AWA: Academic Writing at Auckland

In New Zealand (NZ) thermal injuries are one of the main causes of hospital admission in those under 14 years (Harre, Field, & Polzer-Debruyne, 1998; Kypri, Chalmers, Langley, & Wright, 2001). This health issue provides an ideal basis for demonstrating the ways of addressing underlying determinants that negatively affect health; for this essay namely education and housing. Using the Ottawa Charter (World Health Organisation, 1986) interventions for improvement can be identified. The five strands are the development of personal skills, the strengthening of community action, the development of supportive environments, the building of healthy public policy and the reorienting of health services. Incorporated with these responses are the values of equity, social justice and empowerment, the benefits and actions of which are explained in the closing paragraphs.

Burns present a huge physical and psychological burden, particularly in children (Delgado, et al., 2002). They can be debilitating, requiring surgery and lengthy rehabilitation, and possibly long-term disability or disfigurement, placing strain not only on the child, but on the family, wider community and medical resources (Kypri, Chalmers, Langley, & Wright, 2001). Statistics show that, on average, in NZ 5.5 children are burnt severely enough to require hospital admission per week (Safekids New Zealand, 2009). Children aged 0 to 14 years are at the greatest risk for hospitalisation due to thermal injury than other age groups (Waller & Marshall, 1993). In early childhood, below the age of four years, burns are the third most common type of injury, with the majority of those being caused by hot water and steam (Kypri, Chalmers, Langley, & Wright, 2001). 60 to 80 NZ children are admitted to hospital annually for hot tap water burns alone (Jaye, Simpson, & Langley, 1999) Burns, or thermal injuries, are classified by the World Health Organisation (WHO, 2008) to include thermal burns such as scalds, flame burns and chemical burns, as well as inhalation burns which are the result on breathing in steam, hot liquids, super-heated gases and other noxious products.

Burns are one of the most costly injuries to treat, both in terms of economic and time resources (Delgado, et al., 2002). Childhood burns is particularly important in a NZ context as the patterns victims follows a downward social gradient, with those with a lower socioeconomic status or part of a marginalised population presenting with more burns than more affluent communities (Moses, 2009). This indicates that it is an issue that is contributed to by social and economic determinants as opposed to biological. Decreasing childhood burns in NZ involves the need to address underlying determinants that are a violation of social justice and show population inequalities such as poor education and inadequate housing.

As with the majority of health issues, childhood burns are the result of the culmination of many underlying influences. Education is a determinant that has been linked to this health issue. Due to the age of the victims, adult education is particularly emphasised, but educating children is also a crucial element (Harre, Field, & Polzer-Debruyne, 1998). Lack of education on the part of the parent can lead to poor child supervision in risky situations, lack of knowledge about how and what can burn a child and what to do when that occurs, and giving responsibilities to children beyond their capability level, increasing the risk of an accident that leads to thermal trauma (Delgado, et al., 2002). Education around hot water and fire safety needs to increase as to minimise the risk of accidents that cause burns. Furthermore, tradesmen need to be educated about the possible consequences of setting water temperatures above 55 degrees Celsius (°C) (Jaye, Simpson, & Langley, 1999).     

Poor housing is another determinant that contributes to behaviours and events that result in burns of children (Shai, 2006). Poor housing for this health issue can be in the form of hazardous cooking spaces and potentially dangerous heating systems. Combined with a lack of education, this increases the likelihood of fires or other thermal accidents that lead to burns in children. A frequent occurrence is the displacement of kettles leading to scalds. In one study, this accounted for 41 percent of those that presented with burns to the head and neck (Herd, Widdowson, & Tanner, 1986). This was generally due to children playing with the hanging cord of the appliance.

Older homes are generally those more associated with this kind of incident (Shai, 2006). They generally have fewer electrical outlets, leading to overloading of the outlets or the use of extension cords. This increases the chances of an electrical fire and appliances overheating, but also if several bench top appliances are competing for one outlet in a kitchen, cords are more likely to be hanging in riskier locations (Shai, 2006).

Education is a crucial determinant that needs to be addressed to decrease the prevalence and severity of childhood burns. Strengthening community action is a way in which this can be achieved. This encourages wider community participation, allowing issues that increase the risk of burns in the home to be identified by the community and strategies to address the issue created by the communities affected. The aim of this is to enable communities to change the patterns of behaviour that increase the likelihood of a burn to a child. School based programs that aim to teach children about being more safety conscious around flames and hot water not only increases the child’s personal knowledge, but it unites the community towards combating the health issue increasing the likelihood of improvement (Warda, Tenenbein, & Moffatt, House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions, 1999).

School-based programs develop the personal skills of the child. Education campaigns of any kind generally result in the gaining of knowledge and this is, or has, the potential to increase skills. This leads to the increased ability of an individual to control their life and the factors impacting on it.

Furthermore education empowers children to become their own advocates and bring changes to their own environments, making them safer. The creation of supportive environments is crucial, as it allows issues to be more openly discussed as well and improving the physical environment. School curriculums open up the forum for discussion around fire safety and ideally lead to changes such as closer supervision of children in the kitchen and bathroom.

Healthy public policy allows the above to occur. The Ottawa Charter (1986) outlines the need for public policies to be analysed for their direct and indirect effects on health, so that all policies support the health of the population. This is not solely health policies. In terms of addressing childhood burns, education policies can include the compulsory inclusion of fire safety in the school curriculum. In this instance, the Ministry of Education would be acting as an advocate for the vulnerable population (the children) and acting to ensure that their personal skills are further developed, community action is strengthened and environments become more supportive.

Lastly, the reorientation of health services is the involvement of the health care service in addressing health issues from the prevention level upwards. Primary health clinics could potentially become a source for subsidised smoke alarms and batteries so that operating smoke detectors in homes across NZ is increased, decreasing the chance of more serious burn injury.

Similarly, housing can be addressed using the same strands from the Ottawa Charter (1986). Strengthening community action can be seen in education programs for new public housing residents, where fire safety in the home is increased while uniting the community (Warda, Tenenbein, & Moffatt, House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions, 1999).

As housing, as a determinant, addresses the physical qualities of dwellings, it is in development of personal skills of plumbers, to make them more safety conscious, that will lead to improved dwellings. New homes are required to have maximum hot tap water delivery set at 55°C or below (Jaye, Simpson, & Langley, 1999). Tradesmen require their awareness of the potential consequences of non-compliance with this standard to be increases so that they are more likely to adhere to guidelines not only in new homes, but when examining older homes.

These guidelines for water temperature are another example of healthy public policy in action. They were motivated by campaigns by groups such as the Royal NZ Plunket Society (Jaye, Simpson, & Langley, 1999), whose intervention demonstrates their mediating position between policy makers in NZ and the children that they are advocating for. Campaigns such as this are an example of strengthening of community action, while the issue of lowering household water temperatures encourages the creating of supportive environments.

As previously mentioned, health services need to be reoriented, and part of this is towards research. The cooperative effort between communities and health service providers could produce more research about the risk factors in the home that increase the chance of a childhood burn, which would enable policy makers to make more informed decisions to improve housing and decrease the number of burns in children.

Incorporated throughout the interventions to alter the determinants that underlie burns in children are the ideas of equity, justice and empowerment. Equity encompasses the idea of fairness, of making outcomes more equal (Baum, 2008), and is one of the prerequisite conditions for health identified in the Ottawa Charter (World Health Organisation, 1986). Inequalities can be seen when examining who is more likely to obtain a burn in childhood, being those living in lower socioeconomic, remote or non-white areas (Warda, Tenenbein, & Moffatt, House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury, 1999). Campaigns, such as education programs in new public housing residents, specifically target increased risk populations with the aim of making the health outcomes of these populations more equitable.

Social justice is another prerequisite for health (World Health Organisation, 1986). The establishment of equity is in itself a form of social justice, which aims to protect vulnerable populations and ensure fairness. Improving housing and increasing education are both examples of furthering social justice. Inadequate housing and poor education are factors that increase the risk of children obtaining a thermal injury thereby breaching social justice as it disadvantages those whom the determinants affect. Justice is achieved through creating equity by using the Ottawa Charter to implement interventions such as education campaigns for public housing residents, who are likely to the individuals with less income as well and education, and who are inhabiting housing that is potentially dangerous.

Finally, empowerment is the increased ability of an individual to make informed choices and acquire more control over their own circumstances (Baum, 2008). This can be done at an individual and a community level. Improving education and housing empowers individuals and populations as it increases awareness and knowledge, resulting in a heightened capacity to make decisions that minimise the risk of a child receiving a burn (Warda, Tenenbein, & Moffatt, House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions, 1999). This is specifically demonstrated in school-based education programs, as they aim to empower children by teaching them basic fire safety. This empowerment has far-reaching effects, as those empowered children have the potential to influence their household’s behaviours, as well as educate the next generation.

References

Baum, F. (2008). The New Public Health (3rd Edition ed.). Melbourne: Oxford University Press.

Delgado, J., Ramirez-Cardich, M. E., Gilman, R. H., Lavarello, R., Dahodwala, N., Bazan, A., et al. (2002). Risk factors for burns in children: crowding, poverty, and poor maternal education. Injury Prevention , 8 (1), 38-41.

Harre, N., Field, J., & Polzer-Debruyne, A. (1998). New Zealand children's involvement in home activities that carry a burn or scald risk. Injury Prevention , 4 (4), 266-271.

Herd, A. N., Widdowson, P., & Tanner, N. S. (1986). Scalds in the very young: prevention or cure? Burns , 12 (4), 246-249.

Jaye, C., Simpson, J., & Langley, J. (1999). Barriers to Safe Hot Water. Dunedin: Injury Prevention Research Unit.

Kypri, K., Chalmers, D. J., Langley, J. D., & Wright, C. S. (2001). Child injury morbidity in New Zealand, 1987-1996. Journal of Paediatrics and Child Health , 37 (3), 227-234.

Moses, A. (2009). Analysis of Unintentional Child Injury Data in New Zealand: Mortality (2001-2005) and Morbidity (2003-2007). Auckland: Safekids New Zealand.

Safekids New Zealand. (2009, July 22). Safekids New Zealand. Retrieved September 10, 2010, from Safekids New Zealand: http://www.safekids.org.nz/Downloads/Safekids%20Factsheets/Safekids%20Burn%20Injury%20Factsheet%202008.pdf

Shai, D. (2006). Income, Housing and Fire Injuries: A Census Tract Analysis. Public Health Reports , 121 (2), 149-154.

Waller, A. E., & Marshall, S. W. (1993). Childhood thermal injuries in New Zealand resulting in death and hospitalisation. Burns , 19 (5), 371-376.

Warda, L., Tenenbein, M., & Moffatt, M. E. (1999). House fire injury prevention update. Part I. A review of risk factors for fatal and non-fatal house fire injury. Injury Prevention , 5 (2), 145-150.

Warda, L., Tenenbein, M., & Moffatt, M. (1999). House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions. Injury Prevention , 5 (3), 217-225.

World Health Organisation. (1986, 21 November). The Ottawa Charter for Health Promotion. Retrieved September 14, 2010, from http://www.pha.org.nz/documents/ottawa_charter_hp.pdf