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Journal Article


Hyder AA. Am. J. Public Health 2004; 94(12): 2047.


Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Suite E-8132, Baltimore, MD 21205.


(Copyright © 2004, American Public Health Association)








In the June 2004 issue of the AJPH, Greenberg-Seth et al. raise several generic issues for the field of injury prevention that need to be discussed if we are to understand the potential public health implications of intervention assessments.

Greenberg-Seth et al. demonstrated the effectiveness of an intervention for increasing child rear seating in a short time frame. The improvements were greater in high-income areas, one feature of educational interventions that must be carefully monitored. Interventions that benefit the richer segments of society more than the poorer segments further existing inequalities and do not serve the goal of health equity. Even if such a trend is temporary, it may have a longer-term effect in terms of perceptions of the intervention and an eventual impact on equity between socioeconomic groups.

The impact on equity becomes even more important in the context of interventions in low-income countries where literacy and access to media is far from universal. More than 90% of the burden of injuries is in the developing world, and this burden is marked by major inequalities in access to preventive and curative health care. It would be critical for interventions implemented in such settings to be modified to ensure that they are pro-poor.

The effect of education as an independent intervention for injury prevention is not clear. It is an effective component when it is accompanied by another intervention or when it is part of a set of specific interventions. It is natural to assume that health education is beneficial. However, health education may use resources that might be better used to fund interventions with proven effectiveness, especially in resource-scarce environments. Maximizing health outcomes in terms of reduction in injury burden per unit of investment is a critical measure for guiding resource allocation.

It is important to note that output indicators such as use of devices is only half of impact assessment. The more important indicator would be a decrease in childhood injury rates as a result of interventions. Outcome measures require larger samples and longer time frames but are essential in determining the true impact of interventions. Outcome evaluation for interventions, especially education-related interventions, is lacking.

Defining a global research agenda for preventing child injuries and leveraging funds should be a priority for injury prevention stakeholders.


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