injuries and violence prevention: who's approach injuries and violence prevention: who's...
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Injuries and Violence Prevention:WHO's approach
Injuries and Violence Prevention:WHO's approach
Etienne Krug, MD, MPHDirector, Department of
Injuries and Violence Prevention,World Health Organization
Leading causes of death, both sexes, 2002
Rank 04 years 514 years 1529 years 3044 years 45-59 years ≥60 years All Ages
1 Perinatal conditions Lower respiratory infections HIV/AIDS HIV/AIDS Ischaemic heart disease Ischaemic heart disease Ischaemic heart disease
2Lower respiratory infections Road traffic injuries Road traffic injuries Tuberculosis Cerebrovascular disease Cerebrovascular disease Cerebrovascular disease
3 Diarrhoeal diseases HIV/AIDS Maternal conditions Road traffic injuries HIV/AIDS Chronic obstructive pulmonary disease
Lower respiratory infections
4 Childhood diseases Drownings Self-inflicted injuries Maternal conditions Tuberculosis Lower respiratory infections HIV/AIDS
5 Malaria Childhood diseases Tuberculosis Ischaemic heart disease Chronic obstructive pulmonary disease
Trachea, bronchus, lung cancers
Chronic obstructive pulmonary disease
6 Congenital anomalies Fires Violence Self-inflicted injuries Trachea, bronchus, lung cancers Diabetes mellitus Perinatal conditions
7 HIV/AIDS Tuberculosis Lower respiratory infections Violence Cirrhosis of the liver Hypertensive heart
disease Diarrhoeal diseases
8Protein-energy malnutrition
Protein-energy malnutrition Drownings Cerebrovascular disease Road traffic injuries Stomach cancer Tuberculosis
9 Syphilis Meningitis Fires Lower respiratory infections Self-inflicted injuries Tuberculosis Trachea, bronchus, lung
cancers
10 Meningitis Leukaemia War injuries Cirrhosis of the liver Stomach cancer Colon and rectum cancers Road traffic injuries
11 Drownings Congenital anomalies Ischaemic heart disease Poisonings Liver cancer Nephritis and nephrosis Childhood diseases
12 Road traffic injuries Falls Poisonings Fires Lower respiratory infections
Alzheimer and other dementias Diabetes mellitus
13 Tuberculosis Poisonings Falls War injuries Diabetes mellitus Cirrhosis of the liver Malaria
14 Endocrine disorders Violence Leukaemia Drownings Breast cancer Liver cancer Hypertensive heart disease
15 Fires Leishmaniasis Rheumatic heart disease Liver Cancer Hypertensive heart disease Oesophagus cancer Self-inflicted injuries
Source: Global Burden of Disease Project for 2002, Version 5> 5,000,000 Deaths p
er year
InequalitiesInequalities
More exposed to risks
Less exposed to prevention
Less access to quality trauma care and rehabilitation
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths
• drowning: fencing, swimming pools
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths
• drowning: fencing swimming pools
• drowning: swimming lessons
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths
• drowning: fencing swimming pools
• drowning: swimming lessons
• burns: safer stoves
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths drowning: fencing swimming pools
• drowning: swimming lessons
• burns: safer stoves
• child abuse and neglect: e.g. home visitation contributed to a median reduction of 40% of cases
Injuries are preventable
• Child restraints: 35% reduction in fatal traffic injuries among children (US)
• Speed : for 1 km/hr less, 2-3% less fatal collisions
• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths drowning: fencing swimming pools
• drowning: swimming lessons
• burns: safer stoves
• child abuse and neglect: e.g. home visitation contributed to a median reduction of 40% of cases
• alcohol related violence: e.g. reduction of 43% of assault related ED visits
Injuries are preventable
Public health
Justice
Diplomacy
PoliceLabour
Education
Transport
Public health
Public health
Research
AdvocacyEpidemiology
Prevention
Evaluation
Policy
Services
Road
trafficFallsBurns Drowning War
Inter -
personal
violence
Suicide
Health
Trans
port
Interior
Police
Road
trafficFallsBurns Drowning War
Inter -
personal
violence
Suicide
Health
Trans
port
Interior
Police
Health
Trans
port
Interior
Police
Health
Welfare
Interior
Police
Health
Interior
Police Health
Health
Justice
Interior
Police
Health
Diplo
macy
Defense
Health
Welfare
Police
Consultative process
World report
Technical support(guidelines, best practices)
Regional/country
programsAdvocacy
Political support(WHA, UN GA, etc)
Funding Model region/country
programs
Road
trafficFallsBurns Drowning War
Inter -
personal
violence
Suicide
2003 - Implementing the recommendations of the
World report on violence and health, WHA56.24
2004 - Road traffic safety and health, WHA57.10
Traffic injury preventionTraffic injury prevention
UN passes historic resolution on Road Safety
United Nations General Assembly
2005 - Resolution A/60/L.8 "Improving global road safety"
Road
trafficFallsBurns Drowning War
Inter -
personal
violence
Suicide
Policy
Data
Research
Prevention
Services
Advocacy
– Preventing violence
– Handbook for documenting violence prevention programmes
– Framework for child maltreatment prevention (upcoming)
– Road safety best practice documents• Helmets
• Seat-belts
• Drinking and driving
– Best practices on child injury prevention (upcoming)
PreventionPrevention
Cross-cutting: Capacity buildingCross-cutting: Capacity building
Road
trafficFallsBurns Drowning War
Inter -
personal
violence
Suicide
Child injury preventionChild injury prevention
Ap
ril
200
5
No
vem
be
r 2
005
Mar
ch
2006
Good
Practices
booklet
May
200
7
200
8
Collaborating Centres
PartnershipsPartnerships
Network of Ministry of HealthFocal Persons
– Lead injury/violence prevention in the country
– Be a catalyst
– Coordinate public health efforts
– If needed and appropriate, coordinate multi-sectoral efforts
– Promote scientific approach
Role of Focal Persons: in the countryRole of Focal Persons: in the country
– Fund raising
– Make sure the different elements of a system are being developed:• National report National plan• Data collection• Primary prevention• Services• Capacity building
– Contribute to regional and global policy making
– Contribute to regional and global estimates
– Share best practice
– Mentor
Role of Focal Persons: internationallyRole of Focal Persons: internationally
Network of Ministry of Health
Focal PersonsWHO
– an enormous public health challenge– more attention from policy makers– Important recent WHA and UN GA resolutions– Ministries of health and WHO have an important role to play and
can gain from collaboration– sometimes "all injury" approaches are best, sometimes approaches
should be by "injury type"– Whatever the approach, there are common elements – Key role in setting priorities and catalysing action – We lack indicators – A major priority is to develop successful prevention programmes
ConclusionsConclusions
Dr Etienne KrugDirectorInjuries and Violence PreventionWorld Health Organization20 Avenue Appia1211 Geneva, Switzerland
Tel: 41 22 791 3480E-mail: [email protected]