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Injuries are no accident.

My first job in public health involved the establishment of a program in Consumer Product Safety. The goal of that program, as declared by Congress in the Consumer Product Safety Act, was to reduce injuries associated with products intended for home and recreation that presented an unreasonable risk of injury. The more I learned about the impact of injury as a cause of morbidity and mortality, the more I became perplexed by the discrepancy between the magnitude of the problem and the resources allocated to address it. I thought it would be useful to explore the problem of injury prevention briefly, as it is the theme for this issue of the Journal.

Statistics show that injury is the leading cause of death, in the U.S., in those persons below age 44. It is generally accepted that most injuries are preventable through awareness, education and regulation. What an opportunity for the implementation of a primary prevention effort in response to this public health problem, right? Well, maybe not.

There is widespread belief that injuries are indeed the result of accidents. Accidents can be defined as unforeseen, unplanned events. Injuries may be unplanned, but unforeseen? Frequently that is not the case. How often have you heard the well-used expression, "he or she was an injury waiting to happen?"

For example, investigations show routinely that crashes of private aircraft involve pilot error that is most frequently the result of a pattern of inadequate planning and poor decision making. A similar explanation follows many motor vehicle crashes and injuries. Consider the role of alcohol or the failure to wear seatbelts or motorcycle helmets. Is the resulting injury unforeseen or inevitable?

The public has been generally complacent when ranking the importance of injuries, because the risk of injury is often accepted as a voluntary one for which the hazards are known. This is in contrast to the involuntary risk and unknown hazard of exposure to toxic substances, for example. Government is most often directed to eliminate these involuntary risks with little regard for their magnitude when compared to other risks, like injuries, that the public encounters. Without the public outrage that has been expressed for certain environmental pollutants, resources are less likely to be allocated to government agencies in support of programs like injury prevention.

Despite the fact that injury is the leading cause of death, many state and local health agencies have made minimal effort to establish injury prevention programs. As environmental health professionals, we in NEHA have not promoted injury prevention with enthusiasm, either. This is despite excellent leadership from our Injury Prevention Section.

Finally, Congress certainly hasn't served as a good example over the years. For example, the Consumer Product Safety Commission's current budget is about the same today as it was in 1973 when the agency was created. That's 20 years ago. State legislatures also find it difficult to generate support for proposals that add health and safety requirements to the statutes, i.e., helmet law proposals, especially if they are perceived as infringing upon the rights of individuals.

Although attention to injury prevention and funds allocated to that task have increased in recent years, the response still does not correspond to the size of the problem. It's not only an issue of funding, but also recognition of the problem and education of the public about the causes of injury and means of effective intervention.

The typical environmental health professional has all of the tools to play a leadership role in reducing injuries. In many cases, he or she also works in the proper setting, at the community level.

Take the time to explore the problems and solutions in injury incidence and prevention. Injury is no accident, but it is a significant public health problem that needs attention.
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Author:Wiant, Chris
Publication:Journal of Environmental Health
Date:Apr 1, 1993
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