California Department of Health Services What? So What? Now What?
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Transcript of California Department of Health Services What? So What? Now What?
California Department of Health Services
What? So What?
Now What?
What? So What?
Now What?
California Department of Health Services
What ?What ?
• Injuries remain the leading cause of death for children (and adults under 45 years old)
• Mortality from injuries has declined• along with almost everything else
• New approaches to analysis by age• analysis by periods less than years of age
• Infanticide rates vary by hours and days of age
California Department of Health Services
What ?What ?
“In the October issue of Good Housekeeping, a revealing child safety report names California the safest state for child safety report names California the safest state for children in the United Stateschildren in the United States. Good Housekeeping arrived at the winning states by analyzing data compiled from the National Safe Kids Campaign, the Insurance Institute for Highway Safety, the National Conference of State Legislators, the National Association of State Boating Law Administrators and the National Program for Playground Safety. It was concluded that California's It was concluded that California's state laws top the list as the toughest in the nation in state laws top the list as the toughest in the nation in protecting our childrenprotecting our children.”
California Department of Health Services
What ?What ?
• Are new threats emerging?
• Are we losing control over old threats?
• What important injuries continue in spite of what we are (or are not) doing?
California Department of Health Services
Statistics Never LieStatistics Never Lie
California Department of Health Services
What’s downWhat’s down
California Department of Health Services
Homicides, Males, CaliforniansHomicides, Males, Californians
0
500
1000
1500
2000
2500
3000
3500
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Homicides, Females, CaliforniansHomicides, Females, Californians
0
100
200
300
400
500
600
700
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Suicides, CaliforniansSuicides, Californians
0
500
1000
1500
2000
2500
3000
3500
4000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Suicides, Under 18, CaliforniansSuicides, Under 18, Californians
0
20
40
60
80
100
120
140
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Fatal Child Abuse*, 0-18, CaliforniaFatal Child Abuse*, 0-18, California
0
20
40
60
80
100
120
140
160
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
* calculated* calculated
California Department of Health Services
Suicides, CaliforniansSuicides, Californians
0
500
1000
1500
2000
2500
3000
3500
4000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
M V Occ., Hosp. Nonfatal, 0 - 5 years, Californians
M V Occ., Hosp. Nonfatal, 0 - 5 years, Californians
0
100
200
300
400
500
600
700
800
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
California Department of Health Services
M V Occ., Hosp. Nonfatal, Calif.M V Occ., Hosp. Nonfatal, Calif.
0
5000
10000
15000
20000
25000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
California Department of Health Services
Drowning, Age 0 to 5, CaliforniansDrowning, Age 0 to 5, Californians
0
20
40
60
80
100
120
140
160
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Falls, Under 18, CaliforniansFalls, Under 18, Californians
0
5
10
15
20
25
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
What’s up?What’s up?
California Department of Health Services
Homicides, Males, CaliforniansHomicides, Males, Californians
0
500
1000
1500
2000
2500
3000
3500
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Homicides, Females, CaliforniansHomicides, Females, Californians
0
100
200
300
400
500
600
700
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
Suicides, CaliforniansSuicides, Californians
0
500
1000
1500
2000
2500
3000
3500
4000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
M V Occ., Hosp. Nonfatal, Calif.M V Occ., Hosp. Nonfatal, Calif.
0
5000
10000
15000
20000
25000
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
California Department of Health Services
Falls, Age 55+ Years, CaliforniansFalls, Age 55+ Years, Californians
0
200
400
600
800
1000
1200
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
California Department of Health Services
By the wayBy the way
• One of the most commonly used flavorings in Chocolate...
...is Vanilla.
Think about it
California Department of Health Services
Our Product Line...Our Product Line...• pool barriers• car seats• trigger locks• safety belts/air bags• flame-proof sleepwear• helmets• smoke alarms• child-resistant Rx,
disposable lighters
• Drug & Alcohol treatment• Rape Prevention Education• Batterers’ Treatment• Incarceration• after school “programs”• traffic enforcement• building code, enforcement• PHN home visiting• DV shelters
California Department of Health Services
So What? Well, if “we” could...
So What? Well, if “we” could...
• Reduce explicit violence in:• movies
• games
• TV journalism
• Reduce the divorce rate
• upgrade the worst tier of housing
California Department of Health Services
So What? Well, if “we” could...
So What? Well, if “we” could...
• Reduce addiction in released prisoners
• reduce exposure to methamphetamine
• reduce flux of handgun commerce
• Improve access to quality education
• improve access to good jobs
California Department of Health Services
Our Product Line...Our Product Line...• pool barriers• car seats• trigger locks• safety belts/air bags• flame-proof sleepwear• helmets• smoke alarms• child-resistant Rx,
disposable lighters
• Drug & Alcohol treatment• Rape Prevention Education• Batterers’ Treatment• Incarceration• after school “programs”• traffic enforcement• building code, enforcement• PHN home visiting• DV shelters
California Department of Health Services
By the wayBy the way
• If the Clintons had converted to Buddhism during his Presidency…
• …we would have had an example of
the POTUS, the FLOTUS, and the Lotus.
California Department of Health Services
Now What?Now What?
• “Programs” operate for hours at a time
• The structure of a community is on duty
24 / 7 / 365
California Department of Health Services
Now What? Place mattersNow What? Place matters
• The Old
California Department of Health Services
Now What? Place mattersNow What? Place matters
• The New
California Department of Health Services
Create, Refine, Advance, ExecuteCreate, Refine, Advance, Execute
• We do a lot of creating, refining and advancing
• We don’t do enough executing
• What is feasible now?
• Now What?
California Department of Health Services
What is feasible now?What is feasible now?
• Car Seats - and we’re doing it, mostly
• Bike Helmets - we’re not doing much
• Smoke Alarms - we’re doing almost nothing
• Pool Safety - law covers new pools only
• Trigger locks - totally unevaluated
• Sleepwear - new concern over toxicity
California Department of Health Services
What is feasible now?What is feasible now?
• Drug & Alcohol - Prop 36, but little in-house Rx
• Rape Prev. Educ. - largely unevaluated
• Batterers’ Treatment - largely unevaluated
• After School - Prop.47, but no money for it
• PHN Home Visiting - growing under Prop. 10
• DV Shelters - largely unevaluated
• Suicide Prevention - largely unevaluated
California Department of Health Services
What ain’t we got?What ain’t we got?
Don’t know how to do it• DV intervention• Sexual assault prev.• Elder falls prev.• Violent crime prev.• Suicide prevention
Know how, just don’t do it• Bike helmets• Smoke alarms• reduce impaired driving• truancy prevention• Suicide prevention• Playground improvement
California Department of Health Services
Now what?Now what?
• What is worth doing?
California Department of Health Services
Old problem, new package Old problem, new package
• Psychological Trauma from Disasters
• combination of “PTS” [post-traumatic stress] and TV journalism exposure
• Recent example; 8 hours of WTC collapsing on CNN, Fox, and everywhere else.
• Children 3,000 miles away react as if in NYC
California Department of Health Services
• Created by the PL 107-188 Section 104(a), the Public Health Security and Bioterrorism Preparedness and Response Act of 2002.
• A FACA committee (PL 92-463).
• See http://www.bt.cdc.gov/children for more background, and related documents and links.
National Advisory Committee on Children and Terrorism (NACCT)National Advisory Committee on Children and Terrorism (NACCT)
California Department of Health Services
National Advisory CommitteeNational Advisory Committee
Charge
• Assess the nation’s preparedness w/ the physical and mental health needs of children
• Make recommendations to the Secretary
• Review the Strategic National Stockpile and make recommendations to the Secretary
California Department of Health Services
National Advisory CommitteeNational Advisory Committee
Charge
• Oh, yes, and do it in the next 90 days !
California Department of Health Services
4 Phases of an Emergency4 Phases of an Emergency
Planning
Response
Recovery
Mitigation
California Department of Health Services
NACCT IssuesNACCT Issues
• The primary agent of terrorists is not a germ, a chemical, a bomb or a radioisotope.
• Rather, the primary agent of terrorists is terror.
• Children are more susceptible to terror than adults, but this has never guided us.
California Department of Health Services
NACCT IssuesNACCT Issues
• Children are not small adults, but
• Planning has never effectively included children, schools, or pediatricians
• Neither have children’s special psychosocial and mental health needs been planned for
California Department of Health Services
NACCT IssuesNACCT Issues
• Neither surveillance systems nor surveillance definitions have been developed for these needs
• The concept of first responders must include teachers, CBOs and clergy, who therefore need training, resources and a role in planning.
California Department of Health Services
NACCT IssuesNACCT Issues
• Planning for health care and hospital capacity for adults has taken priority over that for children, but• children have higher risk from airborne,
waterborne, food-borne and soil contamination, • and their risk for being terrorized and having
post-traumatic stress disorders is higher.
California Department of Health Services
NACCT IssuesNACCT Issues
• Research into the special needs of children is sorely needed if we are to learn how to mitigate the effects of future disasters.• For example, children all over the U.S. may
suffer from viewing events and hearing warning messages on television even though these events occur thousands of miles away
California Department of Health Services
Now what?Now what?
• Assure that Education, Pediatrics, Mental Health and Public Health Surveillance sectors are fully involved in all 4 phases
• Require all local planning to do likewise as a condition of continued funding
California Department of Health Services
Now what?Now what?
• Facilitate research to supply missing skills, knowledge and techniques, both before and during emergencies of all types, since the initial agent is often of least importance
California Department of Health Services
The buck stops hereThe buck stops here
• Some of this has already begun to shape HRSA guidance
• Not clear which, if any, NACCT recommendations will be acted upon federally
• All politics, public health, and emergency response are local
• We have the opportunity to act if we choose to
California Department of Health Services
The Future ?The Future ?
"The future. . . .is just one damned thing after
another" -- Churchill
California Department of Health Services
Alex Kelter [email protected]