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And when all the tigers are caged, what then the need to hide, the world all being safe?1 2
There is substantial need indeed if the results of the study by Pickett et al3 reported in their article published in this issue of Injury Prevention (see page 376) are an indication. While the reported study is one of the most important recently undertaken, it is not only in the analytical results that the importance of this paper lies, but also in the questions the authors raise. The study was grounded in the ecological understanding of the causation and prevention of injury introduced by Haddon in his seminal paper published 40 years ago.2 Pickett et al have worked towards actualising that theory (using multi-level models of causation), describing the concept of ‘exposure’ within an ecological framework, and accurately measuring the relevant contextual and individual level component causes. The issues addressed by the authors are critical (both in content and timing) for the future of injury prevention practice, and, in exploring these issues through empirical study rather than conceptual discussion, the authors have made an important contribution to the field.
The conventional position on injury prevention recommends that efforts should be restricted to a consideration of ‘the necessary conditions for harmful results’ and not of the ‘complex mix of factors’ that lead to serious injury events.4 5 Pickett et al have based their study on the alternative position; that …