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Journal Article


Waller JA. Am. J. Public Health 1974; 64(4): 408-409.


(Copyright © 1974, American Public Health Association)








A long long time ago (1788, to be exact)[1] when Johann Frank became father to the entire brood of public health programs, he begot also an ugly duckling. And he named it "accident prevention". And Frank said, "this too shall be a public health program because injury is a grievous scourge upon the land".

All other public health programs grew to adulthood because they all shared the three necessary attributes of maturity known as primary, secondary, and tertiary prevention. They could prevent disease, avert complications, and restore the body and the spirit. But Accident Prevention had a congenital defect that precluded maturation. It's only attribute was primary prevention, and it could do this only by monotonous moralistic mumbling about acts of God, and about banishing human carelessness and sinful behavior. With only one attribute, accident prevention was found by handsome health officers to be a dull and childish teammate indeed, and it did poorly in the sport of public health improvement.

One decade, give or take a few years, a band of wise gurus came around. They were called scientists. And they said, "accident prevention has only one attribute because of poor nutrition, not congenital deformity. If you wish it to mature you must stop feeding it pre-scientific garbage. The problem you wish to reduce is injury and its effects, not just accidents. The program needs a new name "Injury Control", so that it can take on the three attributes of maturity -- prevention of potentially injurious events, reduction of the complications known as injury even though the events continue to occur, and rehabilitation of the injured through the provision of adequate emergency care.

And lo, the ugly duckling now named Injury Control began to flourish and mature and to bring benefit to the public. A few health officers began to invite injury control to play on their teams and they were no longer disappointed. Finally in 1972, at the age of 184, injury control was invited into the public health honor society, the APHA. And it, and the public lived happily ever after.

MORAL: the term accident prevention, is a misnomer which has led Public Health personnel astray for years. It has inappropriate connotations of randomness of occurrence, and emphasis only on primary prevention and predominantly through changing human behavior. We now know that injury events are the results of human exposure to and the use of sources of physical energy (kinetic, thermal, electrical, radiation, and chemical) in which the prevention of undesirable energy transfers (or so-called accidents) depends BOTH on an adequate level of human performance and on a task that is not too demanding....

[1] Baumgartner, L., and Ramsey, E. M. Johann Peter Frank and His "System einer vollstandigen medicininschen Polizey." Ann. Med. Hist. 5:525-532, 1933.



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