news focus: Many public health initiatives that save the NHS a lot of money do not get the recognition they deserve, says Nicholas Pyke

Published: 14/03/2002, Volume II2, No. 5796 Page 16 17

They have provoked a furious reaction, but Ken Livingstone's controversial congestion charges are going ahead and could be operating by next February. The London mayor has now announced the final details of a scheme to tax drivers£5 every time they want to cross the inner ring road into the city centre. It will ease traffic flow and, he has claimed, improve Londoners' health in the process.

As a piece of municipal engineering, Ken's congestion-charging network, and his attempts to drive the pigeons he describes as 'rats with wings' from Trafalgar Square, can hardly rival the great Victorian innovations such as the giant sewerage system built under London by Joseph Bazalgette - a different sort of congestion relief scheme. Commissioned after the 'great stink' of 1858 drove MPs from the debating chamber, the 85 miles of tunnelling put an end to the capital's cholera outbreaks, saving up to 20,000 lives a year.

But attempts to improve public health and safety outside the hospital ward are continuing, even if they usually attract less notice than Ken Livingstone and are unlikely to join Bazalgette in the history books.

The widespread introduction of speed cameras at accident black spots, for example, has already reduced the toll of death and injury. Around 5,000 people a year are killed in traffic accidents, most very young or old, and pedestrians. Each death on urban roads costs an estimated£1.2m to the health service and economy.

Trials in Lincolnshire showed a 90 per cent fall in the number of crashes resulting in death or serious injury in areas where cameras were sited. Northamptonshire police point to a 45 per cent drop in the numbers killed or badly injured after a similar experiment.

In London, congestion charging is part of an attempt to strengthen public transport, improve the capital's notoriously unbreathable air and turn back a rising tide of traffic which kills or seriously injures 6,000 a year. Health service workers will not have to pay the£5.

Household accidents are another significant, if little publicised, source of injury. While ministers have targets for reducing accidents in the workplace, nothing similar exists for the home, although 2.8 million people a year end up in hospital.

Around 4,000 people are killed outright each year. No department or branch of local government has taken overall responsibility.

But now the Department for Trade and Industry is sponsoring a three-year,£4m scheme to get basic safety equipment into family homes, to protect children in particular. This includes stair gates, fire guards, smoke alarms and devices to stop doors slamming on fingers. In Merseyside, the fire service is equipping every home with a smoke alarm.

Toughening beer glasses is another simple measure with the potential to save the NHS millions of pounds. A standard pub glass breaks into shards and becomes a potentially lethal weapon. But a new generation of heat-treated, toughened glasses breaks into little pieces - like a car windscreen - rather than jagged edges.About a quarter to two-thirds of bar glasses are thought to be strengthened. So far, there are no figures to show the benefits - if anything there have been more minor injuries to bar staff because the toughened glasses shatter more easily.

But experts and campaigners like Jonathan Shepherd, professor of oral and maxillo-facial surgery at University of Wales College of Medicine, are convinced it will reduce the number of 'glassings', which injure up to 55,000 a year.

Professor Shepherd has an even simpler strategy.With police, magistrates and victim support groups he has compiled league tables of the city's most violent pubs, clubs and bars, and published them in the South Wales Echo. The result has been a 20 per cent fall in victims of violence attending accident and emergency at University Hospital ofWales, Cardiff.

But little is being done in many public policy areas identified as key health risks.Despite an initiative to put fresh fruit into primary schools, nutritionists are in despair at the growth of 'food deserts' in poorer parts of the country - where elderly people have to walk over a mile to find a shop selling fresh food or a basic range of important products. Ministers have promised to help corner shops escape the supermarket stranglehold, but there is little sign of action.

According to Professor John Ashton, North West regional public health director, the public neglect of working-class teenagers is another serious health issue. It is well known that 12-16 year old boys are at significant risk of violent accident. Yet, he says, there is no co-ordinated attempt to look after them and get them off the streets - or rooftops.

Another area in which public health could improve is the health service itself, he adds. Europe's biggest employer is also a huge source of traffic and pollution.He says public health could benefit if the NHS cut down on car traffic to hospitals by co-ordinating adequate public transport; if dangerous clinical waste were separated out and disposed of more effectively; and if its heating and recycling policies were more efficient.

'Work on public health needs to start at home, 'he adds. 'The health service needs to put its own house in order. It will get a bit more credibility then, when it tells other people how to behave.'