Opinion of the Committee of the Regions on:

- the 'Communication from the Commission concerning a Community Action Programme on Injury Prevention in the context of the framework for action in the field of public health`, and - the 'Proposal for a European Parliament and Council Decision adopting a Programme of Community Action on Injury Prevention in the context of the framework for action in the field of public health` (97/C 379/09)

THE COMMITTEE OF THE REGIONS,

having regard to the Communication from the Commission and the Proposal for European Parliament and Council Decision [COM(97) 178 final - 97/0132 (COD)] ();

having regard to the decision by the Council of 6 June 1997 to consult the Committee of the Regions, under Article 129 and the first paragraph of Article 198c of the Treaty establishing the European Community, on this subject;

having regard to its decision of 8 March 1996 to instruct Commission 8 for Economic and Social Cohesion, Social Policy and Public Health to prepare the opinion;

having regard to the draft opinion (CdR 456/96 rev. 2) adopted by Commission 8 on 23 June 1997 (rapporteur: Mr Bengt Mollstedt),

adopted the following opinion at its 19th plenary session of 17 and 18 September 1997 (meeting of 18 September).

1. Introduction

The Committee of the Regions has studied the Community action programme on Injury Prevention with great interest. The Commission presents the field of injury of injury prevention and all different activities concerned within the Union. After stating the magnitude of the problem, the different types of accidents and injuries and the target groups (risk populations and risk environment), the communication focuses on fields where action should be taken. Five areas for action are presented:

a) home, leisure and school accidents to children;

b) home and leisure accidents to young adults;

c) home and leisure accidents to elderly people;

d) suicide;

e) injury prevention systems.

2. General comments on the communication

2.1. The communication presents a programme for accident prevention, but the reasons for the European Union to engage in this field could be more specified, even though the proposal puts forward a range of important arguments.

2.2. The presentation is made in a logical way, and presented on scientific grounds. However, it applies views mainly seen from a national perspective. A lot of the practical solutions are based on activities on regional and local level, which should be duly noticed. These are for example child accident prevention in local playgrounds, education in traffic safety at local schools, preventive measures at homes for the elderly run by local authorities, suicide prevention based at regional hospitals, etc.

2.3. The Communication presents all activities within the Union where accidents and injury prevention play a role. In some instances like food hygiene and occupational safety the communication covers areas that do not concern accidents as such. However, it is particularly important in this field to make links with other Community programmes and policies, such as food hygiene or occupational health, as any acts or omissions in these fields can have potentially tragic consequences.

2.4. The Committee of the Regions is very pleased to notice that duplication of work is sought to be avoided. There are many national, regional and local agencies as well as NGOs involved in the preventive work, and this is taken into consideration in the Commission document, although the responsibilities and activities of local and regional authorities should be better clarified. There are already different collaborating centres (WHO etc.), but more could be of use in the prevention programme.

2.5. The proposed improvement of the quality of data on accidents is welcome. However, the Committee of the Regions believes that all types of injuries shall be registered in hospital emergency wards and in first aid services, without omitting neither age groups nor types of accidents, such as suicide, violence and work injuries. Through this better epidemiological knowledge will be obtained. The Committee of the Regions also thinks, in line with its report on the Health Indicators Programme, that the principles for this data collecting should primarily be done through and in connection with the Health Indicators Programme.

2.6. The Committee of the Regions agrees with the evaluation of the areas where activities at a national and/or local/regional level are lacking, and supports the Commission's selection of fields for EU action.

2.7. The target groups are well defined and the Committee of the Regions supports the proposed first four areas for intervention. Experience from the local level indicates that accident prevention for children and young adults is very important. The regions, often responsible for medical care, are pleased to support the areas of suicide prevention and protection of the elderly. In some areas even local districts (below municipal level) are involved in accident and suicide prevention.

2.8. The fifth area, improvement of the system for accident prevention is also acceptable in the view of the Committee of the Regions. This field is concerned with data collecting, epidemiology and the Commission's report on 'Health Indicators` as well as methodology in the preventive work. The Committee of the Regions supported the report on Health Indicators, and in line with earlier Opinions the fifth field of action might be labelled 'accidents prevention management`. The coordination between different existing programmes (traffic safety, occupational safety, etc.) and the Health Indicators programme should also be further discussed and defined.

2.9. The action programme has for good reasons limited its scope to five areas of actions. In order to avoid the programme being perceived as a fragmentation of the Union's efforts without taking notice of common and underlying factors for injuries, the Committee of the Regions believe that the programme should be supplemented with a cross sectorial group of experts, which may add knowledge from other areas of science and sectors of the society. This group could provide the Commission with bases for future policy development in the area of accidents and injuries, observing a cross sectorial perspective in the general field of accident prevention.

2.10. In a health policy perspective there is a connection between traffic accidents and alcohol, which should be further examined. The Committee of the Regions proposes that a special study is performed on traffic accidents linked to alcohol, which could form the basis for a Commission initiative on exchange of experience and possible preventive measures within the area of traffic and alcohol. Such a study on the connection between alcohol and traffic accidents can be carried out parallel to the accidents and injuries programme, the public health information programme or a research programme. Furthermore, violence related accidents and alcohol are linked together and support the need for studies. Such studies must cover 'designer` drugs since the increase in abuse of such drugs has made them one of the main causes of road accidents.

2.11. The working methods discussed in the Communication are well defined but need cooperation mainly between local authorities to give results. Prevention is very often linked to changes in human behaviour (parental guidance for children, behaviour in traffic, physical training to prevent fractures among the elderly) and the level closest to the citizen has the best possibilities to achieve results.

2.12. The Commission states that passive protective measures are more effective than active measures. This is true when it comes to safety belts and airbags in cars, motorcycle helmets, automatic locks in trains etc. However, where human behaviour is concerned, e.g. guidance of children, training to swim, control of mental depressions etc., the discussion must be more detailed. There is seldom only one solution to the prevention of accidents.

3. Specific comments on the proposal

3.1. The Committee of the Regions underlines that no duplication of work should take place. Cooperation with organizations such as WHO, the Red Cross (both internationally and locally), churches etc. must be more explicitly supported. Coordination between different health programmes within the Union should be considered anew. The Committee of the Regions suggests that coordination and administration of the various health programmes should be assigned to an independent 'health observatory`.

3.2. Article 3

The proposed ECU 1,3 million budget for 1999 seems to be adequate, but considerably greater resources will be needed for the following four years, despite the potential savings to be gained from coordination with other programmes.

3.3. Article 5

The advisory committee is suggested to consist of representatives from each Member State. Since so much of the work is based on local and regional activities, the Member States should be advised to be represented by at least one person from such a level. It seems more relevant to have experts rather than elected politicians in the advisory committee.

3.4. Article 6

3.4.1. The international cooperation is essential, but the Committee of the Regions underlines the need to take the aspects of different cultures into consideration when advice and detailed programmes are presented, especially since the attitude towards risk taking could be influenced by different cultures.

3.5. Annex

The area referred to as number III in the Annex should be reworded, to read 'accident prevention management`, for example.

3.5.1. The points presented are covering the essential problems. However, in many cases it is important to mention general health promotion. In suicide it is important to consider drug and alcohol problems; to prevent fractures among the elderly it is essential that the elderly have a good muscular activity; nutrition is important for bone structures etc.

3.5.2. As for campaigns, it is important that they are designed and realized at a national and regional level in order to be able to take into account cultural and other differences between different regions and Member States. The subsidiarity principle is as valid as ever in this area.

3.5.3. The Committee of the Regions considers that the proposed working methods are well balanced. One important approach is the organization of seminars and conferences where experts and local/regional politicians can exchange facts, ideas and opinions. In particular, the suggestions to organize exchange of information through data banks is valuable. Using modern information technology is a cost effective way to support national and regional efforts to prevent accidents and injuries, and such data bases are already in existence.

3.5.4. The Committee of the Regions is hesitant on the subject of short time campaigns, competitions etc. Accident prevention is a long time project, and the activity must be continuous rather than depending on campaigns.

3.5.5. Area V (injury prevention capacity) needs to be better defined, and coordination between different Union programmes as well as the Health Observatory must be mentioned.

4. Conclusions

The Committee of the Regions supports the Commission's proposed programme on Injury Prevention and underlines:

- that the programme areas are well chosen;

- that the programme should be supplemented with a cross sectorial group of experts which may add knowledge from other areas of science and sectors of the society;

- that a special study is performed on traffic accidents linked to drug consumption (e.g. alcohol, narcotics, medicines) and possible preventive measures;

- that the cooperation with local and regional authorities are essential;

- that the methods are well presented but a more sophisticated discussion in active and passive prevention would improve the document;

- that coordination of different prevention areas within the Union is an important part in the field of accident prevention management and an independent secretariat ('health observatory`) should be set up; the budget should be revised accordingly;

- that a Community regulation should be drafted on maximum blood alcohol levels;

- that there is a need to draft Community rules in regard to designer drugs, specifying the substances to be covered and maximum permissible levels.

Brussels, 18 September 1997.

The Chairman of the Committee of the Regions

Pasqual MARAGALL i MIRA

() OJ C 202, 2. 7. 1997, p. 20.