Why accident prevention is a major policy issue for public health
The theory goes that prevention of accidents is better, and cheaper, than the cure. Tom Mullarkey argues that it’s now time for public health strategy to put this theory into practice.
The UK has long been a world leader in accident prevention and other nations have drawn considerably on our expertise.
There is good reason for this. Since the mid 1990s, the Department for Transport’s evidence-based road safety strategies, involving many national and local partners, have contributed to reducing annual deaths and serious injuries on Britain’s roads by nearly 21,000 (44 per cent). Similarly, work by the Health and Safety Executive, again supported by others, has helped cut the number of workers killed in accidents by nearly half since 1996.
However, there is a lesser-known side to the UK’s accident prevention story:
- Accidents are the principal cause of death up to the age of 39;
- Accidental injury is the main cause of death among children, post-infancy;
- The overall trend in the number of accidental deaths has been upwards during the last decade;
- The accident death rate in England has all but flat-lined since the late 1990s - at odds with significant reductions in death rates from cancer, circulatory diseases and suicide.
With deaths from road and workplace accidents falling consistently, the problem lies principally within the home and leisure spheres. Indeed, home accident deaths are now at their greatest number in England and Wales since 1985, and they represent a growing proportion of total accidental deaths.
In addition to untimely, often violent deaths, accidents cause millions of injuries requiring treatment at home, by GPs, in A&E or as inpatients.
The Home Accident Surveillance System, operated by the former Department of Trade and Industry, estimated that 2.7 million people, including half a million children under five-years-old, visited A&E following a home accident in 2002. Unfortunately, that’s when the surveillance system ceased operating; however, more recent data reveals that total accident-related A&E attendance is rising.
Since the late 1990s, hospital admissions for treatment of accidental injuries have increased year on year. To give just one example - in 12 years, the number of over-60s requiring inpatient care after falls has doubled, standing at more than 333,000 in 2009/10 in England alone. We have an ageing population and older people are being encouraged to live independently, so this trend will surely continue, if left unchecked.
At an NHS and societal level, the financial burden of accidents is eye-watering. In 2001, the annual cost of accidents to the NHS in England alone was estimated at £2.2bn. This figure could now be in the region of £5-7bn. The cost to the NHS is just the tip of the iceberg; home and leisure accidents prompting a trip to A&E cost UK society as a whole £94.6bn a year.
All this goes to show that accidents are a huge public health problem, and given the NHS needs to save £15-20bn, while also improving health outcomes, a strategic approach to accident prevention would appear highly appropriate.
Unlike many life-limiting conditions which predominantly come to the fore in late middle age, accidents affect the young disproportionately, and victims, and their carers, have to live with the consequences for longer. So, in terms of quality adjusted life years, on which many health decisions are based, there is much to gain.
Numerous studies have shown that accident prevention projects are easy to implement, inexpensive to deliver and have impressive return on investment potential. In Dudley, a falls prevention programme comprising home assessments and exercise sessions, for which the £158k a year costs were funded by the primary care trust and council, saved £3m over five years due to the corresponding reduction in hip fractures.
There are many other examples of successful local working, but it is difficult to see how a lasting impact on reducing the country’s accident toll can be achieved unless such initiatives take place within a strategic context, supported by visible national leadership.
History testifies that when there is a clear national steer on accident prevention, local action follows, for example: the publication of The Health of the Nation in 1992 fuelled the establishment of Healthy Alliances; the introduction of a national indicator by the previous Government meant Local Strategic Partnerships gave more consideration to injury prevention within their local area agreements; and, the National Service Framework for Older People has driven much recent falls prevention work.
While a national strategy should not define the detail of what happens on the ground - in the proposed arrangements for public health, this will be decided by Joint Strategic Needs Assessments - it should make clear that inaction on accident prevention is not an option. Ideally, it should outline a selection of priority issues on which action is desired - for example, preventing home accidents involving young children from disadvantaged families (given the number of children injured at home and the significant social class gradient in the death and injury rate of children).
Everyone knows that prevention is better - and cheaper - than cure. It is time to translate this from theory into practice and for accident prevention to become a permanently-embedded feature of public health in the UK.