Injury Prevention Policy
How large is the injury problem?
In the United States during a typical year, injuries are responsible for more than 147 thousand deaths, 2.6 million hospitalizations, and 36 million emergency department visits (1). Injuries are responsible for more deaths among children, adolescents, and young adults than all other causes combined (2). When thinking about injuries it is useful to distinguish intentional injuries (homicide, suicide) from unintentional injuries (most burns, falls, motor vehicle crashes, etc.) because of the great differences in the implications for preventing these tragedies. These policy recommendations will be limited to those that primarily address unintentional injuries. Intentional injuries will be addressed in a future, separate section.
What is an injury and how do they occur?
An injury is defined as damage or harm to the body caused by
Injuries are not "accidents" in that they don't simply befall an individual from fate or bad luck. Injuries have causes. They are predictable and preventable. What about this word accident? According to the American Heritage Dictionary (Second College Edition), an accident is "an unexpected and undesirable event, especially if resulting in injury; an event that occurs without foresight or expectation, that proceeds from an unknown cause, or is an unusual effect of a known cause; fortune or chance". Because research has shown that injuries can be analyzed and averted, the word "accident" is clearly not appropriate for an intelligent discussion of injury prevention. Random events and bad luck cannot be prevented.
The term injury refers to an adverse health outcome, such as a leg fracture, rather than an event such as a motor vehicle crash. This distinction is important. Although it may be impossible to prevent all adverse events, it is often possible to prevent the adverse consequences of unavoidable events. For example, seatbelts, shoulder restraints, airbags, and the car's energy absorbing frame and body work together to reduce the likelihood of a serious injury resulting from an unavoidable collision.
There are a number of ways to prevent injuries. Ideally, most of these will work in concert. For much of the first half of the 20th century, injury prevention efforts focused on correcting careless or indifferent behavior through education. Although being informed of risks is important, there are other ways to prevent injuries. In the early 1940s it was recognized that products could be made safer through better engineering and design. Enactment and enforcement of laws regulating behavior and the establishment of policies, rules, and standards are also effective at reducing the number and severity of injuries. Economic incentives, (vouchers for safety seats, smoke alarms, or bike helmets; tax breaks for retrofitting home pools with isolation fences, etc.) are useful in minimizing barriers imposed by the cost of safety devices. Finally, the consequences of injuries may be reduced if the injured person receives timely, skilled emergency medical care.
Example: Motor vehicle crash
Research has shown that education alone is unlikely to have a long-lasting impact on people's behavior and thus, the occurrence of injuries. This is particularly true for children and adolescents. Young children are developmentally incapable of recognizing and evaluating the consequences of risk-taking. They are impulsive and cannot be trusted to exercise caution at all times. Children or their parents may not recognize potential hazards from toys, cribs, clothing, etc. Adolescents seek independence by taking risks. Thus, it is important for everyone to ensure the safety of children through policies and standards that minimize the risk of childhood injury.
1. Fingerhut LA, Warner M. Injury Chartbook. Health, United States 1996-1997. Hyattsville, MD: US Department of Health and Human Services, National Center for Health Statistics, 1997.
Last modified: 14-July-2000.