INJURY PREVENTION

Volume 7 Number 3
Winter Issue, 1997

NEW APPROACHES TO INJURY PREVENTION

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For CHRs, these stories are depressingly familiar. Studies show aboriginal people in Canada have one of the highest accidental and violent death rates in the world. Compared to other Canadians, they are four times more likely to die from injuries. According to statistics gathered in 1992, injuries were the greatest single killer of aboriginal people, ahead of heart disease, cancer and respiratory illnesses.

The toll is even higher when looked at from the point of view of Potential Years of Life Lost (PYLL). This formula determines the number of years of life lost because an individual died before the normal life expectancy. Because injury deaths prey so heavily on the young, injuries cause more than three times the PYLL than any other single cause of death.

Injuries in Aboriginal communities not only occur at a much higher rate than in the general Canadian population, they have a number of distinctive characteristics. The most disturbing of these, as Table 1 shows, is that suicide is the greatest single cause of fatal injuries, followed by motor vehicle accidents, homicides and drownings.

It should also be kept in mind that these statistics are for fatalities only. In the field of injury prevention, they are the tip of a very large iceberg. For every death from injury, there are an estimated 40 hospital admissions and 1,300 clinic or emergency room visits.

For those, like CHRs, charged with protecting the health and well-being of aboriginal people, the sheer size of the numbers can seem daunting. But on the hopeful side, studies also suggest that injury prevention is the single most promising area of reducing mortality rates in Aboriginal communities.

New Theories, Strategies, Give CHRs New Tools

In the past, prevention programs have been hampered by the perception of injuries as unavoidable, or as a result of behaviours that were extremely difficult to change. One study also suggested that action in Aboriginal communities has also been complicated by the "ethic of non-interference." But as communities have been taking their present -- and futures -- into their own hands, they have been actively looking for ways to reduce harm to their members.

In the field of injury prevention, they are aided by a new approach that focuses not only on the injury event, but on the risk factors surrounding it. Rather than simply preaching caution or behaviour change, injury prevention now emphasizes eliminating or reducing risk factors for both unintentional injuries (accidents) and intentional injuries (assaults, homicides, suicides). For CHRs, this means new tools for promoting the health and well-being of community members.

The pioneer in this new approach was Dr. William Haddon, an engineer and physician who brought both disciplines to his injury prevention research. He identified what he called the "injury triangle," which includes the host (person injured), the agent (thing or person injuring) and the environment (the overall setting where the injury takes place). To each of these corners of the injury triangle, he looked for risk factors in the "pre-event," "event" and "post-event" phases of injury events. When a pattern of risk factors emerged, Dr. Haddon outlined ten practical measures injury prevention workers can use for reducing or eliminating them (see Haddon's Ten Prevention Strategies or Countermeasures).

A simple example is provided by a rash of house fires in a community. One may have been caused by a youngster playing with matches, another by someone smoking in bed, a third by a sooty stovepipe. In the past, an injury prevention program would have focused simply on the agents of the fires -- playing with matches, smoking in bed, sooty stovepipes -- and the program would have taken the form of a general information campaign warning people to keep matches away from children, not smoke in bed and clean out stovepipes.

While such campaigns are valuable, they generally have limited success when used in isolation because they require people to permanently change their behaviour. Injury prevention workers have observed that the likelihood that a measure will result in protection depends on the frequency and amount of effort required from an individual.

Dr. Haddon's method looks for common risk factors in the three fires that could be addressed in more concrete ways. For example, in examining the environment (setting) of the pre-event phases, you might discover that two of the houses lacked smoke detectors and in the third house, the smoke detector wasn't working because the batteries were dead. A prevention program might then focus on ensuring people in the community had functioning smoke detectors by distributing them free to community members and carrying out annual inspections to ensure they were in working order.

Similarly, with injuries to children in automobile accidents, the leading risk factors in the environment phase are the lack of child safety seats, or safety seats that have been improperly installed. Some Aboriginal communities have addressed this problem with active campaigns to loan or rent safety seats to families with young children. In both cases, changes to the environment lead to a reduction in the number or severity of injuries.

HADDON'S
TEN PREVENTION STRATEGIES OR COUNTERMEASURES

The following are Dr. William Haddon's strategies for injury prevention. The one chosen will depend on a combination of practicality and effectiveness. For example, number "1" would generally be the most effective method of injury prevention, but it is not often practical. If this is the case, simply move down the list to find the measures that may be effective in the circumstances.

Injury Prevention in Aboriginal Communities

In applying Haddon's and other injury prevention techniques, it is essential that the special nature of Aboriginal life and culture be taken into account. The most thorough survey of community injury prevention needs today is being carried out in Northern Saskatchewan where three communities are assembling a team of frontline workers to do a detailed survey of injuries in their communities. When the survey is complete and risk factors analyzed, they will put the appropriate prevention programs in place (see Mapping Trouble in Northern Saskatchewan).

Another approach to injury prevention is to focus on an area of current community concern. For example, a community that has recently had a number of drownings will be interested in setting up a water safety program. A community that has suffered through one or more teen suicides will welcome a program designed to prevent further deaths among their young.

When an injury area has been targeted, the most effective way to launch a prevention campaign is to form a coalition of community members. In our house fire example, the coalition might include the CHR, a member of the band council and someone in the community responsible for fire prevention.

In the case of teenage suicide, an injury prevention coalition might include the CHR, a local mental health professional, alcohol and drug abuse workers, community leaders and, if possible, teenagers who have been motivated to become involved in the issue by the loss of friends or family. (See Developing Effective Injury Prevention Coalitions.)

In this issue of In Touch, we will be looking in more detail at the main causes of intentional and unintentional injury among Aboriginal people and at some local prevention programs where the new approaches are being put into effect. Along with the Saskatchewan surveillance project, we will profile Healing the Family Circle, a family violence prevention project in Kahnawake, and a suicide prevention project in Big Cove, New Brunswick. It is in these living examples where we can most clearly see that injury prevention does not occur in a vacuum. It is, as the Royal Commission on Aboriginal Peoples observed, an essential part of the overall effort "to rebuild the social, cultural and economic foundations of the communities" -- and this begins with efforts to "strengthen the bonds of care and mutual support" among Aboriginal people.

 

Developing Effective Injury Prevention Coalitions:
An Eight-Step Guide

1. Analyze the program's injury prevention objectives and determine whether to form a coalition.
2. Recruit the right people.
3. Devise a set of preliminary objectives and activities for the coalition.
4. Convene the coalition.
5. Anticipate the necessary resources.
6. Weigh elements of a successful structure. There are six issues to consider: coalition life expectancy, meeting frequency and length, official recognition by members' organizations, decision-making process, meeting agendas and participation between meetings.
7. Maintain coalition vitality. Watch for problems yourself, maintain open communication with members so that problems surface quickly, and encourage and share successes.
8. Make improvements through evaluation. Coalition-building is hard, labour-intensive work. Ask for feedback from coalition members.

Source: Prevention Program - Developing Effective Coalitions.

1. Cited in Injury Prevention News, Vol. 8 No. 2, February/March 1995, p.2.
2. Injury Prevention News, Vol. 8 No. 2, February/March 1995, p.14.
3. Injury Prevention: A Guide for Aboriginal Communities, Injury Prevention Centre, 1995, p.8.
4. Leading Cause of People Years of Life Lost, First Nations, 1993, Health Program Analysis, Health Information Library, Medical Services Branch.
5. Injury Prevention News, Vol 8 No. 2, February/March 1995, p.15.
6. Prevention of Injuries Among Aboriginal People: Final Report -- Interdisciplinary Working Group of Injury Prevention, Executive Summary.
7. Cited in Injury Prevention News, Vol. 8 No. 2, February/March 1995, p. 7.

copyright © 1997 NIICHRO 05/01/98