Injury control in developing nations: what can we learn from industrialized countries?

In spite of the enormous differences between industralized countries and developing countries regarding their economics, politics, education, and health priorities, as well as their culture, developing countries can learn health care management from the experiences of industrialized countries. Injury control is no exception. After all, why spend time reinventing the wheel? Injury prevention is the study, identification, and implementation of strategies to prevent or reduce the transfer of energy to the human body or to ensure the supply of such essentials as heat or oxygen to the body. The various forms of energy that may injure the human body include mechanical energy, as in a motor vehicle collision or during a fall, thermal energy, as in a scald burn, electrical energy, as in an electrocution, or chemical energy, as in some forms of poisoning. The human body may also be denied heat during hypothermia, and oxygen during drowning or near drowning. The same public health approach used to successfully eliminate smallpox in both industrialized countries and developing countries has already been applied to injury control in the industrialized world with some success. Much ofwhat we currently know about injury control has been made possible by the pioneering works of several individuals, including Hugh de Haven, Edward Press, John Gordon, James Gibson, and William Haddon Jrall ofwhom worked in industrialized countries,`5 Hugh de Haven paved the way for our understanding of the importance of injury thresholds in the biomechanical energy exchanges,l while Press was the first to propose the epidemiologic approach to injury control.2 Together Gordon and Gibson defined the agent of injury,34 and Haddon is credited with the development of the structured framework for modern injury prevention.56 All these scientific contributions have led to the current understanding of the model of injury causation and the methods for intervention in industrialized countries. Although no injury type has yet been eradicated, the incidence of many has been reduced drastically. For example, a 50" 0 reduction was observed for childhood falls from windows after an intervention program in New York City.7 With the present trend, near elimination ofmany injury types is attainable in the industrialized world. Developing countries are now hanging between the stages of epidemiologic polarization and protracted epidemiologic transition. This means that they have the onerous task of tackling the problem of injuries on top of the longstanding problems of infections, malnutrition, and other serious emerging health problems like HIV/AIDS, diabetes, and hypertension. Thus, in spite of the recent recognition of the importance of injury control by several developing countries, other competing health problems do not permit many developing countries to have the time, take the time, and spend the time and resources to adequately deal with this other major public health problem. The problem is further compounded by the fact that injuries are still viewed in many developing countries as random, haphazard events, or even 'as acts of God'. However, in any way one looks at it, the injury problems from unintentional causes seen in many developing countries are an exact mirror image of those seen in industrialized countries. The exchanges of energy that cause injuries be they mechanical, thermal, electrical, or chemical are the same in industrialized countries as in developing countries. Injuries from motor vehicle collision, falls, burns, and poisonings comprise the bulk of unintentional injuries in developing countries8 just as in industrialized countries.9 Intentional injuries, however, vary slightly due to the prevalence of specific consumer products that are utilized as vectors of the injury causation. For example, firearm related injuries are much more prevalent in the United States partly due to the fact that half of all homes contain a firearm. 10 The science of injury control has been expanded to encompass the totality of health including prevention, promotion, timely treatment, and rehabilitation. For example, injury prevention and promotion campaigns include education of the public about behaviors on how to avoid certain injuries. Public encouragement on the use of safety belts in automobiles and installation and proper placement of smoke detectors on all habitable floors of residential dwellings are but two examples of the myriad of injury prevention drives. The combination of poor resources, lack of personnel, and high illiteracy rates in developing countries dictates that they learn injury control from industralized countries. This learning process should involve the epidemiology, mechanisms, and the patterns of injury in different segments of the population. For instance, the epidemiology of childhood injuries has been found to be characterized by a different set of factors due to the fact that the Department of Emergency Medicine, Center for Injury Research and Control, University of Pittsburgh, 230 McKee Place, Suite 400, Pittsburgh, PA 15213, USA