From accidents to risk: Public health and preventable injury

Abstract

In the nineteenth century reports of Registrar General, fatal accidents were separated from other causes of death because they had neither natural nor motivated causes. As individual and unpredictable misfortunes, they attracted little interest from public health. Accidental injury became a legitimate object of public health concern in the middle of the twentieth century, when accident prevention became professionalised. With the rise of epidemiological research, accidents were made visible as the point of convergence of a series of risk correlates. By the end of the twentieth century, risk management has been, to a large extent, privatised, with incentives for all individuals to be prudent about both reducing the risks for accidents and for the financial arrangements they make for ameliorating the effects of accidents they do incur. In the ‘risk society’ public health has refocused its attention on ‘injury reduction', and on establishing an evidence base for risk reduction. The accident, with its connotations of randomness and unpredictability disappears. This paper reviews these shifts in how ‘accidents’ have been constructed in public health discourses.