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Reducing the Burden of Injury: Advancing Prevention and Treatment
program of studying and preventing violence. The tools and resources of public health should be allocated prudently to this effort.
The recent emphasis on violence prevention has raised some additional questions about the conceptual boundaries of the injury field. At issue are the subtle but important differences between its defining mission—preventing and ameliorating traumatic physical injury—and the more sweeping aims of violence prevention. Physical injuries are among the most serious consequences of violence. However, definitions of violence (and "abuse") focus on the behavior (typically, force or threats of force) rather than the outcome. Moreover, the ultimate harm associated with violent relationships—including psychological distress and developmental harm—is more diffuse than physical harm, affecting both the immediate victim and those who witness the violence (Osofsky, 1995).
This difference in focus has two implications for the mission and boundaries of the injury field. First, violence prevention is a broader mission than prevention of the injury inflicted. The focus of the injury field should remain on preventing injuries, and in identifying and modifying risk factors for injuries. The committee recognizes that targeting abusive relationships and styles of violent interaction can often be effective means of reducing injuries (in the short term and across generations), but the challenge for the injury field is to promote collaboration with violence researchers and intervention agencies without losing sight of its own primary mission. In the final analysis, the value of the injury field's investment will be determined by the impact on injury morbidity and mortality. Second, the focus of the injury field should be on physical injury rather than emotional or developmental harms. One could say that all harmful outcomes from traumatic exposures, including emotional and developmental harm, are "injuries" within the domain of the injury field. However, in the committee's view, the tasks of measuring, understanding, and preventing these psychological harms are best viewed as being within the domain of mental health. This is not to say that psychological trauma is irrelevant to the injury field—emotional sequelae to physical injuries have a direct bearing on treatment, for example, and on the measurement of outcomes; but these concerns call for collaboration between injury and mental health, not for an extension of the boundaries of the injury field. In sum, although the perspectives and tools of the injury field have much to contribute to the study and prevention of violent injuries, the prevention of violence and the amelioration of its consequences comprise a much larger domain. Keeping this distinction in mind helps to shape the priorities of the injury field.