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Reducing the Burden of Injury: Advancing Prevention and Treatment
INJURY AS A PUBLIC HEALTH PROBLEM
The subtitle of Injury in America was ''A Continuing Public Health Problem" (NRC, 1985). What exactly does it mean to say that injury is a public health problem? Injuries constitute a major public health problem because, in the aggregate, they produce such an enormous toll of disability and premature death, draining health care dollars and weakening the nation's productive capacity. Fortunately, these consequences can be reduced or ameliorated by using the analytic tools and preventive perspectives of public health. Indeed, because the public health paradigm can embrace all etiologic factors bearing on prevention, it has been widely accepted by analysts in all disciplines, even though many of the interventions lie outside the expertise and capacity of public health agencies.
This is not to say that the public health approach is the only useful perspective for thinking about injuries. Some perspectives are remedial rather than preventive and normative rather than empirical. Conceptually, issues concerning the remediation of injuries (compensation of injured persons, corrective justice or the punishment of persons or entities responsible for "causing" or failing to prevent injuries) are extrinsic to issues of prevention. Operationally, however, they may converge (e.g., punishment of wrongdoers or imposition of liability can achieve preventive effects through deterrence) or diverge (e.g., the risk of tort liability faced by companies often reduces hazards, but sometimes creates disincentives to disclose safety information and may thereby retard safety innovation).
To say that injury is a public health problem should not be understood to mean that the social response should be mounted primarily or exclusively by public health agencies; nor does it imply that a public health response is superior to other forms of response. Public health agencies lack expertise and command over most of the interventions suggested by the Haddon matrix. Injuries represent a complex set of social problems. 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 are now, but their role should be understood as a contributory one, in collaboration with other agencies.
THE MISSION AND BOUNDARIES OF THE INJURY FIELD
The mission of the injury field is prevention, amelioration, and treatment of injury and the reduction of injury-related disability and death. The field is defined by its focus on the injury, whatever the mechanism by which it was immediately caused and regardless of the contributing role of human intent. This understanding, which emerges clearly from Injury in America, has profoundly important implications for the boundaries of the field because, by drawing no