Injury Prevention Policy

Injury Prevention Programs in State & County Health Departments

Background

How big is the problem?

Injuries are the leading cause of death and disability in children and young adults. Yet, injuries can be prevented through routine public health practices. Most public health activity is carried out at the state and local level. However, many county health departments do not have a designated person, much less a specific division or unit, with the responsibility for injury prevention (1). Although injuries are one of the most significant health problems of the 21st Century, and public health agencies are uniquely well-positioned to implement injury prevention activities, these organizations have been slow to allocate resources to injury prevention.

Policy & Details

State and county health departments shall establish and maintain an injury prevention unit.

There are published standards for what a health department injury program should involve (2, 3). These are similar to the time-tested responsibilities that health departments routinely fill when dealing with any public health problem. State and local health agencies should work together to fill the core functions of an injury prevention unit:

• collection of data on the occurrence, causes, and circumstances of injuries;
• coordination, leadership, and administration;
• program development and implementation;
• policy development;
• evaluation;
• professional training and education;
• public information and education programs; and
• ensuring health and safety of the population by investigating injury clusters or events (3).

• determining the extent and nature of the injury problem within the region;
• identifying key injuries on which prevention efforts will be focused;
• establishing goals and objectives;
• identifying strategies and courses of action that will meet the goals and objectives;
• identifying existing and additional resources needed to implement the injury prevention plan;
• developing an implementation plan;
• coordinating the identified resources, agencies and people to implement the plan;
• monitoring the implementation of the plan; and
• evaluating the plan's impact and revising strategies as needed (2).

Effectiveness

State and local injury prevention programs have demonstrated their effectiveness in preventing a variety of injury problems from routine to unusual.

Deer Hunter Falls in Louisiana

In Louisiana during the 1985 through 1991 hunting seasons, an average of four deer hunters suffered falls every year that led to disabling spinal cord injuries. The state Office of Public Health conducted a campaign to increase the number of hunters who used safety tethers when sitting on their deer stand. During the 3 years following that campaign there was only one hunter who suffered a spinal cord injury. That injury occurred when the hunter fell from a ladder and could not have been prevented by using a safety tether (4). This project cost less than $3,500 including personnel time.

Pediatric Iron Poisoning in California

In the seven months between June 1992 and January 1993, five children in Los Angeles County died from the ingestion of iron supplements. In contrast, a total of three children died from iron poisoning in Los Angeles County during the preceding nine-year period. The California Department of Health Services began an investigation and found that the majority of these poisonings occurred when young children gained access to their mothers' pre- or perinatal vitamins. They also conducted a survey in which they found that many young mothers do not realize that iron supplements are among the most hazardous products kept in the home. As a result of theses findings, the health department recommended that higher dose iron supplements be made available only in unit dose packages with warning pictographs and that prescribing and patient education be changed to recognize the threat posed by iron supplements to small children (5). In 1997, in response to the upsurge in iron poisoning cases among children and citizen petitions submitted by the American Association of Poison Control Centers, the attorneys general of 34 states, and the Nonprescription Drug Manufacturers Association, the U.S. Food and Drug Administration passed regulations that require all iron-containing drugs and dietary supplements to carry a warning about the risk of iron poisoning in young children. In addition, products containing 30 milligrams or more of iron per dosage unit now have to be packaged as individual doses (6).

Residential Fire Injuries in Oklahoma City

In Oklahoma, the State Department of Health identified a specific area of Oklahoma City with a burn injury rate four times higher than the rest of the city. A large smoke detector giveaway was implemented in this target area in May, 1990. During the four years after the program, there was an 80% reduction of residential fire related injuries in the target area while the rest of the city experienced a 7% increase in these types of injuries. A preliminary cost-benefit analysis suggests that for each dollar spent on the intervention, $20 dollars in averted health care costs and productivity loss were saved (7).

These examples demonstrate that health departments are able to identify specific problems, implement targeted interventions, and evaluate their success.

Contacts

David Lawrence, Center Director
Center for Injury Prevention Policy and Practice
San Diego State University
6505 Alvarado Road, Suite 208
San Diego, CA 92120
Phone: (619) 594-3691
Fax: (619) 594-1994
Email: david.lawrence@sdsu.edu
www: http://www.cippp.org

David Sharf, Executive Director
State and Territorial Injury Prevention Directors' Association
2141 Kingston Court, Suite 110-B
Marietta, Georgia 30067
Phone: (770) 690-9000
Fax: (770) 690-8996
Email: stipda@mindspring.org
WWW: http://www.stipda.org

References

1. Christoffel T, Galllagher SS. Developing a Public Health Agency Injury Program, Chapter 11; in Injury Prevention and Public Health: Practical Knowledge, Skills, and Strategies.Gaithersburg, Maryland: Aspen Publishers, 1999.

2. Micik S, Yuwiler J, Walker C. Preventing Childhood Injuries: A Guide for Public Health Services, 2nd edition. San Diego, California: North County Health Services / Center for Childhood Injury Prevention, 1987.

3. State and Territorial Injury Prevention Directors' Association. Safe States. Available online: http://www.stipda.org

4. Lawrence DW, Gibbs LI, Kohn M A. Spinal cord injuries in Louisiana due to falls from deer stands. Journal of the Louisiana State Medical Society 1996. Available online: http://www.injuryprevention.org/states/la/deer/deerstan.htm

5. Arcus A, Kim A. Pediatric iron poisoning: A killer returns. California Epidemiologic Investigation Service - Emergency Preparedness and Injury Control Branch. EPIC Proportions, Report No. 5, March 1995.

6. U.S. Food and Drug Administration. Preventing Iron Poisoning in Children. January 15, 1997. Available online: http://www.fda.gov, June 19, 2000.

7. Reddish DM, Mallonee S, Istre GR. Comparison of community based smoke detector distribution methods in an urban community. Injury Prevention; 4: 28-32, 1998.

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Last modified: 3-August-2000.