Health Education Research, Vol. 16, No. 1, 102-105,
February 2001
© 2001 Oxford University Press
BOOK REVIEW |
Injury Prevention and Public Health: Practical Knowledge, Skills and Strategies
Tom Christoffel and Susan Scavo Gallagher Aspen Publishers, Gaithersburg, MD, 1999 416 pp. ISBN 0-8342-0840-7. $49.00
Division of Unintentional Injury Prevention, National Center for Injury, Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
The time has come for injury prevention to be recognized as a legitimate part of public health. John Last once stated that we sometimes recognize as public health problems, aspects of life that we have previously considered as normal and acceptable (Last, 1987
). Injury prevention is one of these problems and in their text, Injury Prevention and Public Health: Practical Knowledge, Skills and Strategies, Christoffel and Gallagher place injury prevention squarely within the professional context of public health.
Their comprehensive text serves as a technical guide to injury prevention practice. The authors address essential injury prevention knowledge, skills and practice strategies useful to health department officials, public health students, community leaders, advocates and practitioners new to the injury field. Other books in the field published since 1997 (Ohsako, 1997; Widom, 1997; Barss et al., 1998; Horan and Little, 1998; Platt and Little, 1998; Robertson, 1998; Rockett, 1998; Institute of Medicine, 1999; Krug, 1999; David and Lucile Packard Foundation, 2000; Mohan and Tiwari, 2000; Van Hasselt and Hersen, 2000) have been written with a different and specialized audience in mind. This text, by contrast, is more general and is likely to be more useful to a wider audience. Not since Injury Prevention: Meeting the Challenge (National Committee on Injury Prevention and Control, 1989) has the field had a comprehensive resource like this one.
Intended for public health practitioners and students new to the injury field, the book is written in a clear and consistent style that facilitates reading. Language in the book is easy to read, and the authors carefully explain injury terms and concepts that may be new to readers (e.g. the use of E-codes in injury surveillance). When applicable, authors include case studies and real-life examples to make the concepts more tangible and realistic. Of particular value are the specific suggestions on who to contact for assistance, and how to tackle certain challenges and obstacles that are inevitable when planning new efforts like injury prevention.
Well-organized chapters and subheadings make it easy for busy professionals to flip through and find relevant information. The chapters are organized into three sections: Part 1: Magnitude, Concepts and Epidemiology of Unintentional and Intentional Injury (including the importance of injury, historical landmark events, epidemiology and data analysis, Healthy People 2000 goals); Part 2: Concepts of Injury Prevention (including public health planning, educational strategies, environmental approaches, role of the law) and Part 3: Practical Knowledge, Skills and Strategies (including the role of public agencies, federal and state programs, developing an injury program, injury surveillance, evaluation, barriers to injury prevention). The text concludes with a comprehensive list of injury-related Internet sites and listservs. We find this section particularly useful, as it provides readers with a set of contacts and resources, and builds a framework within which practitioners can begin their program activities.
An important feature of the book is the recognition of the important role state health departments play in injury prevention. Authors note that injury activities can be comfortably housed in various departments within the agency, including epidemiology, health promotion, maternal and child health, and emergency health services, and, with increasing support from the CDC's National Center for Injury Prevention and Control, many additional state health departments have established independent injury prevention units (Sleet et al., 1998). This book will help facilitate the national capacity-building process by making practical guidance available to public health professionals who are starting injury prevention programs.
Most of the book addresses unintentional injury topics, and there is but one chapter on violence and intentional injuries. The reader will not find much related to the special problems of occupational safety.
In keeping with the professional orientation of the authors, the book places a heavy emphasis on `structural' or environmental and legal approaches to injury prevention (e.g. laws and regulations, product design, environmental modifications). We would like to have seen more examples of the contribution of behavioral science to injury prevention research and practice. This is an important and growing area, and there are many examples from the literature that could have been highlighted for discussion (Sleet and Hopkins, 2001).
While the authors discuss some applications of health education to injury prevention, there are segments of the book that favor structural approaches to the exclusion of health promotion and education. One section on environmental modification boldly states that `...the subject of this chapter—is to modify the environment to make behavior change easier or, better yet, to make behavior change unnecessary by providing automatic or passive protections' (p. 161). While it is tempting to factor out human behavior and individual choice in preventing injury, it is rarely achievable.
One recent example is the case of automatic protection provided by passenger-side airbags. Once considered a panacea for injury prevention to automotive passengers, the recent and unexpected deaths to children and small-statured adults from airbags resulted in a growing recognition of the need to take an active approach to this passive protection. Public health professionals are now encouraged to actively educate parents to buckle up their children and seat them away from airbags, and to educate drivers about air bag on/off switches. Arguments for health education were largely ignored until after people lost their lives. This example underscores the necessity of combining environmental and behavioral approaches to injury prevention, and the important roles behavioral science, health promotion and modern health education play in injury prevention, even when passive solutions are introduced (Towner et al., 1996; Gielen and Girasek, 2000). As much as we would like to hope otherwise, most injuries cannot be resolved by introducing a vaccine-like technology, as the technology must be proven safe, adopted by people and used properly in order to be effective.
Chapter 7, `Injury Prevention: Educational Strategies', includes an interesting discussion of Stages of Change and the Health Belief Model, but then ends with the admonition that `Our health education efforts need to evolve from focusing on the first three parts of this spectrum [strengthening individual knowledge and skills, promoting community education, and educating providers] to making a commitment to parts four through six [fostering coalitions, changing organizational practices, influencing policy and legislation]' (p. 153). While it is true that naive information-based health education efforts in injury prevention have largely failed, programs employing modern social marketing strategies, behavior modification, behavioral safety and human factors approaches, audience-targeting and message tailoring, and the application of effective theories and models of health behavior change have demonstrated greater success. The authors miss the opportunity to make this important point, and are inconsistent in framing the value of health education, health promotion and health behavior change in injury prevention.
In conclusion, the book goes a long way in offering readers a broad perspective of the field. One measure of maturity in a young field like ours is demand for it by officials, practitioners, students, researchers and the general public. As demand rises for injury prevention, so will the supply of textbooks and resources like this. Donna Shalala was right when she noted in her address celebrating CDC's 50th anniversary that `Public health is a marathon, not a sprint'. It took us over 200 years to eradicate smallpox and over 45 years to virtually eliminate polio, and it will take a long time to make meaningful progress against injury. Books like this will help us get there faster.
References
American Academy of Pediatrics (Committee on Injury and Poison Prevention) (1997) Injury Prevention and Control for Children and Youth. American Academy of Pediatrics, Elk Grove, IL.
Barss, P., Smith, G., Baker, S. and Mohan, D. (1998) Injury Prevention: An International Perspective. Epidemiology, Surveillance, and Policy. Oxford University Press, New York.
David and Lucile Packard Foundation. (2000) Unintentional injuries in childhood. The Future of Children, 10, 1–188.
Gielen, A. C. and Girask, D. (2001) Integrating perspectives on the prevention of unintentional injuries. In Schneiderman, N., Speers, M. A., Silva, J. M., Tomes, H. and Gentry, J. H. (eds), Integrating Behavioral and Social Sciences with Public Health. American Psychological Association, Washington, DC, pp. 203–227.
Horan, M. A. and Little, R. A. (1998) Injury in the Aging. Cambridge University Press, Cambridge.
Institute of Medicine (1999) Reducing the Burden of Injury: Advancing Prevention and Treatment. National Academy Press, Washington, DC.
Krug, E. (ed.) (1999) Injury: A Leading Cause of the Global Burden of Disease. WHO, Department for Disability/Injury Prevention and Rehabilitation, Social Change and Mental Health Cluster, Geneva.
Last, J. M. (1987) Public Health and Human Ecology. Appleton & Lange, Stamford, CT.
Mohan, D. and Tiwari, G. (eds) (2000) Injury Prevention and Control. Taylor & Francis, New York.
National Committee for Injury Prevention and Control (1989) Injury Prevention: Meeting the Challenge [supplement to American Journal of Preventive Medicine, 5(3)]. Oxford University Press, New York.
Ohsako, T. (1997) Violence at School: Global Issues and Interventions. UNESCO, International Bureau of Education, Paris.
Platt, M. P. W. and Little, R. A. (1998) Injury in the Young. Cambridge University Press, Cambridge.
Robertson, L. S. (1998) Injury Epidemiology: Research and Control Strategies, 2nd edn. Oxford University Press, New York.
Rockett, I. R. H. (1998) Injury and Violence: A Public Health Perspective [Special Issue]. Population Bulletin, 53(4).
Sleet, D. A. and Hopkins, K. (2001) Bibliography of Injury Prevention and Behavioral Science Research. CDC, Atlanta, CA. Excerpts available at www.sophe.org/ui/index.html.
Sleet, D. A., Bonzo, S. and Branche, C. (1998) An overview of the National Center for Injury Prevention and Control at CDC. Injury Prevention, 4, 308–312.
Towner, E. M. L., Dowswell, T., Simpson, G. and Jarvis, S. (1996) Health Promotion in Childhood and Young Adolescence for the Prevention of Unintentional Injuries. Health Education Authority, London.
Van Hasselt, V. B. and Hersen, M. (eds) (2000) Aggression and Violence: An Introductory Text. Allyn & Bacon, Boston, MA.
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