Public health outcomes framework proposals include unintentional injuries

Unintentional injuries to children and young people is one of the indicators put forward in the Proposals for a Public Health Outcomes Framework published by the Department of Health on 20 December 2010.  And among the outcomes that apply to all age groups is killed and seriously injured casualties on England's roads.

The document sets out the Government's thoughts for how public health in England should be shaped from 2012/13.  Rather than setting national targets that local areas would be expected to achieve it identifies a number of indicators that should lead to locally delivered programmes, the driving forces being local accountability.

The overarching vision is "to improve and protect the nation's health and to improve the health of the poorest, fastest".  It defines five domains, the first of which relates to national resilience in the event of major emergencies.  The other four are split into two groups: determinants of ill health and outcomes of ill health.  Unintentional injuries for the 5-18 years age group, or more correctly hospital admissions caused by unintentional and intentional injuries, reside in domain 3, health improvement, part of the determinants of ill health.  The equivalent for the 1-4 age group is part of domain 4, prevention of ill-health, which comes under the outcomes of ill health.

But it is interesting to look beyond these obvious indicators.  We have long known that issues around housing and the local environment can impact on the likelihood of injuries, so it is encouraging to see housing overcrowding rates and access and utilisation of green space as well as other relevant factors among the lists.

Throughout the document it is recognised that there is a need to address health inequalities, using whatever determinants for inequalities are appropriate.  It is noted that injuries to children and young people and road casualties have strong links to socio-economic status.

Among the detailed criteria used to guide the selection of the indicators for consultation is the question "Are there evidence-based interventions to support the indicators?".  This emphasises the importance of the strategic and intervention guidance published in November by NICE, presenting the evidence-based strategies and programmes to address the prevention of unintentional injuries.

A more difficult question to answer is whether an indicator can be used at appropriate spatial levels (national, local, community).  We all know that while the hospital admissions for unintentional injuries are numerous, when the data is disaggregated on a spatial basis, by setting, by age group and by the type of event, numbers become small very quickly causing problems in defining local needs and appropriate programmes, and our ability to monitor effectiveness.  The need to improve the quality, in particular the completeness, of admissions data so that it can drive local action is also important.

The consultation on the proposals is open until 31 March 2011.

Update on confirmed public health indicator

Update 25 January 2012: Hospital admissions caused by unintentional and deliberate injuries in under 18s have been confirmed as one of the public health indicators  in the Public Health Outcomes Framework - read our news story here.

Updated March 2012