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1 The Injury Field
Pages 18-40

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From page 18...
... STUDY BACKGROUND In 1966, the National Academy of Sciences' Division of Medical Sciences and the National Research Council (NRC) issued Accidental Death and D'sability: The Neglected Disease of Modern Society, recommending that the nation's public and private resources be mobilized to reduce accidental death and injury in an effort equivalent to the recent assaults on polio and cancer (NRC, 19661.
From page 19...
... Intellectually, the committee set forth the rationale for conceptualizing "injury prevention and control" as a distinct field of interdisciplinary research, drawing together what had been separate strands of scientific study within the framework of public health. In terms of public policy, the committee recommended a major investment in injury research, commensurate with the magnitude of the problem, and proposed creation of a center for injury research within the Centers for Disease Control, now the Centers for Disease Control and Prevention (CDC)
From page 20...
... serve as clearinghouse, coordinator, and lead agency on injury prevention and control among federal agencies and private organizations. Soon after injury in America was released, Congress appropriated funds for a pilot program for injury control at CDC, and two years later, a new IOM-NRC committee reviewed its progress.
From page 21...
... Throughout this formative period, diverse initiatives were undertaken by a variety of other federal agencies, state governments, foundations, and citizen activists to promote safety and ameliorate the burden of injury. Examples include Kellogg Foundation grants for home accident prevention in the 1950s and 1960s, the founding of the American Trauma Society in 1968, the establishment of 600 poison control centers in the 1960s and 1970s, the creation of a federal program on emergency medical services in the 1970s, the funding of state injury prevention programs by the Division of Child and Maternal Health of the Department of Health, Education, and Welfare in 1979, and the founding of Remove Intoxicated Drivers in 1978 and Mothers Against Drunk Driving in 1980.
From page 22...
... a post-event phase, during which attempts can be made to restore homeostasis and repair the damage. This three-phase conceptualization of injury causation can be combined with the traditional public health categorization of risk factors and intervention opportunitieshost (the potential injured person)
From page 23...
... Prevention and remediation of these problems are and should be the responsibility of a wide variety of social institutions, including medicine, alcohol control, fire safety, mental health, criminal justice, the tort system, and many others. As discussed in Chapters 7 and 8, public health agencies should be playing a much more substantial role in injury prevention than they areinow, but their role should be understood as a contributory one, in collaboration with other agencies.
From page 24...
... Typically, they have been regarded as a 'crime problem,' rather than as a health problem, and blame and punishment of the perpetrators have been emphasized, rather than measures to reduce the frequency and severity of such injuries." After identifying several potentially useful interventions for the prevention of firearm-related injuries, the report noted that "assaultive injuries involving other weapons or personal force are virtually unresearched." Similarly, although Injury in America recognized that much research had focused on the diagnosis and treatment of depressed or suicidal people, the report observed that little attention had been paid to public health approaches, such as modifying products or environments to reduce the lethality of means of suicide. It encouraged research into the "validity of the widespread assumption that nonfatal suicide attempts represent a lack of desire to kill oneself, and therefore involve the choice of less lethal means" and on "reducing the lethality of common means of committing suicide." Despite its emphasis on the need for greater attention to assaultive and selfinflicted injuries, Injury in America focused mainly on unintentional injuries, primarily those caused by motor vehicle crashes.
From page 25...
... However, despite the important differences associated with intentionality, the committee strongly endorses and reaffirms continued integration of all injury prevention activities within a common framework of research and program development for several reasons. First, the surveillance systems that undergird injury prevention collect data on all injuries regardless of intent and 2In this report the committee uses the term violence to denote interpersonal violence.
From page 26...
... Viewed in this way, injury prevention is necessarily a collaborative undertaking. The main contributions of injury science lie in its population-based perspective; its capacity to identify and frame interventions for a broad array of risk factors, particularly environmental ones; and its tools for measuring outcomes.
From page 27...
... First, violence prevention is a broader mission than prevention of the injury inflicted. The focus of the injury field should remain on preventing injuries, and in identifying and modifying risk factors for injuries.
From page 28...
... Erasing the term "accident" from the vocabulary of the field has not erased it from everyday speech, however, and the general public and policy makers seem to understand the phrase "accident prevention" much better than they understand "injury prevention." Moreover, as noted by Bijur (1995) , abandoning the term accident has left the field without a generic term for the events that may or may not result in bodily injury.
From page 29...
... Among other concerns, they point out that the focus on intentionality can divert attention to issues relating to individual moral and legal responsibility and away from the broad array of risk factors and interventions represented in the Haddon matrix, many of which can prevent both intentional and unintentional injuries. Intentionality is more sensibly understood as a continuum, ranging from inadvertence to conscious risk taking to purposeful harming, rather than as two categories; and assigning cases to one of the two categories for coding purposes often requires complex judgments based on inadequate information.
From page 30...
... is used to refer to the entire domain of injury prevention and treatment. DEVELOPMENT OF THE INJURY FIELD The committee was assigned the task of reviewing the progress of the injury field since publication of Injury in America and Injury Control and making recommendations to further develop the field and reduce the burden of injury.
From page 31...
... The ICRCs have played an important role in this effort, holding conferences for practitioners and facilitating the implementation and evaluation of interventions. In addition, several journals are now devoted exclusively to the field, including the Journal of Safety Research, Injury Prevention, Accident Analysis and Prevention, and the Journal of Trauma, and an increasing amount of space is devoted to injury-related articles in journals with general professional readerships, including the American Journal of Public Health, Pediatrics, the Journal of the American Medical Association, and the New England Journal of Medicine.
From page 32...
... overlaps with other fields whose knowledge and practice affect injury prevention and treatment. These adjacent fields include substance abuse, disability prevention, criminal justice, child development, and mental health.
From page 33...
... Injury prevention is not free. All preventive interventions have costs, including possible trade-offs with other important social values.
From page 34...
... Regulation and Freedom Injury prevention interventions often aim at protecting people from the consequences of their own risk taking. In some instances, critics may characterize these interventions as "paternalistic" because they curtail people's freedom "for their own good," rather than to protect other people.
From page 35...
... Regardless of one's views on the issue of paternalism, injury prevention interventions always require attention to costs and benefits, and a restriction of individual freedom must sometimes be "weighed" as one of the "costs" of the intervention. One example is the argument that reducing the blood alcohol level (BAL)
From page 36...
... As noted in Chapter 7, advocacy on behalf of injury prevention is a key component of public health practice, and injury scientists may properly want to assume the burdens and risks-of advocacy. How to balance the demands of science and advocacy is one of the ongoing challenges for the field.
From page 37...
... Chapter 3 reviews existing injury data systems and makes recommendations for improving injury surveillance as a necessary foundation for further advances in risk analysis, prevention research, and program evaluation. Chapter 4 highlights opportunities for strengthening injury prevention research.
From page 38...
... 1992. Injury Prevention Professionals: A National Directory, 3rd edition.
From page 39...
... Morbidity and Mortality Weekly Report 43~32~:581-586. National Committee (National Committee for Injury Prevention and Control)
From page 40...
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