Changing the Social Environment to Prevent Injuries

The social environment has a powerful influence on the risk of being injured. This influence is mediated through the myriad ways it shapes the lifestyles, exposures, and behaviors of individuals. The building blocks of our social environment are social interactions or the ways that people act toward, respond to, or influence one another (Robertson, 1987). These interactions are shaped by our culture, the structure of social relations as reflected in the nature of institutions such as the family and the economic order, and processes such as the socialization of children. Although we have made great strides in modifying the physical environment as an injury prevention strategy, our understanding of how to intervene on the social environment to prevent injury remains relatively undeveloped. Part of the reason lies in the imbalance that has existed in epidemiological research on injury. This research, much like for many other areas of public health, has been dominated by an individually focused risk-factor paradigm that directs attention toward programs that are designed to help people change their behavior to lower their risk for injury or behaving violently (Stokols, 1992; Yen & Syme, 1999). A focus on the social environment shares the ultimate intention of changing individual behavior, but the focus of intervention shifts from the individual to the social environment in which people live and interact (Task Force on Community Preventive Services [TFCPS], 2003; Yen & Syme, 1999). The purposes of this chapter are (1) to provide a conceptual framework for discussing the relationship between the social environment and injury prevention; (2) to provide illustrative evidence for a link between the social environment and injury; (3) to articulate the value of modifying the social environment for injury prevention; and (4) to describe and assess the evidence for selected injury prevention interventions, programs, or policies that are related to the social environment.