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Reducing the Burden of Injury: Advancing Prevention and Treatment
distinction between unintentional and intentional injuries (i.e., homicide, assaultive injuries), it broadens the reach of prevention research and practice beyond the traditional domain of "accident prevention."
From "Accident Prevention" to "Injury Prevention"
Injury in America (NRC, 1985) explicitly recognized that the public health paradigm could be usefully applied to the prevention of intentional injuries as well as unintentional ones. The report identified knowledge about assaultive injuries as a major gap in current research: "Nonfatal assaultive injuries and homicides have been subjected to little prevention-oriented research. 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 self-inflicted injuries, Injury in America focused mainly on unintentional injuries, primarily those caused by motor vehicle crashes. Three years later (with the publication of Injury Control), the IOM-NRC committee reviewed the status and progress of the injury control programs at CDC; that report reiterated the need to intensify the study of intentional injury: "The study of intentional injury can be characterized as a neglected but potentially productive research field. . . . The nation now has hundreds of programs aimed at reducing the incidences of suicide, homicide, and other intentional injuries, but there is no commensurate effort to evaluate the effectiveness of the programs" (NRC, 1988).
A Broader Field
Ten years have elapsed since the publication of Injury Control. Over this period, research and program development within the injury field have been expanded to give greater attention to the study of intentional injuries, reflecting a broader movement within medicine and public health embracing the cause of