Towards community-based injury prevention : the Motala model

Sammanfattning: In the Swedish County of Östergötland a comprehensive health policyprogramme including accidents was decided by the health authorities in 1988. An accident prevention programme (the "Motala Accident Prevention Study") had already started with an epidemiological analysis of accidents in the community. The Motala study is based on Bracht and Kingsbury's five-stage model of community development: community analysis, design and initiation,  implementation, maintenance, and reassessment.The scientific reporting of the Motala study in this thesis is based on selected parts of the five-stage model and is grouped into reports from the community analysis (the main study) and an intervention study. The aim was to describe the panorama of accidents, their causes and effects in a defined community, and to account for the economic consequences of these accidents. A secondary aim was to provide an epidemiological basis for a sports accident prevention programme and out of that design such a programme, and to evaluate the effects of loan programmes on infant car restraints. In forthcoming papers other parts of the different stages of the model will be presented.Total population injury surveillance was performed in an area with apopulation of over 41,000. All accidents (N= 4,926) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 118.9 per 1,000. They consisted of accidents in the home (35.0%), sports accidents (18.9%), accidents at work (13.7%), traffic accidents (12.8%), and "other" accidents (19.5%). Half of the victims covered by health insurance were put on sick leave in connection with the accident, and 12.6% of these were admitted to hospital. The age-group 13-19 years, and men between 20-29 years of age, showed the highest accident rate. The total cost to society for people in the labour force, including treatment cost and production loss, was 103.4 million SEK (15.7 million USD). The cost to society of uninsured people for time lost from "normal activities" because of an accident was estimated at 43.1 million SEK (6.5 million USD). There are three important conclusions with regard to the economic consequences of accidents. Firstly, it appears important to assess not only the productive working time of the injured people, but also other time, in which normal activities are restricted. Secondly, the findings reveal the conflict between the utilitarian and the dutybased ethical basis of health care activities. Thirdly, the results show the need for well-controlled studies with alternatives to show the effects of different actions.