It's been called the most under recognized major public health problem facing the nation today, but it's not a disease, a condition, a disorder or a syndrome. Accidents killed 2,212 people in Alabama in 2002, making unintentional injuries the fifth leading cause of death in the state.

"Unintentional deaths are a great expense to everyone. Personal loss, economic loss: It's just a ripple effect," said Carol Mysinger, director of the state health department's injury prevention division.

Mysinger said that while epidemics like cancer and obesity capture the public's attention, unintentional injuries kill more people ages 1 to 34 than any other cause. They account for most of what public health officials call years of potential life lost.

Years of potential life lost is a measure epidemiologists use to emphasize premature mortality by estimating the average time a person would have lived had he or she not died prematurely. In Alabama, it's based on the age of 65.

More than 47,700 potential life years were lost to unintentional injuries in Alabama in 2002. Compare that to just more than 37,000 years lost to heart disease, which -- despite being the state's No. 1 killer -- generally affects the older/spopulation.

"It's striking people in the prime of their life, and it's unexpected, not something they are prepared for. It's taking away people in their youth," said Kathryn Chapman, deputy director of the state health department's division of statistical analysis, of unintentional injuries.

"These are people who aren't going to be contributing to society, being members of family, who aren't going to be able to enjoy life because they died at such a young age."

Alabama ranks seventh in the country in deaths from unintentional injuries, according to the National Vital Statistics System. New Mexico is first, followed by Wyoming and Mississippi.

When talking about injuries, public health officials distinguish between those that are meant to cause harm -- domestic violence, suicides, homicides -- and those that are unintended.

Unintentional injuries include everything from drownings to plane crashes, house fires to snakebites, with the most common three being motor vehicle crashes, poisonings and falls.

But even unintentional injuries are not accidents, say public health officials. Accidents happen by chance. Injuries, they say, can be prevented.

"Many people do think injuries are inevitable, but through the research we've done, we see there are some specific types of prevention programs that work," said Gail Hayes, spokesperson for the Centers for Disease and Control's Injury Prevention Center.

For example, Hayes said studies show that laws requiring people to wear seat belts and lowering the limit at which a person is considered too drunk to drive have greatly reduced the number of fatalities from motor vehicle crashes.

Motor vehicle crashes are the leading cause of fatal injuries in Alabama, killing 1,109 people in 2002 -- more than all other types of unintentional injuries combined.

Alabama ranks eighth in the country in motor vehicle deaths, according to the CDC. Mississippi is first, followed by Wyoming and South Carolina.

The state had 24.5 deaths per 100,000 people in 2002 -- the most recent year available from Alabama Department of Public Health Statistics. For the same year, the national average was 15.5 deaths.

So far in 2004, motor vehicle fatalities are up 30 percent in Alabama, putting the state on pace for a record 1,300 deaths this year.

Those statistics prompted Gov. Bob Riley in August to announce a statewide crackdown on speeding, which last year beat out driving under the influence as the No. 1 cause of fatal crashes in Alabama for the first time since record-keeping began.

Riley and others have blamed the high number of speed-related crashes on a shortage of state troopers. Alabama has 360 troopers on the road, well short of the 800 officials say it should have.

To make up the difference, Riley has called on police and sheriff's departments with the authority to issue tickets on interstates to help with the speeding crackdown.

But interstates are the least of Alabama's problems, said University of Alabama professor David Brown, who directs the Critical Analysis Reporting Environment program that tracks traffic crashes.

A CARE study released in August emphasized that even if all the fatal crashes on interstates in 2004 were eliminated, Alabama's fatal crash and fatality count would still be above what it was for the same time last year.

"The major finding is that selective enforcement needs to be distributed over the entire rural state and county systems, and not be restricted to just interstates," Brown said.

According to the Alabama Department of Public Safety, 100,587 traffic wrecks occurred in urban areas in 2003 compared to 40,442 in rural areas. Yet, wrecks in rural areas accounted for 704 deaths, compared to 297 in urban areas.

The National Fatal Accident Reporting System suggests that rural roads are more dangerous because they have narrow or non-existent shoulders with limited sight distance because of hills and curves and generally are in poorer condition than interstates and urban roads.

Chapman said studies also have shown that drivers on rural roads are more likely not to wear seatbelts and drive while under the influence.

"If you put together not using seatbelts, drinking and windy, curvy roads, you really have a deadly combination, especially when you don't have adequate emergency response coverage out there," she said.

Alabama has been working for some time on a statewide dispatch system that would allow a paramedic to dial a single number and find out instantly the nearest hospital with the capability to treat a specific type of injury.

The system, whose unveiling has yet to be set, also will notify emergency medical responders whether that hospital has the staff and space available to accept the crash victim.

Mike Daughtry, director of the state health department's injury surveillance branch, said the system is aimed at preventing victims from being shuttled from one hospital to the next during what emergency technicians term the "golden hour."

"It's a matter of getting them there before they reach that critical threshold, before they start going downhill," he said.

Once the system is in place, officials say it will join laws like the primary seatbelt law that went into effect in 1999 and enforcement campaigns like Click it or Ticket in reducing the number of traffic fatalities -- and deaths from unintentional injuries overall.

But that may be just a surface fix, said Sgt. Tim Sartain, a spokesman for the Alabama State Troopers.

"We can change actions real quick with traffic citations and actions in the court," Sartain said. "But attitudes -- people believing they can drive as they please on public roadways -- it takes a lot longer to change those."

Reach April Wortham at or 722-0213.