• Main Messages
There is a growing body of evidence to support the notion that the most effective accident prevention interventions involve using environmental and legislative approaches, supported by educational programmes requiring multi-agency collaboration.
In the UK, we have targeted accident mortality in our national health and road transport strategies from 1991, and expect to reinforce this with commitments to reductions in injury morbidity in ‘Our Healthier Nation’ (England). Locally the Avonsafe Accident Prevention Alliance Strategy 1997-2000, takes account of available evidence of effectiveness in its programme of work and commitment to inter-agency working is a priority.
For our citizens between the ages of 1 and 19 years and over 65 years of age, injury represents the greatest risk for sudden death, the commonest reason for hospital attendance resulting in short and long term morbidity. Injuries resulting from accidents are strongly concentrated among those already most socially deprived.
Extent of the problem in children
In England and Wales in 1995, 590 children aged 1 month to 15 years died as a result of injury or poisoning. Over two million children aged 14 and under, went to A and E departments for treatment to injuries resulting from accidents.
Extent of the problem in older people
In the United Kingdom, 544,000 home and leisure accidents to people aged 65 and over required hospital treatments in one year. Approximately 30% of the people aged 65 and over who live in the community fall each year. For those aged over 80 years the rate is as high as 50%.
By the year 2021 it is estimated that one in five of the population will be over 65. If the current rate of accidents is not markedly reduced, the absolute effect on disability and mortality will increase.
Broad estimates have been made to show the scale of the problem for injuries in the home in monetary terms these are:
- A slight injury treated by the GP – £ 120
- A slight injury treated in hospital – £ 3920
- Serious injury treated in hospital – £ 28830
- Fatal injury – £784090
Thus the value to society of preventing these injuries in the home is estimated at £9460 million each year.
The hidden costs in particular personal tragedies should not be overlooked
• What has research shown to be the most effective health promotion approaches used with this topic?
Research evidence suggests that the most effective health promotion approaches which should be used in accident prevention are those which include education, improving the environment and lobbying to make products safer, as well as laws that support prevention programmes. Often approaches will be combined.
An educational approach is aimed at increasing skills, knowledge or awareness of risk factors for accidental injury so as to reduce risky or dangerous behaviour. The educational interventions which have been most effective have concentrated on a single message such as child restraints in cars and smoke alarms.
An environmental approach involves modification of the physical and public environment to eliminate some of the risk factors for accidents, for example traffic calming schemes to reduce the speed of vehicles in a defined area. The use of safety equipment which modifies the physical and personal circumstances such as cycle helmets, stairgates, fireguards and smoke alarms would also be considered to be using environmental approaches.
An enforcement (or legislative) approach is one which laws or rules which govern certain behaviour are introduced and are backed up by rewards or sanctions. Examples of an enforcement approach would include changes to the law requiring seat belts to be worn, drink/driving legislation and changes to the rules in sports such as rugby in which certain play was made illegal.
Most accident prevention health promotion work is concerned with primary and secondary interventions. Examples of primary accident prevention measures are driver education courses designed to alert drivers to the risks of accidents and to teach the skills necessary to avoid accidents. Examples of secondary interventions are smoke alarms, cycle helmets, air bags and car seat restraints intended to reduce the severity of an injury if an accident occurs.
The third area of accident prevention activity, tertiary prevention, is that of treatment and care concerned with reducing long term consequences of injury following an accident. This area is generally outside our health promotion remit, as is health and safety in the workplace.
Addressing inequalities – mortality, morbidity and risk data all demonstrate that accidents tend to disproportionately affect families in deprived communities with high health needs. Social class gradients have widened over the past decade. The social class gradient for deaths due to injuries is steeper than for any other cause of death in childhood. The recommended approach is therefore to give priority to working in these areas and to ensure that the particular needs of black and minority ethnic communities are met.
• Research evidence
The research field of accident prevention is relatively new, but is growing. This is reflected in the number of reviews of effectiveness recently published. Two recently published effectiveness reviews substantially add to the body of research focussing on the issues surrounding accident prevention, identifying what action needs to be taken and where the gaps exist.
Action on Injury: Setting the Agenda for Children and Young People in the UK (1998) is set to become a seminal work on childhood injury prevention. It is intended to provoke a national commitment to injury prevention and control. The current state of knowledge on the prevention of unintentional injury in children through implementing evidence based interventions and approaches is presented. (Injury Prevention, 1998)
Guidelines for the Prevention of Falls in Older People
These guidelines have been developed to translate current trial evidence about falls prevention into recommendations that can be implemented in different settings, with the aim of reducing the rate of falls and injurious falls in people greater than 65 years of age. (Health Promotion Research Programme, 1997)
See also other references below.
• Web Sites
- ROSPA http://www.rospa.co.uk
- Injury Prevention Journal http://www.injuryprevention.com
- Internet http://healthpromis.hea.org.uk
Coleman, P. et al: (1996). The effectiveness of interventions to prevent accidental injury to young persons aged 15-24 years: A review of the evidence. Scharr – Sheffield Centre for Health and Related Research: University of Sheffield.
(available from Maggie Sims, tel: 975 8031)
Department of Health. Our Healthier Nation: a contract for health. A consultation paper – London: The Stationary Office, 1998.
Effective Healthcare Bulletin (1996). Preventing Falls and Subsequent Injury of Older People. Nuffield Institute for Health, University of Leeds. NHS Centre for Reviews and Dissemination. University of York. April vol. 2 no. 4, Issue No: 0965-00288.
Effective Healthcare Bulletin (1996). Preventing Unintentional Injuries in Children and Young Adolescents. Nuffield Institute for Health, University of Leeds. NHS Centre for Review and Dissemination, University of York June, vol. 2 no. 5 Issue No: 0965-288.
Guidelines for the Prevention of Falls in Older People. Unpublished, but available from Maggie Sims at HPSA.
Health Promotion Research Programme (1997) Primary Care to Reduce Falls in Older People, Briefing Review No 6. HPRP, University of Bristol; Bristol
Harker, P. and Moore, L. (1996). Primary health care action to reduce home accidents a review. Health Education Journal, 53 322-331.
Harker, P. (1996) Health Visitor Prevention of Child Home Accidents. Health Promotion Research Programme, Briefing Review No. 1. Bristol: Health Promotion Research Programme, University of Bristol.
Health Education Authority (1996) Health Promotion Effectiveness Reviews. Health Promotion in Childhood and Young Adolescence for the Prevention of Unintentional Injuries. London: Health Education Authority.
Hogg, C. (1996) Preventing Children’s Accidents. A Guide for Health Authorities and Boards. London: Child Accident Prevention Trust.
Injury Prevention – Journal of the International Society for Child and Adolescent Injury Prevention. Action on Injury – Setting the Agenda for Children and Young People in the UK. BMJ Publishing Group. December 1998 Volume No 4 Supplement.
Queen Mary and Westfield College, University of London and South East Institute of Public Health. Guidelines for the Prevention of Falls in Older People. 1998. Unpublished, but available from Maggie Sims at HPSA.
Please note :
‘Injury Prevention’ – the Journal of the International Society for Child and Adolescent Injury Prevention is kept at the Health Promotion Resource and Information Center at Central Health Clinic and contains articles on effectiveness.