Injury Prevention 1998;4:161–163 161 otherwise, from others, especially from parts The green papers are especially noteworthy of the world where we do not have Editorial in that the New Labour administration Inj Prev: first published as 10.1136/ip.4.2.162-b on 1 June 1998. Downloaded from REGIONAL Board members. Please send your contribu- explicitly recognises the strong association tions to the editor, Barry Pless. between poverty and poor health and the REPORTS need to tackle the former (as well as lifestyle and behaviour) in the context of a compre- Pedestrian and bicyclist safety in New hensive health promotion strategy. York City For England, 12 year targets will be set to Southern Africa (and beyond) report reduce mortality and morbidity in four prior- Pedestrian and bicyclist safety in New York ity areas: heart disease and stroke, accidents, I am constantly aware that most of my reports City (NYC) has been in the news lately. Mayor cancer, and mental health (suicide). Targets selfishly concentrate on happenings in South- Rudolph Giuliani has raised the ire of NYC do not feature prominently (although they are ern Africa. Occasionally, I am able to glean residents by increasing the fine for jaywalking not ruled out) in the Scottish paper which, in the odd item on what is happening further from $2 to $50, plus making a court appear- addition to the above four areas, flags up a north from news reports, what little there is ance mandatory for paying fines for this number of others, particularly teenage preg- on the internet, or from that outstanding oVence. In addition, the mayor has recently nancy and dental health. monthly, “BBC Africa”. Rather than bore announced that pedestrian barriers which The green papers have been broadly readers with poor excuses for this imbalance, separate pedestrians and vehicles at certain welcomed by public health professionals. may I rather reconfirm that I would welcome intersections will be kept up “indefinitely”. Disappointment has been expressed however news (in any form whatsoever) related to Anyone who has walked or driven the streets of on two main counts. First, no targets have childhood injury in Africa, and inclusion of New York know that its pedestrians are among been set to monitor progress towards reduc- which would allow this column to become the most aggressive in the world. The scene ing the widening socioeconomic inequalities more representative of the entire continent from the Midnight Cowboy in which Dustin in health in the UK. Second, the proposed than it currently is. Those who are kind HoVman screams to an incensed driver, “I’m action seems weak on specific, sustained, and enough to submit news items will be person- walking here!” exaggerates the attitude of the adequately resourced measures designed to ally acknowledged. New York pedestrian, but only a little. make a major impact on the underlying Having got that oV my chest, I am thrilled Pedestrian and bicyclist injuries are a serious social, environmental, and economic causes to report on a fresh and exciting injury and sizeable problem in NYC city. There was of ill health. Moreover, while the poorer prevention campaign that has been hatched a 23% increase in the number of pedestrians health (including injury) record of the Scots in Uganda, thanks to both support and input and bicyclists killed in motor vehicle crashes in is acknowledged, this is not backed up by a of local and international agencies. I am NYC last year, from 249 in 1996 to 302 commitment to mount a proportionately extremely grateful to Dr Olive Kobusingye, according to preliminary police statistics for more vigorous health improvement pro- Director of the Injury Control Centre based 1997, 3700 hospitalizations annually, and an gramme north of the border. at Makerere Medical School in Kampala, for estimated 10 000 pedestrians struck by motor For injury prevention professionals, the providing me with the following information: vehicles but not hospitalized. Between 1994 statements are a mixed blessing. On the posi- “Representatives from Ethiopia, Kenya, and 1996 pedestrian deaths due to motor veh- tive side, “accidents” have held their place as Uganda, Zambia, Zimbabwe, South Africa, icles declined slightly from 223 to 213. In this priority areas in both England and Scotland. and the World Health Organization (WHO) same period motor vehicle occupant deaths Unfortunately, the writers of the green papers met on December 15–17 in Entebbe, Uganda decreased more substantially from 207 to 169. have clung to an outmoded and discredited at the joint WHO/Injury Control Centre Despite the preponderance of pedestrian and terminology, have oVered virtually no new http://injuryprevention.bmj.com/ Uganda (ICC-U) Working Group Meeting on bicyclist deaths, a study by Transportation ideas to address the injury problem, and have Injury Prevention and Control in East and Alternatives, a NYC watchdog group, found proposed targets that are likely to be met in Southern Africa. Participants focused on the that most of the $400 million of New York the absence of any further policy initiatives health sector issues of injury surveillance State and NYC funds earmarked for trans- whatsoever. Cynics might argue that therein emergency medical systems, and health portation safety in the next five years will go to lies the huge political appeal of the target set- professional training in injury epidemiology improve the safety of vehicle occupants rather ting exercise! and trauma care. A set of recommendations than the safety of pedestrians and bicyclists. DAVID STONE was formulated which has the potential to be From a public health perspective, enforce- The PEACH Unit, a milestone for injury prevention in Africa. ment of laws as well as use of physical barriers Department of Child Health, The adoption of a standardized minimum to separate pedestrians and vehicles are Yorkhill Hospital, Glasgow G3 8SJ data set for hospital based injury surveillance perfectly respectable counter measures against Scotland, UK was discussed. A trauma registry form tested pedestrian injuries. Some of the uproar is and used by the ICC-U will be presented to because the least lethal players in the urban injury control workers in participating coun- drama, the pedestrians and bicyclists, feel they tries for input and development of a common are being unfairly and illogically singled out. on October 2, 2021 by guest. Protected copyright. format; it is hoped that this data set will form And, of course, other measures could and LETTERS TO the core of a common trauma registry system should be taken, including enforcement of in these countries. The single page trauma speed limits, use of speed bumps, creation of THE EDITOR registry form includes ICD-9 categories of walking streets in heavily congested areas, and injury, a severity instrument (the Kampala stricter licensing of taxi drivers. But the public ridicule that has been heaped on the Mayor is score), victim and event information, and in- Safety strategies tentionality. Operate definitions for the registry a reminder of the critical role played by the have been written, and the form has already social context in which environmental and behavioral interventions are launched. EDITOR,—Jan Shield is to be commended for been tested in Uganda and Ethiopia. The rallying the troops in favour of “active” safety trauma registry form is suYcient for base line POLLY E BIJUR strategies,1 and most of her arguments in injury measurements while at the same time Kennedy Center, Room 920, favour of education and enforcement would keeping the form short and simple enough for Albert Einstein College of Medicine, undoubtedly be valid in a developed country. a range of health workers to fill out”. 1410 Pelham Parkway South, However I would like to oVer two contrasting Bronx, NY 10461, USA Contact details for ICC-U: Dr Olive viewpoints on the subject which are based Kobusingye, Makerere Medical School, PO primarily on personal observations related to Box 7072, Kampala, Uganda (fax: +256 41 British green papers highlight injury the challenges of traYc safety confronting us 530022; e-mail: [email protected]). prevention in a cash strapped, developing country. DAVID BASS Firstly, in support of passive measures is Department of Paediatric Surgery, In February 1998, the British government the increasing strain placed on the human Red Cross War Memorial Children’s Hospital, published two green papers (consultative and financial resources essential to conceive Rondebosch 7700, South Africa policy statements) for England and Scotland: and sustain education programmes and law Our Healthier Nation and Working Together for enforcement, particularly in developing Editor’s note: While most Regional Reports a Healthier Scotland. These outline a strategic countries. As such, traYc calming measures have come from regular contributors—our approach to public health that build on earlier are likely to be more eVective than nothing— team of Regional Editors—I am always target setting exercises that have met with simply because there is no other aVordable delighted to receive contributions, regular or limited success. solution to undisciplined traYc flow on a 162 Injury Prevention 1998;4:162 particular thoroughfare. Twelve months ago, 1 Shield J. Have we become so accustomed to 1 Pless IB. The challenge of drowning prevention the community in which which I live opted being passive that we’ve forgotten how to be [Editorial]. Inj Prev 1997;3:237–9. Inj Prev: first published as 10.1136/ip.4.2.162-b on 1 June 1998. Downloaded from active? Inj Prev 1997;3:243–4. 2 Murray CJL, Lopez AD. Global health statistics: a for a system of restricted entry through the compendium of incidence, prevalence, and mortality suburb to reduce to number of “rat runners” estimates for over 200 conditions. Volume II. speeding along a particular route during the Challenge of drowning prevention in low Cambridge: Harvard University Press, 1996.