Focus Area 4: Injuries, Violence and Occupational Health

Defining the Problem

Injuries are a leading cause of death and disability in New York State and are the leading cause of death between ages one and 44.51 Almost 7,500 (21 daily) New Yorkers die every year, as a result of an injury.52 Non-fatal injuries also result in adverse health outcomes ranging from temporary pain to long-term disability, chronic pain, and diminished quality of life. Hospitalization and rehabilitation services are also often needed. Injuries are consistently among the leading cause of hospitalization for New Yorkers of all ages. About 160,000 individuals annually (440 daily) are injured severely enough to require hospitalization.53 Another 1.6 million injured New Yorkers each year (4,374 daily) are treated and released from an emergency department.52

In New York State, falls are the leading cause of unintentional injury and deaths, among people ages 65 and over, and the leading cause of nonfatal injuries, in this age group and among children up to age four.50 Among young children, the primary location where falls occur is the home, primarily due to falls from beds or slips or trips.52 More than one in three people over 65 years of age fall each year.54 These falls account for $2 billion in annual hospitalization charges and $624.4 million in annual outpatient emergency department charges.52 Approximately 95% of the hospitalization charges for older adults are billed to publicly funded programs, such as Medicaid and Medicare.52 In addition, half of adults 65 and older who are hospitalized due to a fall, end up in a nursing home or rehabilitation center.52 The US Preventive Services Task Force recommends that addressing muscle weakness and gait and balance problems are the best prevention approaches. Recommended treatments include Vitamin D supplements, exercise and physical therapy.55

The way we arrange the different land uses listed above – in relation to transportation systems, the natural environment, and one another – also determines the degree to which residents can engage in physical activity. Thus, safe and comfortable streets must be matched with proper land use, zoning and development that bolsters and complements active living. In this regard, 'smart growth' planning offers several planning and design principles that support this goal - including, strategically-targeted density; mixed land uses; inter-connected street and trail networks; and safe, accessible and well-maintained public spaces.

Between 2007 and 2009, homicides and assaults accounted for 832 deaths2, 9,273 hospitalizations, and 85,337 emergency department visits in New York State.52 Those at highest risk are males between the ages of 15 and 24 years of age (SPARCS 2007-2009).52 These hospitalizations cost almost $240 million and the emergency department visits cost approximately $134 million, annually.all outdoor worksites52 This does not include societal costs, such as potential life lost, emergency and protective services

Each year in the United States, more than 4,000 occupational fatalities, three million occupational injuries, and 160,000 cases of occupational illnesses occur.56 Efforts to incorporate patients' occupational information into electronic health records would lead to more informed clinical diagnosis and treatment plans, as well as more effective policies, intervention, and prevention strategies to improve the overall health of the working population. It would also reduce the reporting burden for hospitals and health care providers associated with Part 22 of the State Sanitary Code. Research also has shown associations between many chronic diseases and occupation. Electronic health records also will facilitate the exploration of these data for research purposes to identify appropriate interventions.

Climate change also has the potential to impact workers' health. Workers are exposed to a variety of hazards from the natural environment including extreme temperatures, solar ultra-violet radiation, and vector-borne diseases. Work conditions may contribute to the effect of these hazards due to long hours, insufficient breaks and nourishment, and the under use of protective clothing and measures to adapt to changing environmental conditions. Recently, California and Washington passed regulations requiring employers to take steps to prevent heat illness at all outdoor worksites.all outdoor worksites57 New York State should explore similar regulations for climate-related health issues such as heat and cold stress. Likewise, employers and employees should engage in protective activities towards biological hazards such as poisonous plants and vector-borne diseases such as West Nile Virus and Lyme Disease.

Studies indicate that 80 percent of teens in the United States have worked by the time they finish high school, and each year, about 53,000 youth are injured on the job seriously enough to seek emergency room treatment. In fact, teens are injured at a higher rate than adult workers. Health and safety education is an important component of injury prevention for working teens. While workplace-specific training is most critical, young people also need to learn and practice general health and safety skills that they will carry with them from job to job. Teens should be able to recognize hazards in any workplace. They should understand how hazards can be controlled, what to do in an emergency, what rights they have on the job, and how to speak up effectively when problems arise at work.58

Workers experiencing symptoms from influenza-like illness increase the risk of spreading disease to vulnerable populations such as students, patients and elderly, and their families. Their high absenteeism rates also reduce the capability of the healthcare workforce and may have an economic impact. Research needs to be conducted to identify methods to reduce transmission within a built environment. Healthcare workers face a high risk of infection because of contact with patients, and could potentially put other patients at risk; likewise, school personnel also face a high risk of infection from children spreading infections from themselves or family members. Recent research has shown that health care workers and other hospital employees may unnecessarily be exposed to influenza and other infectious diseases due to unawareness and shortfalls of respiratory protection policies, practices, as well as inadequacies in education and training.59 Influenza vaccination, the most effective way to prevent influenza among health-care providers according to the Advisory Committee on Immunization Practices,60 continues to fall far short of the Health People 2020 goal of 90 percent coverage.

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Goals and Objectives for Action

The Built Environment Focus Area Committee identified the following goals and objectives for action as well as sector level interventions to implement the identified goals and objectives:

Goal #1: Reduce fall risks among the most vulnerable populations

Objective 1a:
Stop the annual increase in the rate of deaths due to falls among residents ages 65 and over by maintaining the rate at 3.5 per 10,000 residents.
Objective 1b:
Stop the annual increase of the rate of hospitalizations due to falls among residents ages 65 and over by maintaining the rate at 204.6 per 10,000 residents.*
Objective 1c:
Stop the annual increase in the rate of ED visits due to falls among residents ages 65 and over by maintaining the rate at 348.2 per 10,000 residents.
Objective 1d:
Reduce hospitalizations rates due to falls among children under 1 year of age from 17.5 to 15.8 per 10,000.
Objective 1e:
Reduce hospitalization rates due to falls among children ages 1 to 4 from 10.1 to 9.1 per 10,000.
Objective 1f:
Reduce ED visits due to falls among children under 1 year of age from 306.4 to 275.7 per 10,000 residents.
Objective 1g:
Reduce ED visits due to falls among children ages 1 to 4 from 476.8 to 429.1 per 10,000 residents.*

Goal #2: Reduce violence by targeting prevention programs particularly to highest-risk populations

Objective 2a:
Reduce rate of homicide deaths from 0.43 to 0.39 per 10,000.
Objective 2b:
Reduce the rate of assault-related hospitalizations from 4.8 to 4.3 per 10,000.*
Reduce disparity (Ratio=1 means no disparity) by 10%:
  • Ratio of Black non-Hispanic rate of assault-related hospitalizations to White non-Hispanic rate of assault-related hospitalizations (Target: 6.69; Baseline: 7.43; Year: 2008-2010; Source: NYS SPARCS Data; Data Availability: State, county)
  • Ratio of Hispanic rate of assault-related hospitalizations to White non-Hispanic rate of assault-related hospitalizations (Target: 2.75; Baseline: 3.06; Year: 2008-2010; Source: NYS SPARCS Data; Data Availability: State, county)
  • Ratio of assault-related hospitalization rate in low income ZIP codes to assault-related hospitalization rate in non-low income ZIP codes (Target: 2.92; Baseline: 3.25; Year: 2008-2010; Source: NYS SPARCS Data; Data Availability: State, county)
Objective 2c:
Reduce the rate of ED visits due to assault from 47.0 to 42.3 per 10,000.

Goal #3: Reduce occupational injury and illness

Objective 3a:
Increase the number of NYSDOH databases computerizing industry and occupation variables from 3 to 15.
Objective 3b:
Reduce the impact of climate change on outdoor workers.
Objective 3c:
Reduce the rate of occupational injuries treated in emergency departments among working adolescents 16-19 years of age from 1.5 per 100 full-time equivalent workers to 1.35.
Objective 3d:
Reduce the rate of emergency room visits for occupational injuries among adolescents 15-19 years of age from 36.7 to 33.0 per 10,000.*
Objective 3e:
Increase the percent of hospitals with comprehensive respiratory protection policies from 39.1% to 54.7%.
Objective 3f:
Increase the percent of health care workers vaccinated for the flu from 75.6% to 90.0%.
Objective 3g:
Increase the percent of workers who come in contact with the public who are vaccinated for the flu.

*Objectives that are bolded are a Tracking Indicator.

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Goal #1: Interventions by Levels of Health Impact Pyramid

Goal #1: Reduce fall risks among vulnerable populations.
Levels of Health Impact Pyramida Interventionsb
Counseling and Education
  • Train community workers in evidence-based intervention programs for older adults such as Tai Chi: Moving for Better Balance and Stepping On and A Matter of Balance.
  • Train physical therapists to deliver the Otago Exercise Program or other equivalent programs.
  • Create Statewide fall prevention awareness campaign.
  • Train podiatrists/primary care providers in appropriate footwear.
Clinical Interventions
  • Promote the use of evidence-based intervention programs for health care providers such as the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) toolkit.
  • Careful assessment for fall risks and fall prevention education and referrals for older adults, such as using "Timed Up and Go".
  • Integrate exercise and fall prevention into physical therapy.
  • Educate parents about falls risks among infants and toddlers.
Long-Lasting Protective Interventions
  • Conduct in-home assessments and interventions to reduce slips and falls among all populations
  • Reduce slip and fall hazards in common areas of residences and public buildings.
  • Improve safety of playground equipment using playground safety regulations.
  • Assess and change building codes to include elimination of fall risks.
  • Promote community-based programs for fall prevention.
Changing the Context to Make Individuals' Decisions Healthy
  • Improve walkability and safety in community and public spaces [see built environment and air-quality priority areas].
  • Expand access to and availability of exercise and information programs in community venues.
  • Increase access to public transportation through subsidy [also see built environment and air quality priority areas].
Socioeconomic Factors
  • Target fall risk in housing in disadvantaged areas.
  • Increase Medicare, Social Security and other benefits to cover fall prevention assessments and interventions, e.g. visual and hearing aids, lighting, non-slip flooring.

aFrieden T. "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595.

bInterventions in boldface type have been proposed for prioritization.

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Goal #2: Interventions by Levels of Health Impact Pyramid

Goal #2: Reduce violence by targeting prevention programs particularly to highest risk populations.
Levels of Health Impact Pyramida Interventionsb
Counseling and Education
  • Train residents, community-based organizations and other organizations in crisis management and dispute mediation.
  • Increase school based and community programs in conflict resolution.
  • Raise community awareness of violence prevention strategies.
Clinical Interventions
  • Provide referrals in emergency departments and hospitals for victims of violence similar to the Strong Memorial Hospital Youth Violence Intervention Program (Rochester, NY).
  • Provide on-going mental health and substance abuse treatment to at-risk youth and their families.
  • Link violence victims and their families to educational opportunities, employment training and assistance, mental health services, substance abuse treatment, etc. as in the CEASEFIRE program.
  • Create standards of care/discharge planning in hospitals.
Long-Lasting Protective Interventions
  • Develop multi-sector violence prevention programs (e.g., LHDs, criminal justice, social services, job training, CBOs) such as SNUG, Cure Violence or CEASEFIRE in high-risk communities.
  • Provide outreach workers and violence interrupters in schools and communities, especially during critical times.
  • Increase safety protections for at risk workers, (e.g. handle cash, work at night.
Changing the Context to Make Individuals' Decisions Healthy
  • Improve safety in school and workplace environments with cameras, better lighting, safes, more than one person on duty.
  • Reduce neighborhood environmental risks, e.g., abandoned buildings, no lighting, deserted street.
  • Reduce access to firearms by strengthening laws and permit requirements.
  • Increase availability of health and mental health care services.
Socioeconomic Factors
  • Increase educational, recreational and employment opportunities for at risk youth potentially through summer work experience programs or youth apprenticeship initiatives.
  • Increase other community amenities, e.g., low cost healthy food, parks.

a Frieden T. "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

b Interventions in boldface type have been proposed for prioritization

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Goal #3: Interventions by Levels of Health Impact Pyramid

Goal #3: Reduce occupational injuries and illnesses
Levels of Health Impact Pyramida Interventionsb
Counseling and Education
  • Train providers in taking occupational history.
  • Develop targeted occupational safety and health training programs for employers and workers in high-risk jobs.
  • Train providers in recognizing signs and symptoms associated with weather-related outcomes, such as heat and cold stress and arboviral infections.
  • Develop targeted occupational health and safety training programs for employers and workers in high-risk jobs.
  • Educate teens about their rights and applicable regulations using curricula such as "Talking Safety" or the "Passport to Safety", targeting vocational schools and industries hiring large numbers of young workers.
  • Develop respiratory protection programs that include written policies and procedures for fit testing, employee training, medical clearance, appropriate selection of respirators, training in the use and maintenance of respirators, recordkeeping and program evaluation.
  • Concerted outreach and media campaigns directed at targeted occupational groups
  • Outreach effort targeting vocational school programs and industries hiring large numbers of young workers.
Clinical Interventions
  • Collect occupational history in routine and emergency medical care.
  • Routinize collection of industry and occupation information in electronic health records and other medical data.
  • Strengthen rehabilitation services for injured and ill workers.
  • Improve diagnosis and treatment of weather-related outcomes, such as heat and cold stress and arboviral infections.
  • Recognize risks based on developmental age prior to approving work permits.
  • Recognize risks based on job duties for transmitting viruses.
Long-Lasting Protective Interventions
  • Develop targeted occupational safety and health inspections and safety programs for high-risk jobs.
  • Provide technical assistance and resources to employers in improving safety of workplace design and equipment.
  • Capture industry and occupation on medical records and in other health reporting.
  • Consider requiring flu vaccine for workers who interact with high-risk populations.
Changing the Context to Make Individuals' Decisions Healthy
  • Remove disincentives to reporting occupational hazards, injuries and illnesses.
  • Increase resources for occupational safety and health safety inspections and programs.
  • Strengthen occupational safety and health laws to provide disincentives for harming workers.
Socioeconomic Factors
  • Continue to reform workers' compensation laws and policies to ensure adequate benefits and reduce barriers to access and payment.
  • Increase compliance with OSHA, wage, benefit and other worker protections such as not reporting work-related injuries.
  • Strengthen work permits laws and use.
  • Supply sick leave or other strategies for workers who have the potential to infect vulnerable populations.

a Frieden T. "A Framework for Public Health Action: The Health Impact Pyramid". American Journal of Public Health. 2010; 100(4): 590-595

b Interventions in boldface type have been proposed for prioritization

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Interventions by Sector

Changes can be made across the sectors identified below to improve health outcomes related to the built environment. Below are examples of how your sector can make a difference.

Healthcare Delivery System

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Train community workers in evidence-based intervention programs for older adults such as Tai Chi: Moving for Better Balance, Stepping On, A Matter of Balance, Otago Exercise Program, and other equivalent programs. (Objectives 1a-1c)
  • Provide screening for older adults using Timed Up and Go and Risk Assessment questionnaires. (Objectives 1a-1c)
  • Provide referrals to physical and occupational therapy. (Objectives 1a-1c)
  • Integrate exercise and fall prevention into physical therapy. (Objectives 1a-1c)
  • Train podiatrists/PCPs in appropriate footwear. (Objectives 1a-1c)
  • Promote the use of evidence-based intervention programs for health care providers such as the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) toolkit. (Objectives 1a-1c)
  • Educate parents about falls risks among infants and toddlers. (Objectives 1d-1g)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Provide referrals in EDs and hospitals for victims of violence similar to the Strong Memorial Hospital Youth Violence Intervention Program (Rochester, NY). (Objectives 2a-2c)
  • Provide on-going mental health and substance abuse treatment to at-risk youth and their families. (Objectives 2a-2c)
  • Create standards of care/discharge planning in hospitals. (Objectives 2a-2c)
  • Increase availability of health and mental health care services. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Incorporate industry and occupation into electronic health records and other health reporting. (Objective 3a, 3c, 3d)
  • Implement appropriate policies to reduce transmission. (Objective 3e, 3f)
  • Inform personnel of respiratory protection programs. (Objective 3e, 3f)
  • Ensure appropriate adherence to policies and procedures for workplace safety. (Objective 3b, 3c, 3d)
  • Recognize risks based on developmental age prior to approving work permits. (Objective 3b, 3c, 3d)
  • Improve awareness of signs and symptoms and treatment to aid in appropriate rapid response. (Objective 3b)
  • Train providers in recognizing signs and symptoms associated with weather-related outcomes, such as heat and cold stress and arboviral infections. (Objective 3b)
  • Routinize collection of industry and occupation in EHR and other medical data. (Objective 3a, 3c, 3d)
  • Strengthen rehab services for injured and ill workers. (Objective 3c, 3d)
  • Improve worker diagnosis and treatment of weather-related outcomes, such as heat and cold stress and arboviral infections. (Objective 3b)
  • Conduct annual comprehensive educational campaigns targeting health care workers to encourage influenza vaccination. (Objective 3f)
  • Provide vaccination free of charge to health care workers on all shifts. (Objective 3f)
  • Consider requiring flu vaccine for health care workers who interact with high-risk populations. (Objectives 3f)

Employers, Businesses, and Unions

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Provide training and appropriate footwear for older employees. (Objectives 1a-1c)
  • Raise awareness and reduce risk of slip and trip hazards for workers and any public that interact with their establishments. (Objectives 1a-1g)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Reduce risks for workplace violence. (Objectives 2a-2c)
  • Increase educational, recreational and employment opportunities for at risk youth potentially through summer work experience programs or youth apprenticeship initiatives. (Objectives 2a-2c)
  • Improve safety in school and workplace environments with cameras, better lighting, safes, more than one person on duty. (Objectives 2a-2c)
  • Increase safety protections for at risk workers, e.g., handle cash, work at night. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Institute appropriate control mechanisms to reduce exposures. (Objectives 3b, 3c, 3d)
  • Provide programs specific to the workplace. (Objectives 3b-3g)
  • Recognize the value of keeping the workforce healthy. (Objectives 3b-3g)
  • Recognize the value of training in workplace safety and health to teens by hiring appropriately trained teens. (Objectives 3b, 3c, 3d)
  • Provide water, shade, and other appropriate controls at reasonable intervals. (Objectives 3b, 3c, 3d)
  • Raise awareness among their employees about the hazards and the need to reduce their exposures. (Objectives 3b-3g)
  • Conduct research to review links between occupation and industry and chronic and infectious diseases. (Objectives 3b, 3e, 3f, 3g)
  • Educate teens about their rights and applicable regulations using curricula such as "Talking Safety" or the "Passport to Safety", targeting vocational schools and industries hiring large numbers of young workers. (Objectives 3b, 3c, 3d)
  • Develop respiratory protection programs which include written policies and procedures for fit testing, employee training, medical clearance, appropriate selection of respirators, training in the use and maintenance of respirators, recordkeeping and program evaluation. (Objectives 3e)
  • Recognize risks based on developmental age prior to approving work permits. (Objectives 3c, 3d)
  • Recognize risks based on job duties for transmitting viruses. (Objectives 3e, 3g)
  • Conduct annual comprehensive educational campaigns targeting workers to encourage influenza vaccination. (Objective 3g)
  • Develop targeted occupational safety and health inspections and safety programs for high-risk jobs. (Objectives 3b-3g)
  • Supply sick leave or other strategies for workers who have the potential to infect vulnerable populations. (Objectives 3e, 3g)
  • Increase compliance with OSHA, wage, benefit and other worker protections. (Objectives 3b-3g)

Media

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Promote independence among older adults through exercise. (Objectives 1a-1c)
  • Promote classes and activities that reduce fall risks. (Objectives 1a-1c)
  • Educate parents about falls risks for infants and toddlers. (Objectives 1d-1g)
  • Disseminate Statewide fall prevention awareness campaign. (Objectives 1a-1g)
  • Conduct outreach and media campaigns directed at targeted occupational groups. (Objectives 1a-1c)
  • Expand access to and availability of exercise and information programs in community venues. (Objectives 1a-1c)
  • Raise awareness of programs, problems and solutions. (Objectives 1a-1g)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Raise community awareness of multi-sectoral violence prevention programs, e.g. LHDs, criminal justice, social services, job training, CBOs, such as SNUG, Cure Violence or CEASEFIRE in high-risk communities. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Raise awareness of workplace hazards and methods to reduce or prevent these risks. (Objectives 3b-3f)
  • Conduct a media and social marketing campaign to increase broad community awareness of the threat of extreme weather conditions, prevention measures needed to avoid it and the roles various players could take. (Objectives 3b)

Academia

Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Increase school based and community programs in conflict resolution. (Objectives 2a-2c)
  • Improve safety in school and workplace environments with cameras, better lighting, safes, more than one person on duty. (Objectives 2a-2c)
Goal #3:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Conduct research to review links between occupation and industry and chronic and infectious diseases. (Objectives 3b, 3e, 3f)
  • Measure absenteeism, due to flu illness among employees and students. (Objectives 3e)
  • Promote appropriate behavior patterns to reduce risks. (Objectives 3b-3f)
  • Provide workplace safety and health information in all vocational school curricula. (Objectives 3c, 3d)
  • Provide basic information about worker safety and health issues to all students as part of their health programs. (Objectives 3c, 3d)
  • Include information about hazards in all vocational training programs geared towards outdoor work. (Objectives 3b, 3c, 3d)
  • Educate teens about their rights and applicable regulations using curricula such as "Talking Safety" or the "Passport to Safety", targeting vocational schools and industries hiring large numbers of young workers. (Objectives 3c, 3d)

Community-Based Organizations

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Train physical therapists to deliver the Otago Exercise Program or other equivalent programs. (Objectives 1a-1c)
  • Conduct in-house falls risk assessments. (Objectives 1a-1g)
  • Provide access to exercise programs. (Objectives 1a-1c)
  • Train community workers in exercise programs for older adults. (Objectives 1a-1c)
  • Educate parents about falls risks among infants and toddlers. (Objectives 1d-1g)
  • Promote community-based programs for fall prevention. (Objectives 1a-1g)
  • Expand access to and availability of exercise and information programs in community venues. (Objectives 1a-1g)
  • Target fall risk in housing in disadvantaged areas. (Objectives 1a-1g)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Raise community awareness of causes and local efforts to prevent violence. (Objectives 2a-2c)
  • Implement evidence-based interventions to address the causes of violence. (Objectives 2a-2c)
  • Provide on-going mental health and substance abuse treatment to at-risk youth and their families. (Objectives 2a-2c)
  • Link violence victims and their families to educational opportunities, employment training and assistance, mental health services, substance abuse treatment, etc. as in the CEASEFIRE program. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Incorporate occupation and industry into all patient-oriented databases. (Objective 3a)
  • Institute appropriate behavior patterns to reduce transmission of infections. (Objectives 3b, 3e, 3f)

Other Governmental Agencies

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Increase awareness of exercise as method to maintain independence for older adults. (Objectives 1a-1c)
  • Provide access to exercise programs. (Objectives 1a-1c)
  • Reduce slip and fall hazards in common areas of residences and public buildings. (Objectives 1a-1c)
  • Assess and change building codes to include elimination of fall risks. (Objectives 1a-1c)
  • Increase access to public transportation through subsidy. (Objectives 1a-1c)
  • Target fall risk in housing in disadvantaged areas. (Objectives 1a-1g)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Partner with identifying high-risk communities and individuals. (Objectives 2a-2c)
  • Provide appropriate educational interventions. (Objectives 2a-2c)
  • Provide support to at-risk individuals and their families to reduce the risks for violence. (Objectives 2a-2c)
  • Increase school based and community programs in conflict resolution. (Objectives 2a-2c)
  • Develop multi-sectoral violence prevention programs, e.g., LHDs, criminal justice, social services, job training, CBOs, such as SNUG, Cure Violence or CEASEFIRE in high-risk communities. (Objectives 2a-2c)
  • Improve safety in school and workplace environments with cameras, better lighting, safes, more than one person on duty.
  • Reduce neighborhood environmental risks (e.g., abandoned buildings, no lighting, deserted streets). (Objectives 2a-2c)
  • Increase other community amenities, e.g., low cost healthy food, parks. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Use federal and State DOL to reach employers about effective methods to protect their workers. (Objectives 3b-3f)
  • Require training for those participating in DOL summer work programs and for those obtaining working papers. (Objective 3c, 3d)
  • Conduct research to review links between occupation and industry and chronic and infectious diseases. (Objectives 3b, 3e, 3f)
  • Train providers in taking occupational history. (Objectives 3a-3f)
  • Develop respiratory protection programs which include written policies and procedures for fit testing, employee training, medical clearance, appropriate selection of respirators, training in the use and maintenance of respirators, recordkeeping and program evaluation. (Objectives 3e)
  • Develop targeted occupational safety and health inspections and safety programs for high-risk jobs. (Objectives 3b-3f)
  • Provide technical assistance and resources to employers in improving safety of workplace design and equipment. (Objectives 3b, 3c, 3d)
  • Remove disincentives to reporting occupational hazards, injuries and illnesses. (Objectives 3a, 3c, 3d)
  • Strengthen occupational safety and health safety inspections and programs. (Objectives 3a-3f)
  • Strengthen occupational safety and health laws to provide disincentives for harming workers. (Objectives 3a, 3c, 3d)
  • Continue to reform workers' compensation laws and policies to ensure adequate benefits and reduce barriers. (Objectives 3a)
  • Increase compliance with OSHA, wage, benefit and other worker protections. (Objectives 3a)
  • Strengthen work permits laws and use. (Objectives 3b-3f)

Governmental (G) and Non-Governmental (NG) Public Health

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Coordinate resources focused on fall prevention. (G) (NG) (Objectives 1a-1g)
  • Increase awareness of exercise as method to maintain independence. (G) (NG) (Objectives 1a-1c)
  • Provide access to exercise programs. (G) (NG) (Objectives 1a-1c)
  • Conduct outreach and media campaigns directed at targeted occupational groups. (G) (NG) (Objectives 1a-1c)
  • Educate parents about falls risks among infants and toddlers. (G) (NG) (Objectives 1d-1g)
  • Promote community-based programs for fall prevention. (G) (NG) (Objectives 1a-1g)
  • Target fall risk in housing in disadvantaged areas. (G) (NG) (Objectives 1a-1g)
  • Increase Medicare, Social Security and other benefits to cover fall prevention assessments and interventions, e.g., visual and hearing aids, lighting, non-slip flooring. (G) (Objectives 1a-1g)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Provide training and resources to local health departments. (G) (NG) (Objectives 2a-2c)
  • Partner with identifying high-risk communities and individuals. (G) (NG) (Objectives 2a-2c)
  • Provide appropriate educational interventions. (G) (NG) (Objectives 2a-2c)
  • Provide support to at-risk individuals and their families to reduce the risks for violence. (G) (NG) (Objectives 2a-2c)
  • Train residents, CBOs and other organizations in crisis management and dispute mediation. (G) (NG) (Objectives 2a-2c)
  • Link violence victims and their families to educational opportunities, employment training and assistance, mental health services, substance abuse treatment, etc. as in the CEASEFIRE program. (G) (NG) (Objectives 2a-2c)
  • Identify high-risk communities for development of multi-sectoral violence prevention programs (e.g. LHDs, criminal justice, social services, job training, CBOs) such as SNUG, Cure Violence or CEASEFIRE in high-risk communities. (G) (NG) (Objectives 2a-2c)
  • Provide outreach workers and violence interrupters in schools and communities, especially during critical times. (G) (NG) (Objectives 2a-2c)
  • Increase educational, recreational and employment opportunities for at risk youth potentially through summer work experience programs or youth apprenticeship initiatives. (G) (NG) (Objectives 2a-2c)
  • Increase availability of health and mental health care services. (G) (NG) (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Research links between diseases that are 'occupational and industrial' and 'chronic and infectious' origin. (G) (NG) (Objectives 3b, 3e, 3f)
  • Incorporate occupation and industry into all DOH databases. (G) (Objectives 3a)
  • Provide methods to link electronic reporting records with occupational health registries. (G) (NG) (Objectives 3a, 3c, 3d)
  • Raise awareness and possibly pass legislation requiring appropriate employer action in times of extreme weather events. (G) (Objectives 3b)
  • Develop targeted occupational safety and health training programs for employers and workers in high-risk jobs. (G) (NG) (Objectives 3b)
  • Train providers in recognizing signs and symptoms associated with weather-related outcomes, such as heat and cold stress and arboviral infections. (G) (NG) (Objectives 3b)
  • Provide technical assistance and resources to employers in improving safety of workplace design and equipment. (G) (NG) (Objectives 3b, 3c, 3d)
  • Consider requiring flu vaccine for workers who interact with high-risk populations. (G) (Objectives 3f, 3g)
  • Conduct annual comprehensive educational campaigns targeting workers to encourage influenza vaccination. (Objective 3f, 3g)

Policymakers and Elected Officials

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Improve walkability and safety in community and public spaces. (Objectives 1a-1c)
  • Assess and change building codes to include elimination of fall risks. (Objectives 1a-1c)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Reduce access to firearms for children and individuals at high-risk for violence. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Raise awareness and possibly pass legislation requiring appropriate employer action in times of extreme weather events. (Objectives 3b)
  • Continue to reform workers' compensation laws and policies to ensure adequate benefits and reduce barriers to access and payment. (Objectives 3a)
  • Increase compliance with OSHA, wage, benefit and other worker protections such as not reporting work-related injuries. (Objectives 3a)
  • Strengthen work permits laws and use. (Objectives 3c, 3d)
  • Consider legislation requiring health care and school personnel to be vaccinated for the flu. (G) (Objectives 3f, 3g)
  • Consider legislation requiring students to be trained about worker health and safety issues as part of the school curricula. (G) (Objectives 3c, 3d)

Communities

Goal #1:
Reduce fall risks among the most vulnerable populations.
  • Provide safe walking environments. (Objectives 1a-1c)
  • Reduce slip and fall hazards in common areas of residences and public buildings. (Objectives 1a-1c)
  • Improve safety of playground equipment using playground safety regulations. (Objectives 1a-1c)
Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Reach high-risk individuals and offer solutions. (Objectives 2a-2c)
  • Create healthier environments. (Objectives 2a-2c)
  • Raise community awareness of violence prevention strategies. (Objectives 2a-2c)
  • Improve school-based, layperson and provider awareness in suicide prevention. (Objectives 2a-2c)
  • Increase educational, recreational and employment opportunities for at risk youth potentially through summer work experience programs or youth apprenticeship initiatives. (Objectives 2a-2c)
Goal #3:
Reduce occupational injury and illness.
  • Provide information to hard to reach populations. (Objectives 3b, 3c, 3d)

Philanthropy

Goal #2:
Reduce violence by targeting prevention programs particularly to highest-risk populations.
  • Offer assistance to high-risk individuals and their families. (Objectives 2a-2c)

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