Injury Prevention By Heidi J. Kuran Injuries are the greatest single cause of death for Aboriginal people under 45 in Canada. Injuries in Aboriginal communities occur at a much higher rate than in the general Canadian population and have a number of distinct characteristics. The most shocking statistic of all is that among fatal injuries, suicide is the most common cause. Motor vehicle accidents rank second followed by homicides and drowning. 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 intentional or unintentional injuries. (1) + During the 1989-1993 period, the mortality rate among registered Indian youth was about 3.6 times higher than that of other Canadian youth. + About 6.5 percent of all Aboriginal youth reported disabilities, which limited normal daily functioning. The incidence of disability among Aboriginal youth was about 1.7 times higher than among other Canadian youth. + Suicide deaths accounted for nearly one-third of all deaths among registered Indian youth. The rate among registered Indian male youth was more than 5 times that of the Canadian youth rate. Among female youth, the rate of suicide deaths among registered Indians was nearly 8 times that of other Canadian youth. (2) INTENTIONAL INJURIES Intentional injury encompasses injuries and deaths that are self-inflicted or perpetrated by another person. Intentional injuries include: + Suicide / Self-abuse + Family Violence + Homicide / Assault Suicide / Self-abuse According to the report submitted by the Royal Commission on Aboriginal Peoples, the suicide rate among Aboriginals of all age groups is three times higher than that of non-Aboriginal people. The rate of suicide with regards to youth is five to six times higher than non-Aboriginal youth. According to the statistics, 38 percent of all registered Indians in Canada are under the age of fifteen, which means that over the next fifteen years this age group will be passing through the years of greatest risk for suicide. Males represent the greatest risk for suicide with approximately 78% of suicide cases. (3) Contributing factors to suicide + Residential school abuse can be directly linked to suicide attempts and deaths among Aboriginal people. Residential schools created overwhelming feelings of loss, depression and loneliness, all a result of children being taken away from their family and culture. For those who are younger and did not experience residential schools there is often an unfortunate domino-effect, where the results of the residential school experience can be felt generations after the fact, by those who did not directly experience the residential school life. + Culture stress. The Royal Commission on Aboriginal Peoples report defines culture stress as: the loss of confidence by individuals or groups in the ways of understanding life and living (norms, values and beliefs) that were taught to them within their original cultures and the personal or collective distress that may result. In studies done on Aboriginal suicide in British Columbia, it was shown that suicide rates were higher when individuals or communities lost traditional culture and values. (4) + Substance abuse. Studies have examined the correlation between substance abuse and suicide. Statistics show that 60 percent of all Aboriginals who attempt to and succeed in committing suicide are acutely intoxicated at the time, compared to 24 percent of all non-Aboriginal cases.   Family violence Although family violence is a problem throughout Canada, victims of family violence in Aboriginal communities face a number of additional concerns when seeking to escape an abusive environment. Often victims who are forced to leave their community experience the distress of having to abandon their support system, kinship network and cultural roots. (5) Contributing Factors to Family Violence While not causes of family violence, certain factors can contribute to the prevalence of family violence. + Poverty and unemployment - Overcrowded housing, poverty, poor health, chronic unemployment and substandard living conditions can exacerbate tensions within families and perpetuate violence. Similarly, poverty and isolation make it difficult for victims to leave abusive situations. (6) - Alcohol and substance abuse - Residential school legacy of patterns of abuse - Access to information and support - Lack of education Many Aboriginal communities have returned to traditional approaches pipe ceremonies, sweat lodges and talking circles for healing and recovery from abuse. (7) Homicide / Assault There is a prevalence of violent offences such as homicides, assaults, and robbery with Aboriginal people as both perpetrators and victims. According to Statistics Canada, 11.3% of homicide victims and 16.5% of homicide suspects were of Aboriginal origin, even though Aboriginal people comprise about 3% of the Canadian population in 1992. (8) UNINTENTIONAL INJURIES Unintentional injuries are injuries that are accidental and can be preventable. The reality of unintentional injuries is that it costs Canadians more than $8.7 billion dollars per year, approximately $4.2 billion of which is spent on health care, and $4.5 billion representing loss of productivity associated with disability and premature death (9). Unintentional injuries can include the following: + Poisonings + Motorized vehicle accidents + Drowning deaths + Fall-related injuries and deaths + Residential fire deaths + Head injuries + Spinal cord injuries + Sports related injuries The three most common unintentional injuries in Aboriginal communities are poisoning, motor vehicle accidents and drowning. Poisoning / Substance abuse Substance abuse is often encountered in aboriginal communities which can contribute to accidental poisoning from overdose. Historically, the Aboriginal population has had a poorer health status than the non-Aboriginal population. First Nations and Inuit people were up to about 6.5 times more likely than the total Canadian population to die of injuries and poisonings. The mortality rate attributed to injuries and poisonings was higher in men in both populations. Motorized vehicle accidents Motorized vehicle accidents account for approximately 40% of unintentional injuries among Aboriginal people. Aboriginal people are about four times more likely to die in a motor vehicle accident than non-Aboriginal people. This includes accidents involving ATVs, motor-cycles, and skidoos. Lack of seatbelt wearing is a problem in many communities because many Aboriginal people live in rural areas and enforcement rates are low for seatbelt wearing infractions on reserve. Many people on reserve do not wear seatbelts because they do not believe that seatbelts will actually save them. In the general Canadian population approximately 90% wear seatbelts regularly. On some reserves, the rate can approximately 54% or lower. Alcohol plays a major role in motor vehicle accidents. The National Survey on Drinking and Driving reported that in fatal crashes involving young Aboriginal males, more than 80% of the drivers had been drinking. Drowning Drowning accounts for the highest number of unintentional injury deaths among children in Canada. In 46% of drowning involving boating activities, alcohol was involved. In 71% of all drowning accidents, the victim was not wearing a proper personal floatation device. In Canada, the Aboriginal population is at particularly high risk; it is the third most common cause of death among all Aboriginal people and in some northern communities the number of boating-related drownings exceeds the number of motor vehicle fatalities.(10) There remains a need for developing programs that involve Aboriginal people that answer the following questions: What will they gain from injury prevention? What is the vision and plan for injury prevention? What are the resources that will develop it? Aboriginal communities must continue working in partnership with local injury prevention organizations to develop culturally appropriate awareness programs about the other causes of death by injury that are at issue in Aboriginal communities. On a positive note, between the years 1979-1994, death from injury slowly came down nationally and continues to do so, but in Aboriginal communities it must come down even faster. For more information about Injury Prevention please read "In Touch", Volume 7, Number 3 Winter Issue 1997. This entire magazine was devoted to the issue of Injury Prevention in Aboriginal communities.