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In this European Public Health news, health is put at the centre of society as it is impacting us from birth until death. Jakab emphasizes the importance of investing in health over the life-course, whilst McKee demonstrates that the whole society impacts health. A strong, unified health care system and seeing healthy people as the cornerstone of healthy economies is the key message in the contribution by Andriukaitis, the newly elected EU Commissioner for Health and Food Safety. Making the voice of public health visible, both nationally and internationally and facilitating a strong and unified voice is what Zeegers and Barnhoorn see as the core activities of EUPHA and the EPH Conference Foundation. # President's Column {#article-title-2} A new year is a time for both reflection and anticipation. Reflection on what has gone well, or not so well in the past year and anticipation of the challenges and opportunities we will face in the year ahead. For EUPHA, we have much to celebrate from the past year and much to look forward to in 2015. In my last column, I wrote about our conference in Glasgow, where a combination of excellent organization and outstanding content created an event that will be remembered for many years. Now we are looking forward to Milan, with a programme that promises to be every bit as imaginative and informative. One of the streams will be on communication and advocacy in public health, something that I am particularly looking forward to, given its importance in making the world a better place. We have a new President Elect, Natasha Muscat, who is already making an invaluable contribution to our work, stimulating our thinking about how we can take EUPHA to ever greater heights. We also have a new website and logo, two things among many for which we are grateful …

The adoption of the 2030 Agenda for Sustainable Development in 2015 opened new opportunities to work towards healthy environments through ‘whole of government’ and ‘whole of society’ approaches. It created a strong policy platform that acknowledges health as a result and an enabler of sustainable policies across all sectors of government. Five years into the process, an initial analysis of emerging trends indicates that, despite some encouraging developments in policy as well as overall progress in economy and technology, there remains a gap between rhetoric, ambition and reality. In particular, the monitoring system for environment and health-related sustainable development goals (SDGs) and targets requires further development; inequalities in environment and health persist and in some areas have increased; equity is not yet a central element of implementation and reporting on the achievement of the SDGs; and, most worrying of all, trends in key environmental indicators that are vital to the survival of the human species, such as those related to climate change and biodiversity, are still on an overall negative path. In summary, governments must significantly and rapidly increase action to secure the habitability and safety of planet Earth. The public health community assumes an unprecedented role in placing and maintaining health and equity at the heart of the political agenda. This demands new governance models conferring on the health sector a clear mandate and legitimacy to operate across sectors. It also requires enhancing capacities among health professionals to embrace this new level of complexity, understand the multiple links between sectoral policies and health, and successfully engage with other government sectors and stakeholders.

The World Health Organization&rsquo, s Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess the health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies at both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. The health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits derived from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, the impacts on carbon emissions from mode shifts to active travel modes can now be assessed. The monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behavior or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.

BACKGROUND: In the fight against rising overweight and obesity levels, and unhealthy urban environments, the renaissance of active mobility (cycling and walking as a transport mode) is encouraging. Transport mode has been shown to be associated to body mass index (BMI), yet there is limited longitudinal evidence demonstrating causality. We aimed to associate transport mode and BMI cross-sectionally, but also prospectively in the first ever European-wide longitudinal study on transport and health. METHODS: Data were from the PASTA project that recruited adults in seven European cities (Antwerp, Barcelona, London, Oerebro, Rome, Vienna, Zurich) to complete a series of questionnaires on travel behavior, physical activity levels, and BMI. To assess the association between transport mode and BMI as well as change in BMI we performed crude and adjusted linear mixed-effects modeling for cross-sectional (n = 7380) and longitudinal (n = 2316) data, respectively. RESULTS: Cross-sectionally, BMI was 0.027 kg/m2 (95%CI 0.015 to 0.040) higher per additional day of car use per month. Inversely, BMI was -0.010 kg/m2 (95%CI -0.020 to -0.0002) lower per additional day of cycling per month. Changes in BMI were smaller in the longitudinal within-person assessment, however still statistically significant. BMI decreased in occasional (less than once per week) and non-cyclists who increased cycling (-0.303 kg/m2, 95%CI -0.530 to -0.077), while frequent (at least once per week) cyclists who stopped cycling increased their BMI (0.417 kg/m2, 95%CI 0.033 to 0.802). CONCLUSIONS: Our analyses showed that people lower their BMI when starting or increasing cycling, demonstrating the health benefits of active mobility. ispartof: ENVIRONMENT INTERNATIONAL vol:119 pages:109-116 ispartof: location:Netherlands status: published

Purpose Cycling and walking is a promising approach to counteract some of the leading risk factors for Europe’s health, including physical inactivity, air pollution and climate change. The Health E...

OBJECTIVE: To review and assess the quality of economic evaluation studies on injury prevention measures. DESIGN: Systematic review. DATA SOURCES: Electronic databases searched included Medline (Pubmed), EMBASE, Web of Science, PsycINFO, and Safetylit. INCLUSION CRITERIA: Empirical studies published in English in international peer-reviewed journals in the period 1998-2009. The subject of the study was economic evaluation of prevention of unintentional injury. Cost-effectiveness (CEA), cost-benefit (CBA) and cost utility (CUA) analyses were included. METHODS: Methodological details, study designs, and analysis and interpretation of results of the included articles were reviewed and extracted into summary tables. Study quality was judged using the criteria recommended by the Panel on cost-effectiveness in health and medicine and the British Medical Journal (BMJ) checklist for economic evaluations. RESULTS: Forty-eight studies met the inclusion criteria of our review. Interventions assessed most frequently were hip protectors and exercise programs for the elderly. A wide variety of methodological approaches was found, including differences in type of economic evaluation, perspective, time horizon, study design, cost categories, effect outcomes, and adjustments for timing and uncertainty used. The majority of studies performed a cost-effectiveness analysis from a societal perspective with a time horizon of one to five years, in which the effect was expressed in terms of injuries prevented and only direct health care costs were included. Most studies deviated from one or more of the Panel recommendations or BMJ guidelines; e.g. not adopting the societal perspective, not including all relevant costs, no incremental analysis. CONCLUSIONS: This review has shown that approaches to economic evaluation of injury prevention vary widely and most studies do not fulfill methodological rigour. Improving quality and harmonization of economic evaluation studies in the field of injury prevention is needed. One way of achieving this would be to establish international guidelines on economic evaluation for injury prevention interventions, based on established economic evaluation checklists, to assist researchers in the design and reporting of economic evaluations. Language: en

Summary Injuries cause 9% of deaths and 14% of ill health in the WHO European Region. This problem is neglected; injuries are often seen as part of everyday life. However, although western Europe has good safety levels, death and disability from injury are rising in eastern Europe. People in low-to-middle-income countries in the Region are 3·6 times more likely to die from injuries than those in high-income countries. Economic and political change have led to unemployment, income inequalities, increased traffic, reduced restrictions on alcohol, and loss of social support. Risks such as movement of vulnerable populations and transfer of lifestyles and products between countries also need attention. In many countries, the public-health response has been inadequate, yet the cost is devastating to individuals and health-service budgets. More than half a million lives could be saved annually in the Region if recent knowledge could be used to prevent injuries and thus redress social injustice in this area.

There has been a world-wide increase in scientific interest in health-enhancing physical activity (HEPA). The importance of a physically active lifestyle has now been well established both on the individual and on the population level. At the same time, physical inactivity has become a global problem. While sports for all has a long history, only a few examples of long-term integrated physical activity promotion strategies have been in place in Europe until recently, namely in Finland, the Netherlands and England. A number of countries have now begun to develop their own activities. However, there has been a noticeable lack of a platform for sharing the development and implementation of evidence-based policies and strategies. In order to fill this gap, HEPA Europe, the European Network for the Promotion of Health-Enhancing Physical Activity, was founded in May 2005 in Gerlev, Denmark. The goal of the network is to strengthen and support efforts and actions that increase participation in physical activity and improve the conditions favourable to a healthy lifestyle, in particular with respect to HEPA. The Network is working closely with the WHO Regional Office for Europe (http://www.euro.who.int/hepa). The network focuses on population-based approaches for the promotion of HEPA, using the best-available scientific evidence, and is currently implementing its first projects. HEPA Europe has established collaboration with EU Commission projects and Agita Mundo. Priorities for future work have been defined, and interested organisations and institutions have the opportunity to join the network and participate in the process.

Purpose Because many emerging economies lack local capacity for scientific research, capacity building has become a priority for many international development organizations. This article describes and critiques an approach used for building local capacity for applied health research in Azerbaijan, one of the newly independent states (NIS) of the former USSR. Methods In 2000, environmental epidemiology training courses were conducted in Azerbaijan. Several local participants of these courses received hands-on training in the planning and conduct of a subsequent cancer study as a practical extension of the training exercises. Results The research demonstrated that international collaboration can not only result in the successful completion of health research in NIS such as Azerbaijan, but also impart research knowledge and experience to local experts. Several practical issues were encountered in the conduct of the training activities that limited their effectiveness. The most desired result (the proposal and conduct of new research by local experts trained through these exercises) has yet to be achieved to the levels expected. Conclusions International collaborations such as the approach described here are useful for imparting expertise to researchers in less affluent countries. However, comprehensive capacity building programs providing ongoing professional development, support, and an enabling environment, rather than scientific training alone, are required to achieve long-term sustainability and measurable outcomes.

Background Physical inactivity is the fourth leading cause of global mortality. Hence, the Physical Activity through Sustainable Transport Approaches (PASTA) study aims to promote active mobility (i.e. walking and cycling) as an innovative measure to increase physical activity levels. Studying the health benefits of an increase in active mobility is challenging as we lack understanding of its relation with overall physical activity. Therefore, we studied the association between changes in overall physical activity level and changes in the amount of active mobility and leisure-time physical activity. Methods A set of online questionnaires was deployed in seven European cities to collect data on travel and physical activity behaviour. After completing a baseline questionnaire, follow-up questionnaires were sent every thirteen days, alternating a short and a longer version (every third follow-up). The amount of total and domain-specific (i.e. transport and leisure-time) physical activity was reported in the Global Physical Activity Questionnaire (GPAQ) (separating cycling and walking for transport). The GPAQ was incorporated in the baseline questionnaire and the longer version of the follow-up. To analyse the association between a change in overall physical activity and a change in active mobility and leisure-time physical activity, a mixed effect model was used. This model included sex, age and season as covariates and all interaction terms for active mobility and leisure-time physical activity. We used random participant effects nested in city effects to account for repeated measures. Results 3083 participants completed at least two GPAQs. The maximum number of GPAQs collected per participant was 14 and the median amount of time between two questionnaires was 51 days (IQR:44-86 days). A one-minute increase in daily active mobility or leisure-time physical activity was associated with an increase of 1.14 (p 0.05), so participants who increased their active mobility did not decrease their leisure-time physical activity accordingly. Changes in overall physical activity were not affected by sex, age and season (p>0.05). However, the increase in total physical activity per unit increase in active mobility depended on sex (p Conclusions Our findings provide evidence that an increase in active mobility translated into an increase in overall physical activity, while the amount of leisure-time physical activity was not modified.

As injuries can happen in any setting, to anyone and at any time, the preventive responses required need to be comprehensive. Accordingly, this requires the involvement of many stakeholders from di...

Injuries both unintentional and intentional are a leading cause of death and in the 53 countries of the WHO European region there were an estimated 790 000, accounting for 9% of deaths from all cau...

Street-vended foods and beverages, an integral part of urban economies in the developing world, have been implicated in cholera transmission in Latin America. To improve the microbiologic quality of market-vended beverages in Guatemala, we tested a simple system consisting of dilute bleach (4.95% free available chlorine) for water purification, narrow-mouth plastic vessels with spigots for disinfecting and storing water and for preparing and storing beverages, handwashing soap, and education in using the system. We conducted a randomized controlled intervention trial among 41 vendors who received the intervention and 42 control vendors, comparing total and fecal coliform bacteria and Escherichia coli contamination of market-vended beverages, stored water, and vendors' hands. Samples were obtained at baseline and at each of six weekly follow-up visits. At baseline, fecal coliform bacteria were found in 40 (48%) market-vended beverages and E. coli in 14 (17%). When compared with samples from control vendors, a significant decrease in total coliform (P < 0.001) and fecal coliform (P < 0.001) bacteria in samples of stored water and beverages sold by intervention vendors was observed over the course of the study. The vessel system was well accepted by vendors. This simple inexpensive system consisting of hypochlorite disinfectant, plastic vessels, soap, and education can significantly reduce fecal contamination of market-vended beverages.

Objectives: The authors designed an instrument to measure objectively aspects of the built and food environments in urban areas, the EURO-PREVOB Community Questionnaire, within the EU-funded project 'Tackling the social and economic determinants of nutrition and physical activity for the prevention of obesity across Europe' (EURO-PREVOB). This paper describes its development, reliability, validity, feasibility and relevance to public health and obesity research. Study design: The Community Questionnaire is designed to measure key aspects of the food and built environments in urban areas of varying levels of affluence or deprivation, within different countries. The questionnaire assesses (1) the food environment and (2) the built environment. Methods: Pilot tests of the EURO-PREVOB Community Questionnaire were conducted in five to 10 purposively sampled urban areas of different socio-economic status in each of Ankara, Brno, Marseille, Riga, and Sarajevo. Inter-rater reliability was compared between two pairs of fieldworkers in each city centre using three methods: inter-observer agreement (IOA), kappa statistics, and intraclass correlation coefficients (ICCs). Results: Data were collected successfully in all five cities. Overall reliability of the EURO-PREVOB Community Questionnaire was excellent (inter-observer agreement (IOA) > 0.87; intraclass correlation coefficients (ICC)s > 0.91 and kappa statistics > 0.7. However, assessment of certain aspects of the quality of the built environment yielded slightly lower IOA coefficients than the quantitative aspects. Conclusions: The EURO-PREVOB Community Questionnaire was found to be a reliable and practical observational tool for measuring differences in community-level data on environmental factors that can impact on dietary intake and physical activity. The next step is to evaluate its predictive power by collecting behavioural and anthropometric data relevant to obesity and its determinants. © 2013 The Royal Society for Public Health.

Background: We aimed to quantify the number of women and men, in Catalonia, among those not achieving physical activity recommendations, making short motorized trips which could have been made on foot, and to estimate the annual economic benefit due to reducing mortality as a result of replacing one short, daily, motorized journey with walking. Methods: Cross-sectional study. Mobility data came from individuals >17 years who reported, in the 2006 Daily Mobility Survey, having travelled on the referred working day (N=80 552). The health economic assessment tool for walking (HEAT) from the World Health Organization (WHO) Regional Office for Europe was used to calculate the economic benefit. Results: Of those not meeting recommendations, 15.6% of men (95% CI 15.2-16.1) and 13.9% of women (95% CI 13.5-14.4) would go on to meet them if they were to replace at least one short motorized trip per day by walking. If applied to the entire population of Catalonia, this change would increase up to 326 557 men (95% CI 313 373-339 740) and up to 252 509 women (95% CI 240 855264 163) who would achieve recommendations through walking rather than driving. According to HEAT estimations, this would suppose a saving of (sic)124 216 000 (95% CI 120 182 000-128 250 000) in men and (sic)84 927 000 (95% CI 81 774 000-88 079 000) in women, derived from the reduction in mortality gained from walking accumulated over one year. Conclusion: This study demonstrates the potential of trips on foot as a source of physical activity. It also points out that both benefits for the health of the population and a huge economic benefit could have been gained through active transportation interventions.

Background “Health in all policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity” (Health in all policies – Seizing opportunities, implementing policies. Copenhagen: WHO Regional Office for Europe; 2013). Description of the problem Drawing from the HiAP approach, a “safety in all policies” (SiAP) framework could help integrating safety into sectoral policies, such as those of transport, infrastructure, housing, leisure, entertainment, sport, justice, education, labour, social services and industry. This calls for “whole-of-government” and “whole-of-society” approaches, as well as for “system approaches”. Through these, safety could become a key component of sectoral performance, and contribute to increasing efficiency, enhancing sectoral performance, reducing inequalities and preventable loss. SiAP entails ownership and accountability for safety by relevant sectors, and promotes a shift towards a proactive identification and management of risks. It could also promote new partnerships between the safety community and different sectors, benefiting from an evidence-based public health approach to safety. Results With several of the Sustainable Development Goals (SDGs) including targets related to safety, SiAP may support the attainment of the SDGs. On the other side, the SDGs provide additional legitimacy and facilitate the implementation of SiAP by placing safety targets squarely within relevant policy domains. Conclusions SiAP requires a cultural shift, and the development of a robust understanding and appreciation of the long-term health, developmental and economic benefits offered by integrating safety in sectoral policies. It may also require changes to institutional accountability frameworks and to how sectoral performance gets appraised.

Introduction: Only one-third of the European population meets the minimum recommended levels of physical activity (PA). Physical inactivity is a major risk factor for non-communicable diseases. Walking and cycling for transport (active mobility, AM) are well suited to provide regular PA. The European research project Physical Activity through Sustainable Transport Approaches (PASTA) pursues the following aims: (1) to investigate correlates and interrelations of AM, PA, air pollution and crash risk; (2) to evaluate the effectiveness of selected interventions to promote AM; (3) to improve health impact assessment (HIA) of AM; (4) to foster the exchange between the disciplines of public health and transport planning, and between research and practice. Methods and analysis: PASTA pursues a mixed-method and multilevel approach that is consistently applied in seven case study cities. Determinants of AM and the evaluation of measures to increase AM are investigated through a large scale longitudinal survey, with overall 14 000 respondents participating in Antwerp, Barcelona, London, Örebro, Rome, Vienna and Zurich. Contextual factors are systematically gathered in each city. PASTA generates empirical findings to improve HIA for AM, for example, with estimates of crash risks, factors on AM-PA substitution and carbon emissions savings from mode shifts. Findings from PASTA will inform WHO's online Health Economic Assessment Tool on the health benefits from cycling and/or walking. The study's wide scope, the combination of qualitative and quantitative methods and health and transport methods, the innovative survey design, the general and city-specific analyses, and the transdisciplinary composition of the consortium and the wider network of partners promise highly relevant insights for research and practice. Ethics and dissemination: Ethics approval has been obtained by the local ethics committees in the countries where the work is being conducted, and sent to the European Commission before the start of the survey. The PASTA website (http://www.pastaproject.eu) is at the core of all communication and dissemination activities. This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (https://creativecommons.org/licenses/by-nc/3.0/igo/), which permits use, distribution, and reproduction for non-commercial purposes in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Bleaches based on solutions of sodium hypochlorite (NaOCl) are widely used in the household to disinfect and clean hard surfaces and to bleach the laundry. A review of both published and unpublished toxicological data is presented. In addition, the results of a survey of human accidents with hypochlorite bleaches by the Poison Control Centers of France, Italy, Belgium, Greece, Turkey, Spain and Portugal for the period 1989-1992 are presented. The data show that acute accidental exposure to household bleach in use or in foreseeable misuse situations results, in the great majority of the cases, in minor, transient adverse effects on health, with no permanent sequelae. Ingestion is the most frequent route of exposure, followed by inhalation of gases evolved by mixing sodium hypochlorite bleach with acid or alkaline products. All evidence presented confirms the normal safety profile of hypochlorite-based bleaches to be similar to that of other 'generally recognized as safe' household products.

Background and Aims: Walking and cycling are increasingly recognized as effective forms of physical activity, an important public health priority. Urban and transport planning are more influential ...

Increasing regular physical activity is a key public health goal. One strategy is to change the physical environment to encourage walking and cycling, requiring partnerships with the transport and urban planning sectors. Economic evaluation is an important factor in the decision to fund any new transport scheme, but techniques for assessing the economic value of the health benefits of cycling and walking have tended to be less sophisticated than the approaches used for assessing other benefits. This study aimed to produce a practical tool for estimating the economic impact of reduced mortality due to increased cycling. The tool was intended to be transparent, easy to use, reliable, and based on conservative assumptions and default values, which can be used in the absence of local data. It addressed the question: For a given volume of cycling within a defined population, what is the economic value of the health benefits? The authors used published estimates of relative risk of all-cause mortality among regular cyclists and applied these to levels of cycling defined by the user to produce an estimate of the number of deaths potentially averted because of regular cycling. The tool then calculates the economic value of the deaths averted using the "value of a statistical life." The outputs of the tool support decision making on cycle infrastructure or policies, or can be used as part of an integrated economic appraisal. The tool's unique contribution is that it takes a public health approach to a transport problem, addresses it in epidemiologic terms, and places the results back into the transport context. Examples of its use include its adoption by the English and Swedish departments of transport as the recommended methodologic approach for estimating the health impact of walking and cycling.

We reviewed published and unpublished studies that presented the findings of an economic valuation of an aspect of transport infrastructure or policy, and included data on walking and/or cycling and health effects in the valuation. We included 16 papers, of which three were classified as ‘high; six as ‘moderate’ and seven as ‘low’ quality. There is a wide variation in the approaches taken for including the health effects of physical activity in economic analyses of transport projects. This is not helped by a lack of transparency of methods in many studies. A more standardised approach is called for, including a clearer description of the applied methods and assumptions taken.

Introduction Injuries and violence are the third leading cause of death in WHO European Region and pose a threat to economic and social development. Aim and methods The results of a 3-year collaborative project between WHO and the European Commission on progress achieved by Member States in implementing resolution EUR/RC55/R9 and the European Council Recommendation on the prevention of injuries are presented. A web-based database of country profiles was developed using a questionnaire survey completed by health ministry focal persons for injury and violence prevention. Information was provided on progress in delivering on key items of resolution EUR/RC55/R9 and on the implementation of 99 selected evidence-based programmes to prevent unintentional injury and violence and on the cross-cutting risk factors of alcohol and socioeconomic inequalities. Results There were responses from 47 of the 51 Member States with focal persons. Good progress is taking place, and resolution EUR/RC55/R9 has catalysed change in 75% of respondent countries. Development of national policies for individual types of injury and violence varied from 95% for road safety to 40% for preventing drowning. Implementation of evidence-based programmes for preventing all types of injury and violence varied in countries, and the median score was 73% for all these together. Conclusions This project reports that the health sector needs to commit more to the widespread implementation of effective programmes both in number and coverage, and to engage with other stakeholders in a multisectoral response to prevent injuries and violence.

Road traffic injuries are a leading cause of death worldwide, accounting for 1.2 million deaths annually. In 2002, road traffic accidents were responsible for 127 000 deaths in the WHO European Region.1 Recently, there have been calls for global action to reduce this public health threat, and the First United Nations Global Road Safety Week was held on 23–29 April 2007.2 Activities during the week focused specifically on preventing road traffic injuries in young people under the age of 25 years. The WHO European Region faces substantial challenges in this respect, as each year 32 000 young people aged under 25 are killed in road traffic accidents in Europe.3 Road traffic injuries are the leading cause of death in the 5–24 years age group.3 However, deaths are only the tip of the iceberg, and it is estimated that, for every death, 20 people are hospitalised and another 70 require outpatient medical treatment.4 5 Although data on non-fatal outcomes and costs are incomplete, the available evidence suggests that the health care and societal costs are enormous, with the latter estimated at 2% of gross domestic product for most countries in the region.1 6 The nature of the risk and exposure changes with age: among European children under 15 years, pedestrians account for the majority of fatalities, whereas in the 15–24 years age group most road death victims are car occupants (59%) or motorcyclists (19%).3 Programmes aimed at reducing road traffic deaths should take into consideration the different needs of groups at different stages of development from infancy to …

Introduction As part of a 3-year collaborative project between WHO and the European Commission on progress achieved by Member States in implementing resolution EUR/RC55/R9 and the European Council Recommendation on the prevention of injuries, an inventory of national policies has been compiled by WHO Regional Office for Europe. Methods and results A web-based database was created using national policies for injury and violence prevention using an internet search in English or German. This was supplemented with a questionnaire survey completed by health ministry focal persons for injury and violence prevention. 97 policies from 30 countries were uploaded on the internet in 2008. These have been supplemented further in 2009 when an additional 72 national policies were identified. A content analysis of policies is being carried out to identify factors thought to be conducive to policy development and implementation. The documents in the inventory reflect policy initiatives undertaken at national level by different sectors such as health, justice, interior, social affairs and transport. Information can be viewed and searched on a country basis or as part of a regional overview and can be searched by type of injury or violence, target group and lead sector. Conclusions This inventory of national policies for injury and violence prevention is a resource for policy-makers and practitioners interested in seeking more information. It represents a user-friendly system that can be used as a baseline to map future progress, to advocate for greater commitment and action, and to facilitate the sharing of information.

Introduction 34 000 drowning-related deaths are observed yearly in WHO European Region. Rates in low- and middle-income countries are six times higher than in high-income countries. Methods A questionnaire survey was undertaken as part of a collaborative project between WHO and the European Commission on progress achieved by Member States in implementing the WHO resolution and the European Council Recommendation on the prevention of injuries. Information was used on the implementation of eight evidence-based interventions to prevent drowning. Countries were grouped according to geographical location. Mortalities for drowning were examined by country grouping and correlated with level of implementation of interventions at a subregional level. Results There were responses from 47 of the 51 Member States with focal persons. Regional median implementation of drowning prevention interventions was 63% (IQR: 38–75%). The average mortality for the Baltic countries is six times higher than that for Nordic countries for both sexes. Implementation was variable across groups: 81% in Nordic countries, 73% in southern countries, 70% in CIS, around 50% in western, central and southeastern countries, only 8% in the three Baltic countries. In particular, no interventions were implemented in Lithuania and Latvia, only 25% in Estonia. Conclusions An inverse correlation can be observed between the implementation of evidence-based interventions and mortality for drowning in European countries when subregions are considered. The health sector needs to take a leadership role in advocating for the widespread implementation of effective programmes and to engage with other stakeholders in a multisectoral response to prevent drowning.

The burden of injury in terms of deaths and disability is considerable. Injuries result in large direct expenditures for healthcare and are a major burden for other sectors. Economic evaluation studies give insight into the (potential) changes in costs and population health as a result of preventive interventions for making the most optimal choices in preventive policies. Our review ‘Economic evaluation studies of injury prevention measures’ showed that in most countries systematic research into the economic impact of injuries is almost totally lacking. Furthermore, there are large differences with respect to the way studies measure and value economic and health consequences of injuries. Therefore, the WHO recognised the need for a systematic yet simple set of guidelines that would enable public health experts, policy makers and researchers to estimate the economic burden of injuries. With this manual we will provide a step-wise guidance according to a standardised methodology, in order to contribute an increased evidence base of cost-effectiveness interventions for injury prevention. The main steps of the guidance are as follows: (1) defining study design, (2) estimating costs, (3) estimating health effects, (4) calculating incremental cost-effectiveness ratio, (5) adjustments for timing and uncertainty and (6) reporting results. The added value of this guide is that it zooms in on the specifics of economic evaluation studies of injury prevention measures. It is hoped that this guidance will support a growing number of scientific analyses of the economic impacts of injuries, and ultimately result in additional prevention programs and lives saved.