Healthy People 2010 - With Annotations
Injury and Violence Prevention
Lead Agency: Centers for Disease Control and Prevention
Reduce injuries, disabilities, and deaths due to unintentional injuries and violence.
The risk of injury is so great that most persons sustain a significant injury at some time during their lives.(1) Nevertheless, this widespread human damage too often is taken for granted, in the erroneous belief that injuries happen by chance and are the result of unpreventable accidents. In fact, many injuries are not accidents, or random, uncontrollable acts of fate; rather, most injuries are predictable and preventable.(2)
Issues and Trends
In 1997, 149,691 Americans died from injuries due to a variety of causes such as motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drownings. About 400 persons die from injuries each day, including 55 children and teenagers. One death out of every 17 in the United States results from injury.(3) Of these deaths, 67 percent are classified as unintentional and 33 percent as intentional. Unintentional injury deaths include approximately 42,000 resulting from motor vehicle crashes per year. In 1997, of approximately 50,000 intentional injury deaths, almost 31,000 were classified as suicide and nearly 20,000 as homicide.(1) In 1997, injuries accounted for 20 percent more years of potential life lost (YPPL) than cancer did (1,990/100,000 compared to 1,500/100,000).(4)
For ages 1 through 44 years, deaths from injuries far surpass those from cancer—the overall leading natural cause of death at these ages—by about 3 to 1. Injuries cause more than two out of five deaths (43 percent) of children aged 1 through 4 years that is four times the number of deaths due to birth defects, the second leading cause of death for this age group. For ages 15 to 24 years, injury deaths exceed deaths from all other causes combined from ages 5 through 44 years. For ages 15 to 24 years, injuries are the cause of nearly four out of five deaths. After age 44 years, injuries account for fewer deaths than other health problems, such as heart disease, cancer, and stroke. However, despite the decrease in the proportion of deaths due to injury, the death rate from injuries is actually higher among older persons than among younger persons.
Injuries are often classified on the basis of events and behaviors that preceded them, as well as the intent of the persons involved. For example, many injuries are preceded by alcohol consumption in amounts or circumstances that increase risk of injury.(5) Although the events leading to an intentional and unintentional injury differ, the outcomes and extent of the injury are similar.
Unintentional Injury Prevention
More persons aged 1 to 34 years die as a result of unintentional injuries than any other cause of death. Across all ages, 95,644 persons died in 1997 as a result of unintentional injuries. Motor vehicle crashes account for approximately half the deaths from unintentional injuries; other unintentional injuries rank second, and falls rank third, followed by poisonings, suffocations, and drownings.(6)
Additional millions of persons are incapacitated by unintentional injuries, with many suffering lifelong disabilities. These events occur disproportionately among the young and the elderly. In 1995, 29 million persons visited emergency departments (EDs) as a result of unintentional injuries.(7)
Although the greatest impact of injury is in human suffering and loss of life, the financial cost is staggering. Included in the costs associated with injuries are the costs of direct medical care and rehabilitation as well as lost income and productivity. By the late 1990s, injury costs were estimated at more than $224 billion annually, an increase of 42 percent over the 1980s.(8) As with other health problems, it costs far less to prevent injuries than to treat them. For example:
- Every child safety seat saves $85 in direct medical costs and an additional $1,275 in other costs.
- Every bicycle helmet saves $395 in direct medical costs and other costs.
- Every smoke detector saves $35 in direct medical costs and an additional $865 in other costs.
- Every dollar spent on poison control centers saves $6.50 in medical costs.(9)
Several themes become evident when examining reports on injury prevention and control, including acute care, treatment, and rehabilitation. First, unintentional injury comprises a group of complex problems involving many different sectors of society. No single force working alone can accomplish everything needed to reduce the number of injuries. Improved outcomes require the combined efforts of many fields, including health, education, transportation, law, engineering, and safety sciences. Second, many of the factors that cause unintentional injuries are closely associated with violent and abusive behavior. Injury prevention and control addresses both unintentional and intentional injuries.
Violence and Abuse Prevention
Violence in the United States is pervasive and can change quality of life. Reports of children killing children in schools are shocking and cause parents to worry about the safety of their children at school. Reports of gang violence make persons fearful for their safety. Although suicide rates began decreasing in the mid 1990s, prior increases among youth aged 10 to 19 years and adults aged 65 years and older have raised concerns about the vulnerability of these population groups. Intimate partner violence and sexual assault threaten people in all walks of life.
Violence claims the lives of many of the Nation’s young persons and threatens the health and well-being of many persons of all ages in the United States. On an average day in America, 53 persons die from homicide and a minimum of 18,000 persons survive interpersonal assaults. Each day 84 persons complete suicide and as many as 3,000 persons attempt suicide. See Focus Area 18. Mental Health and Mental Disorders.(10)
Youth continue to be involved as both perpetrators and victims of violence. The elderly, females, and children continue to be targets of both physical and sexual assaults, which are frequently perpetrated by individuals they know. Examples of general issues that impede the public health response to progress in this area include the lack of comparable data sources, lack of standardized definitions and definitional issues, lack of resources to adequately establish consistent tracking systems, and lack of resources to fund promising prevention programs.
Because national data systems will not be available in the first half of the decade for tracking progress, one subject of interest, maltreatment of elders, is not addressed in this focus area's objectives. The maltreatment of persons aged 60 years and older is a topic for research and data collection for the coming decade.
While every person is at risk for injury, certain types of injuries appear to affect some groups more frequently. American Indians or Alaska Natives have disproportionately higher death rates from motor vehicle crashes, residential fires, and drownings. In addition, their death rates are about 1.75 times higher than the death rate for the overall U.S. population. Higher death rates from unintentional injury also occur among African Americans.(1)
Certain racial and ethnic groups have more new cases of unintentional injuries and deaths than whites. Unintentional injuries are the second leading cause of death for American Indian males and the third leading cause of death for American Indian females. More than 1,000 American Indians die from injuries, and 10,000 more are hospitalized for injuries each year. The age-adjusted injury death rate for American Indians is 3 times higher than that of all other Americans. Among American Indians, 46 percent of the YPLL is a result of injury, which is 5 times greater than the YPLL due to a next highest cause, heart disease (8 percent). Among the factors that contribute to these increased rates for American Indians are rural or isolated living, minimal emergency medical services, and great distances to sophisticated trauma care.(11)
African American, Hispanic, and American Indian children are at higher risk than white children for home fire deaths.(12) Adults aged 65 years and older are at increased risk of death from fire because they are more vulnerable to smoke inhalation and burns and are less likely to recover. Sense impairment (such as blindness or hearing loss) may prevent older adults from noticing a fire, and mobility impairment may prevent them from escaping its consequences. Older adults also are less likely to have learned fire safety behavior and prevention information, since they grew up at a time when little fire safety was taught in schools, and most current educational programs target children.
In every age group, drowning rates are almost 2 to 4 times greater for males than for females.
(13) In 1997, the overall drowning rate for African Americans was 50 percent greater than that for whites; however, the rate was not higher for all age groups. For example, among children aged 1 through 4 years, the drowning rate for whites was slightly higher than the rate for African Americans. For children aged 5 to 19 years, African American children are twice as likely to drown as white children.(14)
Homicide victimization is especially high among African American and Hispanic youths. In 1995, African American males and females aged 15 to 24 years had homicide rates (74.4/100,000) that were more than twice the rate of their Hispanic counterparts (34.1/100,000) and nearly 14 times the rate of their white non-Hispanic counterparts (5.4/100,000).(15)
Trends in suicide among blacks aged 10 to 19 years in the United States during 1980-95 indicate that suicidal behavior among all youth has increased; however, rates for black youth have shown a greater increase.(1)
Although black youth historically have lower suicide rates than have whites, during 1980-95, the suicide rate for black youths aged 10 to 19 years increased from 2.1 to 4.5 per 100,000 population. As of 1995, suicide was the third leading cause of death among blacks aged 15 to 19 years.(17)
To reduce the number and severity of injuries, prevention activities must focus on the type of injury—drowning, fall, fire or burn, firearm, or motor vehicle.(18) For example, a nonfatal spinal cord injury produces the same outcome whether it was caused by an unintentional motor vehicle crash or an attempted suicide.
Understanding injuries allows for development and implementation of effective prevention interventions. Some interventions can reduce injuries from both unintentional and violence-related episodes. For instance, efforts to promote proper storage of firearms in homes can help reduce the risk of assaultive, intentional self-inflicted, and unintentional shootings in the home.(19) Higher taxes on alcoholic beverages are associated with lower death rates from motor vehicle crashes and lower rates for some categories of violent crime, including rape.(20, 21)
Many injuries and injury-related deaths occur in some population groups (such as younger children from birth to 4 years) where the intentionality of the injury is unknown and requires more detailed investigation. As these cases are examined, interventions can be developed to address ways injuries occur—for instance, unintentional poisonings in children or hangings among teenagers—that are emerging in society as growing public health concerns.
Poverty, discrimination, lack of education, and lack of employment opportunities are important risk factors for violence and must be addressed as part of any comprehensive solution to the epidemic of violence. Strategies for reducing violence should begin early in life, before violent beliefs and behavioral patterns can be adopted.
Many potentially effective culturally and linguistically competent intervention strategies for violence prevention exist, such as parent training, mentoring, home visitation, and education.(22) Evaluation of ongoing programs is a major component to help identify effective approaches for violence prevention. The public health approach to violence prevention is multidisciplinary, encouraging experts from scientific disciplines, organizations, and communities to work together to find solutions to violence in our Nation.
Many school-aged children suffer disabling and fatal injuries each year. As educational programs for school children are developed and proven effective in preventing injuries, these programs should be included in quality health education curricula at the appropriate grade level. Education should aim at reducing risks of injury directly and at preparing children to be knowledgeable adults. (See Focus Area 7. Educational and Community-Based Programs.)
Interim Progress Toward Year 2000 Objectives
A total of 45 objectives addressed injury prevention in Healthy People 2000. Twenty-six objectives were specific for unintentional injuries and 19 objectives were specific for violence prevention. By the end of the decade, targets had been met for 11 objectives. Unintentional injury objectives showing achievement were unintentional injury hospitalizations, residential fire deaths, nonfatal head injuries, spinal cord injuries, nonfatal poisonings, and pedestrian deaths. Violence prevention objectives which met their targets were homicide, suicide, weapon carrying by adolescents, conflict resolution in schools, and child death review systems.
Progress was made for 13 objectives. Much of the progress made in unintentional injury objectives were with motor vehicle fatalities and use of vehicle occupant restraints. Those unintentional injury objectives showing progress were unintentional injury deaths, motor vehicle deaths, motor vehicle crash deaths, motor vehicle occupant protection systems, helmet use by motorcyclists and bicyclists, safety belt use laws, alcohol-related motor vehicle deaths, and drownings. Violence prevention objectives showing progress were firearm-related deaths, partner abuse, rape and attempted rape, physical fighting among adolescents 14 to 17 years of age, and the number of States with firearm storage laws.
There were six objectives with no progress or movement away from the Healthy People 2000 targets. In unintentional injury, the hospitalization rate for hip fractures remains above baseline levels, indicating no progress toward the year 2000 target. Data from five violence prevention objectives also show movement away from the year 2000 target. Those objectives relate to child abuse and neglect, assault injuries, suicide attempts among adolescents aged 14 to 17 years, battered women turned away from shelters, and suicide prevention protocols in jails.
Note: Unless otherwise noted, data are from Centers for Disease Control and Prevention, National Center for Health Statistics, Healthy People 2000 Review, 1998-99.
Last modified: 10-Mar-2000.