ReviewThe increasing burden of injuries in Eastern Europe and Eurasia: Making the case for safety investments
Introduction
Morbidity and mortality, due to injuries, is being recognized as a major public health and development problem. It ranks among the leading causes of death and occurs in all regions, affecting people in all age and income groups. It represents 12% of the global burden of disease, as measured by disability-adjusted life years (DALYs). It is the third most important cause of overall mortality, and the main cause of death among 1–40 year olds [1]. Injuries killed over 5 million people globally in 2000 with many more being disabled, resulting in a heavy disease burden [2]. Injuries account for one in seven healthy life years lost worldwide; and by 2020 they will account for one in five, with low and middle-income countries bearing the brunt of this increase [3]. Injuries contribute 4198 DALYs per 100,000 people in low and middle-income countries compared to high-income countries with 1403 DALY per 100,000 people; this three times difference is worth noting.1 The economic and societal cost of injuries is already staggeringly high, and is growing each year.
Of all injury-related causes of deaths, road traffic injuries and violence are universal challenges [4], [5]. Every year, over 1.5 million people die of preventable acts of violence including 800,000 suicides and 500,000 homicides [5], [6]. The first WHO World Report on Violence and Health was released in 2001 with a call by Nelson Mandela to place injuries in the forefront of public health efforts [7]. Road traffic injury is another growing public health issue, which is disproportionately affecting vulnerable groups, including the poor. More than half the people killed in traffic crashes are young adults aged between 15 and 44 years—often the breadwinners of the family [4], [8]. In economic terms, the direct annual cost of global road crashes has been estimated at US $518 billion. The cost in low- and middle-income countries is estimated at US $65 billion, which is 1–2% of their Gross National Product (GNP) and is more than the total development aid received by these countries [9]. Road traffic injury ranks 2nd in terms of leading causes of burden of diseases among males of age group 5–44 years in low- and middle-income countries [2], [3], [4].
Injuries are leading causes of morbidity and mortality in Europe and are responsible for a sizeable economic drain on the countries in this region. Of the 5 million deaths from injury worldwide in 2002, 790 000 were in the WHO European Region (EURO) [10], [11], [12]. Every day, injuries kill over 2000 people, put 60,000 in hospitals, and necessitate outpatient emergency treatment for 600,000 in this region [13]. Overall injuries cause 9% of deaths and 14% of ill health in EURO [11], [13]. The annual health care cost of treating patients of injuries who subsequently die is estimated at about $1.3–7.6 billion USD and that of non-fatal injuries is about $101–368 billion USD [13], [14].
Once thought to be an issue among higher income countries, injuries are exacting an ever-greater toll on middle-income and poor countries, creating an added burden on impoverished families, already over-stretched health care systems, and robbing people of active and productive years. A recent paper points out that this is the case in the European Region as well, where most of the burden falls on low- and middle-income countries, which have undergone great changes brought about by transition to market style economies since the 1990s [11], [15]. These developments have been associated with increases in violence and unintentional injuries [16]. However, the scale and extent of this problem has not been appreciated in Eastern European and Eurasian countries. This paper makes the case that there is a high burden of injuries in the region, and while many pilot programs have been conducted these have not been scaled up or replicated to be effective at national level. To support this, we will first review the high burden of injuries in Eastern European and Eurasian (E&E) countries, and then identify types of injury prevention programs that have been attempted. Analyses of effective injury interventions that exist in the region is then presented in order to recommend approaches to prevent and manage injuries and propose a rationale for investments in this region. Based on the recent work done by WHO [4] and Anderson et al. [17], this paper will attempt to focus on Road traffic injuries, which is a significant sub category of unintentional injuries.
Section snippets
Methodology
An extensive search of the Pub Med database and Google Scholar was done to retrieve literature on morbidity, mortality and cost of various types of injuries in Eastern Europe and Central Asian (E&E) region, which were published either in English or with an English abstract (foreign-language publication). A separate search was also conducted to identify injury prevention programs in the E&E region. The time period of the search range from 1991 till 2006. Combinations of the following types of
Rationale for investments
Through premature death, disability, medical costs and lost productivity, injuries have devastating effects on the health and welfare of all—men, women and children. Death and disability from injury affect people at every age, both genders and all countries. Data from WHO clearly show that injuries are among the top 15 causes of death for people younger than 60 years [12]. In the European region, data from WHO show that the number of deaths due to injuries over 1 year results in 24 million
Acknowledgements
This study was commissioned by the Bureau for Europe and Eurasia of the United States Agency for International Development through the Global Research Activity, cooperative agreement # GHS-A-00-03-0019. The authors would like to thank Paul Holmes, Neal Brandes, Heather Haberle, Nathan Blanchart and Gerry Anderson for helpful comments and Robert Herbert for assistance analyzing the WHO database. The study conclusions are those of the authors and not necessarily of the United States Agency for
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