirin and other medicine containers E.g., In 1973 free, easily installed window guards began to be provided to New
York City families living in high-risk areas; by 1975, a 50% reduction in falls of young children from windows and 35% decrease in deaths from such falls
Litigation Lawsuits from injured victims or their families have been successful in
removing dangerous products from store shelves or otherwise influencing changes in dangerous behavior
E.g., 3rd-party responsibility of bar owners and bartenders for serving alcohol to a drunken customer who later injures another person
Intentional Injuries: Outcomes of Self-Directed or Interpersonal Violence
In the U.S., more than 50,000 people die each year as a result of interpersonal violence
In the U.S., 1/4 million people were treated for injuries from confirmed or suspected interpersonal violence in 1994
The spectrum of violence includes assaults, abuse (child, spouse, elder), rape, robbery, homicide, and suicide In 1994, 51 of every 1,000 U.S. residents age 12 or older were victims of violent
crimes In 1996, homicide and legal intervention ranked as the 14th leading cause of death
in the U.S. In the 15-24-year age group, deaths from homicides and legal interventions were
the second leading cause of death in the U.S.
In 1996, suicide ranked as the ninth leading cause of death in the U.S.
Incidence of Physical Abuse Directedat Women by Male Partners,
United States, 1987-1993
4
5.5 5.6
5
5.5
9.3 9.3
0
1
2
3
4
5
6
7
8
9
10
1987 1988 1989 1990 1991 1992 1993
Cas
es
pe
r 1,
000
Wo
me
n
Risk Factors for Intentional InjuryChild Abuse
Family history of abuse (parent or spouse abuse)Parental mental illness or substance abuseFamily dysfunction or disruption (absent parent or
inadequate parenting skillsSocioeconomic stress (poverty, homelessness)Child characteristics (overactive, difficult, or
disabled)
Approaches to the Preventionof Intentional Injuries
Education Opportunities for Recreation and Employment Regulation and Law Enforcement Counseling and Treatment
Focal Topics for Study:Chapter 24 Injury Control
The epidemiological model of injury and energy transfer as a cause of injury
Haddon’s three phases of injury and examples in the Haddon Matrix
Countermeasures to prevent and control injury Use of E-Codes (and related problems) in injury surveillance Use of injury surveillance data Types and categories of interpersonal violence Violence and violence prevention as public health issues