From injury epidemiology to injury prevention: Lithuanian experience

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From injury epidemiology to injury prevention
Lithuanian experience
 

• Skirmante Starkuviene MD, PhD
• Department of Social Medicine
• Kaunas University of Medicine
• Lithuania

SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH
SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN
MADE AND NATURAL DISASTERS, Kaunas, Lithuania,
August 8-10, 2005
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Introduction (1)

• Rapid development of the country is inevitably
  associated with an initial deterioration of
  health and increasing inequalities.
• There are about 400 000 admissions to health care
  institutions and more than 5000 deaths due to
  external causes registered per year in Lithuania.

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Introduction (2)

• Although mortality from external causes have a
  decreasing tendency in Lithuania, increasing
  number of non-fatal injuries and several times
  higher injury rates, if compared with other
  European countries, demonstrates the great need
  for the definite, well-coordinated and competent
  injury prevention strategy.

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The aim of the presentation -

• to highlight the burden of injury in Lithuania
  and examine injury prevention activities in order
  to assess what may work in prevention of injuries.

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Methods

• The patterns and trends of external causes
  mortality and injury prevention activities and
  programs in Lithuania were studied.
• The data was derived from Lithuanian Department
  of Statistics, Lithuanian Health Information
  Center, and different studies conducted at the
  Kaunas University of Medicine, Lithuania.
• International comparisons were performed using
  Health for all Database, WHO/Europe, January
  2005.

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The Injury iceberg
1 death
14 hospitalizations
79 admissions to outpatient clinics
????? thousands of injuries treated at home
Source Lithuanian Health Information Center,
2004
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Proportion of the external causes of death in the
overall mortality structure by sex and age in
Lithuania, 2003
Source Lithuanian Health Information Center,
2004
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Mortality from external causes of death by sex
and age in Lithuania, 2002
Source Kalediene R. et al 2003
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Mortality from external causes of death by place
of residence and age in Lithuania, 2002
Source Kalediene R. et al 2003
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Comparison of external causes mortality of
Lithuanian population with university and
primary/lower education in 1989 and 2001
plt0.05 compare to university educational group
Mortality of the university educational group 1
Source Starkuviene S. et al 2004
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Comparison of external causes mortality of
Lithuanian population by marital status in 1989
and 2001
plt0.05 compare to married
Mortality of the married 1
Source Kalediene R. et al 2005
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Trends in mortality from external causes of death
in selected European countries, 1988-2003
Source Health for all Database, WHO/Europe,
January 2005
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Mortality from external causes in selected
European countries
Mortality per 100 000
Source Health for all Database, WHO/Europe,
January 2005
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Mortality from suicides in selected European
countries
Mortality per 100 000
Source Health for all Database, WHO/Europe,
January 2005
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Road traffic accidents involving alcohol in
selected European countries per 100 000 population
170701 Road traffic accidents involving alcohol
per 100000
Greece
2001
Slovenia
2001
Croatia
2001
Monaco
1999
Belgium
1999
Estonia
2001
Latvia
2001
Luxembourg
2001
Czech Republic
2001
Switzerland
2000
Austria
2001
Germany
2001
Lithuania
2001
EU average
2000
Poland
2000
Slovakia
2001
CSEC average
2001
Russian Federation
2001
Portugal
1999
Denmark
2001
Hungary
2001
EUROPE
2001
United Kingdom
1996
Finland
2001
Andorra
2000
Iceland
1998
Nordic average
2001
CIS average
2001
Netherlands
2001
Per 100 000
Source Health for all Database, WHO/Europe,
January 2005
Kazakhstan
2001
Sweden
2001
Spain
1992
Republic of Moldova
2001
Kyrgyzstan
2001
Belarus
2001
Ukraine
2001
Italy
2000
Bulgaria
2001
Israel
2001
TFYR Macedonia
2001
CARK average
1999
Turkey
2001
Georgia
2000
Romania
2000
Uzbekistan
1999
Turkmenistan
1999
Azerbaijan
2001
Armenia
2001
Albania
2001
Tajikistan
2001
Malta
1997
0
50
100
150
200
Last Available
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Number of killed persons in traffic accidents per
1 million inhabitants in selected European
countries, 2001
Source ECMT, 2002
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Structure of external causes of death among
children and adolescents (0-19 years old) in
Lithuania, 1988-2000
Source Starkuviene S. 2003
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Mortality from external causes among 0-4 years
old children in selected European countries
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Mortality from external causes among 5-19 years
old children in selected European countries
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Frequency of accidents, requiring medical
attention, among 11-15 years old Lithuanian
schoolchildren during one year in 1994, 1998, and
2002
Source WHO Cross-National Study on Health
Behaviour in School-Aged children (HBSC)
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Safety habits among Lithuanian schoochildren in
2002

• Source WHO Cross-National Study on Health
  Behaviour in School-Aged children (HBSC)

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Injury costs

• 37 million Euro or 9.2 of the total budget of
  Lithuanian Health Insurance Fund was spent on the
  treatment of injuries, poisonings and certain
  other consequences of external causes in 2001
• 26 million Euro was spent from the Social
  Insurance Fund for the temporal and permanent
  disability caused by the injuries in 2001
• Indirect injury costs were about 300 million Euro
  in 2000

Baubinas H. et al 2003
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What are the reasons? (1)

• Political, social and economic transition during
  last decades in Lithuania
• - exposure to risks (increased availability
  of motor vehicles and greater traffic flows etc.)
• - insufficient policy development,
  legislation, implementation and enforcement to
  manage effectively the changing environment
• - socio-economic level and inequalities
  within the country

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What are the reasons? (2)

• Unsafe behaviour, poor safety culture, perceiving
  risks and injury as unpredictable and inevitable
  
• Hazardous environment
• However, we cannot determine how far high injury
  rates in Lithuania are due to unsafe behaviour,
  lack of regulations, absence of enforcement,
  unsafe environment, lack of safety training, or
  even weaknesses in emergency services or trauma
  care

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Lithuanian Health Program 1998 2010, approved
by the Parliament of Lithuania

• Target by the year 2010 to reduce rate of
  accidents, accident related deaths and
  disabilities by 30.
• Strategy
• To develop complex program for accident
  prevention
• Prevention of accidents should be carried out on
  national and regional levels
• On the regional level more cities should be
  involved into programs of healthy and safe
  cities. Activities of individuals, communities
  and non-governmental organizations aimed at safe
  environment should be promoted and supported
• Research should be aimed at accident prevention
  and mechanogenesis of injury

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National Accident Prevention Program (2000-2010),
approved by the Lithuanian Government in 2000

• The aim of the Program to develop sustained,
  well-coordinated safety system, which could help
  to prevent deaths and health impairments due to
  injuries.
• Strategy of the Program targeted at the
  three types of the prevention
• Accident prevention or active prevention
• Prevention of the harm on health or passive
  prevention
• Prevention of the death and disability
• However
• The focus is on the health care in cases of
  injuries
• Poorly funded

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Conclusions

• It can be expected that entering society into
  more stable period of development, mortality and
  morbidity from external causes will level off and
  inequalities will gradually decline.
• Multisectoral commitment to educational,
  engineering, environmental, legislative and
  enforcement interventions and ensuring a proper
  allocation of resources to prevention efforts are
  highly desirable at the national level as much as
  at the community level to prevent accidents,
  violence and suicides.

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