Injury control in South America: the art and science of disentanglement

While musing upon the request to write an indigenous pediatrician’s perspective of the state of play of injury control in South America, particularly as to why matters remain at a rather primitive level and what could be done to move things along, I was struck by this news item: a newspaper in my hometown in southern Brazil reported that a unidentified motorcyclist had fired two gunshots at a brand new mobile speed camera. This camera had replaced a similar one that had been destroyed a month before by two enraged characters armed with iron bars.^{w1 w2} This seemingly simple account actually offers insights into a variety of issues: undue weapon carrying, speeding vehicles, novel traffic calming strategies, newish high tech devices, meager safety knowledge discrimination, sheer public unawareness, violence at-large, and—of course—a middle income developing country with mostly inconsistent and inequitable public health priorities. Does this sound too entangled for the ordinary reader’s liking? Well, bienvenido a Sudamérica!

THE USUAL GRIM FIGURES, WITH SOME NASTY PARTICULARS

The injury problem in South America, as worrisome as in the rest of the world, bears some specific circumstances that are worthy of attention. First, up to 29 years, injuries account for nearly six million disability adjusted years of life lost each year—around 17% of the burden of disease.¹ This means we face a graver public health problem than most.

Second, although the region is by and large free from wars, interpersonal violence has been a frighteningly growing cause of death and disablement from the age of 5 through adolescence.^1–3 Figure 1 shows death rates associated with the main causes of injury in selected countries. While homicide rates may be quite similar to those …