Effective Disease Response

Injury is identified as a neglected Public Health problem in developing countries. The most recent report from the World Health Organisation (WHO) Injuries and violence: the facts states: "..more than 5 million people die each year as a result of injuries, resulting from acts of violence against oneself or others, road traffic crashes, burns, drowning, falls, and poisonings, among other causes. Injuries account for 9% of the world’s deaths, nearly 1.7 times the number of fatalities that result from HIV/AIDS, tuberculosis and malaria combined. In addition tens of millions of people suffer non-fatal injuries which require treatment. There is a broad range of strategies based on sound scientific evidence that have been shown to be effective and cost-effective at reducing injuries."

The burden of disease section of the web site Our World in Data shows this interactive graphic 'The burden of injury, violence, self-harm and accidents by type'. You will see the importance of road injuries on the data.

From Our World in Data. Licensed under CC BY 4.0.

The WHO website Violence and Injury Prevention is a portal to more information about the global situation.

To ensure a healthy life and promote well-being for all is the United Nations (UN) Sustainable Development Goal (SDGs) 3, and the target 3:6 requests everybody to participate in reducing deaths due to injuries from road traffic accidents, the largest cause of injury globally.

The Global Burden of Injuries project produced much valuable information and their web site is worth exploration. It leads to the Global Burden of Road Injuries where you can explore country reports.

The World Bank has a Global Road Safety Facility which you can also explore a large number of useful resources. Here is a quote from the web site: "In the past fifteen years, Road Traffic Injuries (RTIs) have increased by almost 80% in Asia and by 40% in Latin America and Africa. The opposite is true in high-income countries, however, where RTI rates have been on a path of steady decline over several decades. Beyond the enormous personal suffering they cause, RTIs weaken economic growth, place a huge strain on health care systems, and challenge development objectives. Across LMICs, losses due to RTIs are estimated at USD 100 billion/year, ...... losses of 1-3% of GDP, a figure comparable to what LMICs receive in development assistance.”

The WHO Global status report on road safety 2018 finds a regional variation in death rates between 9.3 and 26.6 per 100,000 population - with the highest rate in being in Africa. The picture comes from that report:

From WHO Global status report on road safety 2018, licensed under CC BY-NC-SA 3.0 IGO

You can find more information about the pattern in Africa here: The burden of road traffic crashes, injuries and deaths in Africa: a systematic review and meta-analysis - the paper concludes: "our study suggests that the burden of road traffic injuries in Africa is high and there is an underestimation of road traffic fatalities. Improved road traffic injury surveillance across African countries may be useful in identifying relevant data gaps and developing contextually feasible prevention strategies in these settings."

A paper The Global Challenge of Child Injury Prevention states: "The health of children has changed significantly during the past 50 years. Widespread immunization programs have nearly eliminated the threat of infectious diseases, such as polio, diphtheria, and measles. However, a major public health problem that continues to threaten the health of all children has no vaccine: injury. Child injury represents one of the most immediate public health threats, resulting in the death of nearly 2000 children under age 14 every day around the world." It quotes Margaret Chan "Once children reach the age of five years, unintentional injuries are the biggest threat to their survival. Unintentional injuries are also a major cause of disabilities, which can have a long-lasting impact on all facets of children’s lives: relationships, learning and play. Among those children who live in poverty, the burden of injury is highest. Child injuries have been neglected for many years and are largely absent from child survival initiatives presently on the global agenda. The World Health Organization, the United Nations Children’s Fund and many partners have set out to elevate child injury to a priority for the global public health and development communities."

Risk factors for injury

This table show the matrix developed by Haddon and you can see that the various factors can influence various stages of the injury

An example can be applied to road traffic injuries (taken from the WHO Road safety training manual web site) "A road traffic crash results from a combination of factors related to the components of the system comprising roads, the environment, vehicles and road users, and the way they interact. Some factors contribute to the occurrence of a collision and are therefore part of crash causation. Other factors aggravate the effects of the collision and thus contribute to trauma severity. Some factors may not appear to be directly related to road traffic injuries. Some causes are immediate, but they may be underpinned by medium-term and long-term structural causes. Identifying the risk factors that contribute to road traffic crashes is important in identifying interventions that can reduce the risks associated with those factors."

Prevention and control programmes.

The Public Health approach to dealing with the problem of injury is summarised nicely by the National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention (CDC) as Our Approach  "To solve public health problems—including injuries—CDC uses a systematic process called the public health approach. This approach has four steps: define the problem, identify risk and protective factors, develop and test prevention strategies, and assure widespread adoption of effective injury prevention principles and strategies."

The link between risk factors and evidence based interventions can be seen in Disease Control Priorities DCP3, which has two relevant sections.

Road Traffic Injuries where the summary states: "This chapter discusses the leading cause of unintentional injuries, road traffic injuries (RTIs), poses a significant economic and societal burden. Although definite data on the number of people who survive RTIs but live with disabilities are almost nonexistent, estimates suggest that for every one RTI-related death, an additional 20–50 more individuals suffer some disability. Risk factors for RTIs include precrash behavior such as speeding, driving while impaired or distracted, or driving a compromised vehicle; crash phase outcomes due to failure to use seat belts, helmets, and child restraints; and postcrash care deficiencies in trauma and emergency care services. Legislatures can encourage a culture of safe road behavior by setting speed limits, enforcing helmet use, penalizing alcohol-impaired driving, and requiring seat belt use and child restraint use. Enhancements to vehicles can also reduce or eliminate the hazard of RTIs. The safe systems approach recognizes that multiple sectors need to work in harmony to minimize the occurrence of these crashes and their impacts." 

Non-Transport Unintentional Injury summarises: "Nontransport unintentional injuries result primarily from falls, drownings, poisoning, and exposure to natural disasters like earthquakes and floods. Older people experience falls more than other age groups, and falls occur more often from factors relating to street and house design, transport, violence, and rural locations. Men and boys are more susceptible to drowning due to increased exposure to water and riskier behaviors. In low- and middle-income countries (LMICs) a large proportion of burns happen in the kitchen or cooking area due to the nature of the cooking appliances, the source of heat, and the heating of liquids. Child poisoning cases result frequently from unsafe storage of chemicals or medicines. Prevention efforts focus on education, installation of safety features like smoke detectors and pool fencing, construction safety standards, exercise programs, and platform, instead of floor-level, cooking. In LMICs government interventions are not likely to address these types of injuries, so nongovernmental organizations’ and health practitioners’ support becomes increasingly important."

In both of the above sections of DCP3, you can easily find and download a pdf file with much more detail - just click in the links shown.

Although we have not covered violence in much detail here, this is a cause of injury, and here is the summary  of the DCP3 section Interpersonal Violence: Global Impact and Paths to Prevention. "Interpersonal violence has expanded as a global issue and encompasses physical, sexual, or psychological violence used by an individual or small group of individuals. Low- and middle-income countries (LMICs) account for 91.4 percent of 2011 deaths from interpersonal violence. Household surveys provide the bulk of the data on violence against children and youth as well as against women and the elderly. Serious and enduring consequences from such violence include increased risks of injuries, infectious diseases, mental health problems, reproductive health problems, and noncommunicable diseases. Public health interventions aim to prevent violence from occurring, and specific prevention programs fall into seven categories: (1) developing safe, stable parent-child relationships; (2) developing life skills in children and adolescents; (3) reducing availability and harmful use of alcohol; (4) decreasing access to lethal means; (5) promoting gender equality; (6) changing cultural and societal norms; and (7) implementing victim identification, care, and support programs."

The paper The Global Challenge of Child Injury Prevention we saw above, lists some of the interventions

Among some of the common themes in national and international plans to advance child injury prevention are the following:

1. Integrate child injury prevention into a comprehensive approach to child health and development;
2. Develop, implement, and evaluate national child injury prevention policies and plans of action;
3. Implement evidence-based strategies to prevent and control injuries among children;
4. Evaluate existing programs, policies and strategies to determine what works best;
5. Improve efforts to raise public awareness of injuries to children and prevention strategies through traditional and modern communication channels;
6. Implement and disseminate child injury education and training programs in schools and in allied health professions;
7. Improve existing surveillance systems to address gaps in child injury data and improve access;
8. Define priorities for, and support research and evaluation on, the causes, effects, costs, and prevention of injury among children, including research to identify and reduce disparities;
9. Strengthen health care systems to support quality care of injured children in hospitals and clinics; and
10. Support the adoption and implementation of effective laws and policies that prevent child injuries.