• traffic accidents

In whatever direction a ship is moving the surge where the prow cuts the waves will always be noticeable ahead.... Whichever way the ship turns, the surge which neither directs nor accelerates her movement will always foam ahead of her and at a distance seems to us not merely to be moving on its own account but to be governing the ship's movement also.

Leo Tolstoy

In War and Peace, Tolstoy uses the analogy of the bow wave of a ship to represent the illusion of bureaucratic control of the destiny of nations. Tolstoy understood that mass social change is seldom the anticipated outcome of carefully planned strategy, but that when strategic aims are met, albeit fortuitously, the illusion of control can be compelling. His analogy might also be invoked to describe the role of the UK Department of Health in achieving the Health of the Nation injury reduction targets. Although injury death rates have fallen, this is may not be the anticipated result of government health strategy, but primarily a consequence of changing transportation patterns, forces over which the Department of Health had little or no control. In this paper we examine the forces that on this occasion appear to have resulted in fewer deaths, and suggest how these and other social trends might be steered towards more favourable policy destinations.