ADVANCES IN THE EPIDEMIOLOGY

OF INJURIES
AS A BASIS FOR PUBLIC POLICY
By Dr. William Haddon, Jr., MD, MPH
Public Health Reports, Vol. 95, September- October 1980, pp. 411-421.
This article Advances in the epidemiology of injuries as a basis for public policy
has been published in Journal Landmarks in American Epidemiology by Public Health
Reports which is a official journal of the U.S. Public health Service. This paper has
been written by Dr. William Haddon Jr. who was a leader in highway accident
research since 1969 of the Insurance Institute for Highway Safety and was the first
federal Highway Safety Chief. Paper highlights the importance of injury control as
that has been hampered by the failure due to proper recognition of injuries agents
as vehicle and vectors.
The paper has been written keeping in mind that the readers are professionals and
policy makers from different fields and thus author completely describes the paper
in very obvious and simple manner based on his researches that injuries cannot
occur without the action of a specific agent like those of infectious diseases and he
denote the vehicles as agents for injury in a particular crash. He defines injury as a
disease that results from an acute exposure of the human body to transfer of
energy from the environment around it in a very short time and specifies the time
as 48 hours or less. He highlights the fact that several measures has been taken by
societies to deal with all types of environmental hazards and diseases and even
individual have also reduced their injuries by taking various safety measures from
completely nonrandom hazards but researchers lack in understanding that like of a
diseases or infections a particular injury also has an agent without which it cannot
occur and damage and needs preventive measures to control its consequences.
This paper focusses on that injuries should be well recognized with their causing
agents and specific measures should be taken and strategies to be formed to
control them keeping in mind the safety of an individual which is the basis objective
of Transport safety course. Author focused on various historical discussions and
researches by various scientists in the fields relating to the injuries and identifies
the agent for a particular injury to understand the role of an agent defining that
injuries are basically caused by the interchange of various types of energies from
one form to another like transform of mechanical injury of vehicle into the human
being during a crash and leading to injury to the man as he cannot tolerate the
sudden transfer. Here mechanical energy of vehicle is transferred to man which
dont have the ability to sustain against the transfer and get an injury.
At present accidents are the major causes of deaths in many societies and they can
be associated with the genetic factors also as some may not be resistant to agents
and nature of injury and may be very susceptible to injury agents i.e. may not be
able to tolerate the smallest ate of change of energy under given environmental
conditions. This can be understood like that the host is susceptible to particular
injury comes in contact with mechanical energy and get injured under the

environmental conditions prevailing at that time without showing any resistance to

the conditions.
It is said that Prevention is better than cure. In transportation safety, it has been
documented in paper that if several safety measures has been taken in the design
of vehicles many of the fatalities could have been reduced if the vehicle had been
designed to provide proper crash packaging to the occupants of the vehicle as
humans have certain amount of ability to transform the mechanical energy without
fatal injuries and can sustain against the impact of a particular injury of lower
impact on human body.
Injuries and diseases can be understood as same thing with agents with difference
that injuries are those kind of damage to body which are produced and reflected
within 48 hours of contact of an agent and transfer of energy or even a shorter
period whereas disease take much more longer time of exposure of an agent. It can
be understood by high speed cameras which captures in very high range like of
about 20000 frames per second and when seen in slow motion of about 20-30
frames per sec, it is clearly seen and identify the agent of particular injury and
thats the way adopted by Insurance institute of Highway Safety to show to people
for a clear understanding among people of different understandings.
Author has prepared a matrix named as Haddon matrix for prevention of crashes by
identifying role of human, vector and environment. He has identified the measures
to be taken under three heads i.e pre crash, crash and post-crash and listed certain
counter measures to be taken under each head for the safety of individuals to
lessen the consequences of particular injuries but some of them are such that they
can not be promoted in the public to adopt like wearing of helmet by pedestrians
may reduce about 50% of fatalities during crash but cannot be widely accepted by
the public and policy makers will be denoted as fools by the vulnerable public and
will be demotivated by even the most educated persons.
Author has listed 10 strategies to counter the occurrence of injury by taking several
effective measures to reduce the occurrence. These can be adopted to safeguard
against injuries. Some statistical numbers could be used to support the strategies as
the paper has been published with the motive to promote the reduction of injuries
and is intended to be read by the various professionals and policy makers which can
help in implementing the strategies if they are supported by the numbers of injuries
reduced.
Motor vehicle manufacturers give emphasis on that its the responsibility of an
individual among the public to be safe and taking steps to reduce injury but policy
makers should make laws to focus on the responsibility of the manufacturers of
vehicle to adopt the design of vehicle in such a way that occupant of that vehicle is
safe taking safety as the first concern. There are certain things that shows that
there is some flaw in a system like that if roads are designed for being running
maximum at 100 kms per hour than why the vehicle manufacturers provide the
max speed of even 200 kms per hour in vehicles promoting the public to drive fast
and got injured and even leading to fatalities most of the time with a probability of
being an fatality of 80% if not driving at the posted speed.

The laws should be such that emphasis should be given on the injury control by
making designs of roads, vehicles safer and not hoping that the public will be
responsible for its own safety for use of vehicle. It has been seen that education of
users/drivers dont work as if the drivers are given an opportunity by vehicle
manufacturers to drive at 200 km/hour, they will certainly try to do that without
thinking of the consequences and thus measures should be taken as such that users
are less vulnerable to injury caused by vehicles.
With the effective emphasision of the author on the ignored topic of injury, it is
expected that certain stress is to be given on taking preventive measures of injuries
also along with diseases and try to reduce the effect of agent and promote safety
among the public by adopting some methodologies and issuing guidelines for
generalization.