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© 2004 American Public Health Association
EDITOR'S CHOICE |
Executive Director, APHA
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I awoke this morning to the news that another American life was tragically lost because of a preventable injury, and I wondered why our nation has been so complacent about this problem. Then I remembered the retort I received from a policymaker the last time I sought funding for an injury program: "Injury is not a public health problem!"
In 2000, injury was responsible for 10% of health care expenditures—more than $117 billion. Injury is the leading cause of death for Americans younger than 35 years and is a leading cause of disability. In this issue of the Journal, Lynda Doll and Sue Binder of the National Center for Injury Prevention and Control lay out the case for injury as one our nation’s most preventable problems. They point to the incredible toll extracted by injury in human suffering as well as the staggering fiscal costs to society.
Why, then, is it so difficult to convince policymakers that injury is a public health problem worth addressing? Maybe because they still believe in the accident paradigm. This line of thinking argues that injuries are an act of fate, and while it makes sense to be more careful, injuries will occur despite our best efforts.
The evidence against the accident paradigm is exhaustive. Automobile-related injury has been dramatically reduced by a multifaceted effort to make cars safer. By redesigning automobile brakes, steering columns, sidewall protections, seat belts, air bags, and a host of other safety features, we have made the automobile a much safer machine. The addition of programs to reduce the incidence of impaired driving and promote driver training have addressed the human aspects of automobile safety.
Pedestrian trauma from motor vehicles is on the rise and, once again, safety experts are intervening by developing novel ways to reduce the hazards of walking. On April 7, 2004, the World Health Organization is emphasizing the global scope of the problem by declaring road safety as the theme for World Health Day.
In my days as an emergency physician, I was struck by the fact that most of the injuries I treated could have been prevented if only simple precautions had been taken. My colleagues and I would give individualized advice to patients on how to prevent future injuries while we provided medical care for their current injuries. Later, when I became active in public health, I recognized the need for population-based interventions as tools to reduce injuries, such as the interventions advanced in this issue of the Journal regarding motorcycle helmet laws, speed bumps, and programs to prevent dating violence. These interventions work. They reduce injuries, save lives, and prevent disabilities. They also save money—lots of money. These are marvelous accomplishments that are largely overlooked by most policymakers.
At a time when economists predict double-digit increases in health care expenditures, I have a solution: injury prevention. At a time when we are looking for ways to address disparities in health care, I have a solution: injury prevention. At a time when we are looking to protect our children from harm, I have a solution: injury prevention. The next time someone challenges us on the propriety of addressing injury as a public health problem, point out that if something kills people or hurts people, it’s our responsibility as public health leaders to find a solution.
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