Guidelines/brochures | Date: 1997-05-05
Ministry of Health and Social Affairs in co-operation with Ministry of Children and Family Affairs, Ministry of Defence, Ministry of Justice, Ministry of Education, Research and Church Affairs, Ministry of Local Government and Labour, Ministry of Cultural Affairs, Ministry of the Environment, Ministry of Transport and Communications
Plan of action 1997-2002 - prevention of injuries at home, school and recreation
Plan of action Part I
Background documentation - facts and data Part II
- Chapter 4 Unintentional injuries
- Chapter 5 Registration of unintentional injuries
- Chapter 6 Prevention of injuries: experience to-date
- Chapter 7 Means and Challenges
- Chapter 8 Ministries involved
Plan of action Part I
In its handling of the Report to the Storting (Norwegian Parliament) no. 37 (1992-93) Challenges in health promotion and preventive efforts, cfr. Innst.S. nr. 118 (1993-94), the Storting agreed to focus nationally on four areas in prevention and health promotion.
The prevention of injuries is one of these areas. Close co-operation between sectors, professional groups and levels of public administration is a necessary prerequisite in the prevention of unintentional injuries.
Plan of Action 1997-2002 prevention of injuries at home, school and recreation has been prepared by the Ministry of Health and Social Affairs in co-operation with the following eight other ministries:
- Ministry of Children and Family Affairs
- Ministry of Defence
- Ministry of Justice
- Ministry of Education, Research and Church Affairs
- Ministry of Local Government and Labour
- Ministry of Cultural Affairs
- Ministry of the Environment
- Ministry of Transport and Communications
This publication represents a short report of the Plan of Action 1997-2002 prevention of injuries at home, school and recreation, intended to include goals and the means to reach them (part I) and background documentation - facts and data (part II). The Plan of Action is a co-ordinated presentation of the participating ministries' contributions in the field. The goal is that this work will contribute to a reduction in the number of injuries and the consequences that injuries have both for the individual and for society.
The prevention of accidents that can lead to personal injury is the purpose of the Plan of Action.
The Plan covers injuries at home, school and during recreation. Injuries sustained during working hours and in traffic are discussed in the plan with respect to the overall personal injury panorama, but are not dealt with explicitly in this Plan of Action.
Goals and initiatives outlined in the plan have been formulated based on the responsibilities of, and means available to the different participating ministries. At the same time it is important to emphasise that injury prevention efforts at the municipal level, those carried out by voluntary organisations and by private enterprises are essential in order that results can be achieved. These efforts must be encouraged.
An accident refers to a sudden, unintentional, and unplanned event, characterised by the sudden release of an external force or impact that can result in a bodily injury. An injury is the concrete, demonstrable result of an accident. Personal injuries are the result of the sudden or acute impact upon the body of physical factors in an amount or size that exceeds the tolerance level of the human body. The Plan of Action covers human activities, factors in the person's environment or surroundings such as product defects, the actual injury incident and the consequences there of. The goal of the Plan of Action is the prevention of accidents that can result in personal injury.
Developments that reflect safety and security are the goals of preventive efforts. Their ultimate effects must also be evaluated with respect to the developmental needs of the individual. For example, it is only natural for children to kick balls and climb trees. Methods to improve safety might include the use of leg pads or providing a foundation that is as secure as possible, while at the same time not preventing or obstructing a child's development.
The goal of providing for a secure development is an important basis for injury prevention. Injury prevention must be active and not result in pacifying the individual.
The Storting agreed to focus on the national goal in this area in connection with its handling of the Report to the Storting no. 37 (1992-93) Challenges in health promotion and preventive efforts :
- By the year 2002 the co-ordinated planning and development of a positive attitude towards safety measures at all levels of decision making and in all sectors will result in the reduction in the number of injuries that result in death, hospital admission and medical treatment due to accidents.
This is the main goal of the Plan of Action.
Two additional objectives have been formulated for the Plan of Action:
- Injury deaths will be reduced by at least 25% from 1980 to the year 2000.
- Injuries that result in hospital admission and medical treatment will be reduced by at least 10% from 1993 to the year 2002.
The stated objective to reduce injury deaths is in accordance with goals set by the World Health Organisation in this area.
In actual numbers these objectives imply a
reduction of injuries at home, school and during recreation by
100 injury deaths in relation to the 1980 level
30 000 injuries in relation to the 1993 level
Taking as a basis the cost of injuries to society in 1989, in the form of production loss, treatment costs, medicine, rehabilitation etc., the Plan of Action estimates the following costs (in 1995 NOK) for home, school and recreational injuries:
Production loss per injury death: 640000 NOK
Cost per personal injury: 23000 NOK
It is then possible that the full realisation of the two stated objectives could result in an annual gross economic profit to society of
- 64 mill. NOK following the reduction in number of injury deaths (objective I)
- 690 mill. NOK following the reduction in number of injured (objective II)
It should be noted that the figures presented here are subject to a degree of uncertainty. In addition, it must be clearly understood that the economic assessments are a part of the decision making process. They are meant to supplement, and not replace those decisions covering ethics, politics and health promotion in the area of injury prevention. The purpose of prevention is not first and foremost to save money, but to improve standards of health and quality of life.
Both outcomes and the means to reach them have been formulated for the prevention of injuries in homes, schools and during recreation. In addition, more general goals have been formulated. The means or resources that are outlined here include information, improved competence, co-operative measures, research and development as well as the influence of legal, regulative and economic factors.
The prevention of injuries requires that specific initiatives be set in motion. Through the support of several ministries working co-operatively, chances are that these measures will be successful.
In the list below, the ministry named first has the administrative responsibility. Other participating ministries are listed (in parentheses) thereafter.
|MCF||Ministry of Children and Family Affairs|
|MD||Ministry of Defence|
|MJ||Ministry of Justice|
|MERC||Ministry of Education, Research and Church Affairs|
|MLGL||Ministry of Local Government and Labour|
|MC||Ministry of Cultural Affairs|
|ME||Ministry of the Environment|
|MTC||Ministry of Transport and Communications|
|MHS||Ministry of Health and Social Affairs|
|MF||Ministry of Fisheries|
3.2.1. Prevention of injuries at home (i.e. injuries in and around the place of residence)
1. Manufacturers of products designed for use in the home will increase their competence in the area of risk analysis.
1a.Norwegian Directorate for Product and Electrical Safety supervises activities by authority of product control regulations (MCF).
1b.Supervision is made of electrical installations and equipment (MLGL).
2. Regulations will be formulated to ensure an acceptable degree of security with respect to building construction and their subsequent use.
2.The National Office of Building, Technology and Administration and the Ministry of Local Government and Labour formulate regulations (MLGL).
3. Loan and subsidy arrangements for building constructions will stimulate injury prevention initiatives.
3.Influence/formulate conditions for loans that encourage the improvement of housing, better adaptation to the homeowners needs, arrange- ment for a higher percentage of new housing that is adequate for all phases of life, and stimulate both housing and neighbourhood renovation/ renewal in cities and towns to secure increased accessibility, traffic-safe neighbourhoods etc. (MLGL, MD).
4. Senior citizens will become better informed of the ways in which the most usual home injuries can be prevented.
4. Dissemination of information through the Senior citizen centre programme (MHS).
5.Improved system of reporting and follow-up of home injuries.
5a.The National Office of Building, Technology and Administration/the municipalities assess the needs and possibilities for improved routines in co-operation with the National Institute of Public Health/Central Bureau of Statistics (MLGL, MHS).
5b.Increased knowledge of, and the development of measures for, improved home security (MLGL, MHS, MCF).
6.Municipal employees and others involved in the home-care of the elderly will improve their competence in the prevention of injuries among the elderly.
6. Municipal employees are offered further education that gives competence in the prevention of injuries among the elderly (MHS, MLGL, MCF).
7.Municipal employees as well as others who work with children and youths, together with parents, will improve their competence with respect to prevention of home injuries among children and youths from 0-18 years of age.
7.The prevention of injuries among children and youths is included as a part of the Action programme for children and health 1995-99. Follow-up of earlier project experience from the Red Book period 1989-1994 will be continued at the municipal level (MHS). Follow-up of the action programme will be conducted by the following ministries: MHS, MCF, MERC, MC, ME.
8.Parents of new-borns and infants will be aware of methods of home injury prevention among preschool children.
8.The Public Health Station will provide information on injury prevention among children to all parents of new-borns and infants (MHS).
9.As a part of it's regional planning, the municipality will allocate areas in the local environment that are both safe for the use of children and youths.
9.In the municipality's follow-up of "National political directives for strengthening the interest of children and youths in planning" emphasis in the local environment will be placed on the allocation of areas for children and youths. The planning of housing areas will take this into account (ME).
3.2.2. Prevention of injuries in special-care residences, old-age and nursing homes
1. The knowledge of factors that contribute to injuries in specialcare residences, old-age and nursing homes will increase during the period of the Plan of Action. Knowledge will be directed towards preventive efforts in this area.
1a.The National Institute of Public Health's research project "Security for the Elderly" has been concluded. The results of the research are distributed to all municipalities (MHS).
1b. Priority will be placed on the knowledge of maintenance and dangers involved in the use of electromedical equipment utilised in these institutions (MLGL).
2.The results of goal oriented measures for the prevention of injuries in old-age and nursing homes will be made available to the municipalities.
2. Results and measures are made available to all municipalities (MHS).
3.Injury prevention is emphasised in the planning and financing of all special-care and nursing residences.
3. The conditions for loans and subsidies for special-care and nursing residences are assessed with the goal of stimulating injury prevention in this area (MLGL/MHS).
3.2.3. Prevention of fires at home
1. More awareness among the general population with respect to the risks of fires and explosions including the use of electrical equipment.
1a. Regular information campaigns and education of owners/users, preferably in association with professionals (MLGL).
1b. Attitude forming education of elementary school students in co-operation with the Norwegian Fire Safety Association and Insurance Federation (MLGL, MERC).
2.Contribute to more co-ordination and better use of resources within the area of fires and explosions, with more emphasis placed on the preventive aspects, and increased quality of fire investigation.
2. Strive for better co-operation between munici- palities with respect to both fire preparedness and prevention (MLGL).
3.Development of the knowledge and competence level in order to improve the quality of the work in the area of fires and explosives and electrical installations.
3.Improve educational opportunities for full and part-time fire fighting personnel and electricians. Improve co-operation with police investigations (MLGL, MERC, MJ, MD).
3.3. Schools and day-care centres
3.3.1. Prevention of injuries at school
1.Regulations covering health, the environment and security must also be assessed with respect to school children.
1a.Safety and security will be assessed in the formulation of new laws on education and training or when changing existing laws (MERC).
1b.Support of research that can improve safety in connection with school sports (MERC, MD).
1c.As a part of the police's education programme in schools, students are taught the proper and safe use of bicycles. Students are given information on the risk of injury and how injuries can be prevented (MJ).
2.Schools will have an internal control system designed to serve the needs of students with respect to their physical and psycho-social health, environment and security.
2a. Schools will be planned and run in such a way that accidents and injuries are prevented (MHS, MERC).
2b. Follow-up is ensured through supervision (MCF, MHS).
2c. Consideration for the prevention of accidents shall be taken in the planning of both school grounds and school access routes (ME).
3.School personnel and school health services will improve their competence in the prevention of school injuries.
3. School personnel and school health services are offered measures to improve competence, with the goal of encouraging injury prevention activities in the school (MHS, MERC). The follo wing ministries are represented in the followup of the Action programme for children and health 1995-99: MHS, MCF, MERC, MC, ME.
4. Students, teachers and parents will have access to information regarding injury risk, and how injuries can be prevented. This also includes those in compulsory military service and their instructors.
4a. Involved ministries ensure that relevant information is made available (MERC, MHS, MC, MD).
4b.The development of local registration and knowledge-based injury prevention initiatives in schools, day-care centres including school access routes is stimulated (MERC, MHS, MCF, MTC).
5. Activities offered to children and youths, including physical education, will contribute to a level of bodily awareness and accomplishment that will provide for the ability to foresee and avoid injuries.
5. Development and information measures in accordance with the Plan of Action for the Prevention of Musculoskeletal Injuries (1994-98) are implemented (MHS, MERC, MC).
3.3.2. Prevention of injuries at day-care centres and playgrounds
1. Day-care centres will have an internal control system, with the goal of promoting health, environment and security. In municipal day-care centres this will be a part of the municipal internal control system.
1a.Day-care centres will be planned and run in such a way that accidents and injuries are prevented (MHS, MCF).
1b.Follow-up is ensured through supervision (MCF, MHS).
2. Employees at day-care centres shall, during the period of the Plan of Action, increase their competence in the prevention of injuries in day-care centres.
2. Injury prevention is a specific area in the Action programme for children and health 1995-99 (MHS). The following ministries are represented in the follow-up of the action programme: MHS, MCF, MC, MERC, ME.
3. In its regional planning, the municipality will ensure that day-care centres, playgrounds and schools are located and constructed in such a way that they are secure from pollution, noise, traffic and other health hazards. Furthermore the municipality will ensure that traffic safety is central with respect to travel to and from these localities.
3. In the municipality's follow-up to the "National political directives for strengthening the interest of children and youths in planning" emphasis will be placed on the localisation and the physical structures of day-care centres, playgrounds and schools. Requirements concerning size and function pertaining to play and other outdoor areas may be formulated in the municipal regulation and building plans. Under conditions of pollution, noise, traffic and other health hazards, rectifying measures must be instigated (ME).
4. The municipality asks children and youths about what they think should be done with, for example, planned renovations. The municipality accepts suggestions from children and youths concerning the need for renovations.
4a. According to the "National political directives for strengthening the interest of children and youths in planning" the municipality will organise the planning process such that the views of children, as the affected group, are presented and that different groups of children and youths are permitted to participate. In addition children have, according to the UN's Child Convention, the right to be heard in matters that concern them, and their opinions shall be given extra weight (ME, MCF).
4b. According to the planning and construction law § 9-1 the municipal board will name a senior civil servant responsible for the interests of children and youths in the handling of planning matters. This person will take care of the interests of children and youths when those responsible for planning matters formulate and handle planning suggestions (ME, MCF).
3.4. Recreation and leisure
3.4.1. Prevention of injuries during recreation (including injuries at sea, on lakes and rivers)
1. Administrative responsibility for the prevention of injuries during recreation will be clearly defined.
1. Lines of responsibility with regard to unorganised recreational activities is assessed (ME, MHS, MLGL, MCF, MF, MD).
2. The number of rescue operations resulting from lack of knowledge concerning safety during unorganised recreational activities will be reduced during the period of the Plan of Action.
2a.Information on safety during unorganised recreational activities in Norway are formulated and distributed. The material will be available and comprehensible to the majority of those who make use of Norwegian nature (ME, MHS, MCF, MD).
2b.For school children at outdoor camps, education concerning safety in connection with recreational activities in the wilderness is a priority measure (MERC).
3. Increase security for the general public when hiking in the mountains.
3. Revenues from lotteries can be applied to for financial support for shelters, markings, foot- bridges and other bridges (MC).
4.Approval of apparatus and equipment will be based on the optimal levels of technical expertise, knowledge and experience.
4.Ensure that the level of competence among the responsible authorities is up-dated. (MLGL).
5. Control of all apparatus and equipment will follow risk assessment and accidents.
5. An annual programme to ensure that adequate safety control is formulated (MLGL).
6. Those who offer consumer services will formulate an internal control system for their operations.
6a. Information concerning regulations are worked out (MCF).
6b. Follow-up is ensured through supervision (MCF).
3.4.2. Prevention of sports injuries
1.Sports arenas that receive revenues from lotteries will be in a condition that is considered to be adequately safe.
1.Means to renovate and rehabilitate sports arenas are available through revenues from lotteries (MC).
2.Foundations (gymnasium floors, athletic fields, artificial grass etc.) for physical activity will meet prevailing norms and demands.
2. It is assumed that the foundation of a sports arena meets prevailing norms and demands in order to be in a position to apply for subsidies from lotteries (MC).
3.Both leaders and participants in sports will have increased knowledge of the ways in which sports injuries can be prevented.
3.Co-operation between the different parties involved in sports activities with the goal of prevention of sports injuries (MC, MHS, MD).
3.4.3. Prevention of pedestrian (non-traffic) injuries
The Ministry of Transport and Communications' document "Traffic safety towards the year 2000" covers work in the area of traffic safety. The document represents a collaborative effort between the Ministry of Justice, Ministry of Education, Research and Church Affairs and Ministry of Health and Social Affairs together with the Directorate of Public Roads, and will be followed-up by these institutions. Particular emphasis will be placed on:
- The Ministry of Transport and Communications will undertake an evaluation of traffic regulations and road signs for cyclists.
- The Ministry of Transport and Communications will evaluate immediate solutions for improved passage for cyclists in heavily trafficated areas. Efforts directed towards both the physical and attitude changing effects in "cycle-cities" will be assessed. A number of information programmes are relevant in this area, for example, to increase the use of bicycle helmets.
1.Prevention of falls on slippery sidewalks and foot paths.
1a. Municipalities are encouraged to pass by-laws that direct property owners to maintain clean, icefree sidewalks (MJ).
1b. Municipalities distribute information to property owners regarding their responsibilities with respect to these by-laws (MJ).
1c. The police enforcement of by-laws is intensified through information, and if necessary notification and the stipulation of fines (MJ).
3.5. Other areas, general means
A number of outcomes and means are independent of arena.
Central authorities can also co-ordinate initiatives in many arenas in the prevention of injuries.
1. Definition of clear lines of responsibility and active follow-up of all areas covered by the Plan of Action.
1.An interdepartmental collaborating group provide the initiative for follow-up of the Plan of Action during the period 1997-2002. An evaluation of the follow-up will be undertaken. The collabora-ting group will initiate an evaluation of the degree to which current laws cover the area of injury prevention as outlined in the Plan of Action, and for their possible improvement (MHS, MCF, MJ, MERC, MLGL, MC, ME, MTC, MD).
2. Follow-up of the Plan of Action in co-operation with the involved ministries.
2. The status of progress in injury prevention is reported in connection with the Report of Public Health in Norway (MHS, MCF, MJ, MERC, MLGL, MC, ME, MD).
3. Co-ordinated information and measures in those areas where several ministries are involved.
3a. A publication is prepared, based on the Plan of Action, targeted to the general population (MHS, MCF, MJ, MERC, MLGL, MC, ME, MD).
3b. A national injury prevention conference is arranged in co-operation with the involved ministries and the voluntary sector. Others are encouraged to undertake similar initiatives (MHS, MCF, MJ, MERC, MLGL, MC, ME, MTC, MD).
4. Input at the national level will stimulate local injury prevention efforts.
4a.National measures will support the work of municipalities and counties in developing reliable methods for providing an overview of and planning and supporting the development of competence in the field (MHS, ME, MLGL, MERC, MD).
4b.An instruction guide is prepared with the goal of preventing, among other, dental injuries (MHS/ Norwegian Board of Health).
5. Financial arrangements at the national level that will stimulate efforts in injury prevention.
5.In co-operation with interested municipalities, trial activities are initiated that are intended to stimulate the financial co-ordination between municipal injury prevention programs, and national/county funds earmarked to those instances where injury prevention is lacking. (MHS, MLGL, MTC).
6a. At least 15 Norwegian municipalities will fulfil the criteria approval equivalent to "Safe Communities" by the year 2002.
6a. In providing resources to the secretariat for "Safe Communities" in Norway, particular weight is placed on the secretariats' contribution to municipalities to assist them in fulfilling the criteria to achieve "Safe Community" status (MHS).
6b. By the year 2002, at least 10% of the country's municipalities will have implemented injury prevention initiatives in line with the following important criteria for approval as a "Safe Community":
6b. In providing state project resources to trial activities associated with injury prevention activities it is required that reports be made of developments in the direction of meeting the criteria for acceptance as a "Safe Community" (MHS, MERC, MTC).
6c. Counselling and instruction directed towards the municipality's injury prevention efforts are strengthened (MHS).
6d.The County Governor provides instructions to municipalities through the use of circulars, brochures and conferences (ME).
6e.Information campaigns, based on the method of risk and vulnerabilityanalysis, are conducted with the intention of stimulating injury prevention initiatives (MLGL).
7. Improved and co-ordinated injury statistics.
7a. A system for national personal injury statistics is planned, in such a way that there is a compa- tibility with existing registers (MHS, MLGL, MCF, MD).
7b. Uniform reporting of external causes of injuries is promoted through the introduction of ICD-10 in Norwegian hospitals (MHS).
8. Knowledge of the consequences of injuries and injury prevention is improved.
8. The instigation of co-ordinated measures to improve knowledge with respect to consequences of injuries is assessed, along with a streng- thening of injury prevention efforts (MHS, MTC, MLGL, MCF, MERC, MD).
9. Prevention of product and servicerelated injuries.
9. Norwegian Directorate for Product and Electrical Safety will carry out system revisions of selected activities. In addition are those supervisory tasks that are triggered through reports of dangerous products or services from consumers, the mass media, international reporting systems and infor-mation measures. These supervisory activities will build on the principle of internal control (MCF).
10. Aspects of safety will be a part of relevant educational plans.
10. Aspects of safety will be assessed through recommendations to educational plans in relevant areas (MERC, MHS, MCF, MLGL, ME, MD).
11. Injury prevention efforts in the voluntary sector will be stimulated.
11. Support to injury prevention efforts in the voluntary sector (MHS, MCF, ME, MC, MTC, MD).
Background documentation - facts and data Part II
Between 450,000-500,000 unintentional injuries require medical treatment each year. Of these, 55,000 are admitted to hospital, and approximately 1,800 result in death. 10 % of all hospital beds at any given time are occupied by patients with unintentional injuries.
Falls are the single most important causes of unintentional injury deaths. The majority of such deaths are falls on the same level among those over 75 years of age. Injuries at home, school and during recreation dominate as arenas for unintentional injury deaths in all age groups with the exception of those 15-24 years, where traffic accidents account for 65% of all unintentional injury deaths.
Unintentional injury deaths have decreased by 19% from 1980 to 1993, due primarily to a decrease in traffic accidents, but also in some years to fewer falls among the elderly (despite increases in both traffic density and number of elderly). During this period additional efforts have been made in the area of traffic safety, improved housing standards, more emphasis placed on safety through the legal system as well as through specific efforts.
Injuries at home, school and during recreation in all age groups dominate among those unintentional injuries that do not result in death. These account for 70-95% of all unintentional injuries. Overall the highest prevalence of injuries occur among children and youths aged 10-20 years. Gender differences show that boys and men have the highest prevalence up to 50 years of age, at which point accidents among women predominate. 22% of all injury diagnoses are fractures.
Looking closer at the injury arena, those associated with sports and training activities dominate among youths and young adults up to 30 years of age. Apart from these, injuries in and around the home predominate in all age groups, in particular among the youngest and the oldest.
Injuries at home are most often characterised by falls among both children and the elderly. 52% of home accidents among those over 65 years result in fractures.
95% of injuries in old-age and nursing homes are the result of falls, and almost half of these injuries are diagnosed as hip fractures. Electrical tools and parts of buildings are often seen to play a part in injuries among adults. Circa 50 fires annually result in fatalities; house fires are the cause of approximately 50 deaths and 170 injuries yearly.
Injuries at school account for 5% of all injuries, i.e. annually 22,500 school children receive treatment as a result of injuries. 26% of injuries sustained during school hours occur in the school building, 36% on the school grounds and 42% in the gymnasium/sports complex. Sprains are the most common diagnoses. 40-50% of injuries to teeth occur at school.
Playground equipment is implicated in approximately 30% of injuries among small children in day-care centres and playgrounds.
Injuries during leisure/recreation account for 3% of all injuries, the majority of these are connected to activities in and around open water as well as hiking in the outdoors. 198 persons drowned in 1993, the main reasons being alcohol, suicide, ship wreck/boat capsizing, rough and/or cold weather. Sports injuries account for 15.4% of all injuries and this is the most common injury arena among those 10-20 years of age. Ball and ski sports predominate in both number of injuries and number of participants. Half of all falls on sidewalks and roads due to snow and ice results in fractures.
Injuries related to specific products are distributed in the population in the same way as injuries in general.
It has been calculated that unintentional injuries cost society ca. 25 billion NOK annually (treatment, production loss and damage to property). Costs for medical treatment up to one year after an injury are calculated at 1.55 billion NOK annually, 36% of these costs are related to injuries at home.
Deaths due to unintentional injuries and discharges from hospital are registered by the Central Bureau of Statistics. Based on injury registration at 4 selected hospitals and emergency departments, the National Institute of Public Health is able to calculate national estimates for injuries that require medical treatment. A number of additional institutions are also active in the registration of injuries in different areas and for different purposes.
Improved co-operation between those active in the area of injury registration is desired. A system for national personal injury statistics can lead to the establishment of national statistics based on all existing registers.
In the USA efforts made to prevent home injuries among children have resulted in a 31% reduction in mortality due to falls from windows; this due to better information on health hazards, home visits by housing inspectors and the distribution of free window locks.
During the period 1985-1993 in town of Harstad there was a 10% reduction in fractures due to fall injuries among the elderly. Women aged 65-79 years experienced a 29% reduction in injury fractures occurring in the home. Among men, a reduction of injury fractures in trafficated areas during the winter of almost 50% was recorded. These results seen in Harstad were achieved through the efforts at the local level where the public, private and voluntary sectors actively took part. Work was based on local injury data and consisted of various enterprises, including the distribution of information and the removal of "injury traps" in the home. Individual/personal safety equipment such as non-slip foot wear was made readily available, and the elderly were encouraged to make use of them.
Another investigation looked at the frequency of falls among a specific group of elderly, and instituted measures directed towards a combination of risk factors including the adjustment of medications. The frequency of falls was thus reduced by 12% in this group of elderly over 70 years. A study in France demonstrated that a calcium and Vitamin D3 supplement reduced the risk of fractures among elderly by 25-30% over three years.
An attempt has been made in Denmark to prevent sports injuries. The frequency of injuries was reduced by an average of 25% by means of providing better health information in combination with adequate time spent warming up and stretching out. Ski injuries dominate among non-organised sports. Considerable headway has been made in this area by focusing on improved inspection of equipment.
It has been demonstrated that smoke detectors can prevent over 80% of fire-related personal injuries, including deaths.
A wide ranging prevention programme carried out in the municipality of Harstad resulted in a decrease in burn injuries among children by over 50% over a 7 year period. The programme comprised information on burn prevention in schools, information programmes directed at childcare workers, safety stops on hot waterfaucets and information to the parents of children who have experienced burn injuries.
Experience shows that there does not exist an automatic relationship between knowledge, attitudes and behaviour with respect to the prevention of injuries. Generally, it could be said that health information has an effect on the individual's knowledge and under- standing, but to a lesser degree on their behaviour. The most promising programmes will be those where engagement and interest in injury prevention occurs at the local level.
Accidents were reduced from 218 in 1980 to 59 in 1988 in the small municipality of Værøy. Injury prevention programmes included the provision of information, education and home visits.
The town of Falköping in Sweden achieved an injury reduction of approximately 30% in the course of three years by means of local injury prevention initiatives. These results in Falköping were possible through the provision of information, educational aids and alterations made in the physical environment, e.g. the building of bicycle paths.
The prevention of injuries can be initiated through political resolutions made centrally, or alternatively, work can be based more on decisions arrived at locally. Efforts can be directed towards the entire population, or towards certain high risk groups. The goals of injury prevention programmes can be general in nature or they can be focused on more specific injury arenas. Different combinations and overlapping of the above axes will, of necessity, occur. Above all, the Plan of Action is not meant to alter the individual's own responsibility for his/her own safety.
Public injury prevention initiatives are performed under state, county or municipal auspices. The state sector takes on those tasks that are best solved on the national level. This is accomplished with the help of laws and regulations. More indirect implementation of desired policy is achieved through economic and educational means. State agencies at the county level also have their own important responsibilities with respect to injury prevention.
Health care services can be said to influence 10% of the population's health. The remaining 90% falls under conditions that the health care services alone are unable to influence, such as standard of living and social support. Close co-operation between all interested sectors is essential in order to attain results.
The municipalities are responsible for the planning and execution of initiatives at the local community level. The most comprehensive efforts in injury prevention must occur at the local level, in munici- palities around the country, and by individuals - where they live, work and play.
It is important that the value represented by the voluntary sector be recognised and made use of in the collaboration across sectors. A large proportion of the work done in injury prevention is addressed either outside of the public sector, or in collaboration with other sectors. Through it's history of competence and activities, the voluntary sector has significant resources that are of use in injury prevention.
Co-operative bodies or agencies for the various participants and sectors involved in injury prevention can be an important tool in the co-ordination and strengthening of prevention efforts. This requires a clear mandate that reflects both the desires of the members involved and the goals of the collaboration.
Industry and private enterprise have an important role to play in injury prevention. The responsibility of the private sector is to ensure that products put on the market do not represent a risk of injury. The private sector can, by imparting their experience in the area of safety to other sectors, be an important partner in the development of a positive attitude towards safety measures.
In the municipality of Årdal, injury prevention has taken the form of a project-oriented collaboration, "Årdal thinks safety", between the municipality, the private sector and voluntary organisations. One of the conclusions of the work to-date is that efforts in prevention cross the boundaries between sectors.
An employee who has suffered an injury will have an effect upon the employer regardless of when or where the injury occurred. For this reason the private sector contributes actively in the prevention of injuries at home and during recreation.
The strength in local initiatives lies in the fact that they are rooted in real life experiences and they have the ability to call on large resources through the commitment and contributions of the local inhabitants themselves. Experience has shown that goal-oriented prevention based on a knowledge of local injury statistics and the use of a wide range of actions gives measurable effects. These findings should be shared with other municipalities to stimulate injury prevention activities.
In the municipality of Alvdal a collaboration has been established between those responsible for maintenance of chimneys (chimney sweeps) and the local health authorities. The chimney sweeps give out information and instructions on prevention of injuries at home, at the same time as technical standards of chimneys are checked. In smaller municipalities, where the chimney sweep is known among the local inhabitants, the sweep can act as a "safety consultant" for the community in a new and interesting way.
The Ministry of Children and Family Affairs has subsidised projects in municipalities that have developed methods for incorporating the contributions made by children and youths to municipal planning and to the formulating of efforts, as well as injury prevention initiatives.
All public school children and youths in the munic- ipality of Klepp have been asked where the municipality should use 800,000 NOK for street lighting. The municipality will follow the priorities outlined by the "municipal student council".
Using a method called "Child step", children mark on a map places where they think it is dangerous to walk, play or hang out. These can be, for example, places where there is little protection against traffic or playgrounds where equipment should be either repaired or removed.
In addition, work in the area of crime prevention shows clear parallels with injury prevention, and provides examples of successful co-operation across sectors.
In Skien, a formal collaboration has been established between the municipality and the police force (CLM= co-ordination of local measures). The purpose of this is to prevent criminality among children and youths.
The municipality of Rakkestad has implemented a successful CLM collaboration. The actual form of the collaboration is emphasised as a good basis for injury prevention initiatives in the municipality.
The World Health Organisation (WHO) has, through the concept Safe Community, taken the consequences of the fact that the work of injury prevention must be organised across the different sectors involved. Specific criteria have been established and must be met before a community can be approved as a Safe Community.
A Norwegian secretariat for Safe Communities has been established. One of its responsibilities is to assist communities in the development of initiatives directed at local injury prevention, and to establish a national network of municipalities that are active in the area of injury prevention.
To date, Harstad is the only municipality in Norway to be given the status of Safe Community. Harstad has documented a reduction in fall injuries among the elderly, burn injuries among children and traffic injuries in general. The community can also claim to have increased the public's awareness of and belief in injury prevention. Harstad makes use of local injury data in a goal-oriented approach to these problems.
The Plan of Action for the Prevention of Injuries will defeat its own purpose if the individual's responsibility for his/her own safety is not stressed. We are responsible for our own safety and security, that our homes are reasonably safe, we are responsible for the supervision of our children, and responsible for ourselves when we go hiking in the mountains. These are responsibilities that will not be assumed by the public sector. The responsibility of the individual is however regulated by means of a number of laws and regulations in, for example, insurance and penal legislation.
Risk and vulnerability analysis is a working method for the systematic mapping of events that can represent risks or hazards for people, things of economic value and important social functions. The analysis consists of the mapping of causes of undesired events, the likelihood that they will occur and an overview of implemented preventive measures. In addition, a resource analysis is carried out, i.e. a discussion to show the positive resources that are available and can be built upon. Finally the analysis is followed by a political decision as to which injury prevention counter-measures will be initiated locally, and the way in which the initiatives will be followed-up.
A risk and vulnerability analysis can form the basis of a model for goal-oriented working procedures in local injury prevention. The starting point is an analysis of vulnerability on the local level, and counter-measures take the form of injury prevention and injury limitation. The analysis must result in political action and follow-up in order to reduce the level of vulnerability in the local community, and in this way the work can contribute to the development of a positive attitude towards safety locally.
Regulations relating to environmental impact assessment, in accordance with the planning and building legislation (PBL), establish that notification must be made (including a description of possible effects) before going ahead with large projects, if it is thought that these activities will have substantial consequences for the environment, natural resources and society. Some of these consequences are significant to injury prevention, such as discharges to the air or water, noise, radiation, and risks of explosion, all of which can be hazardous to health. The regulations relating to environmental impact assessment in PBL will result in placing greater weight on the consequences for the environment, natural resources and society through planning and development. Furthermore, the regulations call for an account to be made of the activities' essential impact on the environment, natural resources and society in the construction phase, operational phase, in the event of an accident and in the event of a possible shut down.
Prevention is also assessed in connection within the framework of the physical planning of the municipality. One of the overall goals in the regional planning and area policy is to ensure health, prosperity, security and a good standard of living for the population. These goals will again form the basis of the municipality's regional planning. Both the prevention and the reduction of injuries form one of the themes that is assessed under projects connected to road building and/or improvement in all road and traffic planning. According to the planning and building regulations it is possible to mark off areas that are potentially dangerous to the general public; for example high voltage electrical power lines, shooting ranges and areas considered to be susceptible to either landslide or flood. Further initiatives include, for example, the restriction of airports and ensuring that drivers have a clear view of roads and that hidden access ways are clearly marked.
It is also important to look at the National political directives for strengthening the interest of children and youths in planning as a tool to secure for these groups access to nature in their local environment where they can, through play, experience physical proficiency and competence with respect to the natural environment, and develop a positive attitude to the natural environment including the assessment of any potential dangers. Emphasis must be placed on ensuring that outdoor areas connected to day-care centres and schools also allow for this type of learning experience.
The goals of injury prevention are firstly associated with established welfare policies. Economy is also an important factor, especially for the municipalities. They finance their injury prevention initiatives through creating municipal political priorities within a fixed economic framework consisting of tax revenues, duties and transfers of capital.
Earmarked subsidies can contribute to emphasising a priority area. A municipality can increase its efforts in a particular area following an increase in earmarked national subsidies. In an investigation, the amount that a municipality was willing to invest in preventive efforts was assessed through the municipality's accounts. A relationship was found between national subsides and the municipality's use of its own resources for prevention. The overall municipal investment in preventive efforts increased by 2.09 NOK for each NOK that the municipality received in subsidies from the state.
Different levels of administration have economic responsibility for different services that are relevant for injury prevention. Within the health services, the county administration is responsible for hospitals, while social security payments are the responsibility of the state. With respect to injuries, prevention is thus the responsibility of the municipality, while the county administration is responsible for treating those who have received unintentional injuries. The munici- palities carry much of the expenses for preventive measures, such as sanding/salting icy sidewalks and ensuring that playgrounds are safe. The county administration must ultimately take over those expenses if the municipality does not set high enough priority on the prevention of injuries. In the same way injury prevention initiatives in the municipality will lead to a savings at the national level in the form of reduced expenses for sick benefits.
Through the National Insurance the state contributes to cover a considerable portion of fees that go to doctor's and physiotherapist's curative treatment functions in the municipalities. The administration of this through municipal budgets will be a considerable incentive to the preventive efforts made by the municipality. A trial arrangement with financial co-operation between different levels of administration, with the goal of stimulating preventive efforts depends upon municipalities indicating their wish to participate.
Economic measures can both stimulate behaviours that increase safety, and act to impede certain factors that increase risk. Such measures are used both by the public and private sectors. An example of such a measure is the fee for failure to use a helmet when driving a motorcycle or moped in traffic, and the fee for failure to wear a seat belt in a car.
Almost 40 % of all automobile drivers killed in road accidents are influenced by alcohol and/or drugs at the time of the accident. The high price of alcohol, resulting from taxes imposed, is meant to make alcohol less attractive. Limited access through the retail monopoly system acts as an additional barrier. The connection between these alcohol policies and the goals of injury prevention are thus well illustrated.
Economic benefits of being accident free are a part of the comprehensive insurance and bonus point systems of insurance companies.
Nine ministries are responsible for the Plan of Action, and for implementing the interdepartmental initiatives for the prevention of unintentional injuries. In the following table the responsible authorities and collaborators are listed according to the different injury arena classifications.
|Injury Arena||Ministries||Supervising Authority||Regional/County Authority||Local Authority||Co-operating|
|Co-ordinating/ initiating responsibility||Ministry of Health and Social Affairs||Regional/County Authority||County Medical Officer, County Administration||Municipality||Voluntary Organisations|
|In and around the place of residence||Ministry of Local Government and Labour||The National Office of Building, Technology and Administration||Municipality||Voluntary Organisations|
|Sports||Ministry of Cultural Affairs||County Administration||Municipality||Voluntary Organisations|
|School||Ministry of Education, Research and Church Affairs, Ministry of Health and Social Affairs||National Education Offices in counties||Municipality||Voluntary Organisations|
|Defence||Ministry of Defence||Head Quarters Defence Command Norway||Voluntary Organisations|
|Day-care centres, playgrounds||Ministry of Children and Family Affairs, Ministry of Health and Social Affairs, Ministry of the Environment||Municipality (Norwegian Directorate for Product and Electrical Safety)||County Governor||Municipality||Voluntary Organisations|
|Recreation (including sea, lakes and rivers)||Ministry of the Environment, Ministry of Justice, Ministry of Children and Family Affairs, Ministry of Local Government and Labour, Ministry of Foreign Affairs||Norwegian Directorate for Product and Electrical Safety, Directorate for Nature Management, Norwegian Maritime Directorate||Municipality, Police||Voluntary Organisations, Veritas|
|Pedestrian (non-traffic)||Ministry of Transport and Communications, Ministry of Justice||County Medical Officer||County Administration||Municipality, Police|
|Fire, electrical||Ministry of Local Government and Labour||Directorate for Fire and Explosion Prevention, Norwegian Directorate for Product and Electrical Safety||Municipality||Voluntary Organisations
Norwegian Electrotechnical Commitee
|Products (all arenas)||Ministry of Children and Family Affairs, Ministry of the Environment||Norwegian Directorate for Product and Electrical Safety, State Pollution Control Authority||Municipality||Private sector|
|Outdoor environment (all arenas)||Ministry of the Environment||County Governor, County Administration||Municipality|
The Ministry of Children and Family Affairs' responsibility with respect to the prevention of injuries is concentrated in the area of product safety and consumer services. The Ministry is also responsible for policies regarding day-care centres, children, youths and families.
The Ministry of Defence priorises the prevention of injuries within its area of responsibility. Knowledge and understanding of the prevention of injuries can be taken up among recruits to compulsory military service, a group that represents a large part of the youth cohort.
The Ministry of Justice has the responsibility for laws governing insurance and compensation; laws that generally have prevention as a goal. The Ministry's responsibility for the police force also covers the preventive efforts undertaken in this area, including the care and safety of those incarcerated.
The Ministry of Education, Research and Church Affairs has, through the school system, the responsibility for an important health promotion and injury prevention arena in the local environment.
The Ministry of Local Government and Labour, in addition to its responsibility with respect to the work force, also has responsibility for building safety, fire, electrical and explosive protection.
The Ministry of Cultural Affairs' responsibility for sports includes the organisation of physical activity for the general population. Measures to improve safety through physical activity, including sports, fall under this heading.
The Ministry of the Environment is responsible for the preparing adapting/organising of regional planning, therein local political means for strengthening local planning. The Ministry also has a responsibility for the possibilities open to the public with respect to use of the outdoors, and for the prevention of injuries due to chemical exposure.
The Ministry of Transport and Communications has the responsibility for traffic safety.
The Ministry of Health and Social Affairs is responsible for prevention, treatment and rehabilitation within the areas of health and social services. This Ministry has in addition been given the role of initiator in health promotion and injury prevention.
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