Introduction to Injuries
The G B D defines injuries as death or disability due to the direct or indirect result of a physical force, immersion, or exposure, including accidental, interpersonal, or self-inflicted forces as well as war, conflict, violence, and natural disasters.
GBD 2019 - Injury
- Out of three major categories, communicable diseases, non-communicable diseases, and injuries, injuries account for the smallest portion of deaths, contributing to 7.6% of all deaths.
- Injury death rates are higher in males (2.94 million) than females (1.36 million).
- The top causes of death due to injury in 2019 were falls, road injuries, self-harm, and interpersonal violence
- From 2010 to 2019, the age-standardized death rate due to injuries decreased by 19.4%
Interpersonal Violence
Interpersonal violence may be physical, sexual, or psychological (also called emotional violence), and it may involve deprivation and neglect
Injuries by Geographic Areas
- The rates of a particular cause of injury varies between geographic areas
- For example, in 2013 it was recorded that the DALY rate for road injuries is 9.7 times higher in boys living in central sub-Saharan Africa compared with high-income Asia Pacific
In what sex and region based category is self harm the number one cause of injury? In what category is interpersonal violence the biggest cause of injury?
Self-harm is the number one cause of injury in Eastern European males. Interpersonal violence is the biggest cause of injury in males living in Central Latin America.
Suicide
- Around 800,000 people die by suicide every year, a tragedy that reverberates through families, communities, and entire nations, producing long-lasting emotional effects on those that are left behind. Shockingly, in 2018, it was the leading cause of death for children ages 10 - 14 and it was the second leading cause of death for those between the ages of 15 - 34 in Canada. Suicide rates are also significant in populations that experience isolation and discrimination, including the L G B T Q 2 s+ population, refugees and migrants, and Indigenous Peoples.
- Although suicide is prevalent in high income countries, 79% of global suicides in 2016 occurred in low and middle income countries. Note that while suicide is part of the injuries category, it is very closely tied to mental illness, which is part of the non-communicable diseases group
Sixties Scoop
Indigenous children were “scooped” away from their families and placed in fosters homes and up for adoption. The name refers to the 1960s, but this occurred from the 1950s - 1980s.
Residential Schools
A government initiative in Canada that aimed to “kill the indian in the child” through assimilation tactics. Such tactics included forcefully separating Indigenous children from their families, isolating them from their culture, and prohibiting their language. Children were given an inferior education and were often physically, sexually, emotionally, and psychologically abused. These schools remained open from 1831 to 1996, during which an estimated 150 000 children attended.
Transmission Models for Intergenerational Trauma
Intergenerational trauma occurs when trauma experienced by one generation is passed down to other generations. For over 100 years the Canadian government systematically oppressed Indigenous Peoples through the Residential School education system, which has been described as an act of cultural genocide, and has led to intergenerational trauma. The last Residential School closed in 1996
Sociocultural Model
- The sociocultural model explains intergenerational trauma through parenting styles and exposure to environmental factors that may impact a child’s development. This model is based on the assumption that children are directly influenced by the home environment they are raised in. Many Indigenous children were raised in the residential schooling system where they were subjected to abuse, neglect, and high levels of stress
- This model explains that as these children grow and become parents, they may lack the skills and knowledge to create a nurturing family environment and to support their own children. A cycle of negative parenting behaviours then ensues and results in intergenerational trauma
Psychological Model
The psychological model explains intergenerational trauma based on the understanding that a child’s brain development can be significantly impacted if during the early years of development they are subjected to harsh conditions. The model suggests that a child’s brain development, and ability to self-regulate, may be affected if their basic needs are not met. In the residential schooling system, many children were unable to develop a sense of trust and security with the majority of people around them. As such, this theory suggests that children raised in poor conditions may develop cognitive delays and negative coping strategies that can heavily impact their lives in the future. In addition, a culture lacking trust and security may be instilled and passed from generation to generation.
Physiological Model
- The physiological model explains intergenerational trauma through biological factors and predisposed genetic factors. It suggests that when a child is subjected to excess levels of stress, there are abnormal levels of cortisol, dopamine, and serotonin, which may affect brain development. These changes can affect the ability to process and handle stressful environments, and can potentially lead to heightened activity levels and/or learning disabilities.
- Epigenetic theories suggest that high levels of maternal stress can influence in-utero development and actually alter the function of some genes in the offspring. It is thought that these changes in gene function can occur preconception, affecting the germ-line (from either parent) or in-utero due to high maternal stress during pregnancy, and can result in negative responses to stress in the offspring
Dopamine
An important messenger involved in reward, motivation, memory, attention, and even
regulating body movements
Serotonin
The key hormone that stabilizes our mood, feelings of well-being, and happiness
Cortisol
The body’s main stress hormone released by the adrenal glands
Epigenetic
Epigenetics is the process of altering gene activity and expression through external
modifications to D N A. These external modifications turn genes “on” or “off” and although they do not
change the D N A sequence, they affect how cells “read” genes
In-utero
A term used to describe “In the womb” or “in the uterus” typically denoting before birth
Suicide Rates in Various Indigenous Groups
One of the health disparities in Canada is suicide rates among Indigenous Peoples. This disparity is caused by the mass trauma that Indigenous Peoples are subjected to due to colonization, as well as the ongoing battle of reconciliation. Social, familial, and cultural factors also impact suicide rates
Protective factors for Indigenous youth may include
- High community knowledge of the Indigenous language
- Secure Indigenous titles to traditional lands
- Self-governance, leading to control over essential services (such as health care, education, police,
fire department) - School attendance
- Sustainable employment
- Easy access to social support and tailored mental health services
Language
The words used to describe suicide may themselves be stigmatizing. For example, using language such as “committed suicide” comes from the repealed law that stated taking one’s own life was a criminal act. In Canada, and many parts of North America, suicide is no longer recognized as a criminal act, and should be discussed through terms such as “took their own life” or “died by suicide
Respect
It is becoming more common and safe for people to share their experiences with suicide. Although this is undoubtedly a good thing, one important consideration for reducing stigma is respecting the decisions of individuals who choose not to discuss their experiences. Not all people are eager to talk about their experience, and that should not impact the level of support they receive
Advocate
An easy way to help reduce the stigma around suicide is to use your voice. People who are experiencing a mental health problem or survivors of suicide should not be expected to navigate advocacy by themselves. Using our voices to tackle the stigma and prejudice around mental illness is a part we can all play
Suicide Prevention
Fortunately, suicides can be prevented, but it will take a concerted global effort. There are a number of preventative methods that can be implemented to reduce suicide rates
Policy
Policies can help reduce suicide through multiple avenues. For example, strict public policies on the reduction of the harmful use of alcohol and other substances may help limit the rates of suicide
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