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The role of health education in childhood injury prevention.

In the debate about the relative merits of different preventive strategies in injury prevention, environmental changes, and legislation are often regarded as superior and more effective approaches to those involving health education. Stone, for example, has suggested that an inverse proportion law operates, with preventive activities receiving official support in inverse proportion to their effectiveness. 'socio-environmental change is costly, radical and unpredictable and is consequently unattractive to politicians, in contrast to health education which is, 'cheap, generally uncontroversial and safe'.' Roberts et al support this viewpoint: 'It is unclear what part, if any, educational health promotion messages have played in the reduction of accidents',2 as does Sibert: 'The evidence that these [educational campaigns] are effective is unconvincing' and in most cases, effective solutions 'involve environmental changes'.3 Within the authors' definitions of health education their comments have some validity, but what is their definition of health education? This review contends that many criticisms of health education are based on a narrow view ofwhat it can contribute. For example, Roberts et al question whether health education is effective for parents, but later in their arguments advocate that knowledge of local lay opinion and citizens' safe keeping strategies could be fruitfully used 'to provide information and education, not only for other parents, but for decision makers in local and central government'.2 Education is rejected in the first instance and advocated in the second. In supporting the superiority ofenvironmental and legislative interventions, the wider processes of education are largely ignored. This paper seeks to demonstrate that health education has a wider role than one solely directed at individualised behaviour change. Health education underpins both legislative and environmental measures. My goal is to set the scene by summarising different ideologies that underlie contrasting models of health education and the principles of education that facilitate effective teaching and learning. I examine the range of available strategies for different injury types, and assess whether educational programmes focused on individuals or groups can be effective in promoting safety or preventing injuries by comparing the characteristics of ineffective and effective programmes. The processes by which legislation and environmental measures are introduced are then described and issues related to education of professionals, policy makers, and the wider community are discussed.