BY EVERY MEASURE. Opportunities in Injury Prevention Across the Lifespan. Grant Baldwin, PhD, MPH. October 1, 2013

Transcription

1 BY EVERY MEASURE Opportunities in Injury Prevention Across the Lifespan Grant Baldwin, PhD, MPH October 1, 2013 National Center for Injury Prevention and Control Division of Unintentional Injury Prevention

2 Michigan Stadium

3 Universal WHYs NUMBERS BELIEF STORIED OPPORTUNITY WHY for Public Health CORE TENET

4 The Public Health Approach to Prevention Assess the Problem What s the problem? Identify the Causes Why did it happen? Implementation & Dissemination How do you do it? Develop & Evaluate Programs & Policies What works?

5 A Multilevel Approach to Epidemiology

6 Change the Context Frieden Pyramid Increasing Population Impact Counseling & Education Clinical Interventions Long-lasting, Protective Interventions Changing the Context to Make Individuals Default Decisions Healthy/Safe Increasing Individual Effort Needed Socioeconomic Factors Frieden, TR. A Framework for Action: The Public Health Pyramid. American Journal of Public Health,2010 ;100(4),

7 Lifecourse

8 WHY #1: Numbers 180,000+ deaths 29 million ED visits 2.8 million hospitalizations $406 billion in medical & work loss costs

9 United States - 10 Leading Causes of Death

10 Number of Deaths Injury Deaths Compared to Other Leading Causes of Death for Persons Ages 1-44, United States, ,000 80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 0 Injury Non-Communicable Diseases Infectious Diseases Note: Injury includes unintentional injury, homicide, suicide, legal intervention, and those of undetermined intent. Non-communicable diseases include cancer, cardiovascular, kidney, respiratory, liver, diabetes, and other diseases. Infectious diseases include HIV, influenza, pneumonia, tuberculosis, and other infectious diseases. Data Source: National Vital Statistics System using CDC Wonder (

11 Preventing motor vehicle injuries and deaths is a CDC Winnable Battle Tobacco use Nutrition/obesity (including food safety) HIV Healthcare-associated infections Motor vehicle crashes Teen pregnancy

12 WHY #2: Belief It should be a HUMAN RIGHT for everyone to live safe and injury free.

13 WHY #3: Storied Opportunity Potential to Save a Life Tragic loss and suffering of every injury

14 WHY #4: Core Tenet Science in Action to Protect and Promote Health for the Greatest Good for the Greatest Number of People

15 CDC Injury Center CHILD INJURY PREVENTION

16 Kayleigh Armstrong Photo: NOT Kayleigh Armstrong

17 07/11/2011

18

19 Unintentional Injury Deaths (2009) and 10 Year Trends ( ) among U.S. Children 0-19 SOURCE: CDC Vital Signs, 2012

20 SOURCE: CDC Vital Signs, 2012

21 Unintentional Injury Death Rate among Children 0-14 Selected Countries U.S. rate is over FOUR times the rate of country with the best rate SOURCE: Global Health Observatory Data Repository, 2008

22 Child Injury Death Rates* by State U.S., US rate = NA * Per 100,000 population

23 CDC s Role Identify and share tools and strategies to prevent injuries and support organizations and individuals in their implementation. Protect the Ones You Love World Report on Child Injury Prevention & CDC Childhood Injury Report

24 Development of NAP

25 National Action Plan for Child Injury Prevention: Goals Raise awareness Highlight prevention solutions Mobilize action

26 A Framework for Action Data & Surveillance Research Communication Education & Training Health Systems & Health Care Policy

27 Implementation of the NAP Strengthen collaboration of key stakeholders. Provide tools for the field to improve data and consistency in program execution. Showcase the promise of evidencebased programs on high burden topics. Build capacity in hospital settings and among employer networks.

28 Linked Lives

29 CDC Injury Center: MOTOR VEHICLE INJURY PREVENTION

30 Motor Vehicle Injury Prevention Motor vehicle crashes killed more than 33,000 people in Related injuries send more than 4 million people to EDs every year. In 2005, crash-related injuries and deaths cost $99 billion in medical and work loss costs. 2010, NHTSA Traffic Safety Facts

31 Age-adjusted Rate per 100,000 7 Fold Variation in Age-Adjusted Motor Vehicle Death Rate by State States with lowest rates tend to have stronger laws, but the relationship is not that simple State Source: CDC, NCIPC, Office of Statistics and Programming, WISQARS. Data Source: CDC, NCHS, National Vital Statistics System.

32 Percent Restraint use, alcohol, and speeding are key risk factors in the United States Year All Three Source: NHTSA Traffic Safety Facts

33 Public Health Leadership to Keep People Safe on the Road Everyday.

34 CDC focuses on THREE high-impact areas Seat belts & child passenger safety Teen driver safety Alcohol-impaired driving

35 Tyreic Elyja Hemphill Source: WRAL, Durham Sept 21, 2013

36 POLICY SOLUTION: Graduated Driver Licensing Systems GDL systems address the high risks faced by new drivers by first granting privileges in phases. Key restrictions: limits on nighttime driving limits on the number of teen passengers Comprehensive GDL laws are associated with 38% reductions in fatal among 16-year-old drivers.

37 Parents are the Key

38 Leveraging Areas of Strength Regulatory & public safety agency Advancing injury prevention policies, programs, & practices Enforcing safety standards Overseeing highway safety grants Data-driven behavioral & safety research Regulations & enforcement Public health agency Strengthening science base Engaging public health community Interdisciplinary research Translating data into evidencebased programs & policies Global road safety leadership

39 Building Partnerships Explore opportunities to work collaboratively with other federal, state and local partners, and NGOs

40 Human Agency

41 CDC Injury Center TBI PREVENTION

42 Per 100, Falls and motor vehicle crashes are the leading causes of TBI Years Falls Struck by/against Motor vehicle Assault Age group (years) Faul, M et al. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2010

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44 Where are we now?

45 Zack Lystedt Source:

46 Time & Place

47 CDC Injury Center OLDER ADULT FALL PREVENTION

48 A Worsening Problem More than 1/3 of all adults 65+ falls down each year. Every 15 seconds an older adult goes to the emergency department because of a fall. Fall-related hospitalizations are on the rise. Over 19,000 deaths in 2008 Direct medical costs = $28.2 billion

49 Fall Risk Factors Biological Behavioral Environmental Age Previous falls Female sex Muscle weakness Poor balance/ coordination Chronic conditions Poor vision Multiple or psychoactive medications Inactivity Poor nutrition Inappropriate footwear Risky behaviors Lack of stair handrails or bathroom grab bars Poor lighting Obstacles and tripping hazards Slippery or uneven surfaces

50 Improving Prevention in Health Care Five Key Drivers Reduce practice variability Engage the entire care team Build accountability through IT support Remain patient centered Support innovation & evalution

51 Strategies to Preventing Falls Among Older Adults Clinical risk assessment, treatment management, and referral Exercise or physical therapy programs for balance and strength AGS, Clinical Practice Guidelines, 2010 USPSTF Clinical Guideline, 2010

52 CDC Compedium and User Guide

53 Return on Investment of Falls Prevention Programs Tai Chi Moving for Better Balance $1.60 return on a $1 investment in direct medical costs Stepping On Fall Prevention Program $70 return on a $100 investment in direct medical costs Otago Exercise Program delivered to persons aged 80 and older $1 return on a $1 investment in direct medical costs

54 Patient self risk assessment Provider guide on how to conduct risk assessment of patient Provider guide on patient treatment Provider guide on patient referral Guide will be used to integrate primary care with community based programs

55 Stay Independent A validated self-risk assessment brochure Rubenstein, J Safety Res, 2011

56 Talking with Patients Based on Stages of Change

57 Gait & Balance Assessment Tools

58 Timing

59 We are the bows from which future generations as living arrows are sent forth. ~ adapted from Khalil Gibran For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: cdcinfo@cdc.gov Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Photo attribution provided upon request. National Center for Injury Prevention and Control Division of Unintentional Injury Prevention