Injury prevention

Burden of disease

A good way to start this Topic on the burden of disease is a quote from the WHO document Injuries and violence: the facts

“Every day the lives of more than 14 000 people are cut short as a result of an injury. Among the causes of injury are acts of violence against others or oneself, road traffic crashes, burns, drowning, falls, and poisonings. The deaths caused by injuries have an immeasurable impact on the families and communities affected, whose lives are often changed irrevocably by these tragedies.

Injuries and violence have been neglected from the global health agenda for many years, despite being predictable and largely preventable. Evidence from many countries shows that dramatic successes in preventing injuries and violence can be achieved through concerted efforts that involve, but are not limited to, the health sector. The international community needs to work with governments and civil society around the world to implement these proven measures and reduce the unnecessary loss of life that occurs each day as a result of injuries and violence.” Please look at the full pdf here.

The paper The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013  is a very important paper which is worth studying for many reasons. First is to explore the methods used to examine the burden of disease and second is to review the actual burden caused by injury. The study found:

“In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY (Disability Adjusted Life Years) rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries.”

And concluded:

“Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made. “

If you look through the paper, you will see interesting graphics that show differences by region.

If you go to the Institute of Health Metrics and Evaluation site , you can explore a number of resources relating to the burden of injuries. You can also explore country data to see data from countries of relevance to you.

Surveillance

An editorial in Injury Prevention Injury surveillance as a distributed system of systems quotes: “The contemporary definition of surveillance is 'The ongoing systematic collection, analysis, and interpretation of health data essential to the planning, implementation and evaluation of public health practice, closely integrated with timely dissemination of these data to those who need to know. The final link the surveillance chain is the application of these data to prevention and control'.”

The paper then goes on to quote Pless: “I question whether there is any evidence that a surveillance system—even one that operates perfectly—actually contributes to prevention. …. Surveillance is sterile and pointless if it is not somehow tied to preventive interventions.”

A successful model of road traffic injury surveillance in a developing country: process and lessons learnt.  describes the development of a surveillance programme in Pakistan. This is from the abstract:

“Methods. We describe the process of establishing a surveillance system including assembling a multi-institution research group, developing a data collection methodology, carrying out data collection and analysis and dissemination of information to the relevant stakeholders. In the absence of a road safety agency, the surveillance system required developing individual partnerships with industry, police, city government, media and many other stakeholders. Impact of the surveillance is demonstrated by some initiatives in the local trauma system and improvements in road design to effect hazard reduction.”

Note that the paper does go on to talk about the impact – measurement needs to be followed by action!

Which brings us to evaluation – how do we assemble evidence that a surveillance system is of appropriate quality?

The development of an evaluation framework for injury surveillance systems identified “18 characteristics that assess three areas of an injury surveillance system – five characteristics assess data quality, nine characteristics assess the system's operation, and four characteristics assess the practical capability of an injury surveillance system“.

Surveillance is part of the Public Health approach and this paper from WHO Europe The role of public health in injury prevention is worth reading. We will  come back to it later in the course.