Insult to Injury: Public healthcare and injury prevention

Injury preventionAlmost 200,000 preventable injury deaths occur every year in the United States, but injury prevention has been historically underfunded. These are a couple of findings outlined in a new Trust for America's Health (TFAH) report. “Injuries are not just acts of fate.  Research shows they are pretty predictable and preventable,” TFAH executive director Jeffrey Levi said in a press release. “This report illustrates how evidence-based strategies can actually help prevent and reduce motor vehicle crashes, head injuries, fires, falls, homicide, suicide, assaults, sexual violence, child abuse, drug misuse, overdoses and more.  It’s not rocket science, but it does require common sense and investment in good public health practice.”

Life-threatening injuries include:

  • Drug overdoses.
  • Motor vehicle crashes.
  • Suicides.
  • Homicides.
  • Falls.
  • Fires.
  • Suffocation.

Granted, personal safety is a, well, personal matter; after all, you can’t blame society at large when someone decides to take a long walk on a short pier, or when someone else hallucinates that his neighbor Sam’s dog – who is possessed by a demonic entity – orders them to kill, or when someone falls asleep with their cigarette on (“Why bother, baby? One smoke detector's enough for Mad Dog”). Similarly, you could argue that there is no such thing as an ‘accidental’ overdose. And there is also something to be said of a paternalistic state that makes use of helmets and seatbelts mandatory. However, the report does highlight several public healthcare injury prevention success stories, such as the following:

  • Seat belts. They save about 12,000 lives a year.
  • Motorcycle helmets. They save approximately 1,600 lives a year
  • Child safety seats, booster seats, and seat belts. They save the lives of some 12,200 children a year.
  • Sobriety checkpoints. They have helped lower alcohol-related crashes and deaths by about 9%.
  • Falls amongst seniors. They have been decreased by about 50% for people who participate in fall prevention programs.
  • School-based violence prevention programs. They have reduced violent behavior by 15% for all school years, and 29% for high school students.

Those numbers are even more meaningful when considering that only 5% of the Centers for Disease Control and Prevention’s budget goes to injury prevention. On the other hand, the National Center for Injury Prevention and Control (NCIPC) has consistently received increasing funding, as seen below:


NCIPC funding

Fiscal year


















2016 (proposed)



Still, experts worry about the decrease of NCIPC research funding overtime, especially in regards to Injury Control Research Centers, created by NCIPC in 1987 to be at the forefront of research and training. There are only 10 such centers (including none in the Mountain or Western/Pacific states), though, and their yearly budgets have been decreased. Additionally, several states use limited resources like the DC’s Preventive Health Services Block Grant, or the Maternal and Child Health Block Grant at the Health Resources and Services Administration.

The question is whether injury prevention warrants a much larger investment. If one takes into the account that every year 30 million people are medically treated for injuries, 2.5 million are hospitalized, 27 million are treated in ERs, over 30% of ER visits are injury-related, that injuries are the leading cause of death in Americans aged 1-44, or that every three minutes one person dies from an injury – and that’s an injured reserve list you cannot come back from –, then the answer should be obvious. And if it isn’t, let’s take a look at the annual lifetime cost of injuries:

Lifetime cost of injuries


Medical cost

Productivity loss














Motor vehicle/traffic




















Struck by or against









“This report provides state leaders and policymakers with the information needed to make evidence-based decisions to not only save lives, but also save state and taxpayers’ money,” Executive Director of the Safe States Alliance Amber Williams said in the press release. “The average injury-related death in the U.S. costs over $1 million in medical costs and lost wages. Preventing these injuries will allow for investments in other critical areas including education and infrastructure.” Coincidentally, the report included data compiled by a survey of representatives from each state conducted by the Alliance, which yielded the following:

  • Injury prevention activities are becoming more decentralized within state health departments.
  • Injury and violence program staff is limited.
  • 60% of states reported budget cuts to injury and violence prevention in 2013.
  • A growing number of state injury and prevention programs reported no access to an epidemiologist, statistician or other data professional.
  • Injury and violence prevention programs maintained, on average, partnerships with 12 other offices within the state health department; 8 partnerships with other agencies within the state; 11 partnerships with non-governmental organizations; and 5 partnerships with federal agencies.

Partnerships between state health officials and public safety, healthcare providers, transportation, social services, businesses, and faith-based organizations, among other sectors, are instrumental to understand and assess the scope of injury prevention as well as to identify opportunities and barriers in order to create support for policy, regulatory, and programmatic changes that will help prevent and decrease injuries. Certainly, some states are ahead of others when it comes to the 10 indicators that TFAH used to devise a report card.




  1. Does the state have a primary seat belt law?

34 states and DC

16 states

  1. Does the state require mandatory ignition interlocks for all convicted drunk drivers, even first-time offenders?

21 states

29 states and DC

  1. Does the state require car seats or booster seats for children up to at least the age of 8?

35 states and DC

15 states

  1. Does the state have Graduated Driver Licensing laws - restricting driving for teens starting at 10 pm?

11 states

39 states and DC

  1. Does the state require bicycle helmets for all children?

21 states and DC

29 states

  1. Does the state have fewer homicides than the national goal of 5.5 per 100,000 people?

31 states

19 states and DC

  1. Does the state have a child abuse and neglect victimization rate at or below the national rate of 9.1 per 1,000 children (2013 data)?

25 states

25 states and DC

  1. Does the state have fewer deaths from unintentional falls than the national goal of 7.2 per 100,000 people established by HHS (2011-2013 data)?

13 states

37 states and DC

  1. Does the state require mandatory use of data from the prescription drug monitoring program by at least some healthcare providers?

25 states

25 states and DC

  1. Does the state have laws in place to expand access to, and use of, naloxone, an overdose rescue drug by laypersons?

34 states and DC

16 states.


At the very top, New York scored 9 out of 10 indicators, while Florida, Iowa, Missouri, and Montana scored 2 out of 10. Unsurprisingly, New York is the state with the lowest injury death rate at 40.3/100,000. Not so unsurprisingly, however, is it that West Virginia – even though it scored 7 out of 10 indicators – had the highest rate with 97.9 injury deaths per 100,000 people.

In a nutshell, the report concluded that thousands of injuries could be prevented and billions of dollars saved if:

  • More resources and workforce are devoted to injury prevention.
  • Increased investment is allotted to injury prevention research.
  • Public healthcare partnerships with other sectors are strengthened.

Might we add that education and awareness are also essential to the issue at hand. Let’s face it; many injuries occur because people know too little or think they know too much. As Socrates put it, knowledge is virtue, and the greatest wisdom comes from realizing that we’re not wise at all. To put it in context, many preventable injuries take place because people don’t know any better; but if people were enlightened, their choices would not have to be limited – they simply could not, would not choose the wrong. Until then, the laws will have to be enforced in the states where they exist and implemented in the states where they do not. And if you’re still unconvinced, just think of the children. That’s not a cliché, mind you. According to the report, injury is the number one killer of children in the United States.


Related Read:

- Pediatric trauma supplies for head injuries