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Reducing the Burden of Injury: Advancing Prevention and Treatment
strategies for prevention are prayer and human improvement. With the advent of industrialization in the nineteenth century, the environmental risk factors for injury became more discernible, and the challenges of "accident prevention" and industrial safety began to receive sustained attention. Railroad, textile, and mining industries began recording work-related injuries in the early 1800s (Loimer et al., 1996). Political movements for worker protection developed in Europe in the mid-nineteenth century and later in the United States. Early developments include the creation of the National Safety Council in the United States in 1913 and the Royal Society for the Prevention of Accidents in England in 1916.
Although interest in worker safety, child safety, and driver safety grew over the course of the twentieth century, systematic scientific inquiry was rare, and the ameliorative efforts undertaken by interested private constituencies were episodic and unconnected. This situation changed dramatically during the 1960s and 1970s when two developments converged to establish the intellectual and programmatic foundation for a new field of research and social action: (1) a substantial social investment in injury prevention, spurred by a burst of federal regulatory action and (2) the emergence of injury science as a distinct interdisciplinary field of research within the domain of public health (Baker, 1989; also, see the following discussion).
The Highway Safety Act of 1966 signaled a national commitment to reducing injuries and deaths on the nation's highways. In this path-breaking legislation, Congress empowered a federal agency, the National Highway Safety Bureau (now the National Highway Traffic Safety Administration [NHTSA]), to set motor vehicle safety standards and to make grants for research and programs promoting highway safety. Four years later, the federal Occupational Safety and Health Act established a regulatory agency (Occupational Safety and Health Administration) to set and enforce workplace safety standards, and a separate research agency (National Institute for Occupational Safety and Health). This period of federal regulatory innovation was consummated with the enactment of the Consumer Product Safety Act and companion legislation in 1972 that established the Consumer Product Safety Commission. 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. Although these activities were not coordinated, they reflected a common aspiration and a shared recognition of the potential benefits of concerted social action to reduce injury. Taken together, they substantially increased the number of individuals and