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Tom Christoffel and Susan Scavo Gallagher. (Pp 402; $US 50.00.) Aspen Publishers, Gaitherburg, Maryland, 1999. ISBN 0-8342-840-7.
Injury prevention remains a neglected aspect of health policies in many countries round the world. An important reason for this is that many health professionals are unaware of the magnitude of the injury problem and lack the knowledge, skills, and strategies to tackle it successfully. Injury Prevention and Public Health: Practical Knowledge, Skills, and Strategies attempts to provide such a resource for public health professionals, by bridging the gap between research and practice and enabling them to implement injury prevention measures in real world settings. Tom Christoffel and Susan Scavo Gallagher have distilled nearly 40 (combined) years' experience of working in the injury field in the United States and have produced an excellent practical addition to the literature. It is focused on injury problems in the United States and acknowledges that an international perspective is not presented.
The book does not assume that the reader is already expert in the field of public health. In part I, it provides background information on the magnitude, concepts, and epidemiology of both intentional and unintentional injury. Part II considers the basic concepts of injury prevention and examines educational, environmental, and legislative approaches. What emerges is a balanced view of the need for a variety of approaches. One of the authors is a lawyer by training and the chapter on “The role of the Law” leads the injury prevention professional through the “unplanned hodgepodge or patchwork” of injury prevention laws to enable them “to steadily push this flawed system towards a more rational, comprehensive future”. Part III is concerned with programme effects to reduce injury: “the practical knowledge, skills and strategies” of the book's subtitle. This practical application section is not relegated to a final chapter, instead it takes up half the book.
The great strength of this book is in its applied orientation. The chapter of injury surveillance presents a 10 step plan to define what data are needed and how one can establish a good surveillance system, how data can be disseminated and translated into action. There is a useful summary of national sources of data in the United States. Another chapter examines the barriers to injury prevention in the real world context. This includes an interesting section on advocacy, including a number of practical tips (start with a focus on children, the group that needs the most protection...), providing case studies of past successes, such as hot water heaters and opening up a debate about whether health professionals should involve themselves in advocacy efforts. In an appendix a helpful listing of injury related world wide web sites is provided.
My one criticism of this book is that it does not attempt to come to grips with the underlying causes of injury. On 349 we are told that, “injury and injury prevention are extremely political” and that, “injury prevention can only be properly understood within a political, economic, and sociohistorical framework”. But the authors chose not to explore questions about social control or power in society, saying that these issues lie behind the discussions but would require far more space to do the subject justice. Within the index “poverty” receives two mentions and “race” one; such areas could have been explored in more depth to provide more of a challenge to the health professionals.
Nevertheless this is a clearly written, well organised book, with a well chosen useful reference list and illustrated by practical case studies. I believe it will prove to be an essential text for health professionals in the United States and internationally.