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
Self-inflicted injuriesOesophagus cancerHypertensive heart diseaseLiver CancerRheumatic heart diseaseLeishmaniasisFires15
Hypertensive heart diseaseLiver cancerBreast cancerDrowningsLeukaemiaViolenceEndocrine disorders14
Malaria Cirrhosis of the liverDiabetes mellitusWar injuriesFallsPoisoningsTuberculosis13
Diabetes mellitusAlzheimer and other dementias
Lower respiratory infectionsFiresPoisoningsFallsRoad traffic injuries12
Childhood diseasesNephritis and nephrosisLiver cancerPoisoningsIschaemic heart diseaseCongenital anomaliesDrownings11
Road traffic injuriesColon and rectum cancersStomach cancerCirrhosis of the liverWar injuriesLeukaemiaMeningitis10
Trachea, bronchus, lung cancersTuberculosisSelf-inflicted injuriesLower respiratory
infectionsFiresMeningitisSyphilis9
TuberculosisStomach cancerRoad traffic injuriesCerebrovascular diseaseDrowningsProtein-energy malnutrition
Protein-energy malnutrition8
Diarrhoeal diseasesHypertensive heart diseaseCirrhosis of the liverViolenceLower respiratory
infectionsTuberculosisHIV/AIDS7
Perinatal conditionsDiabetes mellitusTrachea, bronchus, lung cancersSelf-inflicted injuriesViolenceFiresCongenital anomalies6
Chronic obstructive pulmonary disease
Trachea, bronchus, lung cancers
Chronic obstructive pulmonary diseaseIschaemic heart diseaseTuberculosisChildhood diseasesMalaria5
HIV/AIDSLower respiratory infectionsTuberculosisMaternal conditionsSelf-inflicted injuriesDrowningsChildhood diseases4
Lower respiratory infections
Chronic obstructive pulmonary diseaseHIV/AIDSRoad traffic injuriesMaternal conditionsHIV/AIDSDiarrhoeal diseases3
Cerebrovascular diseaseCerebrovascular diseaseCerebrovascular diseaseTuberculosisRoad traffic injuriesRoad traffic injuriesLower respiratory infections2
Ischaemic heart diseaseIschaemic heart diseaseIschaemic heart diseaseHIV/AIDSHIV/AIDSLower respiratory infectionsPerinatal conditions1
All Ages≥60 years45-59 years30−44 years15−29 years5−14 years0−4 yearsRank
Source: Global Burden of Disease Project for 2002, Version 5
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
Police Labour
Education
Transport
Public health
Public health
Research
AdvocacyEpidemiology
Prevention
Evaluation
Policy
Services
Road traffic
FallsBurns Drowning WarInter -personal violence
Suicide
Health
Transport
Interior
Police
Road traffic
FallsBurns Drowning WarInter -personal violence
Suicide
Health
Transport
Interior
Police
Health
Transport
Interior
Police
Health
Welfare
Interior
Police
Health
Interior
Police Health
Health
Justice
Interior
Police
Health
Diplomacy
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 traffic
FallsBurns Drowning WarInter -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 SafetyUnited Nations General Assembly
2005 - Resolution A/60/L.8 "Improving global road safety"
Road traffic
FallsBurns Drowning WarInter -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 traffic
FallsBurns Drowning WarInter -personal violence
Suicide
Child injury preventionChild injury prevention
Apr
il 20
05
Nov
embe
r 20
05
Mar
ch 2
006
Good Practices
booklet
May
200
7
2008
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]
