County Health Rankings & Roadmaps, A Healthier Nation, County by County

The County Health Rankings models and measures

Our Approach

The County Health Rankings model of population health

What can I do?

Action Center

Explore guides and tools for improving health.

What Works for Health

Explore programs and policies that work!

What can I learn from others?

Reports

Key findings from the last four years of County Health Rankings and other national reports.

County-by-County Blog

Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.

Community Safety Measurement Strategies

Community safety is often measured using the levels of violence and injuries experienced by the population. There are several mechanisms in which to characterize injury, including injury mortality (measured by injury death data) and injury morbidity (typically measured by hospitalization and Emergency Department (ED) use data). The leading causes of injury differ based on how injury is measured. For instance, the leading cause for injury death in the U.S. in 2012 was poisoning followed by motor vehicle traffic crashes, whereas for non-fatal injuries, falls were the leading cause of injury ED visits [1].

Additional ways to classify injuries are by intent and by setting. Injury data can be characterized as unintentional, intentional (such as homicides and suicides), and undetermined intent. Another way to measure injury applicable to the safety of a community is by setting, including occupational safety, safety in the home, and safety on the streets. Almost half of non-fatal injuries occur in or around the home, and although the number of occupationally related fatalities is a small subset of overall injury fatalities, these injuries are important to consider as they occur in a more controlled environment with a potentially better opportunity for targeted interventions [1,2].

One issue that arises with injury measurement is the paucity of state-level data on the external causes of non-fatal injuries. Classification of external causes of injury has not been consistently defined or reported. As of 2009, only 26 states mandated routine collection of external cause codes (ICD codes) in their hospital discharge data sets. Improvements to the reporting and standardization of the classification of external causes of injury have been seen in recent years [2,3].

Studies exploring the impact of neighborhood violence on health traditionally measure violence in one of three ways: perception of neighborhood safety, exposure to neighborhood violence, or actual measures of crime or disorder [4]. Johnson et al. notes that studies that explore general health or physical activity tend to focus on perceptions of neighborhood safety, studies that investigate mental health tend to measure exposure to violence, and multi-community studies use actual measures of crimes or disorder [4].

There is no gold standard for assessing crime rates at the neighborhood level, but some researchers have successfully used the Federal Bureau of Investigation’s Uniform Crime Reports because they are used consistently across government reporting agencies and are considered a valid and reliable index of the types of crime residents view as serious events [5]. According to the FBI, violent crime is defined to include murder and nonnegligent manslaughter, rape, robbery, and aggravated assault. Nonviolent crimes, including crimes such as drug abuse or counterfeiting, are often not considered in assessing community safety as they do not usually cause threat or physical harm to other persons.

References

[1] Centers for Disease Control and Prevention. Ten Leading Causes of Death and Injury. Updated November 14, 2014. Accessed March 13, 2015.
[2] Bergen G , Chen LH, Warner M, Fingerhut LA. Injury in the United States: 2007 Chartbook. Hyattsville, MD: National Center for Health Statistics. 2008.
[3] Centers for Disease Control and Prevention. Recommended Framework for Presenting Injury Mortality Data. Morbidity and Mortality Weekly Report 1997;46:1-30.
[4] Johnson SL, Solomon BS, Shields WC, McDonald EM, McKenzie LB, Gielen AC. Neighborhood violence and its association with mothers' health: Assessing the relative importance of perceived safety and exposure to violence. J Urban Health. 2009;86:538-550.
[5] Clark C, Kawachi I, Ryan L, Ertel K, Fay M, Berkman L. Perceived neighborhood safety and incident mobility disability among elders: The hazards of poverty. BMC Public Health. 2009;9:162.