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A double standard? Disease v injury
  1. I B Pless, Editor

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    During the spring of 1998, after lengthy investigation and frequent discussions among federal and provincial health ministers, the Minister of Health announced a decision to financially compensate Canadians who had become infected with hepatitis C after 1986. Why 1986? This date was chosen because it was only subsequent to 1986 that the blood banking system had a proven method of screening, and thus, presumably, preventing hepatitis C being contracted through blood transfusions. The reasons for not adopting the screening procedure immediately after that date remain unclear. Nevertheless, the decision to compensate was an admission by government that it had an obligation to act once this preventive technique was available.

    I find the logic behind the Health Minister's tough decision persuasive and irresistible on two counts. He has been criticised for not compensating all victims, regardless of when they became infected, but this seems illogical and he continues to resist the persistent pressure to do so. The second point of agreement is the key one; establishing a principle that governments may be held responsible if they fail to use proven methods of disease prevention.

    Of what conceivable interest is this account to readers of Injury Prevention? To begin with it illustrates the pervasive double standard that applies when policy makers consider diseases and injuries. This split thinking is familiar to readers of this journal. In few (if any) countries are injuries viewed as a disease. Therefore, any principles that would be applied by the public health authorities or any other sector responsible for the prevention of diseases are usually abandoned when confronting analogous injury prevention challenges. As has been pointed out many times previously, health departments show little inclination to override decisions of other branches of government when it comes to injuries. The exact opposite is true, however, when the disease involves an outbreak of meningitis or the contamination of a food product. In such instances, health departments have the obligation and power to step in and do whatever is needed to control the causative agent. The Canadian decision now makes it appear that there is a legal and moral obligation to do so as well.

    The important lesson in the hepatitis C story is the government's agreement to compensate victims for its failure to apply knowledge that had been shown to be effective in preventing this disease. Think about that for a moment, and then consider the implications if the same principle were applied to injuries. The ramifications are enormous. Choose any example you wish and you will readily appreciate how radically different the injury prevention picture would be if the same principle of government responsibility applied. Why should any branch of government, not just health, not be held to be similarly responsible for refusing to use what is known to be effective in the case of injuries.

    There are numerous examples that serve to illustrate the point. The one I have chosen is speeding in school zones and residential neighbourhoods. There is no country in which this problem does not exist. Yet the facts are these: it has been shown that a reduction in speed of 1 mph reduces the injury rate by 5%.1 It has also been established that the proportion of pedestrians who will die when hit by a car at 50 mph is 90%, but falls to 40% at 40 mph and 20% at 30 mph.2 The abbreviated injury scores increase from 0.5 when a car is moving at 10 mph to 6.4 at 38 mph, and part of the reason may be that at higher speeds a motorist's field of vision is restricted.3 Finally, and importantly, recent work in the UK makes it clear that speed cameras are highly effective in reducing these injuries.4

    Surely, if these data are correct, the logic of reducing and enforcing speed limits becomes every bit as compelling as screening for a blood contaminant. If this principle were accepted, logically those injured by speeding cars should be entitled to compensation from governments who have failed to apply this proven preventive measure in the same way as were victims of hepatitis C.

    It all seems so amazingly simple that I wonder why this has not happened. Why have we not seen this argument being put forward by victims of speeding or their families? Could it be that they have convinced themselves (or have been convinced by others—including the media)—that they themselves are really to blame, not the speeding driver? Or could it be that they believe that being struck by a speeding care is truly an accident and not preventable? Food for thought.