Effectiveness - Social Legislation - Lecture Slides, Slides of Introduction to Sociology

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The Effectiveness of Interventions Addressing the Social

Determinants of Injuries: What do we think we know?

What do we still need to find out?

(Work in progress)

Health inequities

• Differences in population health status are

primarily attributable to population-level disparities in the social determinants of health, including income, social status, education, and employment.

• The 2008 report by the Canadian Senate

Subcommittee on Population Health¹ concluded that about 50% of health outcomes are attributable to social-economic factors

¹ Keon, W. J., and Pepin, L. (2009) A Healthy Productive Canada: A Determinant of Health Approach Ottawa: The Senate Subcommittee on Population Health

Factors Included in Literature Search*

Measures of SES Life Course Cross-Cutting Issues

Income Children Gender

Education Youth/Adolescents First Nations/Inuit/Metis

Occupational Status Adults Diversity/culture

Others (e.g., deprivation measures, eligibility for targeted supports)

Older adults/seniors Geography (urban, rural, remote)

• Based partially on SmartRisk (2006) framework

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Databases searched

• Medline

• Pyschinfo

• Embase

• Cochrane

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Eligible Study Designs

1. Systematic reviews, syntheses and meta-analyses
2. Before/after studies
3. Controlled trials
4. Observational studies: prospective and retrospective cohort studies, case control and cross-sectional studies

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Injuries and SES: what the literature tells us

• Generally, low SES groups have higher rates of injuries, which tend to be of greater severity and more often fatal
• Strength of inverse relationship between SES and injuries varies according to injury type and indicator of SES chosen

Exceptions to Inverse Gradient B/W Injury and

SES

• No clear relationship during adolescent years (a period of greater risk taking among young people across all socio-economic strata)
• Higher SES groups at greater risk of sports/recreational injuries

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Injury Hospitalizations and SES: Unintentional Falls (CIHI, 2010)

Injury Hospitalizations and SES: Motor Vehicle Traffic Injuries (CIHI, 2010)

Explanatory Factors for the Relationship between SES and Injury*

Individual Factors

• Differences in knowledge and beliefs about potential sources of injury
• Differences in health behaviours
• Fewer economic resources to buy appropriate safety devices
• Greater exposure to hazards
• Organization of Work and Occupational Exposure
• Psychosocial – (e.g., poverty-related stressors, social isolation)

Family-Related Factors

• Parental knowledge of child development and abilities
• Greater family size/single parenthood (could influence level of supervision)

Community/Social Factors

• Greater exposure to hazardous environments
• Poor access to servicers
• Social environment/culture/norms

• Source: Alberta Centre for Injury Control Research (2006) 14

Injuries and SES: Implications for Interventions

What the Literature tell us

• Lack of evidence on nature of the mechanisms underlying socio-economic differences in injury morbidity and mortality
• Vast majority of interventions focus on improving the knowledge and practices of “high risk” groups (presumably because broader determinants viewed as less amenable to change)
• Majority of interventions focus on childhood injuries (in the home or traffic environment)
• Limited evidence that interventions targeting more vulnerable populations are more effective at preventing injuries than population-level approaches; in fact, some studies show that disadvantaged groups receive a greater proportional benefit from population-level approaches (e.g., bicycle helmet legislation)

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Injuries and SES: Implications for Interventions

What the Literature DOES NOT tell us

• At the population level, effective injury

prevention programs are comprehensive and

multi-faceted (i.e., the “three Es”: education,

engineering and enforcement ). Unclear to

what extent these programs are reducing (or

potentially exacerbating?) socio-economic

inequities in injury outcomes

• In summary, existing studies provide a poor

evidence base on how best to avoid – or (^) Docsity.com^17

Conclusions

• More research on mechanisms by which SES may influence injury risk to

guide development of effective programs and policies

• Need to determine impact of comprehensive, multi-component

approaches to injury prevention, which have been shown to be effective at

the population level, on disadvantaged groups – will help to determine

optimal balance between targeted approaches, population-wide

programs/policies and targeted universalism

• Advocate to reduce social inequalities contributing to injury inequalities

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