Download Chapter 15

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 injuryrelated deaths in the U.S.
• Injury prevention or injury control
• Unsafe act and unsafe condition
• Types of unintentional injuries
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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
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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 144
• 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
• 2005-2010: 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
2009-2010 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
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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?