Trevor Hancock: Safe communities prevent ‘accidental’ injury

Two weeks ago, I pointed out that most injuries are unintentional. The B.C. Injury Research and Prevention Unit notes that in the five-year period 2010 to 2014, the main forms of unintentional injury — falls, unintentional poisoning and transport-related deaths — accounted for more than six in 10 of all deaths due to injury in B.C. and more than two-thirds of acute hospitalization for injury in 2013-14.

Of these, the most important are falls, which have been responsible for about 600 deaths annually in recent years in B.C. and account for more than half of acute hospitalization for injury. Overall, the costs of falls in 2010 was $1.2 billion, about one-third of the total costs of all injuries in B.C., with about half of that due to direct health-care costs.

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Falls are the leading cause of injury hospitalization for every age group except under age one. Most of these falls, and most of the costs, occur among older adults, accounting for about half of the health-care cost of all falls. But we shouldn’t ignore the other half of falls in those under age 65.

A Statistics Canada report based on the 2009-10 Canadian Community Health Survey noted that one-third of all self-reported injuries, many of which are falls, “occurred during participation in some type of sports or exercise” and this was the case in two-thirds of those aged 12 to 19. Among adults, work injuries are also an important factor; a 2015 article by Cindy Hunter in OHS Canada noted “more than 40,000 workers get injured annually due to fall accidents.”

Not surprisingly, a great deal of attention has been paid to preventing falls among older adults, given the high rate of falls and the high costs. The injury unit reports that “each year, one in three B.C. seniors (age 65+) experience at least one fall,” with the rate being “three times higher for seniors who live in institutional/residential facilities.” This is an area where B.C. has shown leadership, with a major effort to address this in seniors’ homes and other facilities.

But in addition to falls in institutions, seniors also fall at home and out in the community; a Statistics Canada report based on the 2009-10 Canadian Community Health Survey noted that: “Everyday activities like household chores and walking accounted for over half of their injuries.”

A 2012 review of the evidence from around the world found several effective fall-prevention strategies. These included group and home-based exercise programs and interventions to improve home safety, with some evidence for reviewing medications and gradually withdrawing some forms of psychotropic medicines.

In the U.K., Help the Aged has focused on poorly maintained pavement, noting that: “More than 2,300 older people fall on broken pavements every day.” Noting that municipal governments have reserve funds to pay for claims, it makes the reasonable suggestion that: “Some of the funds councils hold in legal and compensation reserves should be spent on pavement repairs rather than compensation claims.”

One of my favourite stories about community injury prevention, which I came across many years ago, came from a small hospital in Wales. Recognizing that falls in the home were a costly problem for the hospital, it wisely decided to send its hospital carpenter out to fix seniors’ homes, which reduced the number of falls. Perhaps our health authorities should consider this.

We have often treated falls as “accidents,” but in the world of injury prevention, they are not seen that way; there is almost always a preventable human factor at the root of the problem. But there is a very wide range of falls, and they vary a great deal by age, so there are no simple solutions, no quick fixes or universal approach. It might be said that it takes a whole community to prevent “accidents”: homes, schools, workplaces, sports organizations, health-care facilities and many others.

One common factor, however — and one that is a significant contributor to all forms of injury — is alcohol use. So a centrepiece of any community injury-prevention initiative should be improved control on the availability and price of alcohol, as well as on responsible use. I shall turn to this topic next week.

 

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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