Injuries are a focus of public health practice because they pose a serious health threat, occur frequently, and are in most situations preventable.1 Preventing traumatic injuries and controlling their severity offer a cost-effective approach to improve the health status of populations. Injuries are a very broad group of afflictions, arising from many different activities and risk factors, and can affect all organ systems of the body. Since injuries are so diverse in mechanisms of occurrence, formulating an organized and structured approach to studying their incidence and prevention is helpful.
Injuries affect people of all ages and range from minor cuts and bruises to major catastrophes that take thousands of lives. Some injuries may result in prolonged pain or lifelong disabilities that restrict an individual from performing personal, recreational, or work-related activities. Serious injuries affect more than the individual: they can destroy families and devastate communities as seen in recent earthquakes, hurricanes, and tsunamis. These events can leave individuals and societies with enormous medical costs, extensive rehabilitation needs, major lifestyle adjustments, and depression—losses that cannot easily, if ever, be recouped.
However, the majority of injuries do not occur as a result of a catastrophic disaster; they are usually related to the activities of everyday life. For example, the annual number of deaths from motor vehicle crashes in the United States far exceeds that from airline crashes and natural disasters combined. Injuries disproportionately affect the young, the frail, and underserved populations. Because injuries disproportionately affect children and adolescents, they account for a high proportion of premature productive life lost and a large proportion of the number of school and workdays missed, and have become a large component of the medical care dollar expenditure per capita.
The public is largely unaware of the preventable nature of many injuries. The most common reference to injurious events, “accidents,” evokes a feeling of chance, misfortune, and helplessness. Hence, the word “accident” should be avoided in discussing injury control, and instead, the focus should be on exposures to hazards and resulting injuries, as well as their preventability.
In recent years, great strides have been made in injury prevention. In the last 75 years, the motor vehicle fatality rate per mile driven has decreased 90%, and this has occurred as the number of miles of driving has risen by more than 100%. Despite this decrease, motor vehicles remain the most common cause of injury death. Causes for the decreases seen include modifications in roadway environments and vehicle design, changes of hazardous behaviors, such as drunk driving, and policies that have regulated driving conditions. Preventive measures have been successful in reducing the incidence of drowning, poisoning, falls, and fires.
Despite successes in many areas of injury prevention, the potential of preventing traumatic injuries has not been realized. There remains much to be done. This chapter presents a short public health history of injuries, examines the ...