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Public Health Approach: Success Stories in Injury Prevention

Explore the success stories and history of injury prevention through a public health approach, featuring examples from various fields such as motor vehicle safety, scald prevention, fire-safe cigarettes, and more.

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Public Health Approach: Success Stories in Injury Prevention

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  1. “While We Were Sleeping”Success Stories in Injury PreventionU Cal Press (2009) David Hemenway, PhD Harvard Injury Control Research Center

  2. Injury & Violence Prevention: History & Successes David Hemenway Harvard School of Public Health Safe States Alliance Webinar January 6, 2016

  3. CDC history • Founded in 1946 as: “Communicable Disease Center” to fight malaria

  4. As infectious disease problem lessens, CDC takes on chronic disease (e.g., cancer, heart disease)

  5. Injury in America 1985 report of the IOM Recommends: (1) Establish a center for injury control (2) Funding commensurate with the problem

  6. Unfortunately injury receives only 2% of CDC budget

  7. People use the public health approach: to everything • Antimicrobial resistance • Bereavement • Bullying • Climate change • Cyber security • Education • Fracking • Gambling • Homelessness • Justice reform • Malware propagation • Obesity • Parenting • War

  8. The Public Health Approach

  9. “While We Were Sleeping”Success Stories in Injury PreventionU Cal Press (2009) David Hemenway, PhD Harvard Injury Control Research Center

  10. While We Were Sleeping: 64 documented successes 36 heroes Explain “What is the public health approach?” --and “what is public health?”

  11. The Elves and the Shoemaker

  12. Public Health Approach: One Sentence Description Make it easy for people to stay healthy, difficult to become sick or injured.

  13. The Public Health Approach • Prevention (upstream if possible)

  14. The Public Health Approach • Population based (not named individuals)

  15. The Public Health Approach • Systems Approach

  16. Public Health Approach • Broad and Inclusive (get everyone to help) • Less Blame, more shared responsibility

  17. Motor Vehicle Injuries: CDC calls one of the great public health accomplishment of 20th Century

  18. Motor Vehicles Most motor vehicle crashes are due to driver error (e.g. tired drivers, distracted drivers, angry drivers.)

  19. Policy? Educate and train drivers!

  20. Motor Vehicles Most motor vehicle deaths are associated with clear and deliberate unlawful behavior by motorists (e.g. speeding, drunk driving, running red lights)

  21. Policy? Educate and train drivers!

  22. Public health physicians changed the question: Not, Who caused the crash? But, What caused the injury?

  23. Punchline Nobody thinks drivers today are better than they were in the 1950s: Fatalities per mile driven have fallen 85%

  24. Key Insight: Don’t have to change people Create a system • Hard to make mistakes • Hard to behave inappropriately • If do, no one seriously injured

  25. Dr. William Haddon, Jr (1926-1985) “Where are the studies?”

  26. Haddon Matrix

  27. Haddon Matrix

  28. Graduated Driver Licensing • Crashes of 16 &17 year olds fall ~30% (MI, FL, NC, OH, PA, CA)

  29. Evaluate and Roll OutThird Brake Light 1977-80 Randomized control trial taxicabs telephone company cars Rear-end collisions while braking fall 50%

  30. Collapsible Steering Column • Risk of driver death in frontal crash falls 12%

  31. Highway Crash Cushions • Reduce death in crashes by 70%

  32. Home

  33. Kenneth Feldman, Murray Katcher

  34. Tap Water Scalds • Seattle child scalds fall from 5.5/year in 1970s to 2.3/year in the 1980s

  35. Andrew McGuire

  36. Fire-Safer Cigarettes • New York 2004 • Canada 2005 • California 2006 By 2011, 50 states

  37. Citizens Against Fire Safe Cigarettes

  38. Play

  39. Harvard Football, 1905 In one year, injuries tumble: Fractures 29 to 5 Dislocations 28 to 3 Concussions 19 to 4

  40. Paul Vinger, Tom Pashby

  41. Hockey Eye Injuries 1972: 287 eye injuries 20 blind eyes 2000: 6 eye injuries 1 blind eye

  42. Barbara Barlow

  43. Playground Injuries in Harlem • 1988 2x national average • 1998 ½ national average

  44. Work

  45. Building the Golden Gate Bridge Expected deaths 35+ Actual deaths 11

  46. Violence

  47. DC Metro Murder, rape, robbery, assault 75% lower than in comparable cities

  48. Medicine

  49. Anesthesia From early 1980s to late 1990s, deaths fell 98%!

  50. Models Sweden: Child Injuries

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