Adding insult to injury

In its report ‘Injury Prevention’, released on 28 June 2001, the British Medical Association (BMA) outlines a national plan for the prevention of injuries (1).

‘Injury’, the press release informs us, is ‘Britain’s biggest child killer’. Injuries account for more than half of the deaths of 15- to 24-year-olds, and treating injuries accounts for at least 5 percent of NHS expenditure.

And…?

Yes, people can and do hurt themselves (and each other), intentionally and unintentionally. Yes, this physical damage costs money to repair. Yes, some people are killed or permanently damaged by the injury they sustain. But surely medics should realise that most people do not suffer fatal injuries – and that, if injuries account for a high proportion of deaths of children and young people, it is because advances in living standards and medical treatment mean they are extremely unlikely to die from disease. And there is surely a limit to how far injury can be prevented.

The BMA doesn’t seem to think so, however. In its 96-page report, the BMA seems to be representing ‘injury’ as a new category that should frame government policy. Policy at present does not organise around injury as such – there are suicides, murders, people falling down stairs, food poisonings, and car accidents. Different government departments currently take measures to prevent, or deal with the effects of, some of these injuries – improving the safety of cars and roads, for example, would fall to a different department than improvements in food safety.

The BMA suggests creating an agency for injury prevention in each of the four UK countries, headed by a single government minister. These agencies would have the responsibility for coordinating strategy in different areas, particularly targeting vulnerable groups, such as the young and the elderly. In effect, the agency would try to ensure that safety comes first, in all areas of life.

Like beer-drinking, for instance. At the launch of the report Professor William Asscher suggested using plastic cups in bars and pubs to help reduce beer-glass-related injuries (apparently, on a Saturday night Accident & Emergency departments are full of people suffering from these). This policy might well be successful – but it would have injurous implications for the enjoyment for millions of Britons, forced to drink vile plastic-tasting bitter and lager. Yet in its obsession with putting safety first, the BMA seems reluctant to recognise that there is a trade-off between safety and quality of life – let alone that this might be problematic.

Curiously, the BMA also seems to be redefining the concept of injury. According to the BMA press release, most injuries are not the result of ‘accidents’, but ‘preventable, non-random events’. It proposes a comprehensive research strategy, to work out why people injure themselves and how this can be prevented.

This could be a big job. According to the Home and Leisure Accident Surveillance System report, in 1999 there were 10,773 hospitalisations caused by socks and tights, 13,132 injuries inflicted by vegetables, and 1810 involving tree trunks (2). These statistics suggest that accidents do happen – if people are going to move around, and do things, then sometimes they will get injured. If injury from socks and tights, for example, is not an accident but a ‘preventable, non-random event’, what possible preventative measure could be taken – other than banning socks and tights?

Taken too far, measures aiming to prevent injury effectively treat people like children. We are surrounded with things that could potentially cause harm – but the vast majority of people, most of the time, use these things for the purposes they are intended, and remain unscathed.

Parents of young children have stair-gates to prevent falls, because they know their children lack experience in negotiating stairs and recognising dangers; adults are assumed to be able to cope (and generally do). If they fall, it is an accident – not a preventable, non-random event. Likewise, people who cut themselves on beer glasses do so because of a fight (for which they are responsible), or through accident. Arguing that plastic beer-glasses would prevent this problem treats all drinkers like toddlers, given plastic beakers just in case they might drop or throw them at somebody.

And if parents are viewed as toddlers, they clearly are not responsible enough to make decisions about their own children’s safety. Instead, it would seem they need child injury prevention guidelines laid down by the national agency for injury prevention.

In arguing the need to put safety first, the BMA appears to view its patients as a bunch of infantile incompetents. Cheers.

(1) ‘Injury Prevention’, British Medical Association, board of science and education, June 2001

(2) Feedback 9 June 2001, New Scientist