Perspectives in Disease Prevention and Health Promotion
Unintentional and Intentional Injuries -- United States
Injuries rank as the fourth leading cause of death in the
United
States, exceeded only by heart diseases, malignant neoplasms, and
cerebrovascular diseases. In terms of years of life lost
prematurely,
however, injuries rank first (1). In the United States alone in
1980,
there were over 70 million injuries and 150,000 unintentional and
intentional injury-related deaths. Motor-vehicle deaths account
for
nearly 35% of all injury-related deaths; homicides and suicides
account for over 30%; and burns, falls, and drownings account for
nearly 18% (2).
The societal cost of injuries is high--estimated at more than
$83
billion per year (2); yet relatively little effort has been devoted
to
the prevention of injuries. This imbalance is, in part, the result
of
a widespread misunderstanding of injury causation. Often, cause is
characterized by the term "accident," which connotes chance or
fate,
while actually many injuries, like diseases, can be prevented.
Also,
epidemiologic analyses of injuries describing the relationship of
host, agent, and environmental variables may provide useful
information about injury prevention. However, education-oriented
intervention strategies directed at host variables such as
risk-taking
behavior and alcohol and drug use typically have had little effect
on
injury rates. Automatic or "passive" protection is gaining
recognition as the major focus of prevention efforts because it
requires no individual action by those protected and has
considerable
potential for preventing injury morbidity and mortality. Ten
interrelated strategies that can help prevent injuries have
recently
been summarized (3,4) (Table 3).
Listed below are 3 injury-control measures designed to
eliminate
or modify potentially injurious environmental factors that have
been
associated with substantial decreases in morbidity and mortality.
Since the introduction in 1972 of childproof caps on aspirin
and other medication containers, there has been a substantial
reduction in childhood poisonings. In the period 1971-1977,
deaths attributable to ingestion of analgesics and
antipyretics
decreased 41% for all age groups (5).
In New York City, there was a substantial reduction in the
incidence of childhood injuries and deaths due to falls after
the
health department provided free, easily installed window guards
to
families with young children living in high-risk areas.
Between
1973, when the program began, and 1975, the number of falls
reported declined 50%, and the number of deaths due to falls
decreased 35% (6).
In Honolulu, where legislation requires protective fencing
around public and private pools, childhood drowning fatalities
associated with swimming pools occur substantially less
frequently
than in cities without such legislation. Total population
studies
of swimming pool fatalities have been done in Honolulu and in
Brisbane, Australia, a city that does not have a law requiring
fencing but is similar to Honolulu in size, pool-to-house
ratio,
climate, and life style (7). The fatality rate for
swimming-pool
drownings in Honolulu is 0.9/100,000 population, compared with
a
rate of 2.6/100,000 in Brisbane, Australia.
Two other areas in which control measures are likely to
decrease
injuries include tap-water scalds and childhood automobile
injuries.
Each year 4,000 persons require extended hospital care for
tap-water
scalds. Although it is still too early to measure the outcome,
many
cities are actively involved in programs to prevent these injuries.
Tap-water-scald injuries can be virtually eliminated by limiting
water-heater temperature to no more than 120 F (48.9 C) (8).
Recognizing that automobile child-restraint devices, when
properly
used, can be up to 90% effective in reducing fatalities and serious
injuries, 10 states have passed child-restraint laws. At least 20
more states have such bills pending.
These examples of injury-control methods have several common
elements (5). 1) The injury pattern is fairly obvious and
consistent
so that it can be defined through data-collection methods currently
available. 2) The countermeasure consists of modifying the
environment to eliminate the hazard or reduce it demonstrably. 3)
The
need for behavior change on the part of the potential victim is
minimal. 4) The countermeasure and its cost are accepted by the
public
or are sufficiently minor to be of little significance. 5) The cost
and ease of introducing the countermeasure is acceptable to
manufacturers or others responsible for it. 6) The injury-producing
product or environment is susceptible to relatively rapid
modification
or replacement.
Reported by Environmental Health Svcs Div, Center for Environmental
Health, CDC.
Editorial Note
Editorial Note: A 1981 survey of state and territorial health
departments conducted by the National Environmental Health
Association
identifed only 12 state health departments that maintain
injury-control programs. Expansion of the field of injury control
requires the involvement of voluntary and private organizations, as
well as federal, state, and local governments, and the commitment
of
health professionals--physicians, nurses, epidemiologists, and
public
health officials--all of whom can be leaders in advocating and
implementing injury-control programs.
References
CDC. Introduction to Table V. Premature deaths, monthly
mortality, and monthly physician contacts--United States. MMWR
1982;31:109-10.
Baker SP, Dietz PE. Injury prevention. In: Healthy people.
The
Surgeon's General's Report on Health Promotion and Disease
Prevention, background papers. Washington, D.C.: U.S.
Department
of Health, Education, and Welfare, 1979.
Haddon W, Jr, Baker SP. Injury control. In: Clark DW,
MacMahon
B, eds. Preventive and community medicine. Boston: Little,
Brown,
1981.
Planek, W. A continuing social problem, accident analysis and
prevention. Accident Analysis and Prevention 1982;14:107-20.
Spiegel CN, Lindaman FC. Children can't fly: a program to
prevent
childhood morbidity and mortality from window falls. Am J
Public
Health 1977;67:1143-7.
Pearn, JH, Wong RY, Brown J, Ching Y-C, Bart R, Hammar S.
Drowning and near drowning involving children: a five-year
total
population study from the city and county of Honolulu. Am J
Public Health 1979;69:450-4.
Katcher, ML. Scald burns from hot tap water. JAMA
1981;246:1219-22.
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