Improving the public's health - report from The King's Fund

January 2014

The King’s Fund has published a report to help local authorities identify ‘what works’ in improving public health and reducing health inequalities. Here we summarise the key information relating to preventing unintentional injuries.

Resource overview

The Improving the public’s health report provides local authorities with information about evidence-based interventions and practical actions for improving public health and reducing health inequalities. It focuses on nine areas where there is strong and clear evidence that local authorities can have a major impact on health. Childhood unintentional injury prevention is relevant to a number of these areas, including:

  • the best start in life
  • healthy schools and pupils
  • active and safe travel
  • warmer and safer homes
  • public protection and regulatory services (including takeaway/fast food, air pollution and fire safety).

The report finds that: “The broader determinants of health – people's local environment, housing, transport, employment, and their social interactions – can be significantly influenced by how local authorities deliver their core roles and functions. Local authorities also now have to demonstrate that they are delivering 'social value' – that is, that they have considered the social, environmental and economic impacts of their commissioning decisions.”

Key points relating to childhood accident prevention

Early years

  • There is compelling evidence that a child’s experiences in the early years (0-4) has a major impact on their health and life chances, as children and adults. Babies that are born below the low birth weight threshold are five times more likely to die as an infant than those of normal birth weight.
  • Local authorities can target the most disadvantaged children and families with intensive support, supplementing specific interventions with mainstream universal family support services. Successful interventions tend to be behaviour-focused (for example, coaching parents during play sessions) rather than simply providing information.
  • Programmes that offer support to vulnerable mothers from pregnancy until the age of two (such as the Family Nurse Partnership programme) have had successful outcomes, including fewer childhood injuries.
  • The Early Intervention Foundation was established in 2013 and will initially work with 20 local authorities to tackle the root causes of social problems among children and young people.

Healthy schools and pupils

  • Local authorities can support schools to help children develop life skills such as problem-solving and to build self-esteem and resilience to peer pressure. This has relevance to work to promote safe driving behaviours among young people.
  • Local authorities can also help schools to promote healthy diets, focusing on 6-12 year olds. Programmes focusing on healthy cooking can easily incorporate fire safety messages.
  • Warmer and safer homes

    • Every year, more than 1 million children under the age of 15 have accidents in and around the home that result in a visit to A&E. Children aged 0-4 are at highest risk. Home accidents are the most common cause of death in children over the age of one year. Most home accidents are preventable with improvements in the home environment, education or awareness-raising, and greater product safety.
    • To prevent accidents in the home, local authorities should target interventions at high-risk groups, including families with children under the age of five, those living in rented or overcrowded conditions and those on low incomes.
    • Local authorities can implement guidance from NICE and the Safe at Home programme, including:
      • installing safety gates for stairs and doorways, window restrictors and cupboard locks
      • training staff such as health visitors and family support workers, and community members, to run home safety equipment schemes.
    • In the 10 best-performing Safe at Home scheme areas, hospital admissions fell by 29%. This produced an overall saving of £27 million, while the cost of implementing the programme in these areas was just £1.7 million.
    • RoSPA and Public Health England’s handbook Delivering Accident Prevention at the Local Level in the New Public Health System focuses on accident prevention in the home and includes case studies of interventions targeted at children and young people.

    Fire safety

    • To promote fire safety, local authorities can find ways to incentivise people to use fire alarms in their homes and undertake home safety assessments. Evidence suggests this would reduce accidental dwelling fires.
    • Local authorities can also support the provision of wider public health interventions by fire crews. Merseyside Fire and Rescue Service has won national awards for its innovative work to reduce health inequalities, for example through the promotion of sex, drug and alcohol awareness.

    Active and safe travel

    • Poor transport planning and regulation leads to preventable deaths and injuries (particularly among vulnerable groups). There is a higher incidence of injury and death from traffic collisions in lower socio-economic groups – the most deprived 10% of ward account for more than a quarter of child pedestrian casualties. Traffic accident rates for children are four times higher in deprived areas.
    • More than half of all serious and fatal injuries to pedestrians (of all ages) occur on roads with a 30mph speed limit. On urban roads with low average speeds, any further reduction of 1mph reduces collisions by about 6%. Evidence suggests that in high casualty areas, 20mph zones can reduce traffic accidents, injuries and deaths.
    • Local authorities should prioritise densely populated areas with consistently high accident rates and residential areas around common urban destinations, including developing safer routes to school.
    • Lack of enforcement is often an issue with speed limits and other safety measures. Where signs-only schemes are introduced, experience suggests that other ‘soft’ interventions, such as community engagement, may be needed to maximise effectiveness.

    Partnership working and health impact assessments

    The report emphasises that local partnerships must have a clear focus on outcomes, based on evidence of what works. It says: “The systematic use of health impact assessment (HIA) – tools and approaches designed to assess the likely health effects of a given policy when health is not the primary objective – will be critical if local authorities are to deliver their ambitions for improving public health…councils already take health impacts of their different functions into account – for instance, environmental impact assessments consider the pollution effects of housing developments – but these processes need to be systematic, and implemented at scale.”

    It mentions several resources that can help local authorities to incorporate public health into their systems, plans and processes, including:

    About The King’s Fund

    The King's Fund is an independent charity that works to improve health and health care in England. It aims to shape policy and practice through publishing research and analysis; develop the leadership skills and people working in health and social care; and to promote understanding of the health and social care system.

    Updated January 2014