An Ounce of Prevention?

Working Together, Working Smarteran injury prevention stakeholder workshop

March 18, 2010Ian Pike, PhD

BC Injury Research and Prevention UnitDept. of Pediatrics, Faculty of Medicine, UBC

Injury is the fastest growing and least researched of all modern epidemics

World Bank, 2008

Canada’s Invisible EpidemicSMARTRISK Foundation, 2005

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Presentation Outline

The Scope of the Injury Problem in Canada: Some are at Greater Risk

Are we delivering a full ounce of prevention?

Success Stories in Injury Prevention

What can we (in this room) do? How can we work together?

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Injury Definition and Intent

IntentionalInjury

UnintentionalInjury

SelfInflicted

Inflictedby

Others

Mechanisms of Injury:

Motor Vehicle CrashesFallsDrowningPoisoningBurnsChoking and Suffocation

Injury

Damage to the body resulting from the transfer of physical energy(mechanical, thermal, electrical,radiant, chemical) or from the absenceof essential energies (e.g., heat)

Morrongiello, B., 2003

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Why is this necessary?

People are being hurt

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People are being hurt

Why is this necessary?

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Why is this necessary?

People are being hurt

The Scope of the Problem

Silence will not cure a disease. On the contrary; it will make it worse.

Leo Tolstoy

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The Scope of the Problem

Unintentional injuries:

• Kill more Canadians ages 1 to 34 years of age than any other cause

• Kill more Canadian children and youth than all other causes combined

• Are the leading cause of Potential Years of Life Lost

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In just one year• 9,505 Canadians died - 1,097

on-the-job deaths1,2

• 194,268 were hospitalized1

• Over 3.25 million required medical treatment3

• 335,000 on-the-job injury claims - one in every 39 employed workers2

• Over 62,500 disabled3

• 5,000 were left with a total lifelong disability3

The Scope of the Problem

1. PHAC. Injury and Child Maltreatment Section2. Association of Worker’s Compensation Boards of Canada3. SMARTRISK. The Economic Burden of Injury In Canada

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The Scope of the Problem

Unintentional Injury Deaths in Canada

Source: SMARTRISK (2009)The Economic Burden of Injury In Canada. SMARTRISK, Toronto, ON

n = 9,505

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The Scope of the Problem

Unintentional Injury Hospitalizations & Disability in Canada

Source: SMARTRISK (2009)The Economic Burden of Injury In Canada. SMARTRISK, Toronto, ON

n = 194,268

n = 62,500

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The Scope of the Problem

During the next two days of our meeting:

• 52 Canadian will die as a result of injury

• 1,063 will be hospitalized for injury

• 17,800 Canadians will require emergency medical treatment for their injuries

• 356 will be disabled and of those, 27 people will have a total permanent disabled

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The Scope of the Problem

Individual

Family

Community

Employer

Society

Health Care System

The Scope of the Problem

• Annual health-related cost1 $16.0 B($9.5B direct; $6.5B indirect)

• Annual cost of on-the-job injury & death claims2 $ 8.2 B

• Annual cost of MVC injury & death claims3 $10.3 B

During the next 2 days over $180 M will be added to the cost of injury in Canada

Most conservative estimate: $ 52 M (equivalent of $ 18,056 per minute)

1. SMARTRISK (2009) The Economic Burden of Injury In Canada. SMARTRISK, Toronto, ON2. Association of Worker’s Compensation Boards of Canada3. MADD Canada Estimating the Presence of Alcohol and Drug Impairment in Traffic Crashes and their Costs to Canadians:

1999 Review and 2001 Update

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Some are at Greater Risk

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 on a poorly maintained playground next to his

apartment building and there was some sharp broken edges there that he fell on.

But why was he playing on a playground with old, broken equipment?Because his neighbourhood is kind of run down. Lots 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, his Mom is sick and grandma lives with them.

But why is his Dad unemployed?Because he doesn’t have much education and he can’t find a job.

But why...?

Source: Dr Trevor Hancock, BC Ministry of Health Services

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Some are at Greater Risk

Source: Macpherson, A., et al. Injuries in Ontario: ICES Atlas. September, 2005.

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Some are at Greater Risk

RankChildren & Youth

(0-24 yr)Adults

(25-64 yr)Seniors (65+ yr)

1 Motor Vehicle Crashes 36.0%

Unintentional Poisoning

31.5%

Falls37.6%

2Suicide27.0%

Motor Vehicle Crashes19.6%

Motor Vehicle Crashes22.9%

3Homicide

8.2%Suicide18.9%

Fire and Flames8.3%

Causes of Death: First Nations (Western Canada – 2000-2001)

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Some are at Greater Risk

Mental Health

Endocrine & Digestive Diseases

Nervous System

Perinatal Conditions

Digestive Diseases

Cancer

Ill-Defined Diseases

Circulatory

Injury & Poisoning

Infectious Diseases

Respiratory Diseases

First Nations Canada

PYLL and Cause of Death: First Nations and Canada (1999)

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Some are at Greater Risk

Deaths and Mortality Rate due to Falls Ages 65+

*Age standardized to the 1991 Canadian population.Source: Statistics Canada, Deaths Database.

Source: Scott, V., et al. PHAC Technical Report on Seniors' Falls in Canada (section 2.4)

Are we Delivering a fullOunce of Prevention?

Injury Prevention is not for a day, a week, or a 10-week program; but for a lifetime.

First Nations Elder

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Progress is Being Made

• Pan-Canadian Public Health Network Injury Prevention Task Group

• A Vision for Injury Prevention in Canada

• The ‘Nationals’ (SK, TF, SC, SR) collaboration• Canadian Injury Prevention and Control Conference

• Canadian Collaborating Centres on Injury Prevention• National Curriculum delivery / monthly teleconferences

• Research Collaborations• Improved CIHR and other research funding

• Provincial / Territorial governments• Public Health Program requirements• Falls Prevention and Motor Vehicle Crash Prevention

• Local and Regional Initiatives• Often focused on those most at risk

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There is Good News

Injury deaths and hospitalizations in BC(rates per 100,000 population)

Source: BCIRPU On-line Data Tool www.injuryresearch.bc.ca accessed: December 6, 2009

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There is Good News

Source: Institute for Work & Health October 2009 Issue Briefing.Declining trends in young worker injury rates, 2000 to 2007

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Challenges

• National Centre for Injury Prevention• (e.g. national surveillance system, social marketing)

• Dedicated injury research funding• CIHR and Auto 21 are currently the only national funders

• Lacking a Pan-Canadian Strategy for Injury Prevention• Must include strategies to address the needs of the highest risk

groups• Funding is inadequate

• Short-term and devoted to pilots and demonstration projects• Work often done in silos

• Need to develop and maintain strategic Multi-sector, multi-ministry, multi-jurisdiction partnerships

• Not an academic discipline• Injury prevention classes are rare

• General attitude that injuries are inevitable

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Canada Lagging Behind

Injury Deaths per 100,000 Children Ages 1-14 yr in OECD

Countries

1. (Innocenti Report Card No.2, Feb. 2000 UNICEF Innocenti Research Centre, Florence)2. Leitch, K. (2007). Reaching for the Top: A Report by the Advisor on Healthy Children & Youth

Canada: 18th of 26 OECD nations (2000)1

Canada: 22nd of 29 OECD nations (2007)2

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Are we Delivering a fullOunce of Prevention?

• If, an ounce of prevention is worth a pound of cure• And, 1 ounce = 1/16 or 6.25% of 1 pound• Then, one way to evaluate whether we are resourcing injury

prevention appropriately is to ask, • Is 6.25% of total health resources devoted to prevention?

• Since 2005, Public Health spending as a percentage of total health spending has been a little over 6%, reaching 6.6% in 2007, projected to be 6.2% in 2009

• With regard to Injury Prevention, the answer is less clear• Using the most conservative estimate of the cost of

unintentional injury ($9.5B direct cost only), then injury prevention might argue for $594 M per annum

Success Stories

Strive not to be a success,but rather to be of value.

Albert Einstein

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Swimming& Water Safety

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• A volunteer organization, supported by individuals, private, public, academic and governmental organizations committed to increasing water safety and reducing drowning

• Based on 60 years experience and research into why people drown - drowning surveillance system

• Comprehensive education and training program delivered by 3,800 Authorized Providers and partners

• Each year, more than 1,000,000 Canadians enroll and 21,000 are trained and certified as Instructors and Instructor Trainers; millions more are reached through safety campaigns

Success Story

National AssociationOf Coroners

Public Health Professionals

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Toddler Supervision

National Water Safety and Drowning Prevention Program

Prepare! Stay Safe! & Survive!

Ice Safety

Wearing a Lifejacket

Backyard Pool Safety

Boating Safety

Success Story

National Drowning Research and Surveillance Program

Transport Canada's Marine Safety Award for 2009

Trends:10-Year Study on Drowning in Canada

Drowning Reports:Annual Overview & Specific High Risk Issues

Comprehensive Water Safety and Swim Training Program

3,800 Authorized Providers and delivery partners

MOU with Assembly of First Nations

Pleasure Craft Operator

Infants to Adults

Instructors & Instructor Trainers

National AssociationOf Coroners

Public Health Professionals

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Success Story

Why this works• Alignment of mission, vision and values

• “Their accomplishment has had a significant impact on Canadian marine safety - it has helped to prevent injuries and saved lives.”

(Transport Minister John Baird)

• Cultivated Relationship• Intention, trust, respect, listening, understanding of needs

• Quid Pro Quo• Humanitarian mandate met; public health mandates met;

academic curiosity satisfied• Red Cross mandate resourced; Authorized Provider image

improved; quality product needs met; youth employment and volunteer opportunities

• Leveraged• Other partners, supporters and providers – success attracts; new

high risk targets

• Results to point to: 10-year trend - Drowning Deaths deceased some 22%, equivalent to 100 fewer deaths per year

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Success Story

• A group of private businesses, public, academic and governmental organizations committed to reducing cellphone use while driving

• Based on research evidence

• 6 Partners and Current membership list of 26 companies

• All Members have a cellphone policy that states, employees are not permitted to use a cellphone, either hand-held or hands-free, while operating a motor vehicle on company business and/or on company time

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Success Story

Advocate for Legislation – resolution to change Act

Advocate for Company Policy - company toolkit

Educational Resources

Fatal Distraction Video

Research Collection

Presentation Slides

Case Studies/Toolkits

Media Releases

High School Curriculum

High School Chapters

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Why this works• Alignment of mission, vision and values

• At ConocoPhillips Canada …• We believe all incidents are preventable and must be

reported• We believe safety is a critical part of our performance and

cannot be separated from production and costs• We will never compromise safety in the execution of our

business• We will be personally accountable for our safety and the

safety of others(ConocoPhillips website)

• Relationship• Intention, trust, respect, listening, understanding of needs

• Quid Pro Quo• ConocoPhillips business imperative met, image is improved;

Coalition mandate resourced; public health mandate met; academic curiosity satisfied

• Leveraged• Other partners and supporters – success attracts; new target

market

• Results to point to: There are thousands fewer drivers using cellphones while driving

Success Story

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• Multi-sectoral collaboration of representatives from regional/ provincial organizations, academic institutions, professional associations and community agencies who are concerned with the need to reduce the rate, frequency and severity of falls among older persons

• 20 year collaboration focused on preventing fall-related injuries among seniors

• Coincided with key national policy frameworks and campaigns

• Shift away from disease model to one encompassing biological, social, environmental and behavioral factors

Success Story

Public Health Professionals

CommunityOrganizations

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Public Health Professionals

CommunityOrganizations

Training program for community health workers & home health professionalsEnhanced local, regional

and provincial policy & programs Best Practice guidelines

for Assisted Living facilities

Annual Proclamation: Falls Prevention Week

National Falls Prevention Curriculum

Success Story

International level Program of Research and Publication

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Success Story

Why this works

• Alignment with Provincial and Federal Government Strategies

• Healthy Living / Aging Frameworks• Injury Prevention Strategies/Discussion papers • ActNow BC – cross ministry, partnership-based,

community-focused health promotion platform• 2008 Premier’s Award Promoting Innovation and

Excellence

• Cultivated Relationship• Intention, trust, respect, listening, understanding

of needs

• Quid Pro Quo• Government, health authorities and facility

mandates met; public health mandates met; academic curiosity satisfied

• Leveraged• New partners and supporters – success attracts

Direct & Indirect Deaths Due to Falls Among Seniors in BC, by Gender, 1990-2004

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 20040

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Deaths - Women Deaths - Men

Rate - Women Rate - Men

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 20040

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Deaths - Women Deaths - Men

Rate - Women Rate - Men

Deaths - Women Deaths - Men

Rate - Women Rate - Men

Average Annual Decrease = 2.0% (P=0.001)

Average Annual Decrease = 1.1% ( p=0.041)

Average Annual Decrease = 2.0% (P=0.001)

Average Annual Decrease = 1.1% ( p=0.041)Average Annual Decrease = 1.1% ( p=0.041)

Fall-related Hospital Cases & Rates, Ages 65+ in BC, 1995/96 to 2004/05

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1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05

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Cases 65-74 Cases 75-84 Cases 85+ Cases 65+

Rate 65-74 Rate 75-84 Rates 85+ Rates 65+ *

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1995/96 1996/97 1997/98 1998/99 1999/00 2000/01 2001/02 2002/03 2003/04 2004/05

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Cases 65-74 Cases 75-84 Cases 85+ Cases 65+

Rate 65-74 Rate 75-84 Rates 85+ Rates 65+ *

Decline from 18.3 per 1,000 to 15.5 per 1,000 (p<0.001)

• Positive Results to Point to: Reductions in falls deaths and hospitalizations

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Common Success Elements

• Alignment • Vision, mission, values and mandate

• Relationships • Based on Intention, trust, respect, listening, understanding of needs

• Quid Pro Quo• Partners share strengths, resources and capacity to meet collective and

individual needs and mandates

• Leveraged• Additional partners, supporters and resources attracted – success

attracts

• Increased Efficiency and Effectiveness• Better value in the work of the partnership

“Working Together is Working Smarter”

What Can we Do?

If we think or say there is no solution,then we don’t look for one.

First Nations Elder

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What Can we Do?

We see a Canada where injury is understood to be predictable and preventable; where governments, business and non-profit leaders, and academics work together to ensure healthy public policy, enhance community capacity, support individual skills, and take all appropriate action to reduce the likelihood of injury and death.

Injury Prevention Task Group

Vision without action is merely a dream

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What Can we Do?

• Share generously• Offer all of our knowledge, experience and secrets

• Listen carefully• Obtain information, understand, learn, enjoy

• Think creatively and strategically• Creativity is the most important human resource of all.

Without it, there would be no progress • Be open to possibilities and opportunities

• Look for alignment of mission and mandate• Seek to understand

• Asking questions is OK and welcomed• Remember why we are all here

• Reduce injury death and disability, and the loss of potential

Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not!!

Dr. Suess

Thank you