Future health scenarios as a tool in the surveillance of unintentional injuries

Health policy needs effective public health surveillance systems. In order to support injury control in the Netherlands we established a surveillance system which monitors trends in the epidemiology of injuries due to traffic accidents, occupational accidents and home and leisure accidents. We introduced the combination of traditional monitoring methods with a new tool: the use of future health scenarios. Trends in the epidemiology of injuries since 1985 were compared with observations from the preceding period (1970-1985) and to future health scenarios (1985-2000). These scenarios were based on the opinions of 80 Dutch experts, which had been collected with the help of a Delphi-study. We identified interruptions of the actual injury mortality trends in the Netherlands. In the second half of the 1980s the rapidly declining injury mortality trends of the period 1970-1985 slowed down (traffic accidents), slightly reversed (occupational accidents) or stabilised (home and leisure accidents). The transitions into less favourable developments were already foreseen by Dutch experts. The future health scenarios appear to have added value for health policy. They offer a well-defined conceptual framework for monitoring and facilitate the early detection of trend interruptions. Moreover, they provide information on the most likely future development and on the feasibility of health policy goals. The results of our study show that health policy goals of the Dutch government will not be reached and that new initiatives in injury control are needed.