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HSPH Center Intervenes to Reduce Injuries
What do guns and cars have in common? Not a lot, perhaps, excepting the terrible ability to injure and kill.
It is this shared ability that makes guns, motor vehicles, and other injury-producing devices or activites a concern of public health. "Injuries kill more people under the age of 40 than do diseases," said David Hemenway, professor of health policy and director of the Harvard Injury Control Research Center. In 1997 in the US, 146,400 people were killed by injuries.
"Most injuries are a result of a traumatic event," explained Hemenway. "Automobile accidents, intentional and accidental firearm injuries, harm from fires, child or intimate partner abuse, drowning, and sport injuries--all of these are areas in which we can reduce injury and death."
Members of the National Firearm Injury Statistics System, a component
of the Harvard Injury Control Research Center. Back row, from left: Matthew
Miller, Angela Browne, Mary Kate Newell, and Deborah Azrael. Front row,
from left: Catherine Barber, David Hemenway, and Susan Gallagher.
The benefits of injury prevention strategies have been shown with automobile
accidents. Research that used data from various official reporting systems
established the impact of driver behavior, vehicle characteristics, and
environmental conditions. The data have also allowed the scientific evaluation
of interventions including the effectiveness of drunk-driver legislation,
child restraint laws, mandatory belt-use laws, revised speed limits, motorcycle
helmet laws and air bags. The result: motor vehicle accidents have been
reduced by 75% since the mid 1950s.
Hemenway and his colleagues in the center are now applying the same analysis and prevention strategies used to reduce automobile deaths to other injury-producing events. One area of focus is the hemorrhaging of life and health caused by firearms, an increasingly urgent national concern.
One of the keys to replicating the successful reduction of automobile injuries, according to Hemenway, is the collection of data that describe the extent and nature of the firearm problem over time. "The police collect data about homicides, but there's little or no information about non-fatal shootings, suicides, or events in which guns are brandished without being fired," he said. "There are so little data out there that most policy discussions about guns are driven by rhetoric, rather than by fact.
"In recent years, there have been legislative discussions about banning or limiting the availability of assault rifles and Saturday-night specials. Yet we have no way of knowing how frequently these types of firearms are connected with any kind of shooting.
"If our country is to have productive discussions about gun use and legislation, then we need facts upon which to base our discussions. We need to collect and analyze data about the types of guns that are out there, how they're stored, and when and under what circumstances they're used."
To promote this collection of data, the center has formed the National Firearm Injury Statistics System (NFISS). This program has gathered funding from five non-profit foundations and is coordinating its distribution to start up or improve firearm-data gathering systems at six governmental or educational institutions across the US. "What we're working towards is a national firearm injury surveillance system," said Hemenway. "Ideally, these data would be collected by the government. For the near future, we hope to set up a system and show how useful it can be."
"What we're working towards is a national firearm injury surveillance system," said Hemenway. "Ideally, these data would be collected by the government. For the near future, we hope to set up a system and show how useful it can be."
Ironically, the NFISS is continuing work begun by the Centers for Disease Control and Prevention (CDC) in 1994. At that time, the CDC planned to create a national firearm injury database, and they began by aiding the development of firearm surveillance systems at a group of state health departments. Unfortunately, for political reasons, funding for the system was withdrawn in 1997.
Using some of the few existing state or local surveillance systems, NFISS has provided examples of the useful findings that can be discovered by the collection of firearms data. Work from the Medical College of Wisconsin Firearm Injury Surveillance System, begun in the mid-1990s, showed that five specific gun makes were used in almost half of the fatalities in the Milwaukee area. These makes accounted for only six percent of guns turned in during a Milwaukee buy back program--suggesting that while the buy back program may have been beneficial, it did not rid the streets of the weapons most commonly used in fatal shootings.
Another example originates from the Los Angeles County Department of Health Services system which links data from death certificates, coroner's offices, emergency medical systems, and hospital discharges. The data gathered in this system allowed researchers to discover that the average medical cost incurred in a trauma center from a non-fatal gunshot wound is $25,000 and that there are almost twice as many severe but non-fatal firearm injuries as there are deaths from guns.
The six programs receiving awards through NFISS will share their data with HSPH researchers. "And we'll share the data with anyone who wants it," said Hemenway. "The idea is to convince mayors, governors, and legislators how important these data are for having productive conversations about firearms."
In addition to NFISS, the center has ongoing research projects in other areas of injury prevention. In collaboration with Coast Guard academies, the center is examining the relationship between low-level doses of alcohol and cognitive impairment. The analysis of the data is still underway, but preliminary findings indicate that even a little consumption of alcohol can have deleterious effects on decision-making ability.
"It's been shown that people who binge drink are at higher risk for injuries, but what we're finding is that even those people who just have one or two drinks are at higher risks for injury," said Hemenway. "Because there are a lot more people who have one or two drinks than there are heavy drinkers, low-level consumption of alcohol likely leads to more total injury than does binge drinking."
Students, faculty, and staff who are interested in these projects, or who wish to learn about other work underway at the center, are encouraged to attend the center's Open House on September 30, 4:00 to 6:00 p.m., in Kresge 439.
