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Featured Commentary

Our online subscription format, SRGS Connect, features 10 commentaries on recently published articles in top medical journals with each new edition. The commentaries are by practicing surgeons and focus on the strengths and weaknesses of the research and its contribution to advancing the field of surgery.

Below is a sample of one of the commentaries published in the current edition of SRGS Connect, What You Should Know.


Haegerich TM, Dahlberg LL, Simon TR, et al. Prevention of injury and violence in the USA. Lancet 2014; 384(9937):64-74.

Comment
Michael F. Rotondo, MD, FACS, University of Rochester Medical Center, Rochester, NY

Bottom line: Any long-term investment in improvement in death and disability rates through injury and violence prevention likely will be fully eclipsed by more compelling, pressing needs. In short, there is no universal solution to uniformly apply across a country that clearly has other priorities. Political courage from our leaders and the will of the American people to create long-term solutions for the health and well-being of its people are needed.

Haegerich and colleagues present a superb, and concise, overview of the demography and epidemiology of preventable injury in the U.S. in which the main messages are clear: it is the top cause of death in the first three decades of life, it comes at an enormous price to the American people, and it occurs from driving, ingestions, falls, and firearms. While the data summarized in the work is both comprehensive and current, the message is by no means new or foreign to surgeons in this country. In 1993, C. William Schwab drew attention to the firearm injury epidemic in urban America in his presidential address to the Eastern Association for the Surgery of Trauma (EAST) entitled, “Violence, America’s Uncivil War.”1 Some 12 years later, in my presidential address to the same association, “The Rural Trauma Imperative: Silent Killer in America’s Heartland,” I highlighted the magnitude of preventable death and injury in rural and remote regions. Haegerich’s work once again draws our attention to this devastating and costly problem. Perhaps even more devastating is how little progress we have made.

While the authors point out the usual solutions that include education, systems development, and activism, they leave us with a lingering question: what will it take for the American people to embrace this problem and connect with the consequences of ongoing inaction? After all, if you compare us to virtually any other region in the developed world, we are poor performers at best.2
Why don’t we just step up to the plate and fix it? The fact is that it is complex and vexing problem. We are a country of 330 million people, 3,000 miles across, built on a federation of states where health care is local and the social determinants of injury are quite variable community by community. Moreover, while the authors suggest that the Affordable Care Act offers an opportunity to address the problem, health care systems are focused on more urgent financial concerns. Insurance reform, impending changes in the payment system, and the expenditure of creative effort and money to reengineer health care delivery consume time and attention of health care providers, employers, and local governance structures. Demands for immediate return on investment in the transition from fee for service to fee for value will take top priority. And, any long-term investment in improvement in death and disability rates through injury and violence prevention likely will be fully eclipsed by more compelling, pressing needs. 

In short, there is no universal solution to uniformly apply across a country that clearly has other priorities. Political courage from our leaders and the will of the American people to create long-term solutions for the health and well-being of its people are needed. Both are apparently in short supply in our country today.

  1. Schwab CW. Violence: America's uncivil war--presidential address, Sixth Scientific Assembly of the Eastern Association for the Surgery of Trauma. J Trauma 1993 Nov;35(5):657-65.
  2. Panel on Understanding Cross-National Health Differences Among High-Income Countries. National Research Council and Institute of Medicine of the National Academies. U.S. Health in International Perspective: Shorter Lives, Poorer Health. The National Academies Press: Washington, D.C. 2013.