Global Health Challenges Social Analysis 76: Lecture 16

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Global Health ChallengesSocial Analysis 76
Lecture 16
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Burden of Injuries Road Traffic
Accidents Suicide Homicide
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Injuries
Injuries are a major cause of the burden of
disease and have a disproportionate impact on
young adults, particularly males. Concept of
injuries as a legitimate area of concern for
public health and for health authorities in
countries is relatively new. Many of the
drivers of injury mortality and potential
solutions are not in the narrow purview of health
systems and require broader solutions and
coalitions.
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Distribution of 5.2 Million Global Injury Deaths,
2002
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Burden of Injuries Road Traffic
Accidents Suicide Homicide
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Driver, Passenger, Pedestrian Mix
Road traffic accidents in different societies
vary substantially in the mix of deaths from
drivers, passengers and pedestrians. Although
the nature of death is often not recorded, a
number of studies suggest that a large fraction
of deaths in developing countries are in
pedestrians and/or passengers. In high-income
countries, the majority of deaths are in drivers.
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Road Traffic Accidents
In most but not all higher income countries,
there is a characteristic epidemic curve of road
traffic accidents. With development the
exposure to road traffic accident death, whether
as a driver, passenger or pedestrian, increases
as total miles travelled increases. At some
threshold level of income per capita, societies
begin spending resources to reduce the risks per
mile travelled resulting in a decline in risk,
even though exposure continues to increase.
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Risk Factors
1. Factors influencing exposure to risk 2.
Factors influencing crash involvement 3. Factors
influencing crash severity 4. Factors influencing
post crash injuries
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Intervention Strategies
Decreasing exposure mass transport systems,
land-use policies, trip reduction (e.g. work at
home), increasing legal age for use. Road design
speed limits, road engineering, road networks,
speed bumps, traffic calming, identification and
intervention for high-risk crash sites. Vehicle
design seat belts, airbags, daytime lights,
vehicle crash worthiness, audible seatbelt
reminders, variable speed limitation devices,
alcohol interlocks. Compliance with road safety
speed cameras, enforcement of alcohol laws,
mandatory child seats and seatbelt laws, bicycle
and motorcycle helmet laws and enforcement.
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RTAs in Developing Countries
Since 1960s, developed countries have developed
and tested a range of strategies to reduce the
risk of RTAs. Why have these technologies and
strategies not diffused to developing countries?
Is it a question of cost? Is it a question of
problem recognition and policy priority? In
regions such as EUR B or EMR B with middle to
high levels of income, it is extraordinarily
difficult to understand why effective
technologies have not been adopted. Key maybe
the shift from ethos of personal responsibility
to social responsibility for road traffic
accidents.
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Burden of Injuries Road Traffic
Accidents Suicide Homicide
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Suicide Patterns
Suicide death rates are about 3-6 times higher in
males except in a belt running from South Asia
through China where risks are nearly equal.
Suicide rates rise with age except recently in
countries where young male suicide has risen
dramatically. In many high-income countries,
suicide rates in older adults have been dropping
over the last 50 years. Highest rates are for
males in Eastern Europe and the Former Soviet
Union.
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Suicide Trends
Countries with complete vital registration
systems demonstrate diverse long-term trends in
suicide as well as short-term changes such as in
the Russian Federation. Many explanations are
possible but no coherent theory of variation in
the level or trends in suicide are available.
For a number of developed countries, young male
suicide rates have been rising or are stagnant
for 30-40 years.
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Suicide Risk Factors

1. Psychiatric factors -- major depression bipolar
   disorder schizophrenia anxiety and disorders of
   conduct and personality and impulsivity
2. Biological factors increased risk in families
3. Precipitating life events death of loved one,
   physical or sexual abuse, protective effect of
   stable relationships, social isolation
4. Social, cultural and environmental factors --
   availability of the means of suicide a persons
   place of residence, employment or immigration
   status affiliation to a religion and economic
   conditions

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Public Health Approaches to Reducing Suicide

• Treatment of psychiatric disorders increasing
  concern that in young adults suicide risk is not
  affected or may increase.
• Suicidal behaviour interventions
• Community interventions such as suicide
  prevention centers little evidence of impact
• Restricting access to means of suicide bridge
  fencing, limit access to toxic compounds
• Responsible media reporting

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Global Response to Suicide
World Health Report 2001 and the World Violence
Report in 2002 has brought some increase in
policy attention. Main problem is that there are
few generally effective public health strategies
to reduce suicide. Efforts to restrict means are
by nature highly context specific. Public health
can contribute little at this point to addressing
broad social drivers of suicide such as the
status of women in South Asia and rural China.
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Burden of Injuries Road Traffic
Accidents Suicide Homicide
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AFR E
EUR C
AFR D
SEAR D
AMR B
EMR D
AMR D
AMR A
WPR A EUR A
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Homicide Patterns
Highest rates are in Africa, Eastern Europe and
the Former Soviet Union and particularly for
males in Latin America. Homicide for males and
females is extremely low, less than 0.1
cumulative risk of death in Western Europe,
Japan, Australia and New Zealand. AMR A (US and
Canada) has male homicide rates 7.8 times higher
than WPR B and AMR B is nearly 50 times higher
than WPR B. Homicide rates demonstrate dramatic
fluctuations over relatively short periods of
time some correlate with economic trends.
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Homicide Prevention
Few prevention strategies have been formulated or
tested. Much of the policy debate is national
and focused on law enforcement, prosecution of
criminals and the deterrent effect. Cross-country
and time-series patterns reveal enormous
heterogeneity that must have social, cultural and
economic causes. What is the role of access to
weapons?