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.

1. 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).

2. 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).

3. 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

1. CDC. Introduction to Table V. Premature deaths, monthly mortality, and monthly physician contacts--United States. MMWR 1982;31:109-10.

2. National Safety Council. Accident facts, 1981 Edition. Chicago:National Safety Council, 1981.

3. 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.

4. Haddon W, Jr, Baker SP. Injury control. In: Clark DW, MacMahon B, eds. Preventive and community medicine. Boston: Little, Brown, 1981.

5. Planek, W. A continuing social problem, accident analysis and prevention. Accident Analysis and Prevention 1982;14:107-20.

6. 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.

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.

8. Katcher, ML. Scald burns from hot tap water. JAMA 1981;246:1219-22.

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