Hostname: page-component-7479d7b7d-t6hkb Total loading time: 0 Render date: 2024-07-12T08:45:17.578Z Has data issue: false hasContentIssue false
  • English
  • Français

The Role of Law in Reducing Injury

Published online by Cambridge University Press:  29 April 2021

Tom Christoffel
Get access Rights & Permissions [Opens in a new window]

Extract

Fatal injuries are the leading cause of death in the United States up to age 44 and “kill more Americans aged 1-34 than all diseases combined.” Injuries also constitute the nation's second most costly health problem—after heart disease—and because they disproportionately involve young people, they are the leading cause of productive years of life lost.

Until quite recently, most injuries were viewed as random, uncontrollable events. But this view is changing in the face of mounting evidence that many of the 140,000 injury-related deaths, as well as a large percentage of the estimated 70 million non-fatal injuries annually, were not inevitable.

As in the case of disease, prevention is becoming a major tool in reducing the injury toll. In the development of effective prevention strategies, the law can play a pivotal part. But to make proper use of this preventive approach, there must be considerably more planning, coordination and determination in its application.

Type
Article
Information
Law, Medicine and Healthcare , Volume 17 , Issue 1 , Spring 1989 , pp. 7 - 16
Copyright
Copyright © American Society of Law, Medicine and Ethics 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Committee on Trauma Research, Injury in America: A Continuing Public Health Problem, Washington, D.C., National Academy Press, 1985, p. 1. Also see Baker, S.P. O'Neill, B. Karpf, R.S., The Injury Fact Book. Lexington, MA: Lexington Books, 1984, especially Chapter 2: “Injuries in Relation to Other Health Problems.” Baker, O'Neill, and Karpf, state (p. 1) that: “Injuries are the most serious public health problem facing developed societies. In the United States, they account for the majority of deaths among children and young adults…. About eight million people alive today in the United States can be expected to die from injuries.”Google Scholar
Hartunian, N.S. Smart, C.N. Thompson, M.S.: “The Incidence and Economic Costs of Cancer, Motor Vehicle Injuries, Coronary Heart Disease, and Stroke: A Comparative Analysis. ”American Journal of Public Health 1980; 70:1249–1260 and Hartunian, N.S. Smart, C.N. Thompson, M.S., The Incidence and Economic Costs of Major Health Impairments: A Comparative Analysis of Cancer, Motor Vehicle Injuries, Coronary Heart Disease and Stroke. Lexington, MA: Lexington Books, 1981.Google Scholar
Waller, J., Injury Control: A Guide to the Causes and Prevention of Trauma, Lexington, MA: Lexington Books, 1985, p. 3. Also see Baker, O'Neill, Karpf, , supra, note 1.Google Scholar
Injury in America, supra, note 1, at pp. 1 and 4. The subject of injuries was long dominated by the terms “accident” (as in accident prevention and accidental death; chance, unavoidable events) and carelessness (as in careless driver or “nut behind the wheel”). On a more sophisticated level, Linder argues that there are basically four conceptual views of injury: the medical, public health, legal, and economic views. Linder, S.H.: “On Cogency, Professional Bias, and Public Policy: An Assessment of Four Views of the Injury Problem.” Milbank Quarterly 1987; 65:276–301.Google Scholar
Report of the National Conference on Injury Control, Centers for Disease Control, May 1981.Google Scholar
Injury in America, supra, note 1, p. v. In his Preface to Injury in America, Chairman Foege explains that: “In 1983, Congress enacted a law authorizing the secretary of the Department of Transportation to request a study on trauma (injury) by the National Academy of Sciences, to determine what is known about injury, what research should be done to learn more, and what arrangements the federal government could use to increase and improve the knowledge of injury. In response to that authorization, the Committee on Trauma Research, in the National Research Council's Commission on Life Sciences, was established in collaboration with the Institute of Medicine.” Supra, note 1, p. v. For a comprehensive treatment of injury prevention, also see Waller, supra note 3, and Robertson, L.S., Injuries: Causes, Control Strategies, and Public Policy, Lexington, MA: Lexington books, 1983.Google Scholar
Baker, O'Neill, Karpf, , supra note 1, p. 7.Google Scholar
Injury in America, supra note 1, p. 18.Google Scholar
Injury in America, supra note 1, p. 15. Baker, O'Neill, and Karpf note that: “Even when injury deaths from homicide and suicide are not included, the remaining unintentional injury deaths result in almost 3 million potential years of life lost prematurely, a greater loss than for any single disease.” Supra note 1, p. 15.Google Scholar
Baker, O'Neill, Karpf, , supra note 1, pp. 12–13.Google Scholar
Waller, J.A., “Injury: Conceptual Shifts and Preventive Implications.” American Review of Public Health 1987; 8:21–49 at 25.Google Scholar
Waller, supra note 3, pp. 11–38; Haddon, W. Jr: “On the Escape of Tigers: An Ecologic Note.” Technology Review 1970; 72:44–53; Haddon, W. Jr Baker, S.P.: “Injury control.” In: Clark, D. MacMahon, B. (eds.), Preventive Medicine, 2nd edition, Boston: Little, Brown, 1981, 109–140. Waller defines an unintentional injury event as an event in which “(1) injury occurs over a relatively short period of time–-at most, seconds or minutes, (2) the harmful outcome was not sought, and (3) the injury resulted either from one of the forms of physical energy in the environment (kinetic, chemical, thermal, electrical, or ionizing radiation) or because normal body mechanisms for using such energy were blocked by external means (such as by drowning).” Waller, , supra note 3, p. 8.Google Scholar
Baker, O'Neill, Karpf, , supra note 1, p. 17.Google Scholar
Injury in America, supra note 1, p. 37.Google Scholar
Haddon's ten countermeasure strategies are:Google ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle ScholarGoogle Scholar
See Christoffel, T., Health and the Law: A Handbook for Health Professionals, New York: Free Press, 1982, pp. 60–76; Wing, K.R., The Law and the Public's Health, 2nd edition, Ann Arbor: Health Administration Press, 1985, pp. 17–39; Grad, F.P.: “Communicable Disease and Mental Health: Restrictions of the Person.” American Journal of Law & Medicine 1986; 12:381–403; Burris, S.: “Fear itself: AIDS, Herpes and Public Health Decisions.” Yale Law & Policy Review, 1985; 3:479–518; Gostin, L.O.: “The Future of Public Health Law.” American Journal of Law & Medicine 1986; 12:461–490.Google Scholar
Injury in America, supra note 1, p. 39. Also see Adler, R.S. Pittle, R.D.: “Cajolery or Command: Are Education Campaigns an Adequate Substitute for Regulation?” Yale Journal on Regulation 1984; 1:159–93.Google Scholar
Waller, , supra note 3, pp. 470–471.Google Scholar
Ross, H.L., Deterring the Drinking Driver: Legal Policy and Social Control, Lexington, MA: Lexington Books, 1982.Google Scholar
Robertson, , note 6, p. 133.Google Scholar
Gusfield, J.R., The Culture of Public Problems: Drinking-Driving and the Symbolic Order, Chicago: University of Chicago Press, 1981.Google Scholar
Injury in America, supra note 1, p. 40, citing Baker, S.P. Dietz, P.E.: “Injury Prevention.” In: Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention. Background Papers, Washington, D.C.: U.S. Department of Health, Education, and Welfare, DHEW Publication No. (PHS) 79–55071A, 1979, pp. 53–80.Google Scholar
Robertson, supra note 6, p. 157.Google Scholar
Injury in America, supra, note 1, p. 40.Google Scholar
National Traffic and Motor Vehicle Safety Act of 1966, 15 U.S.C. Secs. 1381 et seq. (1976 and Supp. IV 1980).Google Scholar
Robertson, L.S.: “Automobile Safty Regulation in the United States.” American Journal of Public Health 1981; 71:818–822; Orr, L.D.: “The Effectiveness of Automobile Safety Regulation: Evidence from the FARS Data.” American Journal of Public Health 1984; 14:1384–89; Robertson, L.S.: “Automobile Safety Regulation: Rebuttal and New Data.” American Journal of Public Health 1984; 74:1390–1394.Google Scholar
Mandatory safety standards, 15 U.S.C.A. Sec. 2056; ban hazardous products, 15 U.S.C.A. 2057; initiate recalls for products that pose substantial hazards, 15 U.S.C.A. 2061; require informative labeling of consumer products, 15 U.S.C.A. 2063.Google Scholar
Waller, , supra note 11, p. 40.Google Scholar
“Toughest belt use law proves to be the most effective.” IHHS Status Report 1986; 21:5–6; Calvin, R.M., Seat-Belt Usage in Countries with Belt Laws: A Status Report, Washington, D.C.: Highway Users Federation, 1984; A Preliminary Evaluation of New York and New Jersey Insurance Claim Results Before and After Enactment of Mandatory Seat Belt Legislation, 1983–85 Models, Washington, D.C.: Highway Loss Data Institute, HLDI A-27, 1986; National Highway Traffic Safety Administration, Effectiveness of Safety Belt Use Laws: A Multinational Examination, DOT HS 807 018, 1986.Google Scholar
Agran, P.F. Dunkle, D.E. Winn, D.G.: “Effects of Legislation on Motor Vehicle Injuries to Children.” American Journal of Disabilities in Children 1987; 141:959–964, at p. 959.Google Scholar
Baker, O'Neill, Karpf, , supra note 1, p. 260.Google Scholar
Robertson, , supra note 6, p. 157. Although some of these measures, such as smoke-detector requirements, have been demonstrated to have had a significant impact on injury rates, the unfortunate fact is that the impact of most such laws has not been evaluated.Google Scholar
346 F. Supp. 277 (D. Mass. 1972).Google Scholar
Baker, S.P.: “On Lobbies, Liberty, and the Public Good.” American Journal of Public Health 1980; 70:573–75, at 574.Google Scholar
Beauchamp, D.E.: “Injury, Community and the Republic.” Law Medicine Health Care 1989; 17:1; Beauchamp, D.E.: “Community: The Neglected Tradition of Public Health.” Hastings Center Report 1985; 15:28–36; Beauchamp, D.E.: “Public Health and Individual Liberty.” Annual Review of Public Health 1980; 1:121–36.Google Scholar
Baram, M.S.: “Cost-Benefit Analysis: An Inadequate Basis for Health, Safety, and Environmental Regulatory Decisionmaking.” Ecology Law Quarterly 1980; 8:473–531. Also see Swartzman, D.: “Cost-Benefit Analysis in Environmental Regulation: Sources of the Controversy.” In: Swartzman, , Cost-Benefit Analysis and Environmental Regulations: Politics, Ethics, and Methods, Washington, D.C.: The Conservation Foundation, 1982, pp. 53–85; Tribe, L.H.: “Ways Not to Think about Plastic Trees: New Foundations for Environmental Law.” Yale Law Journal 1974; 83:1315.Google Scholar
See, generally, Bollier, D. Claybrook, J., Freedom from Harm: The Civilizing Influence of Health, Safety and Environmental Regulation, Washington, DC: Public Citizen & Democracy Project, 1986.Google Scholar
Navarro, V.: “Where is the Popular Mandate?” New England Journal of Medicine 1982; 307:1576–81; Navarro, V.: “A Reply to Conventional Wisdom.” International Journal of Health Services 1983; 13:169–76.Google Scholar
For example, the budget of the Consumer Product Safety Commission is approximately $30 million annually. Bollier and Claybrook, supra note 31, p. 210, state that: “Congress allocated less than $2 billion for the lifesaving missions of the EPA, OSHA, FDA, NHTSA, CPSC, and food safety programs of the USDA in 1984. Compare this with the Department of Defense with its $305 billion annual budget (1985), which in just three days spends more than the major health and safety agencies in one year.”Google Scholar
The worst example of the failure of “market forces” is the continued promotion and sale of tobacco products, products which cause over 350,000 deaths per year when used as intended. Other examples of products sold despite their destructive impacts and lack of legitimate function are radar detectors and cheap handguns. See Christoffel, T.: “Putting the Brakes on Lawbreaking: State Bans on Radar Detectors.” American Journal of Public Health 1987; 77:507–511 Kelley v. R. G. Industries, Inc. 304 Md. 124 (1985). The failure of the marketplace to achieve social good is shown most vividly in the case of the Ford Pinto, where a major U.S. corporation consciously chose a predicted 180 deaths, 180 serious injuries, and estimated liability claim of $49.5 million over the $137 million cost of redesigning a flawed gas tank.CrossRefGoogle Scholar
Teret, S.P., “Injury Control and Product Liability.” Journal of Public Health Policy 1981; 2:49; Teret, S.P., “Litigating for the Public's Health.” American Journal of Public Health 1986; 76:1027.Google Scholar
Eads, G. Reuter, P., Designing Safe Products: Corporate Responses to Product Liability Law and Regulation. Santa Monica, CA: Rand Corporation, Institute for Civil Justice, 1983, p. 122, as cited in Teret, S.P.: “The Value of Litigation to Childhood Health.” In Robertson, W.O. Teret, S.P. (eds), Medical-Legal Issues in Pediatrics, Report of the Eighteenth Ross Roundtable on Critical Approaches to Common Pediatric Problems. Columbus, OH: Ross Laboratories, 1987, pp. 43–47.Google Scholar
Teret, S.P. Jacobs, M., “Prevention and torts: The Role of Litigation in Injury Control.” Law Medicine & Health Care 1989; 17:1.Google Scholar
Kitzes, W.F.: “ATVs–-The hidden danger.” Law Medicine & Health Care 1989; 17:1.Google Scholar
Injury in America, supra note 1, p. 46.Google Scholar
Robertson, , supra note 6, p. 126.Google Scholar
Injury in America, supra note 1, p. 40.Google Scholar
Graitcer, P.L.: “The Development of State and Local Injury Surveillance Systems.” Journal of Safety Research 1987; 18:191–198. Also see Standfast, S.J.: “Injury Prevention as a Public Health Responsibility: The New York State Department of Health Injury Control Program.” Law Medicine & Care 1989; 17:1, and Harrington, C., Injury Prevention Programs in State Health Departments: A National Survey. Boston: Childhood Injury Prevention Resource Center, Harvard School of Public Health, 1988, especially pp. 28–30.Google Scholar
Injury in America, supra note 1, p. 37.Google Scholar
Injury in America, supra note 1, p. 37.Google Scholar
“Who benefits?,” Philadelphia Public Ledger, August 28, 30, 1852; reprinted in the New York Times, March 24, 1981, p. 19.Google Scholar