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
Date: 1997-05-14
Institutions: European Commission
Subjects: EU programme, disease prevention, exchange of information, health policy, public health

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 

II. 

PREVENTING  ACCIDENTS AND INJURIES 

ill.  OVERVIEW OF MEASURES TAKEN IN MEMBER  STATES 

AND BY INTERNATIONAL  ORGANIZATIONS 

IV.  OVERVIEW OF CURRENT ACTIVITIES OF THE 

EUROPEAN  COMMUNITY 

V.  THE NEED 7CR ADDITIONAL PUBLIC HEALTH ACTIONS AT 

COMMUNITY LEVEL 

PROPOSED ACTIONS FOR A FIVE-YEAR PROGRAMME 

CONSULTATION  ASSESSMENT AND REPORTS 

4 

5 

9 

13 

Î6 

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. 

the  prevention  of 

In  keeping  with  Article  129's  focus  on  the  "major  health  scourges",  one  of  the 
intentional  and 
is 
Commission's  stated  priority  areas 
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. 

7. 

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. 

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 

at 

of 

the 

those 

altering 

behaviour 

is  often  drawn 

important  distinction 

in  accident  prevention  between 
"active prevention"- 
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). 

risk, 

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, 
inflicted  by 
stressed parents. 

lack  of  supervision  and  even  deliberate 

injuries 

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 
is  Consumer  Affairs  Ministries  and 
it 
Governmental  agencies.  Frequently, 
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 
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. 

to  extend 

3 
4 

5 

COM(95) 282 final of 12 July 1995. 
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. 
OJ No C 317, 28.11.1995. 

Transport 

30. 

the  enforcement  of  driving 

In  the  road  traffic  field,  current  activities  cover  roadworthiness  tests,  speed 
limitation  devices  in  lorries  and  buses,  introduction  of  new  standards  for  driving 
tests,  and  development  of  new 
licence  theoretical,  practical  and  medical 
equipment for 
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. 

time 

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 
7 
8 
9 
10 
11 

Council Decision 93/704/EC, OJ No L 329, 30.12.1993. 
OJ No L 320, 30.12.1995. 
OJ No L  145, 19.6.1996, OJ No L 235, 17.9.1996. 
OJNoL  109,26.4.1986. 
OJ No L 331, 21.12.1994. 
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 
from  17  EC  and  EFTA 
Member States. It is known as ANEC. 

the  standardization  process 

in 

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 
13 

14 
15 
! 6 
17 

18 
19 

Council Directive 89/106/EEC of 21 December  1988, OJ No L 40.  11.2.1989. 
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. 
OJ No L 243. 11.10.1995. 
COM(95) 491 final  of 23 October 1995. 
COM(94)  109 final of 4 July  1994. 
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. 
COM(95) 88 final  of  15 May  1995. 
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 
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. 

the  need 

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 

21 
22 
23 
24 
25 
26 
27 
28 

29 

84/466/Euratom,  OJ  No  L  265,  5.10.1984.  The  proposal  for  revision  is  to  be  found  in 
COM(95) 560. 
80/836/ Euratom, 89/618/ Euratom, 96/29/ Euratom,  OJ No L  159, 29.5.1996. 
Directive 96/56/EC, OJ No L 236,  18.9.1996 and Directive 96/54/EC, OJ No L 248, 30.9.19%. 
OJNoC  174,23.7.1986. 
OJ No C 329, 31.12.1990. 
OJ No C 304, 23.11.1991. 
Resolution of 27 May  1993, OJ No C  174, 25.6.1993. 
OJ No C  165, 17.6.1994. 
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). 
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) 

(b) 

the topic should be a substantial cause of mortality or morbidity, or a cause of 
mortality or morbidity whose rate of increase causes concern; 

the  proposed  measures  should  not  duplicate  other  work  already  under  way, 
and where existing work is relevant they should be coordinated with it; 

30 
31 
32 

OJ No C  124, 21.5.1990. 
OJ No C 62,  12.3.1990. 
OJ No C 388, 31.12.1994. 

13 

(c) 

(d) 

there should be grounds to believe the proposed  means will be  cost-effective; 
and 

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 
its  overall 
social cohesion 
harmonious development. 

the  Community,  and  promote 

in 

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) 
(b) 
(c) 
(d) 
(e) 

home, leisure and school accidents to children; 
home and leisure accidents to young adults; 
home and leisure accidents to elderly people; 
suicide; 
injury prevention capacity. 

The category of leisure would include giving due emphasis to sports injuries. 

52. 

53. 

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. 

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 
technical 
investigations,  improving  the  quality  of  data  and  helping  Member  States  to 
coordinate policies and programmes. These are discussed below. 

information  on  campaigns,  supporting  surveys  and 

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 
to  undertake 

organizations  or  combinations  of  Member  State 
networking actions of various types. 

institutions 

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 
institutions 
will also  promote  conferences  and  exchanges  between 
and programmes. 

such 

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 
the 
Community  shall  encourage  cooperation  between  Member  States  and 
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 

the 

leisure  pursuits, 

inclusion  of  more  general  safety 

72.  Areas  particularly  suitable for  work  under this heading  include  coaching  for  sports 
and 
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. 

information 

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  the  programme,  the 
In  addition  to  the  information  activities  contained 
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. 

2. 

3. 

4. 

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. 

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. 

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. 

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 
preventive action; 

their  amenability 

to 

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 

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; 

lays  down  a  financial  framework  constituting 

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. 

1. 

2. 

1. 

Article 2 
Implementation 

The  Commission  shall  ensure  implementation,  in  close  cooperation  with  the 
Member States, of the actions set out in the Annex. 

The  Commission  shall  cooperate  with  institutions  and  organizations  active  in  the 
field  of injury  prevention. 

Article 3 
Budget 

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 
thereto  concerning 
Association  Agreements  or  Additional  Protocols  related 
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. 

4. 

The  Commission  shall  submit  to  the  European  Parliament  and  the  Council  a  final 
report on completion of the Programme. 

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 

The President 

For the Council 

The President 

30 

ANNEX 

SPECIFIC  OBJECTIVES AND ACTIONS 

I. 

ACCIDENTS 
TO 
ELDERLY  PEOPLE45 

CHILDREN, 

YOUNG 

ADULTS 

AND 

Objective: 

incidence  of 

to contribute to public health activities which aim at  reducing 
the 
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. 

2. 

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. 

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 

4. 

5. 

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. 

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. 

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) 

listed 

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 
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 
(cancer,  Aids  and 
communicable  diseases,  drugs,  health  promotion)  and  its  cost  (ECU  100 000 
per year). 

in  public  health 

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 

ACTION AREA 

YEARS 

1  Contribute to reduction 
! in accidents to children, 

young adults and 
elderly people 

encouraging  and  assisting  the  creation  of  networks; 
disseminating  information  about  campaigns;  improving 
data about accidents; technical investigations of injury risk 
factors; consultation and cooperation; 

1999  |  2000 

2001  |  2002 

2003 

Total 

Indicative programming 

Contribute to reduction 
in the incidence of 
suicide 

1 

I Contribute to 

strengthening  injury 
prevention capacity 

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 

0.7 
0.4 

0.1 

0.1 

-

-

-

-

0.7 
0.4 

0.1 

0.1 

| 

I 
| 

| 

Total 

1.3 

pm 

pm 

pm 

pm 

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 

2000 
-

2001 
-

2002 
-

2003 
-

TOTAL 
1.3 

0.78 
0.52 
-
-
-
-
1.3 

-
-
-
-
-
-
pm 

-
-
-
-
-
-
pm 

-
-

-
-
-
pm 

-
-

-
-
-
pm 

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. 

2. 

3. 

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; 

Health  professionals,  health  epidemiological  services,  health  and  medical 
associations,  specialists  in  the  prevention  of  different  kinds  of  injury, 
academic institutions, etc; 

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 
that 
community  actions  and  retained  on 
communication,  eight priority areas of which injury  prevention was one. 

the  basis  of  criteria 

listed 

in 

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 
addressed  by  other 
Community activities. 

accidents,  which  are  already 

traffic 

road 

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; 

through 

the concept  of added  Community value, which will continue to be realised 
the 
in  particular 
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. 

the  coordination  of  national  measures, 

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 

staff carrying out action 

source of employee 

duration 

permanent 
employees 

temporary 
employees 

1  . 
A 
|  Officials  or 
B 
temporary 
C 
agents 
Other resources 

Total 

1 
1 
1 

3 

0 
0 
0 

0 

from within 
DGor 
service 
1 
1 
1 

3 

supplementary 
staff 

0 
0 
0 

0 

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 
Meetings A2510 

Amounts 
ECU  104 250 

Method of calculation 
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