cellar. But the 'challenge is as difficult as the need is obvious. The two fields are so often felt to be at opposite ends of the human interest spectrum, the one attracting students of individual personality, even idiosyncrasy, the other attracting healers of populations who see things in aggregates. The one is, or was, primarily concerned with prolonging life; the other deals with making it worth living. Not even misery could make companions of our respective teachers, shunted off in the dingier corners of most medical schools, or of our bureaucratic leaders, trying to gain or dodge the spotlight in state capitals. The two have teamed up some in recent years-not yet for the medley relay, but for something more awkward, like a three-legged race. Mental health specialists have had a good deal of consciousness raised about the community, planning, evaluation, and prevention. Public health, for its part, has incorporated behavioral science and mental health to a significant, if still inadequate, degree. Consumerism, litigation, and the scramble for health insurance coverage have brought us to a stage beyond heightened awareness, comparable to having our heads knocked together. It is sometimes painful, but not without value. That our teamwork is improving can be seen in APHA programs. Under Dr. Ernest Gruenberg's leadership, APHA
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LETTERS SOCIAL PROBLEMS AND INJURY To illustrate the need for "social epidemiology," Dr. Saxon Graham (AJPH, November, 1974) has cited examples from the field of injury control. In so doing, he may have misled readers unfamiliar with this field. In the first place, the etiological agent of injury is not an "accident," as stated, but generally some form of energy (mechanical, thermal, electrical, etc.) or a chemical. The distinction is important: it is not necessary to prevent an "accident" in order to prevent an injury.' Second, the statement that even in cases where we know the agent or the vector, it is necessary to know about the cultural situation, the social situation, the personality situation, in order to prevent the disease" is refuted elsewhere in Dr. Graham's article by reference to disease prevention through water and sewage control. To cite one example from the 184
issued Mental Disorders: A Guide to Control Methods (1962), a signal work. Our annual meetings and Journalwitness this issue-reflect increasing quantity and quality of combined efforts. The annual Rema Lapouse award, established in 1972 by Dr. Milton Terris, joins the Epidemiology, Statistics, and Mental Health Sections in a pleasant endeavor; they have honored H. Warren Dunham, Morton Kramer, and Paul V. Lemkau in successive years. In 1974, a psychosocial study "Antecedents of Responsible Parenthood" was launched with family planning funds after a year of preparation involving half the APHA sections. The National Institute of Mental Health has advanced a public health outlook and supported relevant training, research, and service as its major mission. For the past 2 years the NIMH, together with the Ittleson and Hofheimer Foundations, has supported a mental health project at APHA, the chief product of which, Mental Health: The Public Health Challenge, will be published in March, 1975. This new monograph, the work of 60 contributors, provides a kaleidoscopic view of long distance runners who look more like well coordinated twins than stumbling, hapless partners in the race. Long may they endure! E. James Lieberman, MD, MPH Director, APHA Mental Health Project
injury field, well designed roadside guardrails prevent injury to the alcoholic housewife, the teenager trying to impress his peer group, the suicidal businessman suffering from status inconsistency, and the migrant worker who can't afford to repair his brakeswhether or not we understand the underlying social problems. I agree with Dr. Graham that a variety of preventive approaches is available. But the choice of approaches should be determined by their effectiveness in preventing disease or injury.2 Strategies that depend on changing the daily behavior of the individual generally have little or no effect-as illustrated by the careful research of Robertson et al., also described in the November issue. To date, the evidence indicates that the largest strides in prevention can be expected from measures directed toward the community rather than the individual.3 Hopefully, readers inspired by Dr. Graham's article will familiarize themselves with the results of previous research on social and behavioral con-
AJPH FEBRUARY, 1975, Vol. 65, No. 2
comitants of injury. Otherwise they may reinvent a wheel-a square one.
References 1. Baker, S. P., and Haddon, W., Jr. Reducing Injuries and Their Results: The Scientific Approach. Health Soc., in press. 2. Haddon, W., Jr. On the Escape of Tigers: An Ecologic Note. Am. J. Public Health 60:2229-2234, 1970. 3. Barry, P. Z. Individual Versus Community Orientation in the Prevention of Injuries. Prev. Med., in press.
Susan P. Baker, MPH Department of Public Health Administration The Johns Hopkins School of Hygiene and Public Health
Baltimore, Maryland 21205
INJURY: INTENT AND CHANGE I disagree strongly with both of the protests registered by Licht against
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LETTERS SOCIAL PROBLEMS AND INJURY To illustrate the need for "social epidemiology," Dr. Saxon Graham (AJPH, November, 1974) has cited examples from the field of injury control. In so doing, he may have misled readers unfamiliar with this field. In the first place, the etiological agent of injury is not an "accident," as stated, but generally some form of energy (mechanical, thermal, electrical, etc.) or a chemical. The distinction is important: it is not necessary to prevent an "accident" in order to prevent an injury.' Second, the statement that even in cases where we know the agent or the vector, it is necessary to know about the cultural situation, the social situation, the personality situation, in order to prevent the disease" is refuted elsewhere in Dr. Graham's article by reference to disease prevention through water and sewage control. To cite one example from the 184
issued Mental Disorders: A Guide to Control Methods (1962), a signal work. Our annual meetings and Journalwitness this issue-reflect increasing quantity and quality of combined efforts. The annual Rema Lapouse award, established in 1972 by Dr. Milton Terris, joins the Epidemiology, Statistics, and Mental Health Sections in a pleasant endeavor; they have honored H. Warren Dunham, Morton Kramer, and Paul V. Lemkau in successive years. In 1974, a psychosocial study "Antecedents of Responsible Parenthood" was launched with family planning funds after a year of preparation involving half the APHA sections. The National Institute of Mental Health has advanced a public health outlook and supported relevant training, research, and service as its major mission. For the past 2 years the NIMH, together with the Ittleson and Hofheimer Foundations, has supported a mental health project at APHA, the chief product of which, Mental Health: The Public Health Challenge, will be published in March, 1975. This new monograph, the work of 60 contributors, provides a kaleidoscopic view of long distance runners who look more like well coordinated twins than stumbling, hapless partners in the race. Long may they endure! E. James Lieberman, MD, MPH Director, APHA Mental Health Project
injury field, well designed roadside guardrails prevent injury to the alcoholic housewife, the teenager trying to impress his peer group, the suicidal businessman suffering from status inconsistency, and the migrant worker who can't afford to repair his brakeswhether or not we understand the underlying social problems. I agree with Dr. Graham that a variety of preventive approaches is available. But the choice of approaches should be determined by their effectiveness in preventing disease or injury.2 Strategies that depend on changing the daily behavior of the individual generally have little or no effect-as illustrated by the careful research of Robertson et al., also described in the November issue. To date, the evidence indicates that the largest strides in prevention can be expected from measures directed toward the community rather than the individual.3 Hopefully, readers inspired by Dr. Graham's article will familiarize themselves with the results of previous research on social and behavioral con-
AJPH FEBRUARY, 1975, Vol. 65, No. 2
comitants of injury. Otherwise they may reinvent a wheel-a square one.
References 1. Baker, S. P., and Haddon, W., Jr. Reducing Injuries and Their Results: The Scientific Approach. Health Soc., in press. 2. Haddon, W., Jr. On the Escape of Tigers: An Ecologic Note. Am. J. Public Health 60:2229-2234, 1970. 3. Barry, P. Z. Individual Versus Community Orientation in the Prevention of Injuries. Prev. Med., in press.
Susan P. Baker, MPH Department of Public Health Administration The Johns Hopkins School of Hygiene and Public Health
Baltimore, Maryland 21205
INJURY: INTENT AND CHANGE I disagree strongly with both of the protests registered by Licht against
