1. KINE 4565 Social class and injury

2. This week The broad determinants of health The relationship between injury and socio- economic status Student presentations

3. Broad determinants of health For many years, health has been defined as “not merely the absence of disease” Other factors determine health status One of the important factors related to health status is socio-economic status

4. The broad determinants of health Income and Social Status People's health is affected by how big a difference in income distribution there is between the richest and poorest members of the society. When these differences are big, people with lower income and social status have less control and fewer choices in their lives. Social Support Networks People need support to be able to handle difficult situations and to feel that they have some control over their lives. These networks can include their family, friends, and community. Education Education gives people the knowledge and skills they need to make healthy choices, to have a better income and more job security, and to participate in their community.

5. The broad determinants of health Employment and Working Conditions People are healthiest when they have control over work and working conditions. Their health also benefits when they feel that the work they do is important, that their job is secure, and that their workplace is safe and healthy. Indoor and Outdoor Environments Clean air and water, safe houses, communities, workplaces and roads all contribute to good health.

6. The broad determinants of health (continued) Genetics Our genetic makeup plays a part in deciding how long we live, how healthy we'll be and how likely we are to get certain illnesses. Personal Health Practices and Coping Skills Personal practices include whether a person eats well and is physically active, and whether they smoke or drink. Coping skills refer to the way in which we relate to the people around us and handle life's challenges and stresses. Development of Healthy Children People's health throughout their lifetime is affected by prenatal care, and by the kinds of care and experiences they have in early childhood.

7. The broad determinants of health (continued) Health Services It benefits people's health when they have access to health services that prevent disease, as well as maintain and promote health. Gender Men and women get different kinds of diseases and conditions at different ages. They also tend to have different income levels, and to work at different kinds of jobs. Many of these realities result from the differences in the way society treats men and women. Culture People's customs and traditions, and the beliefs of their family and community all affect their health, because these factors will influence what they think, feel, do and believe to be important.

8. What is socioeconomic status? Defined as a hierarchical continuum according to prestige, lifestyles, and values which define a person’s position in society. From Last, J. A Dictionary of Epidemiology

9. Determinants of Health What Makes Canadians Healthy or Unhealthy? This deceptively simple story speaks to the complex set of factors or conditions that determine the level of health of every Canadian. "Why is Jason in the hospital? Because he has a bad infection in his leg. But why does he have an infection? Because he has a cut on his leg and it got infected. But why does he have a cut on his leg? Because he was playing in the junk yard next to his apartment building and there was some sharp, jagged steel there that he fell on. But why was he playing in a junk yard? Because his neighbourhood is kind of run down. A lot of kids play there and there is no one to supervise them. But why does he live in that neighbourhood? Because his parents can't afford a nicer place to live. But why can't his parents afford a nicer place to live? Because his Dad is unemployed and his Mom is sick. But why is his Dad unemployed? Because he doesn't have much education and he can't find a job. But why...?" - from Toward a Healthy Future: Second Report on the Health of Canadians

10. How are SES and injury related? Many studies have shown a relationship between SES and childhood injury mortality For example, Roberts et al reported that the odds of a child in the lowest social class in the UK dying from an injury was 5 times higher than children in the highest social class Morrison et al reported a mortality risk ratio of 2.3 between the lowest and highest SES quintiles in Scotland

11. The 3 ‘Es” of injury prevention Education: Let people know that something is associated with injury so they can change their behaviour Engineering: Make products safer Enforcement: Make laws that require people to comply

12. How are the 3 E’s associated with SES Education: Education appears to work best with people who have higher educational levels Engineering: Works equally for all Enforcement: May work equally for all

13. One example: bicycle helmet laws and neighbourhood SES (enforcement) Does legislation have a long-term effect on helmet use?

14. Methods  One urban Toronto Health district (population 100,000) divided into 5 areas based on census tracts  Low, medium and high SES based on census data from Statistics Canada  Child cyclists observed at 112 pre-selected sites  Schools, parks, residential streets, and intersections  Same sites studied annually from 1993-1997, 1999 and 2001  One urban Toronto Health district (population 100,000) divided into 5 areas based on census tracts  Low, medium and high SES based on census data from Statistics Canada  Child cyclists observed at 112 pre-selected sites  Schools, parks, residential streets, and intersections  Same sites studied annually from 1993-1997, 1999 and 2001

15. Rationale Previous studies have focused on short-term (1-3 years) effects of legislation No Canadian study has examined legislation and helmet use 6 years post-legislation Previous studies have focused on short-term (1-3 years) effects of legislation No Canadian study has examined legislation and helmet use 6 years post-legislation

16. Methods  Proportion of helmeted cyclists reported: -by year -by SES of observed census tract  Proportion of helmeted cyclists reported: -by year -by SES of observed census tract

17. Results: helmet use by children

18. Percent of helmeted children by SES legislation enacted

19. Implications Legislation does remain effective 6 years later, but only for children in high SES Helmet use falls to pre-legislation levels in low and mid-income neighbourhoods Legislation does remain effective 6 years later, but only for children in high SES Helmet use falls to pre-legislation levels in low and mid-income neighbourhoods

20. Close Conclusion Socioeconomic status is an important component of injury research There are implications for approaches to injury prevention Interventions may work differently for different populations