Injury in America A Continuing Public Health Problem (1985) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-17
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Every year, more than 80~000 people in the United States join the ranks of those with unnecessary, but permanently disabling, injury of the brain or spinal cord.
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· Reducing injuries requires coordinated effort among specialists in epidemiology, prevention, biomechanics, treatment, and rehabilitation; trained manpower is inadequate. · Funding for injury control is disproportionately low and discontinuous, in comparison with that for cancer, heart disease, and other major health problems Without funding continuity, centers of excellence in iniurv research and care cannot curers ve and prow.
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Chapters 7 and 8 deal with the research funding and organizational arrangements for research and training related to injury. Appendix A contains some examples of the general research problems associated with injury control and the committee's recommendations for address ing them, and Appendix B contains brief biographies on the committee members.
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, motor-vehicle crash injuries alone are the leading cause of death. For all ages combined, the injury death rate is surpassed only by the rates for heart disease, cancer, and stroke.
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31:599, 1982. Injury greatly surpasses all ma jor disease groups as a cause of prematurely lost years of life, because it is the preeminent cause of death among children and young adults.- More years of future worklife are lost to injury than to heart disease and cancer combined.
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The acquisition of knowledge about motor-vehicle injuries is a direct result of the funding of research on injury epidemiology from two sources whose primary mandate is the study of automobile injuries -- the National Highway Traff ic Safety Administration and the Insurance Institute for Highway Safety. Little funding has been available for researab into the epidemiology of other injuries; consequently, our knowledge of these other injuries is slight.
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· Provide automatic protection by product and environmental design -- for example, by the installation of seatbelts that automatically encompass occupants of motor vehicles or built-in sprinkler systems that automatically extinguish fires. Each of these general strategies has a role in any comprehensive injury-control program; however, a basic finding from research is that the second strategy-requiring behavior change will generally be more effective than the first, and that the third -- providing automatic protection -- will be the most effective.
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And not only are young children hard to influence, but intensive ef forts at a well-baby clinic, for example, had no effect on dangerous maternal behavior, such as leaving knives and matches within the reach of small children. The shortage of health professionals and scientists with relevant training is ~ major impediment to injury control.
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Design of less injurious environments depends partly on knowledge of the effects of specific k inds and amounts of energy on specif ic human tissues . Although we know the approximate limits of forces that can be tolerated by young healthy males in rapid deceleration, we do not have ref ined data on other elements of the population, on the extent of reversibility of damage, or on effects on nervous tissues or tissues outside particular size and structural ranges.
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Understanding of Ache immune system and prevention and control of infection also warrant high priority as does control of spinal coed swelling and research in spinal cord regeneration. Recommendations · Long-term collaborative studies should be instituted by epidemiologists, statisticians, biomedical engineers, trauma physicians, rehabilitation physicians, behavioral scientists, and health economists, to identify and evaluate factors that produce optimal results, to identify factory that result in less than optimal results, and to institute programs for promulgating optimal management techniques.
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In the context of ire jury control, rehabilitation is the process by which biologic, psychos logic, and social functions are restored or developed to permit an injured person to achieve maximal personal autonomy and an independent noninstitutional lifestyle. Rehabilitation is achieved not only through functional change in the person (e.g., development of compensatory muscular strength, use of prosthetic limbs, and treatment of postinjury behavioral disturbances)
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Preventable disability is not an uncommon consequence of inadeguate management of the injury patient -- for example, limitation of motion due to contracture in burned patients or paralysis in patients with unrecognized injury of cervical vertebrae. Pressure sores, or ~bedsores, ~ are an entirely preventable complication that occurs in 35-40 percent of persons with spinal cord injury, at an average cost of $25,000-$28,000 per pressure sore, inestimable misery, and increased debilitation.
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research budget. Although injuries are responsible for the loss of more economically productive years of life than heart disease and cancer combined, the federal expenditure for research in injury control is relatively small approximately one-tenth of that for cancer and less than one-fifth of that for heart disease and stroke (Figure 3)
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. The total federal expenditure for injury research is the sum of the amounts discussed in Chapter 7 plus a ~ percent increment for administration, the latter in line with NIB adminis tration costs.
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The committee does not advocate a reduction in federal expenditures for health researob in cancer or heart disease and stroke. It does feel, however, that federal expenditures for injury research and injury control are seriously inadequate.
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It is imperative that all appropriate disciplines be represented and that the CIC director be a scientist with recognized research accomplishments and successful experience in interdisciplinary investigations of injury. No single discipline or disciplinary orientation can produce the broad spectrum of researab needed for injury control.
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The oppor tunity exists to create a focused, coordinated research effort with the potential to save lives, improve productivity, and reduce costs and long-term losses to the injured, their families, and society. The alternative is the continued loss of health and life to predictable, preventable, or modifiable injuries.
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