There is a significant body of evidence which shows how health and illness is unequally distributed through society, especially between socioeconomic groups where the lower a person’s social position, the more at risk they are of ill health. One of the reasons behind this is the influence of many wider social determinants of health. Reducing inequalities in health by tackling these social determinants has become an important objective of many activities to improve health and reduce illness. Research has shown that similar inequalities exist for injuries. One of the outcome indicators to monitor the success of the recent Strategic Framework for Road Safety (DfT 2011) is a comparison of the number of fatalities and serious injuries between the 10% most and least deprived areas. This document sets out RoSPA’s policy on injury inequality on the roads, and also a review of the social determinants of injury which contribute towards this inequality and how they can be tackled. These are the wider factors that influence the risk of people being involved in an accident and which individuals may or may not have an influence over. The phrase used by the eminent epidemiologist Geoffrey Rose to describe these factors is the ‘causes of the causes’ of ill health (Marmot 2005). The policy paper includes a review of the current evidence showing the gradient in the number of casualties from different areas and socioeconomic groups, as well as the literature which can explain some of the reasons why this gradient exists. This literature identifies many factors which can not only lead to a greater risk of road injury, but which can also dampen the effectiveness of road safety interventions. Social factors can also contribute to the length and likelihood of recovery from injury, and also the extent of change to relationships and personal wellbeing issues resulting from an accident, however, this is outside of the scope of the current paper. Many of the factors which cause injury and ill health are common to both outcomes. This may mean that interventions to address the social factors behind one can incorporate work to address the other. Road safety is a public health issue (WHO 2009) and a greater integration between road safety and public health, at all levels, would help to create both safer and healthier environments. This policy paper also identifies ways of addressing injury inequality in prevention work and should, therefore, be of use to road safety practitioners who wish to design effective road safety activities or initiatives to tackle the issues identified. (Author/publisher)
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