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Avoidable deaths: falling in England; stalled in Scotland and Wales; and up in Northern Ireland

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l860 (Published 22 February 2019) Cite this as: BMJ 2019;364:l860

The need to include accident prevention as a key area in the forthcoming Green Paper on Prevention.

The new data, released by the Office for National Statistics (ONS) shows an alarming trend – a rise in avoidable injury deaths.(1,2) Although accidents are a significant cause of injuries, premature deaths and disability it needs to be stressed that many can be prevented.

There is significant evidence over time that suggests when interventions have been made many injuries have been prevented and a considerable number of lives have been saved.(3-8). Most recently both Public Health England (9,10) and NICE (11-13) have produced clear guidance in order to try to ensure that people are safer both in their homes and on the roads. Priorities for children and young people in relation to schools have also been produced.(14)

There are some good examples of accident prevention initiatives across the country. Nonetheless, some local areas are better served than others and there is little consistency in both the quantity and quality of interventions.(15-17) Practitioners including those in local authorities and the NHS require more support to develop their injury prevention capability. Capacity issues also need to be addressed.(24)

The Royal Society for the Prevention of Accidents in conjunction with many eminent organisations including the Faculty of Public Health and the Royal College of Paediatrics and Child Health have produced a national strategy for England – “Safe and active at all ages”.(25) It draws upon the considerable base of evidence on the effectiveness of accident prevention programmes and recommends interventions for all age groups.

A central aim of this strategy is to reduce the costly burden of accidents on individuals, families, businesses and the health and social care system.(25) It includes recommendations for different age groups as well as themed recommendations that have relevance across the life course. In relation to data for example, improvements are needed in order to monitor injury trends, set priorities, raise public and professional awareness and evaluate interventions. The two other themes are those important areas of health inequalities and safer environments.

The strategy serves as a call to action for a step-change in the delivery of evidence-based accident prevention interventions across the country. It could have a significant impact on preventable causes of ill health, early deaths, and on our overstretched health and social care services. Critically, Government support will be needed if this strategy is to be successful and one way of achieving this would be to include accident prevention as a key area in the forthcoming Green Paper on Prevention.

References
1) Hawkes N. Avoidable deaths: falling in England; stalled in Scotland and Wales; and up in Northern Ireland. BMJ 2019;364:l860

2) Office for National Statistics. Avoidable mortality in the UK 2017. 22 February 2019. www.ons.gov.uk/releases/avoidablemortalityintheuk2017.

3) CDC. Ten Public Health Achievements of the Twentieth Century - United States, 1900-1999. MMWR Weekly 1999;48(12):241–3

4) British Medical Association. Injury Prevention. London: BMA, 2001.

5) Christoffel T and Gallagher S. Injury Prevention and Public Health. Practical Knowledge, Skills and Strategies. Sudbury: Jones and Bartlett, 2006.

6) Peden, M., K. Oyebite, J. Ozanne-Smith, A. Hyder, C. Branche, F. Rahman, F. Rivara, and K. Bartolomeos. World Report on Child Injury Prevention. Geneva: WHO, 2008

7) Hemenway D. While We Were Sleeping. Success Stories in Injury and Violence, Berkeley: University of California Press, 2009.

8) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health.2016; 26(5), 194-199
https://www.paediatricsandchildhealthjournal.co.uk/article/S1751-7222(15)00255-3/pdf

9) Public Health England. Reducing unintentional injuries in and around the home among children under 5 years. London: Public Health England, 2018.

10) Public Health England. Reducing unintentional injuries on the roads among children and young people under 25 years. London: Public Health England, 2018.

11) National Institute for Health and Clinical Excellence. Preventing Unintentional Injuries in the Home among Children and Young People Aged under 15: Home Safety Assessments and Providing Safety Equipment. NICE Public Health Guidance 30. London: NICE, 2010.

12) National Institute for Health and Clinical Excellence. Strategies to Preventing Unintentional Injuries in under 15s. NICE Public Health Guidance 29. London: NICE, 2010.

13) National Institute for Health and Clinical Excellence. Strategies to Prevent Unintentional Injuries among Children and Young People Aged under 15: Evidence Update February 2013. London: NICE, 2013.

14) Lloyd J, Baillie M, Evans I, James A, Bennetts J, Watson M C, Safety Education: Priorities for children and young people – A Manifesto for Action. Welwyn: Institute of Health Promotion and Education, 2015.
https://ihpe.org.uk/wp-content/uploads/2015/06/Safety-Education-A-Manife...

15) Watson, M., C. A. Mulvaney, D. Kendrick, J. Stewart, C. Coupland, M. Hayes, and P. Wynn on behalf of the Keeping Children Safe programme team. “National Survey of the Injury Prevention Activities of Children's Centres.” Health & Social Care in the Community 2014; 22 (1): 40–46.

16) Watson, M., C. Mulvaney, C. Timblin, J. Stewart, C. Coupland, T. Deave, M. Hayes, and D. Kendrick. “Missed Opportunities to Keep Children Safe? National Survey of Injury Prevention Activities of Children’s Centres.” Health Education Journal 2016; 75 (7): 833–842.

17) Chisholm A, Watson M, Jones S, Kendrick D. Child injury prevention: a survey of local authorities and health boards. International Journal of Health Promotion and Education 2017; 5(4):205–214.

24) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.
https://www.bmj.com/content/360/bmj.k1279

25) RoSPA. Safe and active at all ages: a national strategy to prevent serious accidental injuries in England. Birmingham: RoSPA, 2018.
https://www.rospa.com/national-strategy/

Competing interests: No competing interests

28 February 2019
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, Welwyn AL6 0UD, UK. http://ihpe.org.uk/