Disparities in Injuries and Access to Injury Prevention

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Injuries, unintentional and intentional, contribute significantly to ethnic disparities in morbidity, disability and life expectancy. In Harlem childhood injuries occur at twice the national rate. Unintentional injuries are the third leading cause of death in Hispanics and the fourth in blacks--preceded only by heart disease, cancer, and cerebrovascular disease (blacks). In addition, unintentional injuries are a leading cause of years of potential life lost (YPLL) (CDC 2002). Yet the leading role of injuries, both in morbidity and mortality in the general population and as a major dimension of racial and ethnic disparities, has not received full recognition. Inadequate attention to ethnic disparities left Healthy People 2010 (DHHS 2000) with insufficient information to set targets for reduction of ethnic disparities in many injury areas. Both intentional and unintentional injuries have been shown to have a modifiable component when well-focused interventions are implemented in a minority community. Through the efforts of the Co-PI, Dr. Barbara Barlow and others, focused, community-based interventions were put into place that lowered injury rates by 40%-50%. Using funding from the Robert Wood Johnson Foundation, the success of this program has been nationalized. The program now operates sites in 7 of 10 trauma regions covering the mainland United States. As Chief of Surgery at Harlem Hospital, Dr. Barlow has observed the need to expand these efforts to adults and the elderly. The focus of the Injury/Disability Prevention Core is to facilitate the study of racial and ethnic disparities in injuries and injury prevention across all age groups. Specific aims are to: (1) promote research on disparities in access to programs and capabilities to prevent injury and disability among infants, children, adolescents, and elderly to characterize health disparities in injury; (2) expand monitoring of injury surveillance and disparities in health care access to potentially disability-reducing treatments for adult and elderly populations in northern Manhattan; and (3) develop research in collaboration with northern Manhattan organizations to identify potential interventions to reduce injury disparities through primary, secondary, and tertiary prevention of falls, the most prevalent nonfatal injury.