• Motor vehicle fatality rates have declined markedly over the past 25 years (see Chapter 5). The improvement is attributable to reduction in drunk driving and increased use of occupant restraints, together with a continuation of longer-term influences (improved highway design, increased urbanization, improvement in emergency medical services, and safer vehicle designs) (Graham, 1993).

  • Long-term downward trends in occupational fatalities appear to have accelerated in recent years. Although the long-term trends are probably attributable largely to changes in work-force composition and technological improvements, it seems likely that occupational safety initiatives have played a contributing role (McGarity and Shapiro, 1993)

  • Residential fire death rates have also fallen substantially during this period, at least in part due to improvements in building codes, product safety improvements, and increased use of smoke detectors (U.S. Fire Administration, 1997).

  • By contrast, the suicide rate has remained essentially unchanged for the past 20 years, and the homicide rate is the same as it was 20 years ago, although it has fluctuated considerably over this period (Baker et al., 1992; Kachur et al., 1995; Fingerhut and Warner, 1997).

The main challenge for the nation, in the view of the committee, is to consolidate the gains that have been made over the past 25 years, and particularly over the past decade, and to secure the foundation for further advances in injury science and practice. This challenge can be met by adhering to the following plan:

  • Improving coordination and collaboration: Coordinating the diverse efforts currently devoted to injury prevention and treatment, promoting collaboration among interested agencies and constituencies, and clarifying the roles of the main federal agencies.

  • Strengthening capacity for research and practice: Strengthening the infrastructure of the injury field for developing knowledge and for translating knowledge into practice.

  • Integrating the field: Infusing the injury field with a common sense of purpose and a shared understanding of its methods and perspectives, and promoting new channels of communication.

  • Nurturing public understanding and support: Broadening public understanding of the feasibility and value of efforts to prevent and ameliorate injuries and promoting investment in injury prevention by managed care organizations.

  • Promoting informed policy making: Improving the information systems used for identifying and evaluating injury risks and setting priorities for research and intervention.

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