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

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