Injury prevention

Why do we need to learn about conceptual frameworks in injury prevention? It’s because it is always useful to think about and solve any problem in a structured and systematic way! Fortunately for us, the past few decades had seen the development and adaptation of several frameworks to support us in understanding the problem of injury and how to respond to it. We cannot cover all of them in this topic, so we selected the most important and commonly encountered ones. One of those is the public health approach, widely adopted and advocated for by several organizations in the field. One example is the work of the CDC’s Injury Center

“To solve public health problems—including injuries—CDC uses a systematic process called the public health approach. This approach has four steps: define the problem, identify risk and protective factors, develop and test prevention strategies, and assure widespread adoption of effective injury prevention principles and strategies.”

It is also worth revisiting a resource from topic 1: the paper from WHO Europe on the role of public health, which shows how WHO Europe have adopted the public health approach in their work. One of the challenges that had faced the practice of injury prevention is the false perception that injuries are less of an issue for health authorities than diseases caused by biological agents for example. It is true that for some of the major causes like road traffic crashes the non-health sector takes primary responsibility for primary prevention activities such as law enforcement and vehicle safety. However, this does not mean that the health sector and particularly public health is not a major player. So this paper is also useful as it explains the role of the health sector.

Identifying risk factors and preventative strategies are key components of the public health approach. One framework that facilitates that (and also happens to be a very well-known conceptual framework in the injury prevention field) is Haddon’s matrix. Runyan C,1997 describes it as a tool that “provides a compelling framework for understanding the origins of injury problems and for identifying multiple countermeasures to address those problems”. This framework adapts the well-known epidemiological triad of host-agent-environment to the aetiology of injury. We recommend the paper by Runyan for an an easy-to-follow overview of the framework. Runyan also added a third dimension to the framework to make it more fit for decision making, which goes to show how these conceptual models evolve over time. You can also read the original paper by Haddon.

Injury prevention requires a combination of multifaceted strategies; this is embodied in the 5Es framework that describes the essential components of effective programs: education, environmental/engineering modifications, enactment/enforcement, economic incentives, empowerment and evaluation. This resource on poison prevention includes a brief description of the application of the 5Es: Education; Environmental/Engineering modifications; Enactment/Enforcement; Economic incentives; Empowerment; Evaluation. Note that in other literature those components are expressed as three, four or sometimes six Es!

Human behaviour can play a very prominent role in the aetiology of some injuries, particularly in injury due to violence. The ecological model is most helpful in such cases. The model is fully described in the CDC’s application to violence prevention; here is an excerpt:

“This model considers the complex interplay between individual, relationship, community, and societal factors. It allows us to understand the range of factors that put people at risk for violence or protect them from experiencing or perpetrating violence. The overlapping rings in the model illustrate how factors at one level influence factors at another level.”

As you read about all these models and frameworks, try to reflect on how they relate to each other and to ways in which we deal with public health issues in general. Once we finish this topic, you should be prepared to apply them in the coming topics of this course. Also please feel free to explore more literature on this topic on your own, and share links to any interesting reads/websites you find!