Crashes involving young driversBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h659 (Published 11 February 2015) Cite this as: BMJ 2015;350:h659
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I presume it was coincidence rather than mischievousness that resulted in this excellent editorial being placed opposite the 'BMJ Confidential' interview with Celia Ingham Clark - NHS England's director for reducing premature mortality.
Her remaining professional ambition was quoted as ‘I want to be part of a team that reduces premature mortality in England.'
Surely, whilst both are laudable, to prevent a death in one's healthy late teenage has to be more worthwhile than deferring it a few days or weeks in one's debilitated ninth decade (which seems to me to be the aim for most of the in-hospital mortality reviews I am involved with).
Furthermore, why not set her sights higher and do it throughout the UK - by catalysing a change in the law?
Competing interests: No competing interests
We agree with Jones et al that a graduated driver licensing should be introduced as a key element of a safer, healthier, and more sustainable transport strategy.(1) Young people should have the right to safety. It surely makes sense that when they begin driving they only have to negotiate relatively safe conditions that involve lower risk, and as they develop they are gradually introduced to more complex driving situations.(2)
The case for action is strong: for example, the over-representation of young novice drivers in road collisions is well documented.(3,4,5) Between 2008 and 2012, across England, there were 2,316 deaths and 35,783 serious injuries among road users under the age of 25 years.(4) The economic case for action is also considerable and besides the costs to individuals and families there are also considerable costs for the NHS, police and local authorities.
There is strong, consistent international evidence in relation to the effectiveness of graduated driver licensing programmes and their potential public health benefits.(2,3,5). The Cochrane review, for example, evaluated various types licensing and reported positive findings, with reductions for all types of crashes among all teenage drivers.(2) The authors suggested that future research should concentrate on trying to determine the relative impact of different components. Studies published since this 2011 review also support the effectiveness of graduated driver licensing.(5)
Besides evidence of effectiveness, the case for graduated driver licensing is further strengthened as it has support from a range of groups and individuals including: public health, the insurance industry, the road safety sector, the police, and road safety charities.(3,6,7) But what is missing is government support.
When introducing a graduated driver licensing scheme, it is important that we do not forget the needs of young people. They should be able to travel freely for education, work and leisure. This can be a particular issue in certain rural communities. Local authorities have key roles to play here in encouraging: the development of safer cycling and walking routes, and the greater use of public transport.
Given the huge cost of injuries and deaths to health services, economies, and people’s lives, wherever they are throughout the world, more must be done to prevent unintentional injury through high quality health education.(8) Only so much can be done to make environments safer; young people need the knowledge and skills to understand and manage risk in order to take some responsibility for their own safety. Only then will these figures improve.(8)
In conclusion, we strongly believe that the government should create evidence based public health policies and, in relation to graduated driver licensing there is a convincing case for immediate action. The evidence indicates that there would be considerable casualty savings for young people, their passengers, and other road users.
1) Jones S, McKenna F, Stradling S, Christie N, Mullarkey T, Davies D, et al. Crashes involving young drivers. BMJ 2015;350:h659
2) Russell KF, Vandermeer B, Hartling L. Graduated driver licensing for reducing motor vehicle crashes among young drivers. Cochrane Database Syst Rev 2011;10:CD003300.
3) Peden M, Ozanne-Smith J, Hyder A, et al. World report on child injury prevention. Geneva: World Health Organisation, 2008.
4) Public Health England Reducing unintentional injuries on the roads among children and young people under 25 years. London: Public Health England, 2014.
5) Kinnear N, Lloyd L, Helman S, Husband P, Scoons J, Jones S, et al. Novice drivers: evidence review and evaluation. pre-driver training, graduated driver licensing and the new drivers act. project report RPN2553. Transport Research Laboratory, 2013.
6) RAC Foundation. Young driver safety. A public attitude survey. RAC Foundation, 2014.
7) Jones S, McKenna F, Stradling S, Christie N, Mullarkey T, Davies D, et al. Green paper on safety of young drivers has stalled. BMJ 2014:348:g476.
8) Lloyd J. International Journal of Health Promotion and Education 2013;51(3) 169-170.
Competing interests: No competing interests
Whilst I profoundly agree with Sarah Jones and co-authors in almost every respect, I cannot accept their negative approach to reducing the age of eligibility. The relevant sentence is far from clear but the only logic I can see in their assertion that it potentially negates the effect is that it might reduce the average age of attaining the restricted licence within the present limit. On the contrary it will of course increase the probationary period before the next step is reached meaning that the drivers will be more experienced.
Furthermore any activity involving eye/movement coordination or immediate automatic responses is best learned at the earliest age possible. I am not naturally well gifted in this respect and greatly benefited from learning to drive at 14 on an abandoned American airbase in rural Northamptonshire before a misguided policeman transferred from the Metropolitan force stopped it. This is of course an argument for off road provision of learning facilities for young teenagers, which was not mentioned in the editorial.
Competing interests: Not a naturally good driver who benefitted from learning early