7.6. Future perspectives

Generally in the EU Member States, there is a current decreasing trend of the rates of injuries, whereby this development is more pronounced in road traffic and work place and less favourable at home and during leisure time activities. The growing proportion of old and very old people and their high risk of falls play a major role in this development. Thus the public health contribution to injury prevention will become more and more important compared to those of other political sectors. While general strategic framework for this approach is available, its implementation is still at an initial stage. Injury is a major health problem, which can be efficiently tackled but it does not have the appropriate rank on the health policy agendA. The situation may change but some restrictions must be considered:

The realization of the proposed leading role of THE Ministries of health in the field of injury is ambitious. In fact, in many Member States Ministries of health lack constitutional power as well as actual capacities for a strong leading function and interdepartmental coordination. Nevertheless, given the increasing burden of health expenditures and costs of disabilities, governments will soon realize the great potential of prevention.

As long as nobody can be blamed for creating hazards and causing injuries (as it is the case in interpersonal violence, road transport and working conditions), there is a tendency to attribute the main responsibility to victims and their families. As a consequence, there is no strong political demand for governmental prevention in the sphere of home and leisure activities or of suicide and self-harm. The potential for prevention through policy action is seriously underestimated.

Inequalities also in injury risk and access to safety remain a major challenge, while gaps between social classes do not tend to narrow and the social coherence might deteriorate. This will not make it easier to put the safety needs of vulnerable, but politically less well organised groups such as the aged, depressed, or socio-economically disadvantaged people higher on the political agenda.

The decline in the number of fatalities due to injuries is to a large extent the result of improvements of medical treatment ( e.g. trauma and emergency care). This success is owed to the fact that there are a few and strongly organized professional groups involved. The challenge for injury prevention is to create policy platforms that are as successful as emergency care.

The most important challenges are identified and tools are available – at least to a certain extent – for: establishing injury surveillance and information; formulating national action plans; exchanging experiences; including injury prevention knowledge in vocational trainings; improving child safety, safety of elderly, product and service safety. Additional measures are currently being developed for the safety of adolescents, prevention of falls, safety of vulnerable road users, and sport safety. Ther is still much room for improvement in the public health response to interpersonal violence and self-harm. Also the question of indicators for health costs and disability has not yet been solved in a satisfying manner. A remaining challenge is the building up of adequate organizational capacities at national level, e.g. national focal agencies and research centres. The number of centres of excellence for injury prevention in Europe is inappropriately low, when taking into consideration that injury represents the fourth leading cause of death.