Published: 31/10/2002, Volume II2, No. 5829 Page 18

'Injuries and accidents?' said a primary care trust colleague commenting on the report just published by the London Health Observatory, Too High a Price: injuries and accidents in London.

1'Not a priority, sadly, ' she said.

No sign of it in the priorities and planning framework for the NHS.

But what about the newly published cross-government task force report Preventing Accidental Injury: priorities for action that recommends regional directors of public health should develop a unified programme to tackle accidents across the spectrum?

2Not to mention the national service framework for the elderly which tasks us to prevent falls, and the children's framework which will not be able to avoid accident prevention?

'Well, ' she said, 'let me know when it becomes a must do.'

And therein lies the familiar problem of tackling public health issues.Many of the imperatives for effective action lie with government departments other than the Department of Health.

It is not that there is a shortage of effective intervention needed by the NHS; it is that the biggest differences are likely to be made across other areas of government.

Take road safety - one of the key areas identified for action by the task force. It showed how effective action to reduce traffic speeds can be in reducing pedestrian casualties, who were identified as an early priority for action.

The Department for Transport, a task force co-signatory, has announced a new programme of speed reduction across all types of road in Britain in response to the Commons transport select committee's report.

This is a victory for public health and for young pedestrians, who are the most frequent victims of road traffic accidents.

But even compared with other public health issues, the prevention of injury lies scattered so widely that even those most experienced in getting partnerships to work baulk at the size of the task. For London, across the whole span of injuries, this will involve all NHS organisations, including every general practice and pharmacy, all local authority departments and all schools, not to mention all significant workplaces and many voluntary agencies.

In some parts of the country this is already happening - notably through the clever oiling of partnership wheels with health action zone resources.HAZ resources are meant to help mainstream initiatives, not bail out those which are sidelined.

The London Health Observatory analysis identified a number of common underlying factors which need to be addressed across the span of nearly all injuries. These included the need to sever links between poverty and injury, between poor housing and those living alone and injury, and the reduction in alcohol and illicit drug use.

Where is the alcohol strategy? It is still being developed. A consultation document is to emerge from the Cabinet Office.

Legislation to reduce the drink driving limit would be an obvious evidence-based start that is already in place in other countries.Yet it does not appear to be high on the Department for Transport's agenda.

So what is needed? First, a means must be found to bring injury prevention into the mainstream as perceived by the NHS, as well as the rest of the public sector.An obvious route would be through the forthcoming delivery plan to tackle health inequalities. Injuries as a cause of inequalities and a contributor to inequalities in expectation of life are a prime area for delivery.

Second, clear priorities for a three-year programme must be chosen from across the enormous span of injuries.

Fortunately, this has already been done by the accidents task force.

Third, government departments need to recognise the support they need to give one another to help achieve their public service agreements.Cross-government resourcing and matrix management of national initiatives to support local action are a way forward.

Fourth, a means of ensuring joint commitment to local delivery for injury prevention must be found.The priorities and planning framework identifies the NHS as leading on tackling health inequalities. It must also ensure that local authorities are tied into performance management.

If primary care trust performance indicators are to include accident mortality, then so should local authorities'.There is already experience of joint performance monitoring with social services in mental health and child health.There is every reason to cast the performance monitoring net more widely under the banner of tackling health inequalities.


1Fitzpatrick J et al (eds). Too high a price: accidents and injuries in London. London Health Observatory, October 2002.

2Cross-government task force.

Preventing accidental injury - priorities for action. Stationery Office, 2002.

Dr Bobbie Jacobson is director of the London Health Observatory.