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Injuries as a Public Health Problem

Injuries as a Public Health Problem. Intermediate Injury Prevention Course Billings, Montana August 2011. Session Objectives. Severity of injuries facing AI/AN communities Costs of injury / cost benefits of prevention Community benefits of injury prevention

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Injuries as a Public Health Problem

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  1. Injuries as a Public Health Problem Intermediate Injury Prevention Course Billings, Montana August 2011

  2. Session Objectives • 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

  3. 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

  4. Injury Types • Unintentional Injury • falls, motor vehicle crashes, drowning, fire/burn, bicycle, off-road vehicles, • Intentional Injury • Suicide or attempt • homicide & assault • child/elder abuse

  5. What Injuries Are Not • Injuries are not accidents! • They do not happen by chance. • They are not random acts.

  6. Swift River Rescue

  7. “An ounce of prevention is worth a pound of cure.”

  8. 1981 - 2006, United StatesAll Injury Deaths and Rates per 100,000Am Indian/AK Native and All U.S. CDC WISQARS, 1981-2006

  9. Injury Severity • Fatal Injury • Injury that results in death of the victim • Severe Injury • Injury that results in a hospital stay • Ambulatory Injury • Less severe injuries that do not require a hospital visit

  10. Fatal Injury Rates Per IHS Area US All Races Rate: 52.2 Portland 119.5 Billings 168.4 Aberdeen 174.0 Bemidji 164.1 WA MT ND MN OR ID WI SD ME WY MI IA NY NE IN PA NV UT CO Nashville 81.5 California 70.9 CA KS Oklahoma City 87.8 AZ NM NC OK TN SC AL Phoenix 156.1 MS Tucson 166.1 TX LA Navajo 170.2 FL AK Albuquerque 120.6 Source: Indian Health Focus - Injuries US DHHS Data includes all injury types Rates are per 100,000 service population Alaska 185.1

  11. Leading Causes of Injury Death All ages AI/AN – (2007) Billings Area Rates are per 100,000 service population CDC WISQAR’S

  12. What are the costs of injury? • Physical Losses • Financial • Emotional • Treatment

  13. Financialburden of injury

  14. Buzz Group: What injuries affect YOUR community? • Do these data agree with the injury problem in your community/region? • What are leading causes of severe injury in your community? • Why might these lists look different?

  15. National Injury Costs$224 Billion Annually • Cost involved • Medical care, rehabilitation, lost wages / productivity • Who pays • Private share 72% (or about $161 Billion) • Public share 28% (or about $63 Billion) • Federal share • $12.6 Billion in medical costs • $18.4 Billion in disability/death costs Source: CDC, National Center for Injury Prevention and Control

  16. Average Cost of Hospitalizations California, 1996-1997 Source: California Department of Health Services

  17. AI/AN Injury Costs • IHS Injury Treatment Costs • Inpatient • $1507/day (Medicaid reimbursement rate for 1 day at an IHS facility) • Contract Health • $11,305/inpatient case • $570/outpatient case • One Alaska Corporation (TCC) spent $4.15 million for injury 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

  18. Cost of Injury Hospitalizations TCC 1994-1998 Source - Chandler B, Berger L: Financial Burden of Injury-Related Hospitalizations to an Alaska Native Health System

  19. Conceptual Shifts in Injury Prevention Single-cause, Behavioral approach “Blaming the victim” Multiple-causes, Environmental approach Focus on “engineering out” injuries Multiple-causes, Multiple approaches Balanced approach

  20. Prevention Implement & Evaluate Programs • What Works? Find what Prevents the Problem • Who, What? Identify Risk Factors • Surveillance Define the Problem Public Health Approach Source: National Center for Injury Prevention and Control, CDC

  21. A Public Health Approach: Starts with defining the problem and moves toward identifying risk and protective factors. It also includes developing, implementing, and evaluating injury prevention interventions

  22. Financialbenefits of injury prevention

  23. Interventions that $ave Money • Primary seat belt laws/Child Car Seats • Streetlights and guardrails • Bike helmets

  24. Interventions that $ave Money • DUI Laws • Personal Floatation Devices • Smoke detectors • Gun locks

  25. Safety equipment saves more than lives . . . • Every bike helmet (for kids 4 – 15) saves $395 in treatment costs • Every child seat saves $1,360 • Every smoke detector saves $900 References: National Public Services Research Institute / National SAFE KIDS Campaign

  26. Injury Prevention:Potential for Cost Savings Victim Treatment costs resulting from each Motor Vehicle Crash: NOT wearinga seatbelt$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)

  27. Injury Prevention Cost Savings Projects in Indian Country • Navajo Nation – occupant restraint usage • Whiteriver, AZ – pedestrian crash reduction • White Mountain Apache – livestock control • Y-K Delta, AK – drowning prevention

  28. Community Cultures/Values • Extended families • Knowledge of community infrastructure • Local, non-appointed influential people • Traditional values and teachings

  29. Community benefits from injury prevention cost savings Elective medical services more non-emergent treatments (surgeries, therapies, preventive services, other programs) Resources for additional community services housing authorities transportation programs

  30. Using Data to Define Injury Problems • Data identifies patterns and trends • Observation data documents behaviors • Interview and Focus Group data can be used to identify knowledge, perceptions, and attitudes

  31. Collecting and Analyzing Data to Determine Injury Risk Factors • Population at risk • age, gender, specific group • Location(s) of events • inside home, road location, at work • Environmental factors • lighting, road conditions, weather • Other factors • alcohol use, use of safety devices

  32. Using Data to Select Preventive Measures • Modify the Environment • Educate the public • Enact and Enforce safety legislation 3 E's

  33. Using Data to Evaluate Programs • Help develop intervention materials • Analyze effectiveness of methods used • Use evaluation to improve prevention measures

  34. Summary • 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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