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A World of Hurt: Global Injuries

Illustration by Kevin Ghiglione

A World of Hurt: Global Injuries (continued)

Injury in the U.S.

Although they face different types of injuries than children in developing countries, American children remain at great risk. Injury is the leading cause of death for children in the U.S., and the millions of nonfatal injuries cost society an estimated $50 billion annually. For poor children, globally and nationally, the burden is worse. CIRP director Andrea Gielen and colleagues have done research showing that the injury rate for low-income children in Baltimore is twice the national rate. One explanation for the gap is that low-income families often do not have access to safe environments, products and information that can protect them from injuries.

Since 1987, U.S. deaths from unintentional injury have dropped dramatically—43 percent for children ages 0 to 14—as a result of education, safety product development, policy change, research and other measures. “The good news about this field,” says Gielen, ScD ‘89, ScM ’79, professor of Health, Behavior and Society, “is that we don’t have to hunt for a gene. We know a great deal about the causes of injury, and we have already identified many of the solutions. Our challenge is to get them implemented.

The Economics of Injury

Injury prevention products such as smoke detectors, bike helmets and cabinet latches are cheap and work well. But who should pay for their large-scale implementation? That question plagues David Bishai, PFRH associate professor and core faculty in IIRU and CIRP.

In countries with nationalized health care systems, the government pays for medical care and therefore has a financial interest in preventing injuries. In the U.S., though, managed care organizations (MCOs), not the government, bear the costs. So shouldn’t MCOs want to invest in injury prevention? Not necessarily, says Bishai, a health economist. “There’s too much turnover,” he says. On average, a person switches to a new MCO every five years. Some interventions, such as alcohol and drug rehabilitation programs, pay off in the short-run. But other interventions—smoke detectors, for example—need to be in place much longer before they pay off. “There’s no incentive for MCOs to invest in long-term prevention,” Bishai says.

Real progress in injury prevention may require a sea change, says Bishai. A single-payer universal health care system or portable lifelong private insurance contracts would solve the problem. “With the new [presidential] administration, these options are on the table this year,” he says.

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