injuries as a public health problem
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Injuries as a Public Health ProblemInjuries as a Public Health Problem
Intermediate Injury Prevention Course
Billings, Montana
August 2011
Session Session ObjectivesObjectives
• Severity of injuries facing AI/AN communities
• Costs of injury / cost benefits of prevention
• Community benefits of injury prevention
• Public Health Approach to preventing injuries
• Value of data in preventing injury
Why Injury Prevention?Why Injury Prevention?
AI/AN injury rate higher than US all races
AI/AN’s ages 1-44 are greatly affected
Injuries are very costly to treat
Injury TypesInjury Types
Unintentional InjuryUnintentional Injury– falls, motor vehicle crashes, drowning, falls, motor vehicle crashes, drowning,
fire/burn, bicycle, off-road vehicles, fire/burn, bicycle, off-road vehicles,
Intentional InjuryIntentional Injury– Suicide or attemptSuicide or attempt– homicide & assaulthomicide & assault– child/elder abusechild/elder abuse
What Injuries Are NotWhat Injuries Are Not
Injuries are Injuries are notnot accidents!accidents!
They do not happen by They do not happen by chance.chance.
They are not random They are not random acts.acts.
Swift River RescueSwift River Rescue
““An ounce of prevention is An ounce of prevention is worth a pound of cure.”worth a pound of cure.”
1981 - 2006, United States
All Injury Deaths and Rates per 100,000
Am Indian/AK Native and All U.S. and All U.S.
0
20
40
60
80
100
120
140
AI/AN US All Races
CDC WISQARS, 1981-2006
Injury SeverityInjury Severity
Fatal InjuryFatal Injury– Injury that results in death of the victimInjury that results in death of the victim
Severe InjurySevere Injury– Injury that results in a hospital stay Injury that results in a hospital stay
Ambulatory InjuryAmbulatory Injury– Less severe injuries that do not require a Less severe injuries that do not require a
hospital visithospital visit
Fatal Injury Rates Per IHS AreaFatal Injury Rates Per IHS Area
WA
Portland119.5 Billings
168.4Aberdeen
174.0 Bemidji164.1
OR ID
MT
WY
ND
SD
NE
MN
IA
WI
MI
IN
ME
NY
PA
California70.9
CA
NVUT
AZ
AK
CO
NM
KS
OK
TXLA
MS AL
FL
SC
NCTN
Tucson166.1
Navajo170.2
Albuquerque120.6
Oklahoma City87.8
Nashville81.5
Phoenix156.1
Alaska185.1
Source: Indian Health Focus - Injuries US DHHS
Data includes all injury types
Rates are per 100,000 service population
US All Races Rate: 52.2
Leading Causes of Injury Death Leading Causes of Injury Death All ages AI/AN – (2007)All ages AI/AN – (2007)
Billings AreaBillings Area
Cause Rate US RateSuicide 23.9 11.4
Poisoning 27.6 9.9
MVC 69.0 13.7
Homicide 13.8 6.0
Firearms 2.5 4.9
Fall 2.5 7.0
Fire/Burn 0.0 1.0
Rates are per 100,000 service population CDC WISQAR’S
What are the costs of injury?What are the costs of injury?
Physical LossesPhysical Losses
FinancialFinancial
EmotionalEmotional
TreatmentTreatment
Financial Financial burdenburden of injury of injury
Buzz Group: What injuries affect Buzz Group: What injuries affect YOUR community?YOUR community?
Do these data agree with the injury problem in Do these data agree with the injury problem in your community/region?your community/region?
What are leading causes of severe injury in your What are leading causes of severe injury in your community?community?
Why might these lists look different?Why might these lists look different?
National Injury CostsNational Injury Costs$224 Billion Annually$224 Billion Annually
Cost involvedCost involved– Medical care, rehabilitation, lost wages / productivityMedical care, rehabilitation, lost wages / productivity
Who paysWho pays– Private share 72% (or about Private share 72% (or about $161 Billion$161 Billion))– Public share 28% (or about Public share 28% (or about $63 Billion$63 Billion) )
Federal shareFederal share– $12.6 Billion in medical costs$12.6 Billion in medical costs– $18.4 Billion in disability/death costs$18.4 Billion in disability/death costs
Source: CDC, National Center for Injury Prevention and ControlSource: CDC, National Center for Injury Prevention and Control
Average Cost of Hospitalizations Average Cost of Hospitalizations California, 1996-1997California, 1996-1997
$0$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000
$10,000D
olla
rs
Source: California Department of Health Services
AI/AN Injury CostsAI/AN Injury Costs
IHS Injury Treatment CostsIHS Injury Treatment Costs– InpatientInpatient
» $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility) $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility)
– Contract HealthContract Health» $11,305/inpatient case$11,305/inpatient case» $570/outpatient case$570/outpatient case
One Alaska Corporation (TCC) spent One Alaska Corporation (TCC) spent $4.15 million$4.15 million for for injury hospitalizations from ’94-’98injury hospitalizations from ’94-’98
Sources - (1) Indian Health Focus-Injuries 1998-99 (2) Chandler B, Berger L: Financial Burden of Injury-Related Hospitalizations to an Alaska Native Health System
Cost of Injury Hospitalizations TCC Cost of Injury Hospitalizations TCC 1994-19981994-1998
$0$2,000$4,000$6,000$8,000
$10,000$12,000$14,000$16,000$18,000
Do
llars
Source - Chandler B, Berger L: Financial Burden of Injury-Related Hospitalizations to an Alaska Native Health System
Conceptual Shifts in Injury Conceptual Shifts in Injury PreventionPrevention
Single-cause, Behavioral approach
Multiple-causes, Environmental approach
Multiple-causes, Multiple approaches
“Blaming the victim”
Focus on “engineering out” injuries
Balanced approach
Public Health Public Health ApproachApproach
Define the Problem
•SurveillanceIdentify
Risk Factors
•Who, What?
Source: National Center for Injury Prevention and Control, CDC
Find what Prevents
the Problem
•What Works?
Implement &Evaluate Programs
•Prevention
A Public Health Approach:A Public Health Approach:
Starts with defining the problem and moves Starts with defining the problem and moves toward identifying risk and protective factors. toward identifying risk and protective factors.
It also includes developing, implementing, It also includes developing, implementing, and evaluating injury prevention interventionsand evaluating injury prevention interventions
Financial Financial benefitsbenefits of of injury preventioninjury prevention
Interventions that Interventions that $$aveave Money Money Primary seat belt Primary seat belt
laws/Child Car laws/Child Car SeatsSeats
Streetlights and Streetlights and guardrailsguardrails
Bike helmetsBike helmets
Interventions that Interventions that $$aveave Money Money
DUI LawsDUI Laws Personal Floatation DevicesPersonal Floatation Devices Smoke detectorsSmoke detectors Gun locksGun locks
Safety equipment saves more Safety equipment saves more than lives . . .than lives . . .
Every bike helmet (for kids 4 – 15) saves $395 Every bike helmet (for kids 4 – 15) saves $395 in treatment costsin treatment costs
Every child seat saves $1,360Every child seat saves $1,360 Every smoke detector saves $900Every smoke detector saves $900
References: National Public Services Research Institute /References: National Public Services Research Institute /National SAFE KIDS CampaignNational SAFE KIDS Campaign
Injury Prevention:Injury Prevention: Potential for Cost SavingsPotential for Cost Savings
Victim Treatment costs resulting from each Motor Vehicle Crash:
NOT wearing a seat belt $2,395
Wearing a seat belt $470
Source - Phipps L: Cost Comparison of Medical Treatment for Restrained vs. Unrestrained Motor vehicle crash victims at a northeast Oklahoma IHS hospital (IHS Injury Prevention Fellowship)
Injury Prevention Cost Savings Injury Prevention Cost Savings Projects in Indian Country Projects in Indian Country
Navajo NationNavajo Nation – occupant restraint usage – occupant restraint usage
Whiteriver, AZWhiteriver, AZ – pedestrian crash reduction – pedestrian crash reduction
White Mountain ApacheWhite Mountain Apache – livestock control – livestock control
Y-K Delta, AKY-K Delta, AK – drowning prevention – drowning prevention
Community Cultures/ValuesCommunity Cultures/Values
Extended familiesExtended families Knowledge of community infrastructureKnowledge of community infrastructure Local, non-appointed influential peopleLocal, non-appointed influential people Traditional values and teachingsTraditional values and teachings
Community benefits from injury Community benefits from injury prevention cost savingsprevention cost savings
Elective medical servicesElective medical services– more non-emergent treatments (surgeries, more non-emergent treatments (surgeries,
therapies, preventive services, other programs)therapies, preventive services, other programs)
Resources for additional community servicesResources for additional community services– housing authoritieshousing authorities– transportation programstransportation programs
Using Data to Define Injury ProblemsUsing Data to Define Injury Problems
Data identifies patterns and trendsData identifies patterns and trends
Observation data documents behaviorsObservation data documents behaviors
Interview and Focus Group data can be Interview and Focus Group data can be used to identify knowledge, perceptions, used to identify knowledge, perceptions, and attitudesand attitudes
Collecting and Analyzing Data to Collecting and Analyzing Data to Determine Injury Risk FactorsDetermine Injury Risk Factors
Population at riskPopulation at risk – age, gender, specific groupage, gender, specific group
Location(s) of eventsLocation(s) of events– inside home, road location, at workinside home, road location, at work
Environmental factorsEnvironmental factors– lighting, road conditions, weatherlighting, road conditions, weather
Other factorsOther factors– alcohol use, use of safety devicesalcohol use, use of safety devices
Using Data to Select Using Data to Select Preventive MeasuresPreventive Measures
• Modify the EEnvironment
• EEducate the public
• Enact and EEnforce safety legislation
Using Data to Using Data to EvaluateEvaluate Programs Programs
• Help develop intervention materials
• Analyze effectiveness of methods used
• Use evaluation to improve prevention measures
SummarySummary
• Severity of injuries facing AI/AN communities
• Costs of injury / cost benefits of prevention
• Community benefits of injury prevention
• Public Health Approach to preventing injuries
• Value of data in preventing injury
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