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Reducing the Burden of Injury: Advancing Prevention and Treatment
violence2 prevention (see, e.g., Surgeon General's Workshop on Violence and Public Health [U.S. DHHS, 1986;]; Violence in America: A Public Health Approach [Rosenberg and Fenley, 1991]; Understanding and Preventing Violence [NRC, 1993]; Violence in Families: Assessing Prevention and Treatment Programs [NRC, 1998]). The salience of intentional injuries in the collective consciousness of public health has also drawn the attention of injury scientists to the mechanisms of these injuries, principally firearms (see, e.g., Karlson and Hargarten ). However, these developments have exposed some critical tensions within the injury field about its identity, mission, and future direction. Some believe this trend to be a deviation from the core scientific mission of the field and worry about the diversion of limited resources from the chronically neglected problems of unintentional injuries to areas in which the potential contributions of the field are limited. They also believe that it is a strategic mistake for the injury field to take on the daunting, complex, and highly politicized subject of violence. Others believe that the scientific and programmatic advantages of integrating the field, and its potential contributions to the cause of violence prevention, require steadfast continuation of the present course.
From the internal perspective of the injury field, the issue can be posed either as one of boundaries or as one of priorities: Does the prevention of intentional injuries lie within the domain of the field? If so, how should the priorities for research and action be set within such a diverse array of important social problems? From a societal perspective, the argument raises questions about the added value of public health to the prevention of suicide and violence, problems traditionally understood to lie within the respective domains of mental health and criminal justice.
This controversy signifies an important stage in the development of the injury field. Arguments for disaggregating the prevention of violence and suicide from the prevention of unintentional injuries have some force, especially in light of the greater importance of motivational factors and individual vulnerabilities in understanding and responding to violence and suicide and of the traditional roles played by criminal justice and mental health disciplines in these areas. 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
In this report the committee uses the term violence to denote interpersonal violence. A major 1993 report defined violence as "behavior by persons against persons that intentionally threatens, attempts, or actually inflicts physical harm. . . . [The definition] excludes consideration of human behavior that inflicts physical harm unintentionally. Also excluded are certain behaviors that inflict physical harm intentionally: violence against oneself, as in suicides and attempted suicides . . ." (NRC, 1993, pp. 35–36).