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Abstract
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Injuries are the leading cause of death in U.S. children and adults between 1 and 44 years of age, resulting in 3.6 times as many deaths in this age group as cancer and heart disease combined. This burden is disproportionately carried by Black, American Indian and Alaska Native, rural, and low-income communities. Disparities in traumatic injuries have persisted -- and in some cases worsened -- over the past decade, despite research and advocacy in this area.1 We hypothesize that the lack of progress toward addressing these disparities is caused in part by limitations of the tools used to analyze the factors that contribute to injuries and injury-related outcomes.
Such tools, including the Haddon matrix, which was developed in 1970 to systematically determine the observable and modifiable factors affecting injury-related outcomes,2 haven't focused attention on the root causes of disparities based on race, ethnicity, geography, economic status, and other social determinants of health. Interventions aimed at reducing disparities have therefore too often focused narrowly on behavior change and education. There's an urgent need for innovative approaches to address the structural drivers of injury-related disparities. We designed the injury equity framework to provide clinicians, researchers, public health professionals, and policymakers a theoretical basis for identifying and analyzing factors that influence who is injured, the severity of the injury, and the injury outcome using an equity lens.
The injury equity framework is grounded in the work of Camara Jones and colleagues, who depicted a cliff as a representation of good health, with the edge of the cliff signifying the onset of illness or injury and the area below the cliff illustrating the various levels of protection afforded by the health care system to reduce the risk of adverse outcomes.3 As a person gets closer to the edge of the cliff, the risk of injury increases. A person's starting point relative to the edge of the cliff is affected by several factors depicted in the top and leftmost sections of the injury equity framework. The societal context of bigotry, stigma, and systems of oppression -- such as ableism, classism, homophobia, racism, sexism, and transphobia -- is the milieu in which social identities interact and affect health outcomes. The framework calls attention to both historical and current societal contexts, since various forms of oppression and stigma have long histories, with effects that have compounded over time.4 Intersectionality refers to the interconnectedness of various individual identities within the context of these societal factors as well as family experiences and exposures; community-level factors, such as urbanicity or rurality; and the individual person's exposure to risk factors and protective factors...
Language: en |