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Injury control: an opportunity for China
  1. G Hu1,2,
  2. T D Baker3,
  3. G Li4,
  4. S P Baker5
  1. 1
    Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China
  2. 2
    Center for Injury Research and Policy, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3
    Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4
    Department of Epidemiology, Columbia University, New York, New York, USA
  5. 5
    Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Dr S P Baker, Center for Injury Research and Policy, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, MD 21205, USA; sbaker{at}jhsph.edu

Abstract

Injury control is an important health issue in China, but has been less well explored than in other countries. To encourage health policy makers to give greater attention to injury control, this report highlights the great damage caused by injuries and the neglected status of injury control in China. China’s situation and the experiences and lessons from industrialized countries, especially the USA, are summarized. Finally, two opportunities to improve injury control in China are identified: establishment of a mechanism for multi-department coordination and collaboration; and improvement of injury data surveillance.

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Injuries are the leading cause of death from age 1 through 39 in China,1 where they cause an annual loss of 12.6 million potentially productive years of life, a loss greater than for any disease group.2 The estimated annual economic cost of injury (US$12.5 billion) is almost four times the total public health services budget of China.2 However, the importance of injury has not been fully recognized in China, as is true in many other developing countries.3 Despite its importance, injury was excluded from the five priorities for population and health in China’s science and technology development plan for 2006–2020.4

What is happening in China now is similar to what happened in industrialized countries several decades ago, when few countries regarded injuries as a disease, and injury prevention was poorly targeted, inadequately funded, and seldom evaluated.5 Health departments showed little inclination to over-ride decisions of other branches of government when it came to injuries; any efforts that would be applied by the public health authorities or any other disease prevention agencies have often been abandoned when confronting injury prevention challenges.6 For example, research into reducing traffic injuries has been far less well funded than research into cancer and AIDS, partly because of governmental failure to view the problem of traffic injuries as a public health problem; rather, traffic injury has been viewed solely as a transport problem or as a police matter.7

China may wish to consider the route taken in the USA in a concerted effort to address the injury problem. In the early 1980s, it became obvious to members of the US Congress that injuries were one of the most serious and costly health problems. At that time, there was no single agency with a broad mandate including all circumstances of injury and all approaches to its reduction. Through the National Academy of Sciences’ National Research Council and Institute of Medicine, the interdisciplinary Committee on Trauma Research was appointed; its members were leaders who collectively represented all aspects of injury research and control. The Committee was charged with determining what arrangement the federal government could use to significantly advance our efforts to reduce injury. After months of deliberation, it recommended that a new research organization be established—a single unit that would foster research on injury epidemiology, prevention, biomechanics, medical care, and rehabilitation and address all sources of injury. The unit should be highly placed in a federal organization, become recognized as the leader of injury research, and be able to initiate collaborative efforts among various agencies. The result of these recommendations, incorporated in a widely distributed report,8 was the creation of a new center within the Centers for Disease Control, now entitled the National Center for Injury Prevention and Control (NCIPC). Recognizing that injury prevention research must be interdisciplinary if it is to be fruitful, the mandate of the NCIPC included establishment of centers of excellence that would foster cross-cutting collaboration among leaders from many fields. There are now a dozen such centers located in universities or medical centers around the USA. In addition to supporting centers, the NCIPC makes injury data easily accessible, conducts research, and sponsors specific research projects, as well as supporting prevention efforts through federal and state health agencies. It is widely recognized for its leadership and the success of its efforts.

China has an opportunity to reduce its enormous burden of injuries. For example, it might benefit China to have a single agency to specifically take charge of injury control. The governmental departments related to injury control, such as disaster, transportation, public security, health, education, and justice, usually work separately, thereby missing the potential benefits of collaboration to improve injury control. China has taken some initial steps to cope with injuries: the injury control program was assigned to the national CDC’s Chronic Disease Center, and similarly each provincial CDC was assigned an office to take charge of injury control; an academic committee for injury control was established under the Chinese Association of Preventive Medicine; the national conference on injury control is held every 2 years; and several universities, including Tongji Medical College in Wuhan and Jinan Medical College in Guangzhou, have established injury control research centers and offer accredited courses to public health and medical students. However, these efforts are in the early stages and not sufficient to successfully tackle the challenge of injuries, as China’sInjury prevention report stated earlier this year.9

Key points

  • Injuries are the leading cause of death in people aged 1–39 in China.

  • Injury control has been neglected and has not been prioritized as a health issue by China’s government.

  • A comprehensive, multi-department management mechanism for injury control has not been established.

  • A high-quality surveillance system for injury control is lacking.

Moreover, a specific injury-monitoring system could provide policy makers with high-quality data. Currently, China’sHealth statistics yearbook, China’sTransportation statistics yearbook (from the Department of Transportation), and National statistics yearbook (from the National Bureau of Statistics) are three accessible sources of injury data. The first source merely includes age-adjusted mortality for 14 selected causes of injury, far fewer than the complete causes of injury covered by the International classification of diseases (9th and 10th revisions).1 The second and third sources cover only the numbers of deaths, crude death rates, and economic loss from injuries related to road traffic and fire. These two causes comprise only 18% of all injury deaths in China1; the reports could be of greater benefit if their scope were expanded to cover all sources of injury. On the other hand, emergency department visits and hospital discharges, two very important and existing data resources for injury prevention, have not been fully utilized.10 China has built a complete information system for collecting hospital data, but only notifiable infectious diseases, public health emergencies, and other endemic diseases are required to be reported. It is necessary and feasible for China to integrate the existing data resources, such as emergency department visits and hospital discharges, to serve injury control. In addition, China will undoubtedly benefit from improving the quality of the data, a common and serious problem in developing countries.11

Injury has been shown to be largely preventable in many countries.12 It is time for China to target injury as a health priority. China’s government has an opportunity to build a high-quality surveillance system for injury control and an integrated response system, and to give priority to prevention of this most important cause of death and disability among China’s children and young adults.

Acknowledgments

This work was funded by the National Center for Injury Research and Prevention, CDC Grant CCR302486.

REFERENCES

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Footnotes

  • Competing interests: None.

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