Secretary of state for health declines to promote free distribution of smoke alarms

EDITOR,—A recent paper in the New England Journal of Medicine1 on a topic of direct relevance to the Health of the Nation's targets for reducing accidents2 stimulated a parliamentary question that received a rather disappointing response from the Department of Health.

Residential fires are the second commonest cause of accidental death of children in Britain: each year about 70 children die as a result of residential fires in England and Wales.3 Observational epidemiological studies indicate that smoke alarms are effective in preventing deaths due to fires.4 The most compelling evidence for the effectiveness of smoke alarms, however, was provided by a recent report of a controlled intervention trial in which smoke alarms were given away in Oklahoma City.1

Surveillance data were used to identify an area of the city with a high rate of injury due to fires. This area was then targeted in a programme in which smoke alarms were given away. The annual rate of injuries due to fires per 100 000 population fell by 80% in the target area during the four years after the intervention, but little change occurred in the rest of the city. The programme prevented an estimated 39 deaths or serious injuries. In Britain the rate of deaths due to fires among children in social class V is over 14 times that among children in social class I. Data from the Office for National Statistics show that poor families are least likely to have smoke alarms. Taken together, these facts suggest that families most likely to benefit from smoke alarms are least likely to be able to afford them. Thus the free distribution of smoke alarms by health visitors and community care organisations seems to be worthy of consideration.

A Labour MP, John Fraser, also thought that this approach was worth further consideration. The parliamentary question he posed and the response provided were as follows:

“Mr Fraser: To ask the Secretary of State for Health if he will encourage the free distribution of smoke alarms by health visitors and community care organisations.

“Mr Malone: Safety in the home is something which all agencies concerned with community care seek to promote. Fire precautions specifically, however, are a matter for my right honourable and learned Friend the Secretary of State for the Home Department.”5

Has the secretary of state for health lost interest in achieving the targets in the Health of the Nation or is this response simply an attempt to pass on work to another government department? Either way, British children deserve better.