Feature

Accidents will happen… but why?

Mandy Moore looks at how a holistic approach to accidents could reduce death and injury dramatically

It is said that ‘accidents will happen’, as though nothing could be done to prevent them. But this is far from the truth. Many countries, including Britain, have done much to reduce accidents — but more could be done, particularly by following the experience of those with the best accident prevention records.

The World Health Organisation’s Health for All 2000 campaign specifies accident prevention as one of its main targets. Its target 11 states that: “By the year 2000, deaths from accidents in the region should be reduced by at least 25%, through an intensified effort to reduce traffic, home and occupational accidents.” Many of the other targets relate to the causes of accidents, and accident-prevention.

Accident prevention urgently needs to be given higher priority. Accidents are the fourth most common cause of death in this country, they are a major cause of injury, and lead to a greater number of ‘years of life lost’ than any other cause of death. Over half of all deaths in the 15 to 24 year old age range are the result of accidents.

Like all other major causes of ill-health and mortality, accident rates exhibit huge class differentials. In all categories of accident, far more working class people die or suffer injury than others. The Black report in 1980 highlighted the ‘steep class gradient found in deaths attributable to accidents’ and cited social deprivation as a causal factor.

Accidents are expensive in terms of emergency treatment, time off work, etc. The psychological costs are also high, with people having to cope with bereavement or permanent handicap, loss of working capacity and increased stress.

Health and local authorities all over the country have smoking, food and alcohol policies, look-after-your heart campaigns, and health promotion strategies for all kinds of things. Very few have accident prevention strategies. Where work on accident prevention does exist, it is usually based on particular client groups, such as the elderly or children, or specific areas such as road or home safety.

This work has its value, and there are a number of examples of successful initiatives. The Dutch Woonerven (living streets) and Swedish pedestrian/cyclist networks to cut road accidents, and the Massachusetts Childhood Injury Prevention Programme are well known. But it is clear that the greatest success has been achieved where comprehensive, integrated strategies have been adopted.

One of the best examples is the Skaraborg study in Sweden. This took an all-age-all-injury approach, with a detailed monitoring system and a community participation, ‘bottom-up’ programme. The results were remarkable. Huge falls in the number of accidents were seen in all major areas: home accidents were reduced by 27%; occupational accidents by 28%; road traffic accidents by 28%. Those accidents that did occur were of lesser severity, and the downward trend has continued beyond the study period.

The Skaraborg study is a clear example of the value of a collaborative network involving a wide range of professionals, community representatives, local press and politicians attacking all forms of accidents in all age groups, using a structured intervention programme.

Can the same by done in Britain? A number of problems would need to be tackled. First, data collection systems are inadequate. Different agencies use different definitions and criteria when collecting data. Plenty are based on ‘guesstimates’ and some accidents are not recorded at all.

Second, much accident prevention work still follows the traditional ‘health education’ approach — relying on changing the victim rather than the structural causes of accidents.

Third, prevention work remains compartmentalised, involving many professionals, and is often limited to one speciality depending upon which agency set the work in motion. A mention also has to be made of the impact of alcohol in relation to accidents. Alcohol is a major contributory factor in all categories of accident and therefore special attention has to be given to it when considering prevention work.

Finally, resources have to be found. The cost of the Skaraborg study was low because it integrated into the routine activities of participating organisations. It is doubtful if the same could happen here, given the enormous pressure on most health and local authority staff.

A holistic approach is essential if accident prevention programmes are to be effective in reaching the Health for All targets and in tackling health inequalities. The Health Policy Advisory Unit is producing a detailed analysis of accident prevention work, including sources of data and information, examples of prevention initiatives, and a model strategy for use by local and health authorities based on a community participation, all-age-all-injury approach.