Letter

A falling accident rate, but at a cost

Dear healthmatters — In relationto the health promotion policy choices David Seedhouse puts forward (What are the limits to health promotion?, issue 26), I would suggest that one reason most health promoters would choose to introduce policies A (maximising the uptake of childhood immunisation programmes) or B (fluoridation of the public water supply), rather than C (banning the use of private cars to transport children to and from school to reduce road accidents), is because the specific health benefits and general public health application of first two options are already strongly supported by available evidence; whereas the arguments to support the third option need to be developed further.

There are well-founded concerns that the large-scale ‘motorisation’ of the population has resulted in adverse outcomes for health, but these do not include the numbers of child pedestrians and cyclists (0-15 years) killed or seriously injured as a result of road traffic accidents. These, like the numbers of people walking and cycling, have been decreasing steadily in Great Britain over the last ten years.¹

Notwithstanding the indignant cries about restricting individual freedoms, it seems that health promoters would need to refine their arguments considerably before attempting to introduce option C to counter the persuasive view which would undoubtedly be put, that over the same period increased use of the motor car has been associated with a sustained fall in the numbers and rates of fatal and serious road traffic-related injuries in children.

Perhaps the argument for restricting the use of cars might be strengthened by asking whether preventing accidents by reducing the numbers of pedestrians and cyclists exposed to the risk (or at least, concentrating the risk in those groups without access to a car) is an acceptable and effective measure in the context of a wider health promotion strategy.