Over the past decades the EU has developed a variety of actions and measures to improve safety in various sectors of social and economic activities.

Since its early days, the European Community initiated collaboration and coordinated actions in view of improving the working conditions of workers. This has over the years gradually evolved into today’s substantial acquis of legal measures (for instance the framework directive 89/391/EEC) and Community actions that are geared to promoting well being at work.

While transport is an essential factor for economic growth and prosperity, the safety aspects of the growing volume of traffic have been quickly identified as an area of increasing concern. This has triggered the EU to take measures to improve transport safety within the limits of subsidiarity and actions in the field of research and exchange of good practices. In its efforts to further reduce road accidents the Commission has presented in 2001 its new and ambitious target, i.e. to halve the number of road deaths by 2010, and a commitment to the European Road safety Programme.

A third sector of safety concerns lies in the domain of consumer safety in relation to the increase in free circulation of goods within the EU. In order to identify the products involved in accidents and the combination of circumstances which may lead to injuries, the Commission initiated collaborative projects with the Member States for collecting and exchanging information on home and leisure injuries. The aim of protecting health and safety of consumers in the EU is enshrined in Articles 153 and 95 of the Treaty and has led to major regulatory efforts, such as the General Product Safety Directive (2001), and actions to ensure effective enforcement and proper information to consumers (New Consumer Policy Programme 2002-2006).

A forth but no less important field of actions relates to intentional injuries, in particular to the prevention of violence against children, young people and women and to support victims of violence.  In the framework of the Community policies for freedom, security and justice the Commission simulates actions on behalf of NGO’s and voluntary organizations in the fight against violence (DAPHNE Programme 2000-2003).

A most important development for Community activities in the field of safety promotion and injury prevention has been the adoption of a legal base in the Treaty. Pursuant to Article 152 of the Treaty a high level of human health protection will be ensured in the definition and implementation of all Community policies and activities.
Based on Article 152 the European Parliament and the Council have adopted an Action Programme on Injury Prevention (1999-2003) which since 2003 has been incorporated in the Public Health Programme.

In spite of all these initiatives and a commitment to decrease injuries and fatalities in the respective sectors, it is still possible to be more effective in reducing the huge toll of accidents and injuries in society. Because:

• In contrast to many other causes of ill health or premature death, injuries can easily be prevented by making the environment in which we live safer. It does not always necessitate active involvement through behaviour changes of the risk group involved, although a mix of interventions remains the most effective;
• There is ample evidence of proven effectiveness in accident prevention measures that are still not yet widely applied throughout the Community;
• Most of these measures have also been proven to be cost effective, whereas the benefits of preventing injuries often outsize the cost of interventions by a factor ten;
• In countries with a good track record with respect to safety, and in risk areas where significant injury reductions have been achieved, there are more opportunities for further improvements and heath gains to be achieved.

Therefore, acknowledging the major advancements in safety promotion and injury prevention that have been already achieved in the various sectors throughout the Member States of the EU, a major difference can be made by joining forces among all sectors and stakeholders and by fostering collaboration and concerted actions in the EU, the EEA  and candidate countries.

In order do work towards the vision:

The following initial three key objectives have been set:

1. The development of a comprehensive information system on accidents and injuries;
2. To identify and address the top five priority areas in accidents and injuries;
3. The implementation of prevention strategies in all Member States.

The aim of these objectives is to serve as a focus and to enable the consolidation of resource and effort to create the structure and actions necessary to make an impact towards the vision. The detail behind the objectives is described as follows:

The aim of a common information system on accidents and injuries is to provide all stakeholders on Community as well as Member State level with the best available statistical information about the magnitude of the problem, about high risk population groups, and major risk determinants. This information is prerequisite for any rational assessment of the problem.

The system will:

• Pool together existing registers on certain segments of the problem like traffic and work place injuries, as well as on certain consequences like fatalities and hospital admissions;
• Close the most urgent gaps regarding leisure time injuries and risk determinants by the implementation of a supplement register, the so called Injury Data Base;
• Essentially improve the basis for evidence based priority setting, guidance and evaluation of actions for injury prevention and safety promotion.

Priority setting will be facilitated by:

• Giving a comprehensive view on all injury risks, whatever the external causes are (traffic, workplace, leisure time activity, self infliction, violence by others);
• Assessing the burden to health with respect to different consequences (fatality, hospital treatment) and enabling the assessment of the impairment and financial burden;
• Comparing injury risks and risk determinants between countries. International benchmarking which can be considered as a key element of motivation for national efforts.

Guidance of preventive actions will by facilitated by:

• Identifying major injury risks and risk groups (e.g. by gender and age);
• Identifying major risk determinants (e.g. activities, products or services involved, causes of injuries and other external circumstances).

Prioritisation of actions to be taken will be facilitated by:

• Monitoring injury trends concomitant to actions and the resulting savings on health expenditures;
• Identifying emerging trends and injury risks.

Figures on injury outcomes as provided by the most routine health data, e.g. hospital discharge diagnoses, are an important element of a comprehensive injury information system. Key to injury prevention, however, is a view of population safety and its determinants through data sources on the external causes of injuries. For this purpose the existing IDB will be further developed.

Currently, the IDB is based on a hospital surveillance system for home and leisure accidents with data collected in about 60 hospitals in ten EU Member States. This is made accessible by DG SANCO in a central database. From this the IDB will, within the term of the Public Health Programme, be developed into an “All Injury” Monitoring system that provides national and Community estimates of non fatal injuries treated in hospital emergency departments according to an international injury classification standard.

• Provide unique data on the external causes and determinants of accidents and injuries according to international standards (e.g. WHO ICECI);
• Provide an evidence base for consumer product and service related accidents in the common market;
• Filling gaps in information within the established EU traffic and workplace injury information systems;
• Provide comparable data for all sectors of injury prevention: traffic, workplace, suicide and violence with a focus on vulnerable groups and settings of high risks;
• Provide necessary population data for risk calculations.
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By using a sample of hospitals, rather than a full routine implementation, the IDB data collection is most cost-effective compared to other surveillance and monitoring techniques, for example with household surveys.

By applying an international standard of injury classification, namely the International Classification of External Causes of Injuries (ICECI), the IDB joins a forum for international exchange and collaboration in injury data collection and analysis, with the goal to facilitate the comparability and improve quality of injury data. The ICECI is a WHO recommended standard and is already implemented in a number of hospitals world wide.

In order to meet these goals special attention will be paid to:

• Ensuring data quality through common QM-standards, tools and training;
• Increasing the IDB participation through promoting the use of the IDB for injury prevention, financial incentives and the creation of an European network of IDB hospitals;
• Availability of national estimates through respective statistical procedures for population-based injury rates.

The comprehensive information system on accidents and injuries will represent major risk factors determining safety in our society and will make use of existing sources of information including: All dimensions of injury outcomes, statistical information representing factors of risk exposure, community characteristics, the natural environment, and cultural and political contexts. Principal sources to be integrated on the dimensions of injury outcomes are:

• Mortality data on all causes of injuries (national death registers);
• Morbidity data on all of injuries (national hospital discharge register);
• Sector data for workplace accidents (ESAW);
• Sector data for road traffic accidents (CARE, IRTAD);
• Sector data for home and leisure accidents and data on external causes (IDB);
• In-depth databases (e.g. STAIRS, CHILD on traffic accidents);
• Applications for deriving indicators of severity, disability, costs and other indicators of the burden of injuries.

The DG SANCO Health Portal will provide the IT-framework and Data Base design for integrating all relevant components into a comprehensive information system on accidents and injuries  with a number of international examples of “good practice” already available (e.g. CDC’s WISQARSTTM - Web-based Injury Statistics Query and Reporting System).

A comprehensive information system on accidents and injuries has to meet the divergent data needs of a variety of data users in the European Union and elsewhere. Therefore:

• The information system will be made operational in an interactive web-based query and reporting system that provides customised reports of injury-related data;
• It will be accessible through the DG SANCO Health Portal.

As a general principle of data release policy, the data in the information system should be made available on the widest basis practical – following the concept that data collected with public funds, or under the auspices of a public agency, are considered to be a "public good".

As for the IDB, a data release policy that states the terms of collection, storage, use, and dissemination of data is currently being developed.

The comprehensive information system on accidents and injuries will contribute to the E U Public Health reporting through:

• Injury indicators for the ECHI list - providing at least five indicators from the appropriate data sources, preferably from the IDB;
• Regular reports on the status quo and trends of all outcomes of fatal and non-fatal injuries in the EU (standardised comprehensive view tables); 
• Regular reports on the status quo and trends of injury determinants (standardised IDB tables);
• Regular policy documents and press releases;
• IDB indicators for related health sectors, e.g. environmental safety (poisoning), housing safety (in-door accidents) or mental health (attempted suicide).

A number of criteria should be considered to identify appropriate prevention strategies in a variety of settings and for different types of injuries. These criteria are:

• The societal impact of injuries in terms of the number, the severity and the consequences of the various categories of injuries such as loss of productive years, disabilities, and human suffering. Cost estimates of the various injury categories can provide an adequate estimate of the ranking of these categories according to societal impact;
• The evidence regarding the effectiveness of interventions and cost effectiveness of alternative interventions in relation to the various priority options. However for much of the world there are no effectiveness studies and it is unclear how far findings can be generalized across very different settings. Given the scarce information on effectiveness, decisions can only be based on the best available perspectives regarding expected outcomes and impacts of the various options for intervention;
• The feasibility of successful implementation of interventions within the European context and within the great diversity of infrastructures within Member States. Again a proper assessment can only be based on best available practices and consultation of experts in the field;
• The time frame that should fit the short term political agenda’s, and measurability of intermediate outcome of actions and impacts in terms of injury reduction. However, most interventions bear results only on the longer term as they need considerable time for being absorbed in the Community (information and education) and society at large (regulation and enforcement).

Consultation of the Working Party on Accidents and Injuries has currently led to the identification of the following five priorities as being the major topics for concerted actions in the framework of the Public Health Programme:

For children at the age of six months and above and for adolescents, accidents are the number one cause of death. Also in the Accident & Emergency Departments’ statistics, children and adolescents are over-represented compared to other age groups. Children and adolescents have been chosen as priority number one, as an injury and its disabling consequences has a tremendous impact on health and therefore wealth in society.

Owing to European Child Safety Alliance (ECSA), which is being supported by the European Commission in the framework of a number of projects, much progress has been made in addressing the injury issue related to children (0-18 years).Currently,  ECSA facilitates the establishing of national plans of actions for child safety in the majority of E U Member States. The priorities for the forthcoming years are to bring in the remaining Member States and candidate countries and to prepare the implementation of the national child safety action plans. The implementation of these plans must to be evaluated and further enhanced. At present ECSA is conducting Europe-wide campaigns on priority issues such as drowning, and child safety products.  These campaigns and new campaign issues such as transport safety and home safety need to be enhanced.

For the age group of the adolescents, an action plan will be developed. In the work plan of 2005 there is an action foreseen to look into risk taking behaviour of adolescents and the opportunities for communicating proper risk control behaviour amongst this population group. The next step will be the implementation of these  strategies over the years 2006-2008.

Children, the elderly, the handicapped, cyclists, skaters, and pedestrians are vulnerable road users. These risk groups deserve to be better represented in current actions for road safety.

Traffic accident statistics as presented in the CARE database concentrate on vehicle crashes registered by police reports. Most injuries without counterpart, falls of pedestrians or collisions between not motorised road users are not reported in these systems. The Injury Database, IDB, shows that vulnerable road users suffer more accidental injuries than all motorized road users. Therefore this issue is to be considered as a priority area

The public health sector can contribute by:

• Inclusion of these injury data into the traffic accident reporting systems;
• Fostering research on preventive measures;
• Evaluating and benchmarking the effectiveness of measures taken;
• Promote the inclusion of this issue in traffic safety policies as well as in health promotion programmes;
• Joining forces with the traffic welfare, and security sector.

The Public Health Programme will focus attention to the vulnerable road users by:

• Bringing it onto the political agenda;
• Facilitating the exchange of knowledge on good practices;
• Promoting its inclusion in national policies and programs;
• Encouraging stakeholders and special interest groups to articulate safety needs.

A first step was taken by developing a European report on the burden of injury amongst vulnerable road users. Examples of good practice will be highlighted and put together in a user friendly guide book.

The highest mortality rates due to injury are reported to relate to people at age 65 and above, falls being the major cause of these deaths. Injuries and in particular fall-injuries also account for a higher than average hospitalisation rate and an excess share in the direct medical cost due to injuries: almost half of the total medical cost due to injury relate to people aged 65 and over, while their share in the total incidence of injuries is only 10%. Therefore, preventing even a slight portion of these injuries to occur will result in major savings in health expenditures.

A collaborative study under the Work Plan 2003 will identify national and local prevention programmes and projects that may serve as an example to others. It will also earmark existing networks of collaboration and exchange among the respective stakeholders, taking into account the distinct needs and opportunities for interventions focused on senior people at various stages of activity and needs of assisted care.
Future projects will address this priority area in a concerted manner. The available good practices and innovative approaches in relation to the respective risk groups will be disseminated among related professional groups, management of care facilities and elderly / pensioners associations. A European network for safety in the elderly will facilitate an exchange of good practices and the wider implementation of effective actions.

Another major cause of pre-mature death and of hospitalisation is related to acts of self harm and suicide, including suicide attempts. Suicide is a result of a long, and sometimes even life-long, process during which problems accumulate little by little until they finally seem insurmountable. At the end however, suicide always happens suddenly and is rarely predicted by others.

The issue of self harm and suicide is strongly related to mental health and in particular the prevention of depression. Therefore actions in this field should link up with existing projects in the mental health domain. The risk factors for self harm and suicide are known to be evidence of psychiatric disorder, especially psychosis, depression or substance abuse, or persons who live alone, recently attempted suicide, or whose family member has committed suicide.

There is a need for a change in the public perception of self harm and suicide. Health professionals, teachers, community workers and relatives play a key role by being alert when a person carries known risk factors for suicide. Training and education will contribute to the early detection of people at risk and to the prevention of suicide. Awareness building will be promoted by actions under the Public Health Programme.

Interpersonal violence is an issue of growing public concern. It is important to note that behind the official statistics on deaths and hospitalisations, a much bigger part of the problem remains concealed in our society. The threat of personal safety and human dignity result in a burden of fear that often undermines capacities to function within a family, at school and in the communities in general. Interpersonal violence takes many forms, physical, mental and sexual, and it undermines the social and economic conditions in society.

The Public Health Programme will offer new perspectives to existing social welfare and criminal justice approaches, by providing a multidisciplinary framework for understanding the problem and for identifying effective approaches to prevention. This vision suggests a move from reactive responses to violence towards actions that seek to empower people and their communities and to change environmental factors that lead to violence.

Violence registration currently carried out by police departments does not provide the necessary degree of accuracy. In addition, this issue is heavily under reported due to the desire of the victims. In the framework of the Public Health Programme improved reporting will be promoted.  More systematic documentation and dissemination of violence prevention efforts, in particular involving the health sector is needed. The empowerment of stakeholders by the provision of tools for planning, implementing and evaluating violence prevention projects is required.

Actions in this domain will be initiated in close collaboration with the DAPHNE Programme, its network of partners and NGO’s in Member States. The Public Health Programme input will primarily focus on prevention of physical violence and the resulting physical injuries and will aim at a successful implementation of projects in a variety of settings such as schools, universities, workplaces, home care houses and hospitals.

By 2010 it is envisaged to establish a policy for injury prevention in all Member States, i.e. a framework of actions that engages many partners and defines institutional responsibilities. As intentional and unintentional injuries represent a wide range of different causes and remedies, some countries may choose to develop policies for specific aspects such as road safety or violence, others may well address the comprehensive set of actions to reduce injury. The objective is to have policies for all sectors and preferably presented in a comprehensive framework.
Within the Public Health Programme the Commission will encourage the Member States in developing national policies by:


This will be done by creating web based documentations on basic injury information for each of the Member States, on safety solutions and good practices in injury prevention, in collaboration with national and European agencies and experts who play a key role in injury prevention. Regular events and seminars on specific priority issues will be organised in order to strengthen the networks and to create an enhanced commitment of stakeholders.
In this respect close collaboration will be also established with the WHO-Euro and its national focal points for injury prevention, with other international organisations such as OECD, with European organisations active in the various sectors such as road safety, safety at work and violence and with civil society organizations such as consumer associations and victim organizations.

In order to achieve the objectives it is essential to establish a structure which enables the consolidation of expertise, efforts and outputs to deal with the immediate needs for preventing accidents and injuries successfully in Europe. This strategic document and future continuous improvement plans should guide the activities that in the end should lead to a better understanding of injuries and fatalities in the E U. The whole will be used to established concerted and focused campaigns with the intent of targeting and reducing accidents and injuries.

It is very important that this structure is created as a permanent and not a temporary or rotating structure. This is due to the need for consistency and continuity of focus to the issue over time, maximising opportunity to establish and utilise knowledge and expertise.

It is envisaged that this structure would be comprised of a central clearing house and knowledge base supported by centres of excellence. These centres should provide the necessary knowledge for establishing priorities and appropriate approaches to injury prevention and should help in developing template plans for intervention which could be leveraged by each Member State.

The following fields of expertise should initially be offered by the following centres in alignment with the identified priorities:

• Comprehensive information system on accidents and injuries;
• Accidents in childhood and adolescence;
• Vulnerable road users;
• Falls in elderly people;
• Self harm and suicide;
• Violence.

Organisations and groups in Europe, currently dedicated to these areas will be consolidated and focused against the vision and strategy. They will focus on projects aimed to drive improvement in these identified priority areas for all Member States. This will lead to networks of dedicated centres that have gained the required knowledge and competencies in these areas over the years. All these networks are interacting with each other and consolidated in one group.

Once the key priority areas are determined by the Commission, the lead organisations and respective centres will be set to work against the vision and objectives. Project management and communication to stakeholders will be critical for success from the very start of this process.

• Europe wide data on injuries
  Data on injury causes and prevalence are essential to establish focus, priority and effective intervention at a micro and macro level. This strongly underpins the requirement for the consolidation and improvement of data sources across all injury sectors and at a sufficient level of detail as regards to causes of injury. The tool underpins the strategic effort in injury prevention and other E U initiatives e.g. the General Product Safety Directive and the European Charter for Road Safety;
• Accessible models of good/best practice in injury prevention
  Knowledge management and accessibility is a primary enabler for the E U to achieve success in this area. A highly effective way to achieve this is by the establishment of a central clearing house supported by and useable by all Member States;
• Communication and user-friendly information system
  Knowledge needs to be translated and communicated in formats that suit the needs of major stakeholders and change agents in the field of injury prevention and safety promotion. Electronic and interactive media, newsletters, conferences and seminars provide ample opportunities for effective communication.
• Data accessibility is of fundamental importance to professionals in the field of injury prevention in the development of effective intervention projects together with enabling the transparency of awareness in relation to products, services and situations that pose risk to society.

• Governance of dedicated networks, working party and task forces
  The Commission will establish rules for procedure regarding close cooperation between the different bodies. Members of the working party task forces will be assigned by the Commission;
• Clearing house and knowledge management
  This function is of high importance to enable the gathering and review of all known approaches to injury prevention, maintain the knowledge base and make it available to all Member States according to their requirements.

The need to focus and be successful in understanding and driving down injuries in the European Union is clear. The established vision to make Europe the safest place in the world on a continuously improving basis calls directly for a more structured and sustainable approach to the issue. Considerable improvements need to be made against the current situation in terms of organisational effectiveness in the EU. To achieve the desired results the subject focus, understanding, prioritisation and organisation development are clearly vital. In achieving success in the Member States the following are identified as critical management requirements:

• Close co-operation in a pan European consortium or network;
• High commitment and professionalism;
• Total transparency and mutual support in all aspects;
• Trust and appreciation of diversity as key driver for innovation and creation.