FOUR HUNDRED GRIEVing families huddle today around shiny coffins and yawning graves, shocked to weeping numbness by the sudden death of a loved one: a beautiful child, an innocent youth, a beloved father.
And on this same sad day, another 1,000 families hear the horrendous news that one of theirs will be permanently disabled, some so severely that they will never move again.
Thousands of other families suffer this day with someone who breaks a bone or mangles a finger or burns a hand.
It is an average day in America, a day of such mayhem and anguish as to make war almost peaceful by comparison.
And the most incredible aspect of it all-the circumstance that boggles the mind and insults the sensibilities-is our calm acceptance of this daily devastation.
Accidents, fate, misfortune, providence, we say. It happens to others but not to us-and there is nothing to be done about it.
Well, it`s time we woke up and smelled the flowers while we still have breath to do it, because the chances are good that some of the bad things will happen to us, and there is indeed something to be done about it-a lot, in fact.
First of all, forget ”accident” and think ”injury.” Accident is acceptance, a mindless, unquestioning acquiescence. Injury is looking into the bright, limpid eyes of your child, grandchild or helpmate and asking yourself, ”How can I keep you, precious one, from being hurt or killed?”
The answer to your question may surprise you, placed as it is in the vernacular and framework of disease. Injury, we are finally coming to realize, does its dirty work much the same as disease: affecting certain populations, lurking in specific environments and lending itself to prevention much like we inoculate to prevent disease.
We`re coming late to this realization, having lost almost twice as many of our loved ones to injury as have been killed in all the wars combined, and the horrendous toll is mounting daily. We are by no means ready to make any revolutionary changes that will reduce the carnage overnight, but we are beginning to identify the problem. And that is an incredibly important first step.
The problem, of course, is us. It always is. But in the case of injury it is more us than ever, due mainly to our absurd acceptance of the ”accident” philosophy. Within the last decade, that absurdity began to inundate health statistics like a bloody flood: an annual death toll approaching 150,000, some 62 million needing medical attention, an annual cost of $133.2 billion, more lost years of life than from cancer and heart disease combined, the major killer of those aged 1 to 44.
Former Surgeon General C. Everett Koop, commenting on the fact that in a recent year, 8,000 children under 14 were killed by injuries and another 50,000 permanently disabled, said, ”The greatest potential threat to the average American child is that child`s own family and home environment. I don`t think the American people understand this, or want to face up to it.
”If a disease were killing our children in the proportion that injuries are,” Koop says, ”people would be outraged and demand that this killer be stopped.”
Koop made his comments at a meeting of the National Safe Kids Campaign, a nationwide coalition of health and civic organizations formed in 1989 to try to reduce injury among children.
”There`s still a lot of folklore about `accidents,` about fate taking a hand in this or that; in other words, a lot of folklore that relieves adults of responsibility,” Koop says. ”Changing that totally erroneous mindset is our most serious challenge.”
The first chipping away at the ”accident” mindset was done in 1949 by researchers who suggested that injuries were like infectious disease in that they had epidemic episodes, seasonal variation, trends and certain population distributions. Injuries, like disease, the researchers said, were caused by
”forces” from at least three sources: the host, the agent and the environment.
Other scientists built on this work to define injury as exposure to excessive amounts of energy-electrical, chemical, thermal, radiation or the kinetic energy of a crash, fall or bullet-or the absence of oxygen or heat.
Researchers also began to look at the sequence of pre-injury, injury, and postinjury, with the possibility of affecting changes in all three stages. They also separated injuries as to intentional (assault, homicide, suicide, self-inflicted, etc.) and unintentional (falls, crashes, drownings, fires, etc.).
Having thus established a framework for looking at the various aspects and kinds of injury, it became apparent that there were many things that could be done to prevent them, to lessen their severity and to enhance recovery.
AS THE NATIONAL Committee for Injury Prevention and Control said last year in a report titled ”Injury Prevention, Meeting the Challenge,” the contributions of early researchers ”helped to shift injury prevention away from an early, naive preoccupation with distributing educational pamphlets and posters and toward modifying the environments in which injuries occur. By developing new laws and enforcement mechanisms and through new technologies and engineering changes in products, injury experts from a broad range of disciplines sought to protect people from coming into contact with injurious amounts of energy.”
The unofficial kickoff for changing public attitude toward injury occurred in 1985 with the landmark report ”Injury in America” prepared by members of the National Academy of Sciences. Calling injury ”the principal public health problem in America today,” the report says the injury toll was unacceptable and that an investment in injury research could yield an unprecedented public-health return.
The report lamented the lack of research and funding and the absence of national direction in addressing the problem. With the exception of motor-vehicle injury, where there is at least some basic short-term information available, virtually no data exists on the mechanics, frequency or profile of injuries.
This lack of data, the report says, has led to some expensive but ineffective preventive programs. Only recently, for example, has study shown that instead of saving lives, the high school drivers` education program causes an increase in death and injury by putting more 16-year-old drivers on the road. If the minimum driving age had been 17 in 1985, there would have been 1,375 fewer traffic deaths, according to a report made to Congress in 1989.
Researchers have suggested that because driving is a complex activity and that proficiency at it may take years, beginning drivers should start learning earlier, be supervised by parents or others for a longer period and be restricted to daylight hours.
AS THEY LOOKED FOR ways to prevent injuries, researchers established three strategies: persuasion, a ”require” strategy and automatic protection. An example of persuasion is education on the dangers of drinking alcohol and driving. The ”require” strategy would be a law against drinking and driving. And the automatic protection might be an air bag to protect the drunken driver when he smashes into a tree or another vehicle.
As might be expected, it was discovered early on that the ”require”
strategy was more effective than persuasion and that automatic protection was the most effective of all. Part of the reason is that those groups most at risk-teenagers, for example-were least likely to change their behavior when
”persuade” and ”require” were used.
In examining our attitude toward injury, the authors of ”Injury Prevention” say that each person sees him- or herself as being less at risk than others. Thus most people view themselves as safer-than-average drivers. Another element in our attitude is that American society generally sees risk- taking as a good thing (see ”Risks” on page 14).
It is even glorified in the media, the authors say, and they add that most news stories about injury focus on the circumstances and aftermath of a single injury and do not depict injuries as understandable, predictable and in many cases preventable events. As a result, most people continue to view injuries as acts of fate.
It may take a long time and involve painful experience to change attitudes and behavior that prevent injury. Helmets for motorcycle riders are a case in point. Using the clout of withholding highway funds, the federal government forced states to pass helmet laws, and the incidence of head injury to motorcyclists declined markedly. When the clout was lifted, pressure from a vocal minority of motorcyclists got the helmet laws rescinded in 27 states and motorcycle death and serious head injury soared. Opponents to the law say it should be an individual`s choice to wear a helmet because there is no harm to the public.
