Transcript INJURIES AS A PUBLIC HEALTH PROBLEM

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Safety has been replaced by injury prevention or injury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
Burden of Injury, United States -- 1995
(National Center for Health Statistics, 1997)
Deaths
147,891
Hospital discharges
2,591,000
Emergency department visits
36. 961,000
Episodes of injuries reported
59,127,000
Injury Deaths, United States -- 1995
Homicide
15%
Undetermined
0%
Note: Injuries account for 6.4%
of all deaths among U.S.
residents
Suicide
21%
Unintentional
64%
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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
[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, lowquality housing, defective and old cars, and such hazardous products as
space heaters -- all of which contribute to higher injury risks
Emergency Department Visits by
Place of Injury, U.S., 1994
Home
1%
School/day care
7%
Other
13%
Unspecified
35%
Work
21%
Street/highway
23%
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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
Four Characteristics of
Unintentional Injuries
They occur following an unplanned event
They are usually preceded by an unsafe act or
condition (hazard)
They are often accompanied by economic loss or
injury
They interrupt the efficient completion of a task
Costs of Unintentional
Injuries 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 Unintentional
Injuries (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
90
66
80
67
62
59
70
Deaths per 100,000 Population
47
60
49
42
50
Seat Belt Use
Motor Vehicle Crash Deaths
40
30
20
19.2
18.4
17.9
16.4
15.4
15.6
15.6
10
0
1988
1989
1990
1991
1992
1993
1994
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 nonheattransferring 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 Prevention
of 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 Prevention
of 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 SelfDirected 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 Directed
at Women by Male Partners,
United States, 1987-1993
10
9.3
9.3
9
8
Cases per 1,000 Women
7
6
5.5
5.6
5
4
5.5
5
4
3
2
1
0
1987
1988
1989
1990
1991
1992
1993
Risk Factors for Intentional Injury
Child Abuse
Family history of abuse (parent or spouse abuse)
Parental mental illness or substance abuse
Family dysfunction or disruption (absent parent or
inadequate parenting skills
Socioeconomic stress (poverty, homelessness)
Child characteristics (overactive, difficult, or
disabled)
Approaches to the Prevention
of 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