7.5. Policy and Control Tools

 

No situation is without any injury risk and for almost any risk there is an array of opportunities to improve safety. In contrast to many other causes of ill health or premature death, injuries can be prevented by making the living environment and products and services safer, as well as by regulating the behaviour through legislation, supervision & education.

 

There is no country in the EU without any policy in some injury area; laws, policies and programmes for fire prevention, work safety, traffic safety, and consumer safety are in place in all Member States (compare Shields et al, 2006). Other areas that are less well covered are safety at home, safety in sports or during leisure activities, suicide and self-harm. Many measures have been proven to be effective and cost-effective; benefits for health systems often exceed the costs of interventions by a factor of several times. Nevertheless, numerous well justified measures are not implemented thoroughly in Member States of the Community, which gives room for considerable improvement. One argument is the huge disparity between Member States: the risk for fatal injury in one country can exceed the risk in another by a factor up to four.

 

A particular challenge is that injury prevention is a cross-cutting issue and the responsibility for implementing safety measures is vested in diverse policy domains, such as transport, employment, justice, housing, consumer protection, welfare, research and education. Nevertheless, the health sector with its responsibility for health information, health promotion and health protection has an important role to play that is complementary to existing policy initiatives. Although violence and accidents have always been a major cause of mortality and morbidity of the human species, only in rcent years injury prevention has also been accepted as a task of health policy making.

 

The health sector must play a key role also in injury prevention as its mandate includes responding to all major health threats and causes of mortality and morbidity; a substantial proportion of direct cost related to injury is absorbed by the health sector. This offers a unique scientific and prevention-driven approach and highly credible testimonials; it is uniquely positioned to collect data, analyse risk factors and to inform stakeholders about health problems; and it is best-suited to coordinate multi-sectoral prevention efforts. How injury prevention can be supported by Ministries of health is the theme of the guide and reference book “Preventing injuries and violence” (WHO, 2007; Racioppi et al, 2004). The areas of action are described briefly as follows:

 

·          Organization within the Ministry: An appointed focal point in the ministry should take the responsibility for the implementation of injury prevention actions. Focal persons should be active members of the WHO focal persons network.

·          Policy making and planning: National strategies are important for ensuring a target oriented good planning and coordination of actions with all stakeholders.

·          Data collection and reporting: While the power for certain prevention measures is vested in different Ministries, the provision of useful health information is a core competence and responsibility of the health administration

·          Health services: Not all accidents and injuries can be prevented. Pre-hospital care and rehabilitation services play a decisive role in limiting the impact of injuries

·          Prevention: Effective measures are to be promoted, and injury and violence prevention should be included in the existing infrastructures for prevention and health promotion.

·          Capacity-building: The prevention of injury and violence requires knowledgeable and skilled staff. Medical professionals can act as effective advisors towards their patients.

·          Advocacy: Health administrators are most credible advocators towards the public and the other political sectors.

 

Based on general reports about the burden of injury, the analyses of the preventability of the problem and the underdeveloped contribution of the health sector, the WHO Regional Committee for Europe has urged its Member States (i) to put injury on the health policy agenda; (ii) to develop injury surveillance instruments; (iii) to strengthen the technical and institutional capacity for injury prevention; (iv) to promote evidence-based approaches; and (v) to participate in international exchange of experiences (WHO, 2005d). The  WHO Regional Office for Europe has prepared an evaluation report about the progress made in implementing resolution EUR/RC55/R9 during the past three years for the WHO Regional Committee for Europe meeting in September 2008 (Sethi et al. 2008).

 

 

In order to specify the role of EU organizations responsible for carrying forward the public health response, the European Commission has developed a strategic framework for public health action, which is laid down in the “Communication from the Commission to the European Parliament and the Council on actions for a safer Europe” from June 23, 2006, developed by DG Sanco together with governmental and nongovernmental experts from Member States (European Commission, 2006). The Communication informs about the size of the problem, the opportunities of prevention, the added value of public health action, and proposes a framework for Community action. Deriving from this Communication, the Council of the European Union has issued its “Council Recommendation on the prevention of injury and the promotion of safety” on May 31, 2007 (Council of the European Union, 2007).

 

According to this Recommendation, Member States are expected to:

 

Implement appropriate injury surveillance and reporting systems as a pre-requisite for targeted injury prevention and monitoring of progress. Governments should make better use of existing data and should develop representative injury surveillance instruments to obtain EU-wide comparable information and to monitor the evolution of injury risks. Special attention should be paid to product and service safety.

Set up national action plans or programmes for injury prevention and safety promotion: these measures should promote interdepartmental and international cooperation and should ensure funding opportunities. Special attention should be given to gender aspects and to the “seven priorities” children & adolescents; elderly citizens & people with disabilities; vulnerable road users; sport injuries; injuries caused by products and services; self-harm; interpersonal violence.

Enhance the capacity to tackle the injury problem: Injury prevention should be implemented in schools and appropriate knowledge should be incorporated in vocational trainings of health and other professionals, so that these groups can serve as competent actors and advisors.

 

Accordingly, the Commission is requested to support these actions by:

 

·          Gathering and reporting Community-wide injury data and information;

·          Facilitating the exchange of information on good practices and policy actions, and disseminating this information to the relevant stakeholders;

·          Supporting Member States for the inclusion of injury prevention knowledge into the training of health and other professionals;

·          Carrying out accordingly Community initiatives by using existing resources such as the Community Public Health Programme; and

·          Carrying out an evaluation report within 2011.

 

The guideline “How to make Europe a safer place – key areas for consideration in implementing the Council Recommendation” is under preparation in order to assist administrations and other stakeholders with the practical implementation.  (Working Group of Governmental Experts on Injury Prevention and Safety Promotion, 2008). This document describes briefly the current situation of injury prevention in Europe, informs about supporting initiatives of the Community (e.g. projects and tools), and recommends specific actions regarding surveillance, national action plans, capacity building and the seven priority areas (children & youth, elderly people, vulnerable road users, sport injuries, products and services, suicide & self-harm, interpersonal violence).

 

For what concerns injury surveillance, the following guideline by the WHO is to be mentioned: “Injury Surveillance Guidelines” which discusses the different needs and approaches to injury data collection (Holder et al, 2004). Through a series of projects, the Commission has developed the outlines of a common methodology for injury information based on data available in many Member States. In order to provide stakeholders with Community-wide injury information the Member States are invited to:

 

·          Provide injury data on fatalities (mortality statistics), hospitalizations (discharge registers), surveillance of external causes like settings, activities, products and services (emergency room surveys), and other medical treatments (household surveys such as the European Core Health Interview System);

·          Secure the application of existing standards for coding, sampling, data collection, data provision and calculation of internationally comparable national indicators, e.g. on disabilities and costs;

·          Collaborate in implementing a stable Community injury information system, according to existing Community Standards, with knowledge, training and tools meeting the statistical quality criteria of EUROSTAT for inclusion into the EU annual statistical programme;

·          Enhance the detail of information within the national data systems on products and services, in order to serve the needs of the Common Market with reliable information about product and service related injury risks;

·          Encourage collaboration with other relevant policy sectors in Member States and within the Commission, (e.g. Transport, Employment, Justice, Civil Protection and Education) in order to provide appropriate health information also for their purposes, and link existing statistical systems relevant to injury for providing a one access point for stakeholders at national level; and

·          Disseminate injury information for advocacy and policy purposes and provide a help desk and information service at national level where stakeholders get answers to their data questions.

 

The Commission assists these developments by hosting the European Injury Data Base IDB, by making the data publicly available at https://webgate.ec.europa.eu/idb, by supporting the Network of IDB National Data Administrators, and by producing annual reports “Injuries in the European Union” (KfV, 2007).

 

Also policy tools regarding “national action plans” are provided by the WHO (Schopper et al, 2006). This guideline conceptualises a step-by-step process for the development of national policies to prevent violence and injuries. Models are available from a number of countries – at least plans for certain areas. In order to develop human capacities for injury prevention, basic knowledge is condensed in a curriculum for health professionals provided by the WHO called TEACH-VIP. Slide presentations, supporting lecture notes and other materials are freely available in CD-ROM format and supported by a users' manual (WHO, 2005b).

 

As turntable for information between policy makers, researchers and practitioners at all levels, information for all stakeholders serves the European Association for Injury Prevention and Safety Promotion “EuroSafe”. EuroSafe is organized in programmes and task forces (networks) on all aspects of injury prevention and is working together with existing organisations in the field. It provides a comprehensive web portal including a database of “effective measures for injury prevention” and a “Who is who” application, download of documents, press releases, “fact sheets” and “policy briefings”, links to other organizations, and information on ongoing and planned initiatives within the field (www.eurosafe.eu.com). EuroSafe issues a quarterly newsletter, a scientific journal (Injury Control and Safety Promotion) and organizes bi-annual European Conferences (EuroSafe, 2008)

 

Knowledge of ‘what works’ in injury prevention is needed to develop good policies and programmes. The European Association for Injury Prevention and Safety EUROSAFE offers a knowledge database on literature, projects and effective measures in injury prevention where everybody can search for measures that work.

(http://www.eurosafe.eu.com/csi/eurosafe2006.nsf/wwwVwContent/l2introduction-knowledge.htm)

 

Support for policy makers on the “seven priorities” is provided by a number of projects and networks, many of them within the EuroSafe framework and with support from the Commission, e.g. by means of the Public Health Programme.