Healthy People 2000 Consortium Meeting November 7, 1997

Summary of Breakout Group Discussion Concerning Priority Area 9: Unintentional Injuries

Discussion of the Framework ("fan")

• Most participants did not like the reorganization of the focus areas under the four enabling goals because many of the objectives fit underneath more than one goal. It was strongly recommended that the focus areas should not be "forced" into a specific category.
• It is not clear from the "fan" that the two major goals are the foundation for the four enabling goals. The goal entitled "increase years of healthy life" appears to apply only to the two focus areas of Mental and Physical Impairment and Chronic Diseases. The group questioned why they did not apply to all focus areas. It was suggested that the two major goals and the enabling goals appear at the top of the diagram since they are all important. The group created a graphic to submit for consideration as a replacement of the "fan."
• It was suggested that the enabling goal, "assure access to quality health care" should be changed to "assure access to quality clinical preventive services."
• There was a strong recommendation that the Special Populations be eliminated as a distinct focus area because they should be included within the 20 focus areas.
• It was suggested that the four enabling goals should form the strategies under each of the focus areas. For example, for the focus area of Unintentional Injuries, one would develop implementation steps under:
1. promote healthy behaviors (e.g. wearing bicycle helmets);
2. protect health (e.g. enforcing bicycle helmet ordinances);
3. assure access to quality health care (e.g. increasing access to trauma care centers in rural areas);
4. strengthen community prevention (e.g. developing education curriculum in public schools for increasing bicycle helmet use).
• There was much discussion vis-à-vis "eliminating" versus "reducing" health disparities. Some implied that stressing elimination focused more attention on the special populations than was necessary. Also, some felt it was unrealistic to have the same targets for both the general population and the special populations. One member suggested that we use "reduce with the intent to eliminate disparities." Another member preferred "eliminate" with different targets for the special populations.

Discussion of HP2000 Objectives

Note: Handouts were distributed to consortium participants outlining recommendations for objectives to be retained, deleted, or transferred to another chapter, in addition to new proposed objectives. After much discussion, the group offered the following suggestions:

• Strong recommendation to place the HP 2010 objectives under the same categories: Health Status; Risk Reduction; Services and Protection.
• For objective 9.3, we need to determine whether passenger miles traveled (PMT) or vehicle miles traveled (VMT) is the best indicator. Some participants thought that the data are not very reliable for VMT, and have concerns that there is no published baseline data for PMT as yet. The workgroup coordinator will seek information from NHTSA on methods used to calculate both PMT and VMT.
• Suggested that 9.3a be changed to "children aged 5-14 years."
• Regarding objective 9.12a, the group discussed deleting reference to "potentially fatal crashes" because there was concern about the accuracy of the data. However, we will consult with NHTSA and NCHS about the methodology used for calculating these data.
• The group recommended deleting the words "older drivers" in objective 9.20 and replacing it with "drivers." Data to be available by 1998.
• The group agreed with the transfer of selected objectives to another chapter and with deleting other selected objectives.

Discussion of Proposed New Objectives

1. The group suggested that the newly proposed objectives, 9.7b and 9.9a, which both address "reducing the level of impairment and limitation of activity" due to hip fractures among the elderly and non-fatal head injuries respectively, should be included in the Mental and Physical Impairment and Disability chapter.
2. The objective to increase use of "child safety seats" should be worded "child safety restraints." The question also arose as to whether NHTSA is able to provide these data.
3. It was suggested that the proposed objective "to increase the use of child restraint booster seats among children weighing less than 80 lbs" should be deleted.
4. It was recommended that objective 9.13, "increasing bicycle helmet use" should be a developmental objective since there is no recent baseline data available or a potential data source to date.
5. For the new 9.15 objective, the measurement should be changing the rate per 100,000, rather than by percent.
6. One group member suggested that an objective be developed to measure the number of States with firearm "cap" laws.
7. Another participant offered to write an objective related to roadway safety.
8. Guohua Li recommended the following objective: "Reduce emergency room visits caused by unintentional injuries to no more than 111 per 1,000 population." Baseline is 131 per 1,000 in 1995. Special population group would be 15-24 year olds since they are at highest risk (202 per 1,000 in 1995). Some members expressed concern that this objective would be difficult to use at the State and local levels.

Participants

La Tanya Beale, Facilitator, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
Tim Groza, M.P.A., Recorder, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control
Janet Brown, M.A., American Speech-Language-Hearing Association
Guohua Li, M.D., Dr.P.H., Johns Hopkins University School of Medicine
Steven C. McDonald, Ph.D., M.P.H., Centers for Disease Control and Prevention, National Center for Environmental Health
Patricia Smith, M.S., R.D., Michigan Department of Community Health, Violence Prevention Program
Richard L. Hanneman, Salt Institute