7.1. Introduction

Injuries (unintentional due to “accidents” and intentional due to interpersonal violence and self-harm) are the most common cause of death in the EU Member States after cardiovascular diseases, cancer and respiratory diseases. About 60 million people, corresponding to about 12% of the entire European population, are medically treated for injuries each year and about 250,000 citizens of the European Union die as a result of an accident or violence. In children, adolescents and young adults accidents and injuries are the leading cause of death (KfV, 2007). There are large differences in the occurrence of injuries in different EU Member Countries, although over the last ten years a reduction of about 20% has been observed in standardized death rates for many causes except for home and leisure accidents.

Many organisations worldwide cooperate to address this huge health problem. The World Health Organization and the European Union have identified injuries as one area which should rank higher on the political agenda in order to make Europe a safer place to live in for its population. Both have taken recent initiatives to promote forceful public health actions to enhance injury surveillance, injury prevention and safety promotion:

In 2005 the WHO has passed a Regional Committee Resolution on Prevention of Injuries in the WHO European Region. In 2007, the European Council released its Recommendation on Injury Prevention and Safety Promotion based on the conclusions of a Communication from the Commission of 2006. In order to assist national administrations and other stakeholders with the practical implementation of these guidelines a handbook “How to make Europe a safer place – key areas for consideration in implementing the Council Recommendation” has been prepared (Working Group of Governmental Experts on Injury Prevention and Safety Promotion, 2008).

This chapter provides the most recent available information about the injury burden of health, underlining the arguments which already had underpinned the mentioned policy documents. Figures are coming from different data sources: HFA-DB (WHO), COD (EuroStat), CARE, IRTAD, ESAW, HDD (Apollo), IDB.

An injury is a bodily lesion resulting from acute exposure to energy (mechanical, thermal, electrical, chemical or radiant) or from an insufficiency of a vital element (drowning, strangulation or freezing). The time between exposure and the appearance of the injury is short. Injuries are often classified as unintentional (due to accidents) and intentional (due to self harm or interpersonal violence) (WHO, 2001).

In addition to intent and cause, injuries can be categorized by their settings such as the home, work place and road, and by activities, such as sports or other leisure activities (WHO, 2005a).

In contrast to many other causes of illness or premature death, injuries are widely preventable by addressing the external causes of injuries such as roads, work places, homes, sport facilities, products and services, as well as the rules of conduct.

Therefore, effective injury prevention also needs appropriate information on these external factors. Detailed injury data make it possible to develop targeted prevention measures, monitor injury trends, prioritise issues, guide policies and evaluate the success of interventions designed to reduce injuries. In order to be able to prevent injuries effectively it is important not only to know how many fractures or head injuries have occurred, but also where, when, how, to whom and also why.

There are countless examples of how detailed injury data has guided the improvement of standards and regulations for products (e.g. toys, child care articles, sport equipment, electric home appliances, safety labels) and services (e.g. playgrounds, skiing slopes, nursing homes). Public information through media and targeted safety education is almost impossible without proper risk assessment based on data. However, in many Member States this kind of data is not yet available on a routine basis.

A number of initiatives have occurred in the past to reduce the frequency of injuries due to accidents and violence and have been particularly successful in reducing road fatalities, workplace accidents, chemical accidents and consumer product-related injuries. There is also ample evidence that improvements in trauma care have led to a significant reduction in mortality from trauma. Most of these measures have been proven to be cost-effective whereby the benefits of prevention for health systems often exceed the costs of intervention by a factor of several times.

Traditionally injury prevention in EU Member States is segregated into independent sectors – traffic, employment, consumer safety, housing, welfare, police and justice etc. Although injury prevention programmes in the different sectors may have been quite effective within their specific scope, the fragmentation hampers the full use of the prevention potential. In particular the (public) health sector has not yet fully recognised the tremendous potential of taking action within its responsibilities.

Applying the systematic public health approach helps to assess the magnitude of health problems, to identify priority areas, reveal gaps, allocate attention also to vulnerable groups, provide information for targeted prevention, monitor the effectiveness of actions, and create synergies by interdepartmental coordination. Better use of scarce resources for prevention, greater effectiveness of investments and accordingly higher savings in healthcare and welfare costs can be expected.

Although many safety actions are known as effective, e.g. car seat belts, pool fencing, smoke detectors, barrier free homes; there is still a great scope for widespread implementation to reduce the huge social toll of accidents and injuries, in particular by addressing risk settings and risk groups that have until now received limited attention such as the home, leisure and sport accidents, and safety of elderly citizens.

This chapter provides a general overview of injury mortality and morbidity in the EU, a discussion of the evidence base for the proposed seven priority areas for public health action on injuries as proposed by the Council Recommendation (chapter “data discussion”), and a survey on available policy tools and guidelines for action.