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Editors comment: We are proud to be able to bring to our readers this full text version of the Haddon Memorial Lecture delivered at the recent Fifth World Conference on Injury Prevention and Control in New Delhi, India. James Hedlund offers a brilliant review of one of the most important areas of debate in the entire field of injury control. This is the most complete, most perceptive, and well balanced appraisals of this complex issue I have ever read. Take the time to digest it completely. Our thanks to the Insurance Institute for Highway Safety for agreeing to permit us to publish it.
Government regulations and industry practices constrain our behavior in many ways in an attempt to reduce injuries. Safety features are designed into products we use: cars now have airbags; medicine bottles have “childproof” caps. Laws require us to act in a safe manner: we must wear seat belts while driving and hard hats in construction areas. But do these measures influence our behavior in other ways? Risk compensation theory hypothesizes that they do, that we “use up” the additional safety though more risky actions.
This paper surveys risk compensation by reviewing its history, discussing its theoretical foundations, outlining evidence for and against its claims, and providing the author's own views. It concludes by discussing the relevance of risk compensation for injury prevention workers who seek to reduce unintentional injuries.
The setting: injury prevention strategies and risk compensation
Injury prevention as a discipline began when injuries were understood to be both predictable and preventable. Most injuries are the unintended consequences of individual actions in a risky environment; they are not due to fate or to problem behavior. This understanding led to three fundamental injury prevention strategies, as described in the comprehensive report Injury in America1:
Persuade persons at risk to change their behavior,
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