Introduction

We will not solve the public health problem of injury simply by educating individuals about the nature of injury risk, improving their risk assessment and providing these individuals with information to enable them to reduce the level of risk to which they are exposed. Substantial improvement in the societal injury burden will occur only when changes are made at the societal level that focus on reducing the population-level indicators of injury.1 ,2 The shift from an individual to a population perspective has substantial implications for the way we perceive, direct, undertake, and evaluate injury prevention research and practice. The analogy of ‘the population as patient’ provides a clear illustration of the foundational truths that underpin the preferred public health approach to the prevention of injury.

Society is the system within which populations exist. Sustained change made at the societal level to reduce population-level indicators of injury morbidity and mortality involves systemic change. In this paper, we consider a shift from the contemporary systematic approach to unintentional injury and violence prevention,3 to a systemic approach4 more consistent with the principles of ecological public health.5 We consider the extent to which the logic of the systematic model, and the related misconceptions about the role of uncertainty in science, limit local, national and global efforts to minimise injury-related harm. We explore the implications of a systemic perspective for the field of injury prevention and conclude by delineating a new programme of work that could be of considerable benefit to the injury-related health of populations.