Intended for healthcare professionals

Rapid response to:


Bold action is needed to strengthen primary prevention

BMJ 2023; 380 doi: (Published 15 March 2023) Cite this as: BMJ 2023;380:p595

Rapid Response:

Accident prevention: there is a strong case for urgent action targeting primary prevention.

Dear Editor
We are in full agreement with Meier et al; bold action is needed by politicians to strengthen primary prevention.(1) Effective and adequately funded primary prevention would help individuals and families to be healthier and live longer by tackling the root causes of ill health. It would also lessen the demand on the NHS and social care.

There are a number of important public health topics where robust action is needed including: mental health, no smoking, obesity, physical inactivity, addictions, and accident prevention. With all of these there is a strong case for primary prevention, and well-planned initiatives could be used to reduce inequalities.

Accident prevention is one area that has been particularly neglected over the past decades both in terms of funding for initiatives and research. However, when funding has been applied there has been considerable achievements.(2-8) In the home for example, numerous measures have prevented many injuries and saved many lives.(5) Smoke detectors, child resistant packaging, flammability of children’s sleepwear and various guards and gates are but a few initiatives where there is evidence of success.

The approaches used can be classified into three types: education, environmental change, and enforcement (legislation).(3,7) Sometimes the three “E’s” of injury control have been used individually and at other times in combination.(3,7) Effective injury prevention relies on multi-agency working at national and local level and coordination at both levels is vital.(9,10)

In the UK we have a world leading organisation, the Royal Society for the Prevention of Accidents (RoSPA) that has been successful in contributing to reducing accidents, at home, on the road, at work and at leisure. But RoSPA could have a far greater impact if more of the effective approaches described in their national strategy were funded and implemented.(11)

Examples of specific primary prevention programmes that are needed include:
• Reducing child home accidents
• Falls prevention (children and older people)
• Courses for young drivers
• Cycle training
• Courses and awards for couriers (driving and safer handling)
• Safer driving campaigns (e.g. covering – alcohol, speeding, distractions, drugs).

A very important initiative that RoSPA is leading at the moment is its - Protect our People campaign.(12) This aims to avoid crucial laws including those regulating seatbelts, construction, and the safety of children’s toys being undone by default. RoSPA and other leading public health organisations want to amend the Retained EU Law Bill so that a health and safety impact assessment is made on each piece of EU legislation, so that it is not just automatically revoked.

A crucial area to improve primary prevention in relation to accidents, is the use of data from emergency departments and other key sources.(9-11,13) There has been little in the way of national accident data coming from emergency departments for some years. Good quality data is important for finding out new priorities, raising awareness (public and professionals), promoting action and evaluation.(9) Data should be made easily accessible to local and national practitioners.

Preventable accidents result in huge costs to health services, social care, economies, and people’s lives.(10,11,14,15) We need a step-change in the delivery of evidence-based programmes across the country, prioritising and promoting safe and active lives and reducing the burden of serious accidental injury on society.

1) Meier P, Katikireddi S V, Smith K. Bold action is needed to strengthen primary prevention BMJ 2023; 380 :p595 doi:10.1136/bmj.p595

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

3) Christoffel, T., and Gallagher, S. S. Injury prevention and public health: Practical knowledge, skills, and strategies (2nd ed.) 2006. Sudbury: Jones and Bartlett Publishers.

4) World Health Organisation. European Report on Child Injury Prevention. Copenhagen: World Health Organisation, 2008.

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

6) Errington G, Watson M, Hamilton T, Mulvaney C, Smith S, Binley S, Coupland C, Kendrick D, Walsh P. Evaluation of the National Safe At Home Scheme. Final report for RoSPA 2011. Nottingham: University of Nottingham.

7) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health.2016; 26(5), 194-199

8) Hill T, Coupland C, Kendrick D, et al. Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis. J Epidemiol Community Health 2022;76:53-59.

9) Watson M C. Alliances against Accidents. Practice Nursing 1994, 5(13), 20.

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

11) RoSPA. Safe and active at all ages: a national strategy to prevent serious accidental injuries in England 2018. Birmingham: RoSPA.

12) RoSPA. Protect our People campaign. Birmingham: RoSPA.
(Accessed: 18/03/2023)

13) Watson M C and Lloyd J. IHPE Position Statement: Unintentional Home Injuries to Children, June 2019. Lichfield, Institute of Health Promotion and Education.

14) Public Health England. Reducing unintentional injuries in and around the home among children under five years 2018. London: PHE.

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

Competing interests: No competing interests

20 March 2023
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr Karen E. Neil, Trustee, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, 2nd Floor, Fairbank House, 27 Ashley Road, Altrincham, Cheshire, WA14 2DP.