The changing approach to the epidemiology, prevention, and amelioration of trauma: the transition to approaches etiologically rather than descriptively based
- Dr Haddon is Director, National Highway Safety Bureau, Federal Highway Administration, US Department of Transportation, Washington, DC 20591. This paper first appeared in the and is reproduced with permission. Copyright 1968 by the American Public Health Association.
Phenomena of trauma to be dealt with scientifically must be based not on descriptive categorizations, but on etiologic ones. How this is happening and what it means are discussed in this paper.
Background
Approaches to the phenomena of trauma, which are of interest here, are rapidly becoming more rational and scientific. None the less, the field still includes the only substantial, remaining categories of human morbidity and mortality still viewed by most laymen and professionals alike in essentially prescientific terms. The traditional wisdom perpetuates terms and concepts formerly applied to much of human experience. “Luck”, “chance”, “accident”, and other extrarational notions still survive from the times when scientific explanations for plagues, earthquakes, “natural disasters”, and other terrifying phenomena scourged a mankind that had no rational understanding, either of their sources or of the means for dealing with them.
Unfortunately, because of their automatic subscription to the traditional, prescientific wisdom of the field, many professionals—physicians, behavioral scientists, and others—in coming to this field for the first time, still merely translate the traditional wisdom and its terms into their own scientific framework and jargon. Building on the result, they assume they have contributed something. This, however, is likely to occur decreasingly because of the accelerating transition in concepts and research now taking place.
What then, is the essence of this transition? Very broadly and importantly, it is part of the increasing awareness of the relationships between man and his environment, of human ecology, especially of man's relationships with certain potentially or actually hazardous physical and chemical attributes of his environment.
At the beginning of the nineteenth century, man was equally ignorant of both the physical and chemical hazards of his environment, on the one hand, and of the biological hazards on the other. In the 150 years that followed, he moved disproportionately rapidly …
