Three Basic Convictions: A Recipe for Preventing Child injuries/Trois Principes Fondamentaux Pour Prevenir Les Traumatismes Chez l'enfant/Tres Convicciones Basicas: Una Receta Para Prevenir Las Lesiones Infantiles
Pless, Ivan Barry, Bulletin of the World Health Organization
I am sure others have written more profoundly about repetition but I like this quote attributed to Collier: "Constant repetition carries conviction". (1)
It seems especially important to write about these convictions in the context of this theme issue for the World report on child injury prevention. (1) The Department of Violence and Injury Prevention and Disability at WHO has, in recent years, played an increasingly important role in injury prevention worldwide by providing the strong leadership that the field requires.
My perspectives on the additional requirements needed on top of WHO's initiatives arise from training as a paediatrician, working as an investigator and editing Injury Prevention since its inception. Since the mid-1960s, I have also witnessed the birth and growth--and occasional demise--of many well-intentioned efforts, ranging from organizations like Safe Kids Worldwide to more modest, local initiatives. Since the "discovery" of injuries as a health problem nearly 50 years ago, we still find far too many studies that are entirely descriptive, or simply repeat findings from other parts of the world. More importantly, there are far too few studies that describe proven interventions, and fewer still that show how or whether a proven intervention works in the real world.
So much for my qualifications to pontificate; my three ingredients are simple but critical if we are genuinely committed to making real progress in preventing children's injuries and their sequelae. Undoubtedly, other ingredients could be added to this recipe.
Injuries are a health problem
Although many disciplines and many branches of government have important roles to play in preventing childhood injuries, we must hold on to the view that, in the end, injuries are a health problem. This seems so self-evident that it is embarrassing to give examples to support the argument. But, for some inexplicable reason, in most countries injuries are not viewed in this light. Health departments are often disinterested or only pay lip-service to their prevention. So, the reader (or their medical and public health colleagues) needs to be reminded that injuries produce lacerations, broken bones, burned and scalded flesh, clogged airways, damage to vital organs ... the list is long and sad. All of these require medical care. Many require long hospital stays. Some end in life-long disability and some are fatal. Consequently, no reasonable person can deny that injuries are a health problem and that this means that health officials must be involved in their prevention as well as in their treatment.
The only element in this proposition that may be debatable is whether it is medicine or public health that should carry the ball. Many of us are convinced it is primarily a public health issue but I will settle for either. As important as MDS, malaria, and diarrhoeal disease undoubtedly are, injury clearly belongs on WHO's list of priorities.
Before leaving this point we need to reiterate and acknowledge the contributions made to prevention by housing experts; transport experts, trade and industry, alongside a host of other bodies. Yet it is health that must coordinate these efforts to be certain that none of the injury elements falls between stools and to ensure the high quality of the work of the other contributors. Fire departments do much to prevent home fires and this is at it should be. But if they did not, health departments have the ultimate responsibility for urging them to do so. In fact, "urge" is not a sufficiently strong word. The role that I visualize for health departments is "oversight"--a term that implies that it is with them that "the buck stops" and that they have the moral, and perhaps legislative responsibility, to ensure that all that needs to be done is done. In large part, these ideas echo those in a recent policy forum published in Injury Prevention. …