ii -A if 
ii ic COMMISSION OF THE EUROPEAN COMMUNITIES 
Brussels, 14.05.1997 
COM(97) 178 final 
97/0132 (COD) 
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 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action from 1999 to 2003 
on injury prevention in the context of the framework for action 
in the field of public health 
(presented by the Commission) 

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 
I. INTRODUCTION 4 
II. PREVENTING ACCIDENTS AND INJURIES 5 
ill. OVERVIEW OF MEASURES TAKEN IN MEMBER STATES 
AND BY INTERNATIONAL ORGANIZATIONS 
IV. OVERVIEW OF CURRENT ACTIVITIES OF THE 
EUROPEAN COMMUNITY 9 
V. THE NEED 7CR ADDITIONAL PUBLIC HEALTH ACTIONS AT 
COMMUNITY LEVEL 13 
PROPOSED ACTIONS FOR A FIVE-YEAR PROGRAMME Î6 
CONSULTATION ASSESSMENT AND REPORTS 21 
I. INTRODUCTION 
1. By virtue of Articles 3(o) and 129 of the Treaty establishing the 
European Community, the Community has for the first time been given an explicit 
legal basis for undertaking action in the field of public health. The role of the 
Community is to contribute towards ensuring a high level of human health 
protection, directing actions towards the prevention of diseases, in particular by 
encouraging cooperation between Member States and, if necessary, lending support 
to their action, and by promoting coordination of their policies and programmes. In 
its communication of 24 November 1993 on the framework for Community action 
in the field of public health1, the Commission defined the role of the Community as 
underpinning the efforts of the Member States in the public health field, assisting in 
the formulation and implementation of objectives and strategies, and contributing to 
the provision of a high level of health protection across the Community, setting as a 
target the best results already obtained in a given area anywhere in the Community. 
2. In keeping with Article 129's focus on the "major health scourges", one of the 
Commission's stated priority areas is the prevention of intentional and 
unintentional injuries and accidents. Injury accounted for 190 000 deaths in the 
12 EC Member States in 1991 (more than any other category except cardiovascular 
and respiratory diseases and cancer). In the EC, injury remains the leading cause of 
death at all ages between 1 and 34. This concentration of mortality in the youngest 
age groups makes injury à disproportionate cause of potential life years lost. In 
older people, although injury is eclipsed by other causes of death, the death rate 
from injury is still higher in the over-75s than in any other age group. Disability and 
morbidity is also very substantial: in England it is estimated that every year one child 
in ten needs health care following an accidental injury, along with 500 000 people 
over the age of 65 for home and leisure accidents alone. Every year in the EC an 
estimated 700 000 people are admitted to hospital following attempted suicide, in 
France it is estimated that 2.9% of the population (more than 1.5 million people) are 
living with a disability caused by an accident. 
3. The economic impact of injury is also very substantial. In Denmark it has been 
estimated that 11% of ail days in hospital are the result of accidents; the medical 
costs of home and leisure accidents in the Netherlands are thought to be over 
ECU 450 million per year. Costs to the injured person and his or her family are 
much wider than the direct medical expenses. Damages payments by insurance 
companies can give some indications, in France the average payment following each 
road accident to a child are over ECU 15 000. 
4. More encouraging, however, is the evidence that prevention measures can be highly 
cost-effective. There is well-supported evidence that the initial investment can be 
recovered in as little as three years, notably from participants in the WHO Safe 
Communities programme in a number of countries including Sweden, who report 
reductions of 25% or more in accident rates during this period. The strength of this 
evidence for cost-effectiveness is rare among health promotion activities. 
COM(93) 559 final, 24 November 1993. 
5. For these reasons, and those discussed below, the Commission is proposing a 
programme of Community action on injury prevention in the context of the 
framework for action in the field of public health. 
II. PREVENTING ACCIDENTS AND INJURIES 
6. In surveying the field of injury and its prevention, it is appropriate to start by 
considering all external causes of injury and poisoning, for example as defined in the 
WHO's International Classification of Diseases (ICD). This definition covers 
accidents, intentional self-harm, assault, "legal intervention", war, the complications 
of health care and the sequelae of all these. Within this vast field a selection of the 
areas for Community actions will be discussed in sections V and VI. 
7. The key aim of any prevention programme must be to counter the fatalistic view 
that "accidents will happen" and by implication cannot therefore be prevented. This 
attitude must be replaced by the realization that accidents and injuries need not 
happen and thus strenuous efforts must be made to identify the hazards and causes 
so that they can be avoided, prevented or at least guarded against by the best 
possible protective measures. 
8. Accidents and injuries can conveniently be considered for prevention purposes from 
three main aspects: where they happen, to whom they happen, and how they 
happen. The "where" and the "when" aspect gives rise to ,he classic distinctions 
between accidents at work, commuting accidents, those resulting from traffic 
(mainly on the roads) and those that take place at home or in sporting or 
recreational places. These distinctions separate most current Community actions on 
the subject. 
9. The groups of people who are the victims of accidents or injuries - and those who 
cause them - are important as they are the target populations for preventive actions 
High among most people's priorities are infants and children who are the most 
vulnerable and who have most to lose in terms of years of life or quality of life. 
Accidents and injuries are the greatest threat to them. 
10. Elderly people are however another vulnerable group, and the numbers of the very 
old are increasing. More limited target groups can also be distinguished such as 
young people deliberately seeking out dangerous pursuits, sportsmen and 
sportswomen, women and children (often in poor socio-economic circumstances) 
subject to domestic violence, and special groups particularly subject to suicide such 
as farmers, police and doctors. 
11. The nature or immediate cause of the accident or injury is clearly very important for 
prevention purposes as it may point to faults or hazards in products, equipment, 
substances, services or environments which can be put right, reduced or be the 
subject of warnings 
12. An important distinction is often drawn in accident prevention between 
"active prevention"- altering the behaviour of those at risk, and 
"passive prevention"- modifying the environment so as to separate people from 
sources of danger and/or to eliminate the source of risk. There is increasing 
evidence that passive prevention is usually more effective and cost-effective. 
Children and traffic illustrate both cases. In a world dominated so much by motor 
vehicles, road safety skills are obviously essential (active prevention). However 
there is research evidence that while children under about eight or nine years old 
may understand safety messages well, they are unable to remember that these must 
be applied all the time. Children's safety can only be assured by keeping them away 
from moving vehicles (passive prevention). 
Potential areas for injury prevention 
Population groups 
13. The identification of particular population groups to whom preventive actions 
should be directed is not only a matter of those most vulnerable to accidents or 
injuries but also suggests the most appropriate form of the action and the way in 
which it should be delivered. The settings in which particular groups can be reached 
are very important for effective action. 
14. Children are at higher risk because of their relative inability to judge risks, and 
greater vulnerability. Accident risk is strongly associated with social deprivation, for 
example via cramped and inadequate living accommodation, cheap, badly designed 
products, lack of supervision and even deliberate injuries inflicted by 
stressed parents. 
15. Frustration, boredom or just the sheer energy of young adolescents lead to 
deliberate risk-taking which can have tragic consequences. The balance between 
prevention, familiarization with risks, proper preparation and training for dangerous 
pursuits and over protection is a difficult one to strike and dependent on the 
establishment and maintenance of relations with the young people concerned. 
16. Elderly people are most aï risk of accidents when their mobility or faculties become 
impaired, or they are deprived of the partners or environment on which they have 
come to rely. Prevention related to coping skills and the sensible use of appropriate 
tools or appliances can avoid injuries and improve their quality of life considerably. 
The encouragement of self confidence and esteem by using equipment safely, 
participating in social activities and moving without danger indoors and outdoors 
can be extremely important. 
7 The need for accident and injury prevention measures for professional sportsmen 
and women is probably best left to their professional organizations Amateur 
sportsmen, especially those practising on their own without involvement in sporting 
organizations and access to ail necessary information and advice, are at greater risk 
as they may expose themselves to dangerous situations without adequate protection 
and training. Those taking part, in travel to unfrequented parts of the world on their 
own may similarly get into trouble. The provision of information and advice for such 
people is particularly difficult. Similarly the lone do-it-yourself practitioner using 
unfamiliar tools and materials, or the gardener using power tools and materials may 
be at risk and will be difficult to reach. 
18. Other special population groups requiring preventive action include mentally ill, 
physically disabled and sociably deprived people, drug and alcohol abusers and in 
some cases ethnic minorities unused to the precautions that have to be taken in 
dealing with modern urban life in Western society, from the use of utilities such as 
gas or electric devices to the dangers of poisoning from foodstuffs stored at the 
wrong temperature or caustic substances used for domestic purposes. 
Behaviour-related accidents and injuries 
19. These will include both intentional and unintentional accidents and injuries but it is 
not necessary to be too concerned about exact distinctions between the two. This is 
one of the main advantages of a programme which is concerned with both 
categories. Deliberate carelessness or exposure to serious risks may be very difficult 
to distinguish from suicides, para-suicide or, in the case of harm to other persons, 
from homicide or assault. While preventive measures can be clearly distinguished in 
type and approach where an act is clearly intentional or unintentional, the approach 
in the grey area of overlap is harder to devise. The provision of skills, information, 
expertise and self-confidence may be relatively straightforward for those who are in 
full possession of their physical and mental faculties, but it requires special training 
for advisors and counsellors in other cases. 
20. The prevention of suicide and para-suicide poses particular problems and requires 
special services ready at the time they are required. The availability of 
communication channels, particularly telephone counselling services, has proved 
very effective in this context. Social isolation is often a causative factor in suicide 
and telephone counselling provides one acceptable way for the socially isolated to 
obtain help without the threat of a face to face encounter. Other forms of 
counselling and support may however be necessary in the medium term, once the 
immediate threat has been removed. 
Environment-related accidents and injuries 
21. Environments can be very influential in the causation of accidents and injuries 
whether they consist of the inside of the home, the garden, the street, the school or 
the wider world. It is never possible to remove or even guard against all the hazards 
they present but it is possible to identify environmental causes which are most 
frequently involved and to produce safe homes, schools, or communities. Fire and 
security inspections are becoming fairly familiar but more general safety surveys 
would be possible and carefully considered plans for prevention could prove more 
effective than ad hoc panic reactions to horror stories. 
22. Traffic accidents are the single greatest cause of injuries in Europe; road traffic 
accidents alone give rise to some 48 000 deaths per year in the EC. They have been 
tackled with a wide range of prevention measures, some of which are mentioned in 
sections 3 and 4. It should be recalled that transport safety is a specific Community 
competence under Article 75, and that improving transport safety is a prime 
objective of the Common Transport Policy. 
23. Accidents and injuries at work are another field which has already seen much 
prevention activity. This has produced impressive reductions in accidents rates in 
some areas in recent decades. Prevention activities at a European level are part of 
the Community's social policy. 
Product-related accidents and injuries 
24. In this area most of the data will be gathered through the existing Community rapid 
reporting scheme for dangerous products or the Community System of information 
on home and leisure accidents (EHLASS) established under the Community's 
consumer protection policy2. Modifications to products, labelling, warning signs, 
information provisions and standard-setting are among the concerns of Community 
policies on the movement of goods and services. These have achieved an important 
result on general product safety. 
III. OVERVIEW OF MEASURES TAKEN IN MEMBER STATES AND BY 
INTERNATIONAL ORGANIZATIONS 
Member State governmental action 
25. The deaths, injuries, suffering and costs caused by accidents and injuries have 
prompted all Member States to launch programmes to attempt to reduce them. 
Some are directed by Government Departments or groups of Government 
Departments working with non-governmental organizations. Others are run by 
Governmental agencies. Frequently, it is Consumer Affairs Ministries and 
organizations rather than health ones, which run programmes for home and leisure 
accident prevention. Traffic accidents and accidents at work have their own ranges 
of organizations working with Transport and Employment Ministries. Much of 
the most important accident prevention is undertaken at regional and local 
government level. 
Voluntary and non-governmental organizations 
26. Voluntary and non-governmental organizations play a very important part in 
accident and injury prevention reaching out as they often do through local branches 
to the general public and involving in their programmes professional and academic 
experts from national and local organizations. The contribution of the health 
professions to injury prevention, for example through advice to patients and the 
general public, is frequently one of the most significant. In the area of suicide 
prevention voluntary organizations have played a vital role in pioneering ways of 
reaching those at risk and are now beginning to collaborate internationally. In many 
cases poisons and burns centres make a particular contribution to the task of 
informing the public about risks. 
2 OJ No L 319, 21.12.1993, extended by OJ No L 331, 21.12.1994. 
8 
International organizations 
27. International organizations also play an important part in accident and injury 
prevention and actions in the European Community can be most effective if they 
cooperate with the activities of such organizations in Europe to avoid duplication 
and reinforce each other's efforts. The World Health Organization's accident 
prevention programme is directed from its headquarters in Geneva and was 
responsible for the actions associated with World Health Day (7 April) in 1993 on 
the theme "prevent accidents and negligence". Several WHO projects stem from this 
programme: the "helmet initiative" (cyclists), the "safe communities project", injury 
surveillance and data systems and evaluation of the health impact of injuries. 
WHO organizes World Conferences on Safety Promotion and Injury Control. It also 
has a network of collaborating centres concerned with the subject. 
28. Non-governmental international organizations are active in Europe in such fields as 
product safety standards, child safety, fire prevention, sports injury prevention, 
accident research and consumer safety regulation and enforcement. They are also 
concerned with rapid responses to accident and injuries before the victims reach the 
hospital. Such actions can prevent the effects of the injuries from being as serious 
and permanently damaging as otherwise they would have been. The contribution of 
professional organizations at the European level is also an important one. 
IV. OVERVIEW OF CURRENT ACTIVITIES OF THE 
EUROPEAN COMMUNITY 
Health and safety at work 
29. In July 1995 the Commission adopted a Communication on a Community 
programme for safety, hygiene and health at work (1996-2000)3. Its main provisions 
include greater support for improvements to safety in small and medium-sized 
enterprises and non-legislative measures such as guidance notes, information and 
training. The ESAW (European Statistics on Accidents at the Workplace) project, 
which provides statistics on accidents at work for high risk industries, continues 
work on the inclusion of more variables to provide better insight onto the causes of 
accidents at work. In addition, a pilot project has been launched on comparable data 
on occupational diseases in Europe (EODS: European Occupational Disease 
Statistics). Commission work to extend the development of harmonized 
Occupational Exposure Limits also continues4 and in September 1995 a proposal 
was published to amend Directive 90/394/EEC on carcinogens by setting limit 
values and extending its original scope5. 
3 COM(95) 282 final of 12 July 1995. 
4 Including the adoption of a Community Decision establishing a Scientific Committee for 
Occupational Exposure Limits to Chemical Agents: OJ No L 188, 9.8.1995. 
5 OJ No C 317, 28.11.1995. 
Transport 
30. In the road traffic field, current activities cover roadworthiness tests, speed 
limitation devices in lorries and buses, introduction of new standards for driving 
licence theoretical, practical and medical tests, and development of new 
equipment for the enforcement of driving time for professional drivers. 
Non-legislative measures proposed include information campaigns on drink-driving, 
young drivers... Under the CARE programme adopted in 19936 a data bank on 
road accidents has been established allowing the analysis of detailed information on 
accident causes throughout the Community. Other recent transport safety actions 
include a Regulation on safety management in roll-on roll-off ferries7 and Directives 
on the transport of dangerous goods8. 
Home and leisure accident surveillance 
31. Council Decision 86/138/EEC9 approved a demonstration project with a view to the 
introduction of a Community system of information on accidents involving 
consumer products (EHLASS). The initial objective was to identify areas in which 
preventive measures were necessary. The project collected data from the casualty 
departments of selected hospitals or by household survey. The system has made it 
possible to identify products involved in accidents, the resulting need for 
hospitalization, average stay in hospital, type of injury sustained and age of person 
injured. This information has informed prevention (information and awareness) 
campaigns, negotiations with industry to modify products and the introduction of 
standards or regulations. The EHLASS project has now been extended to the end 
ofl99710. 
Product safety 
32. The Council adopted Directive 92/59/EEC on general product safety on 
29 June 199211. This is a broad legislative provision requiring only safe products to 
be placed on the market, the provision of information about possible risks and the 
establishment of mechanisms for reporting risk products and for their withdrawal 
from the market where necessary. The safety of a product is determined by 
Community provisions, Member State provisions or voluntary codes of good 
practice depending on what exists for the product in question. Member States are 
responsible for introducing legislation concerning checks on product safety, 
sampling, temporary prohibitions, etc. and must notify the Commission of 
restrictions on marketing which they have imposed (RAPEX), particularly where 
emergency restrictions have proved necessary because of serious risks. The 
Commission may then require all Member States to take temporary measures, 
stating the reasons for this. An Advisory Committee on Product Safety Emergencies 
is established to assist the Commission. 
6 Council Decision 93/704/EC, OJ No L 329, 30.12.1993. 
7 OJ No L 320, 30.12.1995. 
8 OJ No L 145, 19.6.1996, OJ No L 235, 17.9.1996. 
9 OJNoL 109,26.4.1986. 
10 OJ No L 331, 21.12.1994. 
11 OJ No L 228, 11.8.1992. 
10 
Construction products: fire 
33. Community action relating to the prevention of fires mainly derives from provisions 
for the fire resistance of materials or components used in construction. A Directive 
of 21 December 198812 sets Community standards in this field. 
Product standards 
34. The work of the European Standards organizations CEN, CENELEC, and ETSI 
has been assisted since 1983 by SECO, the European Secretariat for coordinating 
consumer representation in standardization. Since the new approach to the 
reduction of technical barriers to trade in the Community was introduced in 1985, 
the legislation contains only general safety requirements. Manufacturers are 
presumed to conform to essential safety requirements if their products are produced 
to acknowledged European Standards established by the Standards Organizations. 
A new joint structure has been agreed in 1994 for coordinating consumer 
representation in the standardization process from 17 EC and EFTA 
Member States. It is known as ANEC. 
Food safety and agriculture 
35. A high level of Community activity is always devoted to protecting the consumer 
against food poisoning, in the fields for example of hygiene in its production and 
distribution, restricting unsafe imports and regulating maximum permitted pesticide 
residues. In 1995 actions included three Directives harmonizing maximum residue 
levels for nine pesticide active substances and amending the existing levels for 
twenty others13; a Directive amending Directive 64/433/EEC on the production and 
marketing of fresh meat14; and a proposal for a Directive on protection against 
certain zoonoses including rabies15. 
Environmental exposure to risks of poisoning and other injuries 
36. In a similar way, one of the principal emphases of Community environment policy is 
to protect human health, as required by Article 13Or of the Treaty establishing the 
European Community. Most of the possible threats to health come within the 
heading of external causes of injury and poisoning with which section II of this 
Communication began. For example, 1995 saw the consideration of Commission 
proposals on the quality of ambient air16; the control of air pollution arising from 
vehicle motors and other machines17; integrated pollution prevention and control18; 
modifications of the draft Directive on biocide products19; revision of the Directive 
12 Council Directive 89/106/EEC of 21 December 1988, OJ No L 40. 11.2.1989. 
13 Council Directives 95/38/EC, OJ No L 197, 22.8.1995; 95/39/EC, OJ No L 197, 22.8.1995, and 
95/61/EC, OJ No L 292, 7.12.1995. 
14 OJ No L 243. 11.10.1995. 
15 COM(95) 491 final of 23 October 1995. 
! 6 COM(94) 109 final of 4 July 1994. 
17 COM(94) 558 final of 16 December 1994; COM(94) 559 final of 16 December 1994 and 
COM(95) 350 final of 6 September 1995. 
18 COM(95) 88 final of 15 May 1995. 
19 COM(95) 387 final of 20 July 1995. 
II 
on the protection of persons undergoing medical examination or treatment involving 
ionising radiation20. 1996 saw the revision of the Basic Safety Standards Directive 
for the protection of workers and the public against the dangers arising from 
ionising radiation21 and the adaptation to technical progress and modification of the 
classification and labelling of the dangerous substances directive22. 
COUNCIL 
37. In Resolutions of 198623 and 199024 the Council and the representatives of the 
Member States, meeting within the Council, called on the Commission to implement 
specific measures contributing to better toxicology and prevention and treatment of 
acute poisoning, which have since been pursued in collaboration with poison control 
centres in Member States. The Council recognized in its 1991 Resolution on 
fundamental health-policy choices25 the need for closer cooperation and 
collaboration between Member States and singled out among topics warranting joint 
consideration the drawing up of comparative data, the development of strategies to 
facilitate priority-setting and the stimulation of scientific and public debate. In 
May 1993 the Council reaffirmed the need for close cooperation and laid down a 
number of important guidelines for Community action such as adding life to years 
and years to life, multi-annual planning and the selection of areas for action with 
regard to their amenability to preventive action26. These themes were developed in 
its resolution of June 199427 responding to the Commission's Communication on the 
framework for action in the field of public health. 
EUROPEAN PARLIAMENT 
38. The European Parliament has for some time been keen to see a greater Community 
contribution to actions against accidents and injuries as illustrated by a number of 
Resolutions28. Most significantly, its Resolution on public health policy after 
Maastricht of October 199329 called on the Commission to develop and execute 
activities on accident prevention in the context of public health. 
20 84/466/Euratom, OJ No L 265, 5.10.1984. The proposal for revision is to be found in 
COM(95) 560. 
21 80/836/ Euratom, 89/618/ Euratom, 96/29/ Euratom, OJ No L 159, 29.5.1996. 
22 Directive 96/56/EC, OJ No L 236, 18.9.1996 and Directive 96/54/EC, OJ No L 248, 30.9.19%. 
23 OJNoC 174,23.7.1986. 
24 OJ No C 329, 31.12.1990. 
25 OJ No C 304, 23.11.1991. 
26 Resolution of 27 May 1993, OJ No C 174, 25.6.1993. 
27 OJ No C 165, 17.6.1994. 
28 such as its Resolution on dangerous substances (more llian 12 since 1982); health and safely al 
work (more than 30 since 1981); accidents and catastrophes (more than 8 since 1984); toxicology 
(1985); pollution (more than 14 since 1980) and the accidents and dangers related to consumer 
goods (3 since 1980). 
29 OJ No C 329, 6.12.1993. 
12 
ECONOMIC AND SOCIAL COMMITTEE 
39. Opinions have been delivered in recent years on matters such as acute human 
poisoning30 and the Community system of information on accidents involving 
consumer products31. The Committee's wide-ranging Opinion of 6 July 199432 on 
the Commission's Communication on the Framework for action in the field of public 
health urged a wide interpretation of the field for health activities. 
V. THE NEED FOR ADDITIONAL PUBLIC HEALTH ACTIONS AT 
COMMUNITY LEVEL 
40. A study of the scope of the activity just described points to gaps which demonstrate 
the need for new public health actions on accidents and injuries in addition to 
existing Community activities. This section describes first the general principles 
which apply to public health actions at Community level, and then the process of 
reasoning which leads to a selection of a small number of key areas in which new 
actions are now needed. Section VI then gives details of the actions now proposed 
General approach t® Community pubSk health activities 
4 Î. In accordance with the principles established in Article 129 and in the Commission's 
Communication on the framework for action in the field of public health. 
Community action will, in particular, focus on encouraging cooperation between 
Member States, lending support to their action and promoting, in close contact with 
them, useful coordination of their policies and programmes, and fostering 
cooperation with third countries and international organizations. 
42. Community action must also respect the principle of subsidiarity defined in 
Article 3 b of the Treaty establishing the European Community. In matters not under 
its exclusive competence, the Community therefore intervenes only when the action 
proposed, by reason of its scale or effect, may better be carried out at Community 
level. Whether a matter comes under its exclusive competence or not, action by the 
Community must be proportional to the objectives to be achieved. Activities should 
be selected on the basis of prior appraisal and should yield a Community added 
value while achieving maximum cost efficiency. 
43. The criteria mentioned in the Commission's Communication on the framework for 
action in the field of public health can be applied as follows in the selection of topics 
for intervention, and the means to be chosen, by the Community in this programme: 
(a) the topic should be a substantial cause of mortality or morbidity, or a cause of 
mortality or morbidity whose rate of increase causes concern; 
(b) the proposed measures should not duplicate other work already under way, 
and where existing work is relevant they should be coordinated with it; 
30 OJ No C 124, 21.5.1990. 
31 OJ No C 62, 12.3.1990. 
32 OJ No C 388, 31.12.1994. 
13 
(c) there should be grounds to believe the proposed means will be cost-effective; 
and 
(d) the proposed measures should yield a Community added value by fulfilling one 
of the following definitions: 
activities on a scale which Member States themselves could not, or 
could only with difficulty, implement; 
activities, the joint implementation of which would offer obvious 
benefits even after taking account of the extra costs involved; 
activity which, because of the complementary nature of work being 
done at national level, enables significant results to be obtained in the 
Community as a whole; 
activity which leads, where the need is recognized, to the establishment 
of best practice norms and standards; 
activities which contribute to the strengthening of solidarity and 
social cohesion in the Community, and promote its overall 
harmonious development. 
Selection of topics for action 
44. In view of the limited resources at the Community's disposal, large potentially 
promising areas must be excluded. The above criteria are a rational basis for doing 
so. On the first criterion, epidemiology, it is justified to narrow the focus to children, 
young adults and the elderly, since injury is most prevalent in these groups. It is also 
appropriate to exclude injury caused by crime, since the numbers are relatively small 
in relation to accidental injury and suicide. The same applies to medical accidents, 
natural disasters, pollution incidents and international conflict. On the second 
criterion, avoiding duplication, actions to be undertaken under a public health 
programme should in present circumstances avoid the following already occupied 
fields: accidents to vehicle passengers; work-related accidents, accidents caused by 
defective products, and those forms of chronic and acute accidental poisoning which 
are covered by the existing range of actions on toxicology, food safety, the 
environment, etc. 
14 
45. Duplication with the Community programme on health promotion, education and 
training33 will be avoided. Whereas that programme addresses horizontal questions 
including health promotion strategies, means of targeting disadvantaged groups, 
nutrition,, health education and vocational training in health promotion, the injury 
prevention programme will be tightly focused on activities intended to prevent injury 
directly. Similar close coordination will avoid duplication between actions in this 
programme targeted at schools and those which already exist within the 
Community's health and safety at work programme . 
46. The third criterion, cost-effectiveness of the means used, militates against the 
Community directly mounting public information and education campaigns. These 
would probably not be the most cost-effective ways to use a very limited budget 
available for actions at Community level. This criterion is also to be borne 
constantly in mind in the selection of activities. 
47. The criterion of community added value has a particularly strong sifting effect on 
injury prevention: it is very easy to compose long lists of prevention activities that 
are known or likely to be effective, but on examination nearly all of them are most 
suitable for national or sub-national implementation. 
48. Two areas of activity lend themselves to Community action. The first is the sharing 
and shared development of expertise, particularly in the selection of interventions 
and the epidemiology of injury. An enormous amount of experience and ability 
exists in injury prevention in the Member States, but it is spread unevenly and 
practitioners are at times largely unaware of the experience of others. Measures to 
share the best practices with a much wider field would certainly fulfil the criterion in 
paragraph 43 (d) of enabling significant results to flow from the complementary 
nature of work being done at national level. In some cases the result might 
principally be a flow of information from Member States with longer experience of 
highly industrialised societies and their problems to those now experiencing the ill 
effects of their rapid economic development in the 1970s and 1980s. For example 
suicide rates in some southern Member States now appear to be rising steadily and 
public health authorities there may wish to learn from the experiences of 
Member States with established suicide prevention activities. 
49. Other forms of expertise are likely to be less predictably distributed: the point is the 
value to be gained by establishing where it is and making it available. Experience 
also suggests that the centres of expertise which are offering information in a 
particular case also gain through the process of reflecting on their practice and what 
its best or most transferable features might be. 
33 
34 Decision No 645/96/EC, OJ No L 95, 16.4.1996. 
The key text for health and safety at work activities is at present Directive 89/391/EEC of 
12 June 1989 on the introduction of measures to encourage improvements in the safety and health 
of workers at work, often referred to in this field as the "Framework Directive": OJ No L 183, 
29.6.1989. 
15 
50. The other area suitable for Community action is improving the quality of data. Data 
are vital to accident prevention as they allow epidemiological investigation of what 
situations, products, behaviours, chain of events and even places are dangerous. 
This allows scarce prevention resources to be targeted at the right road junction, 
toy, sporting activity, etc. At a European level, comparability of national recording 
systems and the harmonization of methodologies, where this can be agreed, would 
make data a much more powerful tool. The Commission has already proposed a 
programme of Community action on health monitoring35 which envisages actions of 
this type. Work on data in the injury prevention programme will be carefully 
coordinated with that programme's activities. 
VI. PROPOSED ACTIONS FOR A FIVE-YEAR PROGRAMME 
Topics and objectives 
51. The Commission believes that the field of activity indicated by this process of 
selection is a valuable one, in which the distinctive contribution of public health can 
play an important part in injury prevention. The overall goal of such a programme 
should be to make a contribution to public health activities which reduce the 
incidence of injury. The programme should focus on five topics selected by the 
foregoing process of elimination: 
(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 capacity. 
The category of leisure would include giving due emphasis to sports injuries. 
52. In each of the first four fields the objective of Community action should be to 
contribute to the more effective dissemination and application of injury prevention 
techniques whose worth is widely accepted by experts. The detailed subjects which 
might be covered in each area are suggested in paragraphs 70-75 below. 
53. In addition to activity in these fields, a modest investment at Community level in the 
public health sector's more general capacity for injury prevention is justified (e). 
Achievements in the specific areas can be enhanced by sharing public health 
expertise in the generic organization and delivery of injury prevention activities. This 
would help public health authorities improve their capacity to collect, interpret and 
use data, identify the best areas for work, enlist support, build alliances, select the 
best interventions, monitor health effects, evaluate programmes and make 
necessary changes. The detailed subjects which might be covered are described in 
paragraph 75 below. The objective would be to contribute to the strengthening of 
public health bodies' capacity to mount effective injury prevention activities. 
35 COM(95) 449 final of 16 October 1995 and COM(96)581 final of 11 November 1996. 
16 
54. The means which will be appropriate for this sharing of expertise at a Community 
level will be very similar for all five areas. Suitable means are: creating networks, 
disseminating information on campaigns, supporting surveys and technical 
investigations, improving the quality of data and helping Member States to 
coordinate policies and programmes. These are discussed below. 
Creating networks 
55. The interchange of information between government and non-governmental 
organizations is one of the forms of European cooperation most frequently sought 
by these groups, and interest is already being expressed in networks of groups 
working in suicide prevention and child accident prevention. There may also be 
opportunities for fostering links with associated third countries which have interests 
in particular aspects of the subject. Part of this activity may be concerned with the 
development of new approaches or innovative methods of tackling common 
problems. Exchanges of materials, guidelines and handbooks can save a great deal 
of time and effort in the development of preventive actions for local populations. 
Interested organizations might be assisted in using telematic means such as the 
Internet to share information across national boundaries. 
56. The training of groups of staff, frequently of a multi-disciplinary kind, by 
professional organizations would be particularly helpful in spreading messages and 
methods for the prevention of carefully identified aspects of accidents and injuries. 
Thus the training of staff for help-lines and the development of counselling groups 
and organizations able to work in the local community might be a useful 
contribution to combatting suicide. Training for staff in contact with children and 
families on identifying risks and proposing measures to avoid them is another 
example. Professional sports medicine organizations or other professional groups 
can be encouraged to provide training for leaders and coaches from sports clubs and 
recreational centres. 
57. Community action will take the form of encouraging and assisting European 
organizations or combinations of Member State institutions to undertake 
networking actions of various types. 
Disseminating information about campaigns 
58. While the Community will not organize campaigns itself within the programme, it 
will seek to assist those doing so by promoting cooperation and exchanges of 
expertise, staff and materials between Member State organizations arranging these 
activities. To facilitate this process, the Community will seek to develop a bank of 
information on the campaigns that have been carried out with, if possible, 
assessments of their value, effects and generalizability. It might be possible to 
organize a competition to find the best prevention campaigns. 
17 
59. On some subjects it may be appropriate for the Community to promote the 
organization of parallel campaigns in a number of Member States and to assist the 
development of basic materials and publicity which could be used with modifications 
by all participating. 
60. The programme will also seek to list a number of "model" accident prevention 
campaigns, illustrating the processes of fact finding, pre-testing of the methodology 
and materials and appropriate monitoring and evaluation mechanisms. 
Improving data about accidents 
.61. Data on home and leisure accidents have been collected since 1986 under the 
EHLASS system. Because the size of the system, data collection is not sufficient to 
be used as a statistical evidence. Improving data about accidents would help 
considerably in planning cost-effective interventions. The pursuit of agreed 
approaches to coding, the better recording of place of occurrence as well as on 
behavioural aspects and on chain of events, the precision of cause of death 
certification, severity scales and minimum data sets would pay dividends. 
Harmonization of data definitions and minimum data sets should be pursued to 
allow inter-country comparisons, as well as examination of coverage of existing data 
collection systems and where necessary development of measures to improve such 
coverage and, in conjunction with EHLASS, the potential value to the EC of the 
work being done in the International Collaborative Effort on Injury Statistics should 
be maximized. 
62. The conduct of special enquiries and analyses is a frequently used tool in planning 
better prevention activities. Under its proposed Health Monitoring programme, the 
Community could add questions or modules to existing Community-wide surveys. 
In close coordination with the Health Monitoring programme, the injury prevention 
programme could do the same in its own particular field The knowledge and 
contacts gained in the injury prevention programme will make it possible to assist in 
identifying the need for such work, and a database of known surveys could be 
created to help those planning an activity to identify what had already been done. 
This could avoid much wasted effort in, for example, methodologies being 
reinvented in several places. 
Technical investigations 
63. Policy makers and those responsible for prevention measures require technical 
services to inform their actions and decisions and to look into the likelihood of 
accidents, the probable costs arising from them, the causes and the technical 
improvements that can be made. The Community will seek to promote collaboration 
between institutions with specialized knowledge and facilities able to undertake such 
activities, and could develop an inventory of institutions and their projects so that 
each Member State does not need to duplicate analytical or testing programmes but 
instead can draw on information or facilities already available. The Community 
will also promote conferences and exchanges between such institutions 
and programmes. 
18 
64. Technical institutions of this kind are in seme cases also in a good position to carry 
out evaluations of prevention projects and campaigns from an impartial and 
informed standpoint and the Community will support such developments. 
Consultation and cooperation 
65. Article 129 of the Treaty establishing the European Community provides that the 
Community shall encourage cooperation between Member States and the 
coordination of their policies and programmes to ensure a high level of human 
health protection and the prevention of major health scourges. The Commission is 
empowered to take any useful initiative to promote this process. 
66. Consultations may need to be about almost any aspect of the subject but the main 
areas will be the development of public policies and strategies at different levels of 
government (international, national, regional and local) and the comparison of 
measures used to implement those policies, whether legislative, administrative or by 
the negotiation of voluntary standards and codes. 
67. Areas in which such policy cooperation will be paiticularly important are those 
concerning the selection of priorities for action, surveys of public attitudes 
towards accidents, risk-taking and suicide, preventive actions directed towards 
particular population groups e.g. young children, and. measures to reduce 
environment-related risks. 
68. Action organized, sponsored or assisted by the Commission may take the form of 
formal and informs!, meetings at different levels of government, conferences and 
seminars, working groups and advisor}' groups. Consultations could include 
independent experts and representatives of non-governmental organizations. Groups 
will have precise, time-limited mandates. The Committee for the programme 
outlined in paragraph 76 will be the forum for general oversight of these activities. 
Adding public health value to other Community programmes 
69. The fifth specific field of action, strengthening the public health input to injury 
prevention, would also benefit from activities to increase the use which public health 
bodies can make of other Community policies for injury prevention. Several 
umbrella groups already assist their members by raising awareness of Community 
programmes and the conditions for participation in them, helping to set up consortia 
across national boundaries arid helping groups with a particular interest to discover 
the most useful interlocutors in Community institutions. The programme could 
support similar activities focused in more detail on injury prevention and 
disseminated to an injury-related audience. 
Detailed subject cootetst of ths topics selected 
70. The selection of five icpics for action was described in paragraphs 51-53, and 
paragraphs 54-69 showed the means by which Community objectives in those fields 
could be pursued. It remains to illustrate the content in a little more detail. 
19 
Home, leisure and school accidents to children 
71. Best practices being disseminated in this area could include those in areas such as 
home safety check schemes for toddlers, parent support and education, provision of 
safety glass or safety film for glass, provisions of package equipped with child 
resistant closures, smoke alarms and other safety aids in the home, coaching for 
sports and leisure pursuits, learning to swim, daily living skills in, for example, the 
kitchen, safety of playgrounds, specialist work of school health services, safety 
education in the curriculum, training of childcare workers and development of self-
help and voluntary groups. 
Home and leisure accidents to young adults 
72. Areas particularly suitable for work under this heading include coaching for sports 
and leisure pursuits, the inclusion of more general safety information in 
the packaging of sports products, awareness of the effects of alcohol and drugs on 
risk-taking behaviour, awareness in high risk sports such as the danger of spinal 
injury from diving into unknown water, first aid and resuscitation, identifying key 
collaborators such as cycle shops, record shops and youth groups, raising awareness 
of hazards in the kitchen and do-it-yourself, development of self-help and voluntary 
groups. Expertise gained by sports bodies with professional sports people may be 
valuable in preventing accidents to amateurs too. 
Home and leisure accidents to elderly people 
73. In this field best practices should be disseminated in fields such as home safety 
check schemes, appropriate mobility and flexibility exercises, giving advice in 
suitable contexts such as contacts with health services, maintenance of safe and even 
pavements, safety policies in nursing homes, checking on heating arrangements, 
review of medication (especially sedatives, tranquillizers and hypotensive agents) to 
avoid unnecessary use, adequate lighting including street lights and the development 
of self-help and voluntary groups. A particular focus is the prevention of falls which 
can be very disabling and permanent in their effects in the oldest groups. 
Suicide 
74. Those involved in suicide prevention could use the programme to share information 
in areas such as effective help for those have attempted suicide (the group at the 
highest risk of a further attempt), organization of the quality of provision for suicide 
attempters to minimize the risk of repeat attempts, wider understanding of 
depression and support for people with severe somatic illness, evaluation of 
different help line and counselling approaches, and development of self-help 
and voluntary groups (including those for alcohol abusers and people with 
mental illness). 
20 
Strengthening the capacity of the public health sector 
75. In addition to the actions adding value to other Community activities described 
in paragraph 69, information can be shared on topics including epidemiology of 
injury, community mobilization (for example building on the WHO Safe 
Communities programme in coordination with its organizers), building alliances of 
agencies, effectiveness and cost-effectiveness of injury prevention actions and 
evaluation tools. 
VIL CONSULTATION ASSESSMENT AND REPORTS 
Consultation 
76. In seeking to establish a five-year programme in this field, the Commission will rely 
on close collaboration with the Member States, above all in the field of coordination 
of policies and programmes but also in every other part of the programme. In 
implementing the programme, the Commission intends to have recourse to an 
Advisory Committee of representatives of the Member States. Appropriate links will 
be maintained with the WHO, other international organizations and third countries 
as the programme requires, subject to other pertinent Community provisions. 
Evalus&icn reports 
77. Assessment of the programme will be provided in two reports: 
an evaluation report during the third year of this programme to the Council, 
The European Parliament, the Economic and Social Comittee, and the 
Committee of the regions. The purpose of this report is to ensure that the 
Community institutions and5 through them, all the parties concerned, are kept 
fully informed on the progress of the actions undertaken in the context of this 
action plan; 
a final report on the implementation of the programme, which will include an 
evaiustion of the actions undertaken, will be submitted to the abovementioned 
institutions by the Commission after the completion of the programme. 
General information activities 
78. In addition to the information activities contained in the programme, the 
Commission will ensure that the general public and all parties concerned have access 
to reports on the actions, studies, and assessments undertaken. 
21 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action from 1999 to 2003 
on injury prevention in the context of the framework for action 
in the field of public health 
22 
EXPLANATORY MEMORANDUM 
1. In its Communication COM(93) 559 of 24 November 1993 on the framework for 
action in the field of public health, the Commission outlined the principles and 
strategy to be followed in undertaking Community activities directed towards the 
attainment of the objectives on health protection laid down in Articles 3(o) and 129 
of the Treaty establishing the European Community. The role of the Community is 
identified as underpinning the efforts of the Member States in the public health field, 
assisting in the formulation and implementation of objectives and strategies, and 
contributing to the provision of health protection across the Community, setting as 
the target the best results already obtained in a given area anywhere in 
the Community. 
2. In accordance with Article 129, the Commission presents proposals for the adoption 
by the European Parliament and the Council of incentive measures intended to 
contribute towards ensuring a high-level of human health protection. The 
aforementioned Commission Communication sets out criteria on which to determine 
priority areas for Community action programmes. In accordance with these criteria, 
injury prevention was identified as such a priority area. The present Commission 
proposal, based on Article 129 and already announced in the Commission's annual 
programme of work, comes under the principle of shared competence between the 
Community and the Member States, and seeks to promote public health by 
contributing to actions which reduce the incidence of injury. 
3. Injury is a broad concept which in principle covers, according to internationally 
accepted definitions, all kinds of ill-health resulting from external causes 
(as opposed to disease processes), for example impacts, burns, poisoning, bites and 
stings and crushing, and without distinction as to the cause of the external event: 
deliberate self-harm, deliberate harm by another person, lawful or not, or accidental. 
The present Commission proposal targets a small number of key areas within this 
broad field, selected on the basis that they are an important cause of avoidable injury 
and death, are not already addressed by action at Community level, present 
opportunities for cost-effective intervention, and would deliver Community added 
value by bringing together and complementing work done at national and 
sub-national level. 
4. The target areas selected are home and leisure accidents to children, young adults 
and elderly people, and accidents to children while at school, and also the topic of 
suicide and lesser forms of deliberate self-harm (sometimes called parasuicide). This 
selection of fields is amply justified by the criteria just mentioned and tackles all the 
classes of injury which are the most substantial sources of death, disability and 
ill-health, apart from occupational injury and road traffic accidents, which are 
already addressed by other Community activities. For example, data collected by 
Ireland's Hospital In-Patient Enquiry System show that the categories selected here 
cover three-quarters of all injuries which led to in-patient admission in that country 
in 1993. 
23 
The incentive measures proposed are of two kinds. The first is support for the 
sharing - and shared development - of expertise, particularly in the selection of 
interventions and the epidemiology of injury. An enormous amount of experience 
and ability exists in injury prevention in the Member States, but it is spread unevenly 
and practitioners are at times largely unaware of the experience of others. Measures 
to share existing best practices will help to spread more widely the best results 
already obtained anywhere in the Community. When a Member State's incidence of 
injuries is higher than the lowest national rate of any Member State of the 
Community, the excess injuries could reasonably be called avoidable and this 
proposal would help to transfer necessary expertise to assist in reducing such 
avoidable injury. 
The second kind of incentive measure proposed is encouraging improvement in the 
quality of data. Data are vital to injury prevention as they allow epidemiological 
investigation of what situations, products, behaviours, and places are dangerous. 
Whereas the epidemiology of many diseases is increasing better established in the 
Community, the data needed to support a proper epidemiology of injury are gravely 
lacking, and as a result it is correspondingly hard to target scarce resources to the 
most productive prevention activities. At a Community level, better data would be a 
powerful tool in the hands of those planning prevention who could use them to 
identify, for instance, whether or not their national or regional burden of sports or 
cycling injuries was significantly worse than neighbouring countries, and if so in 
what ways, thereby suggesting areas for attention. 
Community action under this proposal would take the form of encouraging and 
supporting the creation of networks, dissemination of information about prevention 
campaigns, work on improving data including surveys and technical investigations. 
Suitable opportunities could also arise for helping Member States to coordinate 
their policies and programmes in the way envisaged in Article 129 of the Treaty 
establishing the European Community. 
Evidence is mounting that injury prevention measures can be both effective and 
cost-effective, particularly those so-called "passive" prevention measures which 
create a safer environment as opposed to training people to live more safely in 
environments which remain potentially dangerous. However, not all interventions 
work equally well and the value of the Commission's proposal is that it would help 
publicize those which have been found to work best and communicate their 
underlying principles to those in other Member States who wish to adopt 
similar measures. 
The European Parliament has long shown an interest in actions at community level 
to prevent injury, and the present proposal responds specifically to its Resolution on 
public health policy after Maastricht which contained a specific call for activities on 
accident prevention. Actions on injury prevention also respond to the priorities 
expressed by the Council in the field of public health such as the need to select areas 
for action with regard to their amenability to preventive action. 
24 
10. This programme can only be undertaken on the basis of a European Parliament and 
Council decision pursuant to Article 129. It does not come under the exclusive 
competence of the Community and does not seek or require the harmonization of 
national provisions in the field covered. 
11. The actions to be implemented under the proposed programme will yield added 
value in a number of different ways: 
(1) they will allow activities already undertaken in relative isolation at national 
level to be brought together and complement one another with significant 
results for the Commumty as a whole, such as the widespread dissemination of 
good practice previously confined to one region, the more rational and 
effective division of labour in technical fields and the preparation of 
Community-wide comparable data; 
(2) they will contribute to the strengthening of solidarity and cohesion in the 
Community and contribute to its overall harmonious development by helping 
regions where injury is most prevalent to benefit from the experience of 
regions where more attention has already been given to injury prevention; and 
(3) they will lead, where the need is recognized, to the establishment of 
best-practice norms and standards. 
12. An evaluation of the actions implemented under the programme will be provided in 
two reports: 
during the third year of the programme, an evaluation report; 
a final report on the implementation of the programme. 
These reports will incorporate information on Community financing in the various 
fields of action as well as the results of evaluations. They will be transmitted to the 
Council and the European Parliament, as well as to the Economic and Social 
Committee and the Committee of the Regions. 
25 
Proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting a programme of Community action from 1999 to 2003 
on injury prevention in the context of the framework for action 
in the field of public health 
THE EUROPEAN PARLIAMENT AND THE COUNCIL OF THE 
EUROPEAN UNION, 
Having regard to the Treaty establishing the European Community, and in particular the 
first indent of Article 129(4) thereof, 
Having regard to the proposal from the Commission36, 
Having regard to the opinion of the Economic and Social Committee37, 
Having regard to the opinion of the Committee of the Regions38, 
Acting in accordance with the procedure referred to in Article 189b of the Treaty39, 
1. Whereas injuries should be considered one of the major health scourges referred 
to in Article 129 throughout the Community and are a cause of substantial 
public concern; 
2. Whereas, in accordance with point (o) of Article 3 of the Treaty, Community action 
shall include a contribution to the attainment of a high level of health protection; 
3. Whereas Article 129 expressly provides for Community competence in this field, by 
encouraging cooperation between the Member States and, if necessary, lending 
support to their action; promoting coordination of their policies and programmes, 
and fostering cooperation with third countries and international organizations 
competent in the sphere of public health; whereas Community action should be 
directed towards the prevention of diseases, and the promotion of health education 
and information; 
4. Whereas the Resolution of the Council and the Ministers for Health, meeting within 
the Council of 27 May 1993 on future action in the field of public health40, affirmed 
the need for Community action aiming at adding life to years and years to life and 
selection of areas for such action with regard to their amenability to 
preventive action; 
OJNo 
OJNo 
OJNo 
OJNo 
OJNoC 174, 25.6.1993, p. 1. 
26 
5. Whereas the European Parliament, in its Resolution on public health policy after 
Maastricht of 19 November 199341 called on the Commission to develop and 
execute activities on accident prevention; 
6. Whereas the Commission, in its Communication of 24 November 1993 on the 
Framework for Action in the Field of Public Health42, identified intentional and 
unintentional injuries and accidents as a priority area for action in the public 
health field; 
7. Whereas the European Parliament and the Council, in their Decision 3092/94/EC4\ 
introduced a Community system of information in home and leisure accidents with 
which this Decision should be closely coordinated; 
8. Whereas, in accordance with the principles of subsidiarity and proportionality laid 
down in Article 3b of the Treaty, action on injury prevention should be undertaken 
by the Community only if and in so far as, by reason of its scale or effects, it may be 
better achieved at Community level; whereas this programme will yield a 
Community-added value by bringing together activities already undertaken in 
relative isolation at national level and by complementing one another with significant 
results for the Community as a whole, by contributing to the strengthening of 
solidarity and cohesion in the Community and by leading, where the need is 
recognized, to the establishment of best-practice norms and standards. 
9. Whereas cooperation with the international organizations competent in the field of 
public health and with third countries should be fostered; 
10. Whereas, by providing support for acquiring better knowledge and understanding 
of, and wider dissemination of information about, injury prevention, ensuring 
improved comparability of information in this field and by developing actions 
complementary to existing Community programmes and actions, while avoiding 
unnecessary duplication, the programme will contribute to the achievement of the 
Community objectives set out in Article 129; 
11. Whereas, in order to increase the value and impact of the programme, a continuous 
assessment of the actions undertaken should be carried out, with particular regard to 
their effectiveness and the achievement of the objectives set and with a view, where 
appropriate, to making the necessary adjustments; 
12. Whereas this Decision lays down a financial framework constituting the 
principal point of reference, within the meaning of point 1 of the Declaration of the 
European Parliament, the Council and Commission of 6 March 199544, for the 
budgetary authority during the annual budgetary procedure; 
13. Whereas the Community's financial perspective is valid up to 1999 and will have to 
be revised for the period beyond that date; 
•il OJ No C 329, 6.12.1993, p. 375. 
COM(93) 559 final of 24 November 1993. 
OJ No L 3.11, 21.12.1994, p. 1. 
OJNoC 102,4.4.19%, p. 4. 
27 
14. Whereas this programme should be of five-year duration in order to allow sufficient 
time for actions to be implemented to achieve the objectives set, 
HAVE DECIDED AS FOLLOWS 
Article 1 
Establishment of the programme 
1. A programme of Community action on injury prevention, hereinafter referred to 
as "the Programme", is hereby adopted for the period 1 January 1999 to 
31 December 2003 in the context of the framework for action in the field of 
public health. 
2. The aim of the Programme is to contribute to public health activities which seek to 
reduce the incidence of injury, by promoting the more effective dissemination and 
application of prevention techniques whose worth is widely accepted by experts, 
and by helping to strengthen the general capacity of public health bodies to mount 
effective injury prevention activities. 
3. The actions to be implemented under the Programme and their specific objectives 
are set out in the Annex. 
Article 2 
Implementation 
1. The Commission shall ensure implementation, in close cooperation with the 
Member States, of the actions set out in the Annex. 
2. The Commission shall cooperate with institutions and organizations active in the 
field of injury prevention. 
Article 3 
Budget 
1. The financial framework for the implementation of the Programme for the year 1999 
shall be ECU 1.3 million, in keeping with current financial perspectives.The financial 
framework for the final four years of the programme (2000-2003) shall be 
determinated in detail after the establishment of the future financial perspectives. 
2. The annual appropriations shall be established by the Budgetary Authority in 
accordance with the current financial perspectives. 
28 
Article 4 
Consistency and complementarity 
The Commission shall ensure that there is consistency and complementarity between the 
Community actions to be implemented under the Programme and those implemented 
under other relevant Community programmes and actions. 
Article 5 
Committee 
1. The Commission shall be assisted by an advisory committee, hereinafter referred to 
as "the Committee", consisting of representatives of the Member States, and chaired 
by the Commission representative. 
The representative of the Commission shall submit to the Committee a draft of the 
measures to be taken. 
The Committee shall deliver its opinion on the draft, within a time limit which the 
chairperson may lay down according to the urgency of the matter, if necessary by 
taking a vote. 
The opinion shall be recorded in the minutes; in addition, each Member State shall 
have the right to ask to have its position recorded in the minutes. 
The Commission shall take the utmost account of the opinion delivered by the 
Committee. It shall inform the Committee on the manner in which its opinion has 
been taken into account. 
2. The Committee shall be consulted, in particular on: 
(a) the criteria and procedures for selecting and financing projects under 
this programme; 
(b) the evaluation procedure. 
3. The representative of the Commission shall keep the Committee regularly informed 
about Commission proposals or Community initiatives and the implementation of 
programmes in other policy areas which are relevant to the achievement of the 
objectives of this programme. 
Article 6 
International cooperation 
1. In the course of implementing the Programme, cooperation with third countries and 
with international organizations competent in the field of public health shall 
be fostered. 
29 
2. The Programme shall be open to participation by the associated countries of 
Central and Eastern Europe, in accordance with the conditions laid down in the 
Association Agreements or Additional Protocols related thereto concerning 
participation in Commumty programmes. The Programme shall be open to 
participation by Cyprus and Malta on the basis of additional appropriations in 
accordance with the same rules as those applied to the EFTA countries, in 
accordance with procedures to be agreed with those countries. 
Article 7 
Monitoring and evaluation 
1. In the implementation of this Decision, the Commission shall take the necessary 
measures to ensure the monitoring and continuous evaluation of the Programme, 
taking account of the general and specific objectives referred to in Article 1 and in 
the Annex. 
2. During the third year of the Programme, the Commission shall present an evaluation 
report to the European Parliament and the Council. 
3. The Commission shall submit to the European Parliament and the Council a final 
report on completion of the Programme. 
4. The Commission shall incorporate into those two reports information on 
Community financing in the various fields of action and on complementarity with the 
other actions referred to in Article 4, as well as the results of the evaluations. It 
shall also send them to the Economic and Social Committee and the Committee of 
the Regions. 
Done at Brussels, 
For the European Parliament For the Council 
The President The President 
30 
ANNEX 
SPECIFIC OBJECTIVES AND ACTIONS 
I. ACCIDENTS TO CHILDREN, YOUNG ADULTS AND 
ELDERLY PEOPLE45 
Objective: to contribute to public health activities which aim at reducing 
the incidence of injury from home, leisure and school 
accidents, by promoting the more effective dissemination and 
application of prevention techniques whose worth is widely 
accepted by experts 
II. SUICIDE 
Objective: to contribute to public health activities which aim at 
reducing the incidence of injury from deliberate self-harm, by 
promoting the more effective dissemination and application 
of prevention techniques whose worth is widely accepted 
by experts 
III. INJURY PREVENTION CAPACITY 
Objective: to contribute to the strengthening of public health bodies' 
capacity to mount effective injury prevention activities. 
Actions to be undertaken in support of each of these objectives: 
(Actions may relate to more than one objective: for example a project on safety in sport 
might affect childre, young adults and older people.) 
1. Networks: encouraging and assisting the creation of networks, dedicated in 
particular to: development of new approaches or innovative methods of tackling 
common problems, exchanges of materials, guidelines and handbooks, 
organization of training activities. 
2. Campaigns: supporting the dissemination of information about campaigns; 
including the development of a bank of information on the campaigns that have 
been carried out, with, if possible assessments of their value, effects and 
transferability, and organization of competitions to identify the best injury 
prevention campaigns; promoting where appropriate the organization of parallel 
campaigns in a number of Member States: assisting the development of basic 
materials and publicity. 
The Community action in the field of civil protection is excluded from this programme 
(cf. in particular Ihc proposal for a Council Decision establishing a Community action programme 
in the field of civil protection COM(95) 155 final). 
31 
3 Data about injuries: in conjunction with EHLASS promoting agreed approaches to 
coding, data definitions, better recording of place of occurrence, as well as on 
behavioural aspects and on chain of events, more precision in cause of death 
certification, the use of relevant severity scales and minimum data sets; supporting 
the application of relevant results of the International Collaborative Effort on 
Injury Statistics; examination of the coverage of existing data collection system 
and where necessary development of measures to improve such coverage inclusion 
of additional questions or modules in existing Community-wide surveys; assistance 
in identifying the need for surveys; promoting the creation of a database of 
known surveys. 
4. Technical investigations of injury risk factors: promoting collaboration between 
institutions with specialized knowledge and facilities able to undertake such 
activities; supporting the development of an inventory of institutions and their 
projects, and evaluations of prevention projects and campaigns. 
5. Consultation and cooperation: support for formal and informal meetings at 
different levels of government, conferences and seminars, working groups and 
advisory groups. 
in addition, the following actions will support objective III: 
6. Activities to increase the use which public health bodies can make of other 
Community policies for injury prevention: raising awareness of Community 
programmes and the conditions for participation in them, helping to set up 
consortia across national boundaries and helping groups with a particular interest 
to discover the most useful interlocutors in Community institutions. 
32 
FINANCIAL STATEMENT 
1; TITLE OF OPERATION 
Proposal for a European Parliament and Council Decision adopting a programme 
of Community action from 1999 to 2003 on injury prevention in the context of the 
framework for action in the field of public health 
2. BUDGET HEADING INVOLVED 
B3-
3. LEGAL BASIS 
Article 3(o) and Article 129 of the Treaty establishing the European Community. 
4. DESCRIPTION OF OPERATION 
4.1 General objective 
To contribute to achieving the objectives laid down by the Treaty: 
under Article 3 (o), the Community is required to make a contribution to 
the attainment of a high level of health protection; 
Article 129 requires the Community to contribute towards ensuring a high 
level of human health protection, in particular by encouraging cooperation 
between the Member States, and if necessary lending support to their 
action, promoting coordination of their policies and programmes, and 
fostering cooperation with third countries and the competent international 
organizations in the sphere of public health. Community action is directed 
towards the prevention of diseases, in particular major health scourges, by 
promoting research into their causes and their transmission, as well as 
health information and education. 
The general objective of the action programme is to contribute to public health 
activities which aim at reducing the incidence of injury from home, leisure and 
school accidents and from deliberate self-harm, by promoting the more effective 
dissemination and application of prevention techniques whose worth is widely 
accepted by experts, and by contributing to the strengthening of public health 
bodies' general capacity to mount effective injury prevention activities. 
33 
The method for achieving this objective consists of undertaking actions which: 
encourage and assist the creation of networks of those active in 
injury prevention; 
disseminate information about injury prevention campaigns; 
improve the available data about accidents by means of surveys 
and otherwise; 
promote better technical investigations of injury risk factors through 
greater collaboration between expert centres; 
foster consultation and cooperation where appropriate between 
Member States; and 
help public health bodies to make better use of other Community policies 
to assist with injury prevention. 
4.2 Period covered and arrangements for renewal or extension 
five years: 1 January 1999 to 31 December 2003 
Report on implementation to be transmitted to the Council and European 
Parliament during the third year of the programme 
Report to the Council and European Parliament after completion of the 
programme together with the results of evaluations. 
5. CLASSIFICATION OF EXPENDITURE OR REVENUE 
Non-compulsory expenditure 
Differentiated appropriations 
6. TYPE OF EXPENDITURE OR REVENUE 
Subsidy for joint financing with other sources in the public and/or private sector 
(not exceeding a certain percentage of the total cost of the proposed projects). 
The level of funding granted depends on the scope of the measure to be financed 
and on the extent to which the action programme is reflected in the various 
activities planned. Such funding will not exceed 70% of the total budget 
earmarked for the proposed projects except in the case of networks and work 
ordered and of direct use to the Commission, where the subsidy may amount 
to 100%. 
34 
7. FINANCIAL IMPACT 
7.1 Method of calculating the total cost of operation (definition of unit cost) 
The method of calculation is the result of experience acquired in previous 
activities related to public health activities. This encompasses the various types of 
Community action listed in Table 4 of Commission Communication 
COM(93) 559 final of 24 November 1993, and represents ten years of know-how 
in financing cooperative efforts with the Member States and NGOs of collection, 
analysis and dissemination of information, setting up of networks, survey of the 
quality of campaigns such as European weeks, establishment of mechanisms and 
procedures of consultation and cooperation for setting common objectives and for 
policy coordination and for the formulation and development of strategies at the 
Community level. The specific cost estimates are based on the assumption that half 
of the activities to be undertaken under this programme will require 100% funding 
while the other half will require 50% funding and that the activities to be 
undertaken will involve most or all of the Member States. An amount of 
ECU 1.3 million is deemed necessary for the implementation of these activities for 
the year 1999. The new budget framework for the final four years will be 
established in the year 2000 taking into account the future Community's financial 
perspectives. The annual allocations will be decided in accordance with the normal 
budgetary procedures. 
7.1.1 Reduction in accidents 
Networks 
In 1999 the running of three networks per year has been scheduled at an average 
cost of ECU 200 000 per year. 
Dissemination of information 
Being a new action estimated cost has been calculated from the experience of 
other already existing programmes in public health (cancer, Aids and 
communicable diseases, drugs, health promotion) and its cost (ECU 100 000 
per year). 
7.1.2 Suicide 
Networks 
In 1999, the running of one network per year has been scheduled at an average 
cost of ECU 200 000 per year. 
35 
Dissemination of network 
Being a new action estimated cost has been calculated from the experience 
of other already existing programmes in public health (cancer, Aids and 
communicable diseases, drugs, health promotion) and its cost 
(ECU 100 000 per year). 
Improving data about suicide 
Being a new action, the estimated cost of ECU 200 000 has been 
calculated from the experiences of EUROSTAT and, the EHLASS system 
on home and leisure accident. 
7.1.3 Prevention Capacity 
Support to at least two country events per year at ECU 50 000 (with special 
relevance in 1999) when lauching the programme. 
7.2 Itemized breakdown of cost (in ECU million) 
H~ OBJECTIVE 
1 Contribute to reduction 
! in accidents to children, 
young adults and 
elderly people 
Contribute to reduction 
in the incidence of 
suicide 
1 
I Contribute to 
strengthening injury 
prevention capacity ACTION AREA 
encouraging and assisting the creation of networks; 
disseminating information about campaigns; improving 
data about accidents; technical investigations of injury risk 
factors; consultation and cooperation; 
encouraging and assisting the creation of networks; 
disseminating information about campaigns; improving 
data about accidents; technical investigations of injury risk 
factors; consultation and cooperation; 
encouraging and assisting the creation of networks; 
disseminating information about campaigns; improving 
data about accidents; technical investigations of injury risk 
factors; consultation and cooperation; 
activities to increase the use which public health bodies 
make of other Community policies to assist with injury 
prevention 
Total YEARS | 
1999 | 2000 2001 | 2002 2003 Total I 
Indicative programming | 
0.7 
0.4 
0.1 
0.1 
1.3 -
pm -
pm -
pm -
pm 0.7 | 
0.4 
0.1 
0.1 
1.3 1 
37 
7.3 Indicative schedule of appropriations (in ECU million) 
Commitment 
appropriations 
Payment 
appropriations 
1999 
2000 
2001 
2002 
2003 
Subsequent years 
TOTAL 1999 
1.3 
0.78 
0.52 
-
-
-
-
1.3 2000 
-
-
-
-
-
-
-
pm 2001 
-
-
-
-
-
-
-
pm 2002 
-
-
-
-
-
-
pm 2003 
-
-
-
-
-
-
pm TOTAL 
1.3 
0.78 
0.52 
-
-
-
-
1.3 
8. FRAUD PREVENTION MEASURES; RESULTS OF MEASURES TAKEN 
The grant application forms will require information on the identity and nature of potential 
beneficiaries so that their reliability can be assessed in advance. 
Fraud prevention measures (checks, intermediate reports, final report) are included in the 
agreements or contracts between the Commission and beneficiaries. The Commission will 
check reports and ensure that work has been properly carried out before intermediate and 
final payments are made. 
In addition, spot checks are carried out by the Commission to verify how funds have been 
used. Checks have already been carried out in other public health budget lines in relation 
to the financial years 1991 to 1995 and have shown their effectiveness. 
9. ELEMENTS OF COST-EFFECTIVENESS ANALYSIS 
9.1 Specific and quantifiable objectives; 
The general objective of the action programme is to contribute towards ensuring a 
high level of health protection against injury by promoting the more effective 
dissemination and application of prevention techniques whose worth is widely 
accepted by experts, and by helping to strengthen public health bodies' general 
capacity to mount effective injury prevention activities. 
The indicators showing whether or not targets are achieved in this field will include 
measures of the following kinds. These will be refined further in collaboration with 
the new programme on health monitoring, whose tasks include the development of 
indicators for Community public health policies. The method for achieving this 
objective consists of undertaking actions which: 
encourage and assist the creation of networks of those active in 
injury prevention; 
38 
measure how active the networks are (membership, production of 
e.g. information bulletins, conferences, WWW discussion groups...), 
disseminate information about injury prevention campaigns (e.g. surveys of 
number and quality of publications assisted by the programme); 
improve the available data about accidents by means of surveys and 
otherwise (e.g. what new measures are brought into use and in 
what countries); 
promote better technical investigations of injury risk factors through 
greater collaboration between expert centres (number and quality of such 
reports assisted by the programme); 
foster consultation and cooperation where appropriate between Member 
States, (description of cases of such consultation etc.); and 
help public health bodies to make better use of other Community policies 
to assist with injury prevention (numbers and description). 
Target Population 
1. Competent public authorities of the Member States, at national, regional 
and local level and competent international organizations in the spheres of 
public health and injury prevention; 
2. Health professionals, health epidemiological services, health and medical 
associations, specialists in the prevention of different kinds of injury, 
academic institutions, etc; 
3. NGO's and other bodies interested in health matters and injury prevention, 
and the public in general. 
9.2 Grounds for the operation 
In initiating action under Article 129, the Community has to address itself to 
preventing diseases and protecting health. The Commission's communication on 
the framework for action in the field of public health (COM(93) 559 final of 
24 November 1993) sets out criteria on which to determine priority areas for 
Community programmes. In accordance with these criteria, the 1993 "framework'1 
Communication evaluated the different options for addressing diseases, in 
particulai- major scourges and their underlying causes, by various types of 
community actions and retained on the basis of criteria listed in that 
communication, eight priority areas of which injury prevention was one. 
39 
The present proposal targets a small number of key areas within this broad field, 
selected on the basis of ex ante evaluation that they are an important cause of 
avoidable injury and death, are not already addressed by action at Community 
level, present opportunities for cost-effective intervention, and would deliver 
Community added value by bringing together and complementing work done at 
national and sub-national level. This would be substantially more effective than 
leaving such questions to inter-governmental cooperation without a Community 
contribution: in this field the input envisaged for the Community and the 
Commission by Article 129 provides a clear common framework of rules, avoiding 
open-ended and time-consuming negotiation, allowing more rapid progress on a 
firmer footing. 
The target areas selected are home and leisure accidents to children, young adults 
and elderly people, and accidents to children while at school, and also the topic of 
suicide and lesser forms of deliberate self-harm (sometimes called parasuicide). 
This selection of fields has been amply justified by ex ante evaluation using the 
criteria just mentioned and tackles all the classes of injury which are the most 
substantial sources of death, disability and ill-health, apart from occupational injury 
and road traffic accidents, which are already addressed by other 
Community activities. 
As regards the intervention methods and the allocation of funds, the following 
will apply: 
specific application of the principle of subsidiarity when identifying 
measures to be undertaken and co-financed; 
identification and selection of projects for co-financing in the fields of 
injury prevention; 
the concept of added Community value, which will continue to be realised 
in particular through the coordination of national measures, the 
dissemination of information and experiences, the establishment of 
priorities, the development of networking as appropriate, selection of 
European projects and the motivation and mobilisation of all involved. 
Two methods will be employed to implement the programme. One is to support 
projects carried out in Member States and at the Community level. The selection 
of priority projects is based largely on general and intermediate objectives, and 
implementation of the measures themselves depends on the quality and 
effectiveness of projects submitted to the competent department during the course 
of the year. The other is to undertake specific activities necessary to achieve the 
objectives of the programme, which will be fully financed by the programme. 
40 
The selection criteria for projects are as follows: 
Compatibility with the objectives and conformity with at least one of the 
established objectives; 
Examination of the "added Community value" of the projects (transnational 
participation, development of a model applicable in other Member States, 
information usable in other Member States, etc.); 
Presumed effectiveness and value; 
Clarity and justification of requirements; 
Relevance of selected methodology; 
Organizational competence and experience; 
Suitability of budget for objectives; 
Support for projects from national partners; 
Objective assessment; 
Opinion of the advisory committee involved. 
The budget proposed of ECU 1.3 million for the first year of this programme, 
matches that proposed at the same time for the programmes on rare diseases and 
on pollution-related diseases. This reflects the equal priority attached to each field 
in the Commission's 1993 Communication, an evaluation which remains valid 
today. The amount proposed represents the bare minimum required to start 
the programme. 
9.3 Monitoring and evaluation of the operation 
9.3.1 Monitoring of the operation 
Monitoring at the Community level is to be carried out by the Commission, which 
will submit a report half-way through the implementation of the programme, and a 
final report after its completion to the Council, the European Parliament, the 
Economic and Social Committee, and the Committee of the Regions, drawing 
from national reports as well as evaluations of the actions under the programme 
and of individuals projects. 
41 
9.3.2 Evaluation 
Evaluation will be by means of: 
An evaluation of the main measures and of subsidised projects involving, 
where necessary, the participation of independent experts; 
An evaluation report during the third year; 
An overall report on the quality and effectiveness of projects implemented 
under the action plan, to be submitted by the Commission to the other 
Commumty institutions after completion of the programme. 
Performance indicators selected for this evaluation: 
Evaluation of projects by Commission officials and/or those cooperating 
with them; 
Analysis of intermediate reports on measures scheduled and financed, 
allowing a shifting of emphasis where possible; 
Impact studies by external bodies; 
Relevance of the methodology used by organizers; 
Suitability of the budget for the objectives; 
Skills and experience of bodies; 
Dissemination of results. 
Evaluation procedures and intervals. 
Drawing up of intermediate and final reports on the various measures 
undertaken in the field; 
Development of a "standard" evaluation form for the measure, to be 
forwarded by the beneficiaries with their final reports, and checking of 
these documents by officiais either at the Commission or in the field. 
10. ADMINISTRATIVE EXPENDITURE (PART A OF THE BUDGET) 
Actual mobilization of the necessary administrative resources will be conditioned 
by the Commission's annual decision on the allocation of resources, having regard 
in particular to additional staff and funds provided by the budgetary authority. 
42 
10.1 Impact on the number of employees 
Types 
employees of 
1 . 
| Officials or 
temporary 
agents A 
B 
C 
Other resources 
Total staff carrying out action 
permanent 
employees 
1 
1 
1 
3 temporary 
employees 
0 
0 
0 
0 source of employee 
from within 
DGor 
service 
1 
1 
1 
3 supplementary 
staff 
0 
0 
0 
0 duration 
10.2 Financial impact of supplementary staff 
No supplementary staff are envisaged. 
10.3 Increase in other running costs arising from the action 
Budget line Amounts Method of calculation 
Meetings A2510 ECU 104 250 2 meetings of advisory committee/year, 
1 representative/Member State = 
2 meetings/year x 15 reprs x ECU 695/repr x 5 years = 
ECU 104 250 
The resources necessary to cover the expenditure below for the five-year period will be 
obtained by re-deployment of existing financial resources and the use of supplementary 
resources will not be required. 
(a) Personnel Expenses (Title Al, A2 and A5) 
3 x ECU 100 000 x 5 years = ECU 1 500 000 
(b) Operational Expenses 
Expenses for meetings (A-250) 
2 meetings/year x 15 experts x ECU 825/expert x 5 years = ECU 123 750 
Expenses for travel (A-l 30) 
24 missions/year Brussels-Luxembourg x 200 ecus/mission x 5 years = 
ECU 24 000 
60 missions/year to Member States x ECU 1 000/mission x 5 years = 
ECU 300 000 
(c) Total: ECU I 947 750 
43 

ISSN 0254-1475 
COM(97) 178 final 
DOCUMENTS 
EN 04 05 15 01 
Catalogue number : CB-CO-97-189-EN-C 
ISBN 92-78-19432-8 
Office for Official Publications of the European Communities 
L-2985 Luxembourg