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Similarly, the term safety is rather vague Safety has been replaced by injury prevention or injury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

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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

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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

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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

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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

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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

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1988 1989 1990 1991 1992 1993 1994

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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

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5

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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