Table Of ContentScenario Committee on Accidents and Traumatology
Chairman: Prof.dr. R.M. Lapre
Accidents and Traumatology Research Team
Institute of Public Health and Social Medicine
Erasmus University Rotterdam
Chief researcher: Dr. J.P. Mackenbach
ACCIDENTS
IN THE YEAR
2000
Accident and Traumatology Scenarios
1985-2000
Commissioned by the
Steering Committee on Future Health Scenarios
1989
Kluwer Academic Publishers
Dordrecht-Boston-London
Distributors
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for aile other countries: Kluwer Academic Publishers Group, Distribution
Center, P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Steering Committee
on Future Health Scenarios
P.O. Box 5406
2280 HK Rijswijk
The Netherlands
Telephone (31-70) 407209
ISBN-13: 978-0-7923-0475-3 e-ISBN-13: 978-94-009-1047-8
DOl: 10.1007/ 978-94-009-1047-8
© 1989 Bohn, Scheltema & Holkema bv, Utrecht and STG, Rijswijk
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers.
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht, The Nether
lands.
Accidents in the year 2000
Using this report
This report is designed for a wide readership. Since it is not easy
to summarize the results of the research in such a way as to produce
a report that is interesting and readable for all, a brief guide on
using the report is provided below.
Readers are advised to begin by reading the summary (at the start of
the report). This will familiarize them with the line of thought and
the overall results of the research.
The report further consists of the following chapters:
Chapter 1 discusses the aims, limits and design of the research;
Chapter 2 provides a review of the current scale of the problem of
accidents in the Netherlands, of developments in the recent past
and of factors that could determine developments in this field in
the future;
Chapter 3 provides an account of the main results of an enquiry
into experts' expectations of future accident trends;
Chapter 4 presents the future health scenarios, together with
their effects on the incidence of accidents and their consequences
in the year 2000;
Chapter 5 falls outside the main lines of this report, in that it
concentrates on three other "external" causes of health problems:
accidents in the course of medical treatment, suicide and
violence;
finally Chapter 6 draws conclusions from the research;
the appendices provide a detailed account of the methods used in
this research (Delphi-study and computer model).
The results of the research may be scanned by referring to sections
3.2 (results of the Delphi-study), 4.2 (the scenarios constructed) and
4.4 (quantitative effects of the scenarios). This might be followed by
Chapter 6, which examines priority areas for government policy. The
remaining parts contain either basic background information (Chapters
1, 2 and 5) or an explanation of the technical procedures (sections
3.1, 3.3, 4.1, 4.3 and the appendices).
As an aid to the reader a number of fold-out tables are included at
the end of the report containing a summary of the scenarios.
Contents
Using this report
o
Summary 1
1 Introduction 13
1.1 For whom is this report intended? 13
1.2 Aims of the research 13
1.3 Delimiting the field: traffic, occupational and
home and leisure accidents 14
1.4 Approach adopted 15
2 Initial situation and background 19
2.1 Introduction and explanation of concepts used 19
2.2 Current scale of the problem 24
2.3 Trends since 1950 35
2.4 What could determine future developments in this field? 44
3 Possible future developments 57
3.1 Brief summary of method used 57
3.2 Results of Delphi-study 61
3.3 Workshop 75
4 Future health scenarios and their consequences
for the year 2000 77
4.1 Introduction 77
4.2 Construction of a set of scenarios 77
4.3 A computer model for quantifying the effects of the
scenarios 84
4.4 Results: possible situations in the year 2000 86
5 Intermezzo: accidents in the course of medical treatment,
suicide and violence 101
5.1 Introduction 101
5.2 A brief survey 103
5.3 Possible future developments 107
6 Final observations and conclusions 109
6.1 The findings 109
6.2 Priority areas for government policy 115
6.3 Conclusions 121
Acknowledgements 123
Appendices 125
I Delphi-study 'Accidents and traumatology in the future'
II Projections of the epidemiology of accidents 195
Summary
In order to chart the way for long-term policies in the field of
public health, the Dutch government needs to have the best possible
insight into potential future trends and the problems to which these
could give rise.
It was with a view to compiling a number of long-range studies that
the independent Steering Committee on Future Health Scenarios was set
up in 1983. In 1985 the Steering Committee appointed a board of
experts to conduct a long-range study of "Accidents and traumatology"
(traumatology being that aspect of medicine concerned with the
treatment of accident victims). In close consultation with this
board, the Institute of Public Health and Social Medicine of the
Erasmus University Rotterdam carried out a scenario study, the results
of which are briefly summarized below.
0.1 Aims and approach
The research had two objectives:
To explore possible "autonomous" developments (in the sense of
being independent of government intervention) in the field of
accidents and the treatment of accident victims.
To specify the effects of possible policy measures, in relation to
both the prevention of accidents and improvements in the care for
accident victims.
The research was exploratory rather than predictive. It did not go
beyond the year 2000, since it was felt that the pace of change in
this field ruled out looking much further than ten to fifteen years
ahead.
The study draws a distinction between traffic accidents, occupational
accidents and home and leisure accidents. In addition, a certain
amount of attention was devoted to accidents sustained in the course
of medical treatment and to suicide and violence, but the results of
this aspect of the study have largely been left out of account in
this summary.
1
The research was tackled in three stages. To begin with, the present
scale of the problem was examined, and a study made of trends in
accident mortality since 1950. The second stage consisted of an
enquiry into possible future developments. This was done with the aid
of a Delphi-study (an anonymous, written survey conducted among a
large number of experts, carried out in two rounds).
On the basis of this survey, a number of scenarios were then
elaborated, differing from one another in terms of the assumed
"autonomous" developments and the degree of government intervention.
Finally, the consequences of the various scenarios for the situation
in the year 2000 were calculated with the aid of a computer model.
0.2 Current scale of the problem and past trends
0.2.1 Current scale of the problem
Accidents are a significant problem for public health: each year there
are nearly 3,900 accident-related deaths and nearly 100,000 accident
related hospital admissions (Table 0.1).
Table 0.1 Estimated annual numbers of deaths and hospital admissions
related to three categories of accidents, c. 1984
Deaths Hospital admissions
Traffic 1750 23500
Occupational 100 3000
Home and leisure 2050 71500
Total 3900 98000
Most of the deaths are from home and leisure accidents, followed
closely by traffic accidents. By comparison the number of occupational
accident deaths is low.
The same rank-order applies in the case of hospital admissions,
although here home and leisure accidents account for an even higher
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share of the total.
The number of injuries in all three sectors is much higher than the
number of deaths and hospital admissions.
With respect to traffic accidents, there are some 50,000 registered
victims. The largest group consists of occupants of passenger cars,
who form roughly a third of the total. In terms of the number of
victims per kilometre travelled, mopeds and motorcycles are the most
dangerous forms of transport. The injuries sustained in traffic
accidents are often serious, with a high incidence of skullfbrain
injuries.
At work some 60,000 accident victims are recorded annually.
Manufacturing, with a 40% share, is the major contributor. In terms
of the number of victims per hour of work, construction and
agriculture and fisheries are the most hazardous industries. The
injuries sustained from occupational accidents are generally less
serious than those sustained in traffic accidents.
As a result of horne and leisure accidents, around 660,000 people
annually require (at the least) out-patient treatment. Sports
injuries, which account for some 30% of the total, form the largest
category. Sports is also a comparatively dangerous pastime when
measured in terms of the number of injuries per hour of time spent.
Like occupational accidents, horne and leisure accidents are generally
less serious than traffic accidents. There is, however, one
significant exception: at more advanced ages a fall often leads to a
hip fracture, which often proves to be fatal.
0.2.2 Trends in the recent past
Accident-related mortality since 1950 has followed a dynamic path:
up to around 1970 there is a rise, which then turns into a spectacular
fall (Figure 0.1). (The peak in 1953 relates to the flood disaster in
the Netherlands.)
3
Figure 0.1 Deaths resulting from accidents in the Netherlands since
1950 (standardized for age and sex)
a all accidents b traffic accidents c non-traffic accidents
4.00
2.00
cr:
~1.00 ~
0.50
0.25 .J...,----.----,----,-,-
1950 60 7Q 84 50 60 70 84 50 60 70 84
The number of traffic accident deaths rose sharply between 1950 and
1970, the major factors being the enormous increase in passenger car
travelling and the growing popularity of mopeds.
The reversal of the trend around 1970 is not readily explained. A
number of preventive measures by the government certainly played a
part, but in addition there was the change in the economic climate
following the first oil crisis, greater familiarity with a large
amount of traffic, technological advances and presumably a host of
other factors.
Similarly the number of non-traffic accident deaths fell sharply after
1970. This decline extended to both occupational and horne and leisure
accidents. The number of occupational accidents had probably already
been falling for some time, and declined further in this period. Among
other things this fall can be explained by the shift in employment to
the services sector and the decline in manual labour. Greater emphasis
on safety will also have played a role.
As far as non-traffic accident mortality is concerned, developments in
the field of horne and leisure accidents have, however, been much more
important. In the case of the major cause of death in this area - hip
fractures - improvements in medical care have probably led to a
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