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Reducing the Burden of Injury: Advancing Prevention and Treatment
focus on the mechanism of injury because the information regarding intent may be subjective and unavailable. Second, even though differences in intentionality are often associated with different risk factors and different targets of intervention, responsibilities for carrying out preventive interventions in the field often converge on the same programs and agencies, particularly in public safety, emergency medical and other health care, and public health. Finally, epidemiologic evidence highlights the powerful etiological role of several factors that cut across all injury categories, whatever the mechanism and regardless of intention. Prominent examples are alcohol use and adolescent impulsivity. Reflecting this, some interventions tend to reduce the incidence and severity of both unintentional and intentional injuries. Examples of interventions shown to have a broad impact include reducing alcohol availability (Chiu et al., 1997; Landen et al., 1997), home visitation for first-time new mothers (Kitzman et al., 1997; Olds et al., 1997), and eliminating the carbon monoxide content of domestically used coal gas (Hassall and Trethowan, 1972).
Viewed in this way, injury prevention is necessarily a collaborative undertaking. The main contributions of injury science lie in its population-based perspective; its capacity to identify and frame interventions for a broad array of risk factors, particularly environmental ones; and its tools for measuring outcomes. However, injury scientists and prevention practitioners need partners in order to mount any successful preventive intervention. Interventions targeted at product design and the physical environment require collaboration with product manufacturers, safety engineers, and so forth. Interventions targeted on human behavior or the social environment require collaboration with schools, family service agencies, mental health agencies, and alcohol control agencies, among others. Interventions aiming to reduce self-inflicted injuries, assaults, and various types of unintentional injuries require different collaborators, but the basic approach is the same: The injury field provides the wide-angle lens, while the specific focus is provided by specialists from pertinent disciplines in adjacent fields.
In summary, by proclaiming that "violence is a public health problem," leaders in medicine and the public health establishment have summoned a growing body of researchers and practitioners to the cause of violence prevention. Perhaps an analogous effort will be undertaken for suicide prevention. However, it is important to clarify the implications of this declaration for the future of the injury field. Conceptually and scientifically, the prevention and treatment of injury (whether intentional or unintentional) may be productively studied and understood from a public health perspective. However, organizing a successful social response to injury is not a conceptual and scientific challenge; it is a political one. To say that violence is a public health problem is not necessarily to say that the public health community should be at the center of the social response to violence. Nor is it to say that the public health infrastructure has any comparative advantage in organizing the social response to violence. What is required is a coordinated effort to harness social energies for a more effective