1. Injuries as a Public Health Problem Intermediate Injury Prevention Course August 23-26, 2011 Billings, MT

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/ANs ages 1-44 are greatly affected Injuries are very costly to treat

4. Injuries in American Indian and Alaska Native Communities Injuries in American Indian and Alaska Native Communities

5. and All U.S. 1981 - 2005, United States All Injury Deaths and Rates per 100,000 Am Indian/AK Native and All U.S. CDC WISQARS, 1981-2005

6. Fatal Injury Rates Per IHS Area 2007 WA Portland 80.0 Billings 159.9 Aberdeen 122.4 Bemidji 77.2 ORID MT WY ND SD NE MN IA WI MI IN ME NY PA California 33.7 CA NV UT AZ AK CO NM KS OK TX LA MS AL FL SC NC TN Tucson 117.2 Navajo 117.5 Albuquerque 107.9 Oklahoma City 62.3 Nashville 47.4 Phoenix 126.8 Alaska 163.6 Source: National Center for Health Statistics – Vital Statistics Systems – CD WISQARS - Data includes all injury types Rates are per 100,000 service population US All Races Rate: 59.3

7. Leading Causes of Death AI/AN – Ages 1-44, US 2007 CausePercentage Unintentional Injury47.1% Suicide13.7% Homicide7.8% Heart Disease9.8% Liver Disease8.4% Diabetes2.3% Other10.6% CDC WISQARS

8. Leading Causes of Unintentional Injury Death Leading Causes of Unintentional Injury Death AI/AN – Ages 1-44, US 2007 CausePercentage Motor Vehicle52.9% Poisoning21.7% Drowning4.9% Pedestrian –Other2.6% Other12.0% Fire/Burn1.9% Natural Environmental3.3% CDC WISQARS

9. Leading Causes of Unintentional Injury Death Leading Causes of Unintentional Injury Death Billings Area AI/AN – Ages 1-44, US 2007 CausePercentage Motor Vehicle66.0% Poisoning9.4% Drowning7.5% Pedestrian –Other3.8% Other11.3% Fire/Burn1.9% Natural Environmental1.9% CDC WISQARS

10. Leading Causes of Injury Death All ages AI/AN – (2007) Billings Area CauseRateUS Rate Suicide23.911.4 Poisoning27.69.9 MVC69.013.7 Homicide13.86.0 Firearms2.54.9 Fall2.57.0 Fire/Burn0.01.0 Rates are per 100,000 service population CDC WISQARS

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

12. Financial burden of injury

13. Buzz Group 1.Why is cost important? 2.Who would find cost interesting?

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

15. AI/AN Injury Costs IHS Injury Treatment 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 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

16. Financial benefits of injury prevention

17. Interventions that $ave Money Primary seat belt laws/Child Car Seats Primary seat belt laws/Child Car Seats Streetlights and guardrails Streetlights and guardrails Bike helmets Bike helmets DUI Laws DUI Laws Personal Floatation Devices Personal Floatation Devices Smoke detectors Smoke detectors Gun locks Gun locks

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

19. Injury Prevention: Potential 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)

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

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

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

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

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

25. Using Data to Select Preventive Measures E Modify the Environment E Educate the public E Enact and Enforce safety legislation

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

27. 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