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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.
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.
Transportation trends and road injury death rates
The British government's strategy for health, The Health of the Nation aimed to reduce the injury death rate among children under 15 by at least 33% by the year 2005.1 If present trends continue, this target will almost certainly be achieved, and probably exceeded. Between 1985 and 1992 the child injury death rate declined by 34%.2 Because pedestrian and cycling deaths account for around 40% of all such deaths, these mechanisms of injury have a …