Chapter 15 Injuries as a Community and Public Health Problem

Introduction Definitions Injury Unintentional injuries Intentional injuries

Cost of Injuries to Society Leading cause of death and disability in the world ~5.8 million people die from injuries each year Cost of injuries $500+ billion annually Fatal injuries Disabling injuries

Injury Deaths, United States, 2011

Burden of Injury, United States, 2011

Unintentional Injuries The cause of nearly two-thirds of all injury- related deaths in the U.S. Injury prevention or injury control Unsafe act and unsafe condition Types of unintentional injuries Motor vehicle crashes Poisonings Falls Other types of unintentional injuries

Motor Vehicle Crashes Leading type of unintentional injury death Leading cause of nonfatal unintentional injury Majority of those killed are Drivers Passengers Motorcycle riders Pedestrians Pedalcyclists

Poisonings Second leading cause of unintentional injury death Unintentional ingestion of fatal doses of medicines and drugs Consumption of toxic foods Exposure to toxic substances in the workplace or elsewhere Most occur in the home

Falls Third leading cause of unintentional injury death Leading cause of injury-related ED visits Most occur in the home Disproportionately affect elders

Epidemiology of Unintentional Injuries Account for large number of early deaths in U.S. Incapacitation significant problem High economic impact

Person Age Leading cause of death in children and ages Gender Males more likely to be involved in fatal unintentional injuries Minority status

Injury-Related Visits to E.D.s by Age and Sex, 2010

Place Home More occur in the home than anyplace else Recreation/sports area Highway Workplace

Unintentional Injury Deaths by Class, 2011

Time Seasonal variations in various causes of unintentional injuries Days of week Time of day

Alcohol and Other Drugs as Risk Factors Alcohol may be most important factor contributing to injuries Involved in high amount of motor vehicle crashes Related to speeding, seat belt use, and other behaviors

Alcohol Impairment for Drivers or Motorcycle Operators Killed

Prevention through Epidemiology Early contributors for injury prevention and control John Gordon William Haddon, Jr. Model for unintentional injuries - triangle Environment, host, and energy producing agent

A Model for Unintentional Injuries

Prevention and Control Tactics Based on the Model Prevent accumulation of energy producing agent Prevent inappropriate release of excess energy Placing barrier between host and agent Separate host from potentially dangerous sources of energy Other tactics

Community Approaches to Prevention of Unintentional Injuries Education – process of changing people’s health-directed behavior Regulation – enacting and enforcing laws to control conduct Automatic protection – modifying products or environments to reduce risk Litigation – seeking justice for injury through courts

Intentional Injuries Outcome of self-directed or interpersonal violence Staggering community health problem in the U.S.

Types of Intentional Injuries Assaults, rapes, suicides, homicides Can be perpetrated against family members, community members, or complete strangers Costly due to loss of life and productivity, and economic cost to community

Epidemiology of Intentional Injuries Interpersonal violence disproportionately affects those frustrated, hopeless, jobless, living in poverty, with low-self esteem More acts committed by males Firearms increasingly involved Alcohol and drug use contributes Perpetrators more likely to have been abused or neglected as children or exposed to violence

Homicide, Assault, Rape, and Property Crimes Males, blacks, and young people experience highest rates of violent victimization Less than half of all violent crimes committed are reported to police : only 36% of rapes and sexual assaults reported to police

Suicide and Attempted Suicide Suicide rate for men four times that for women Suicide rate for young people increased from to highest rate in 10+ years Suicide rates for elder men are highest for any population subgroup

Firearm Injuries and Injury Deaths Intentional and unintentional acts, firearms third leading cause of injury death Highest risk for homicide and suicide involving firearms are teenage boys and young men Guns on college campuses Absence of detailed federally supported reporting system

Violence in Our Society and Resources for Prevention Individuals and Violence Family Violence and Abuse Child maltreatment Child abuse Child neglect Prevention of child maltreatment Elder maltreatment and prevention Intimate partner violence Prevention of intimate partner violence

Violence in Schools Victimization rates have remained steady in recent years Fighting and weapon carrying Zero tolerance policies Bullying and being bullied Safe Schools/Healthy Students Initiative Youth violence after school

Violence in Our Communities Youth gang violence Costs to the community Community response State response Federal response

Discussion Questions What levels of prevention can be most effective in reducing violence in communities? How can unintentional injury rates continue to decline in the coming decades?