Elsevier

Health Policy

Volume 89, Issue 1, January 2009, Pages 1-13
Health Policy

Review
The increasing burden of injuries in Eastern Europe and Eurasia: Making the case for safety investments

https://doi.org/10.1016/j.healthpol.2008.05.001Get rights and content

Abstract

Injuries are one of the leading causes of death and disability in Europe. Within Europe, death rates due to injuries are 60% higher in Eastern compared to Western Europe. This is especially due to unintentional injuries such as road traffic injuries, which is the 2nd leading cause of death in those 5–29 years. The cost of injuries is estimated at 1–2% of GNP. Compared to the burden, the number and types of programs are limited in the Eastern European region. However, the literature reveals the existence of cost-effective interventions for regional and national policy consideration. This is a need to appreciate this problem and promote investments to prevent the high economic and societal costs due to injuries. Results from selected injury prevention programs have shown considerable success and these, if effectively adopted in this region, will make a significant difference in reducing the heavy toll of injuries on lives of people. This paper calls on aid donor agencies and governments to plan and implement injury prevention programs as part of their portfolio of investments, in the Eastern European region.

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

References (67)

  • D. Sethi et al.

    Reducing inequalities from injuries in Europe

    Lancet

    (2006)
  • V. Shkolnikov et al.

    Changes in life expectancy in Russia in the mid-1990s

    Lancet

    (2001)
  • R. Room et al.

    Alcohol and public health

    Lancet

    (2005)
  • WHO. The world health report 2001. Mental health: new understanding, new hope. Geneva: World Health Organization;...
  • WHO. Injury: a leading cause of the global burden of disease. Geneva: World Health Organization;...
  • WHO. European centre on health of societies in transition. Final report. Childhood injuries: a priority area for the...
  • WHO. World report on road traffic injury prevention. Geneva: World Health Organization;...
  • WHO. World report on violence and health. Geneva: World Health Organization;...
  • WHO. Milestones of a global campaign for violence prevention: changing the face of violence prevention. Geneva: World...
  • WHO. Injury: a leading cause of the global burden of disease. Geneva: World Health Organization;...
  • M. Peden et al.

    The injury chart book: a graphical overview of the global burden of injuries

    (2002)
  • L.J. Blincoe et al.

    The economic impact of motor vehicle crashes 2000

    (2002)
  • E. Krug et al.

    Injury: a leading cause of the global burden of disease 2000

    (2002)
  • WHO. GBD 2002 estimates [web site]. Geneva: World Health Organization; 2005....
  • WHO. Injuries and violence in Europe: why they matter and what can be done. Summary report. World Health Organization;...
  • Koupilova I, Leon DA, McKee M, Sethi D, Zwi A. Injuries: a public health threat to children and adolescents in European...
  • World Bank. Country classification: classification of economies. Washington DC: World Bank;...
  • Anderson GF, Hyder AA, Cylus J, Aggarwal A, Harbick D, Calikoglu D. Non Communicable Diseases and Injuries in Eastern...
  • M. McKee et al.

    Health policy-making in central and eastern Europe: lessons from the inaction on injuries?

    Health Policy Planning

    (2000)
  • WHO. Public health action for healthier children and populations: the European health report. WHO Regional Office for...
  • WHO. European health for all database (HFA-DB). WHO Regional Office for Europe; 2005. Available at...
  • WHO. Preventing chronic diseases: a vital investment: WHO global report. World Health Organization;...
  • G. Jacobs et al.

    Estimating global road fatalities

    (2000)
  • ECMT statistics on road accidents. Paris, European conference of ministers of transport; 2002....
  • K. Watt et al.

    Risk of injury from acute alcohol consumption and the influence of confounders

    Addiction

    (2004)
  • J. Pomerleau et al.

    Drinking in the Commonwealth of Independent States—evidence from eight countries

    Addiction

    (2005)
  • M. McKee et al.

    Social transition and substance abuse

    Addiction

    (2005)
  • T. Men et al.

    Russian mortality trends for 1991–2001: analysis by cause and region

    British Medical Journal

    (2003)
  • GRSP. Seat belt Campaign (“tomato” campaign). Global Road Safety Partnership; 2004. Website:...
  • GRSP. Russian Federation: seat belt campaign. Global Road Safety Partnership; 2005. Website:...
  • GRSP. Buckle up you kid. Global Road Safety Partnership; 2002. Website:...
  • GRSP. Black spot treatment. Global Road Safety Partnership; 2006. Website:...
  • Cited by (24)

    • Prognostic Analysis of Emergency Decompressive Craniectomy for Patients with Severe Traumatic Brain Injury with Bilateral Fixed Dilated Pupils

      2021, World Neurosurgery
      Citation Excerpt :

      Traumatic brain injury (TBI) is considered a significant cause of mortality and morbidity, which continues to be a major public health concern.1

    • The challenges of injuries and trauma in Pakistan: An opportunity for concerted action

      2013, Public Health
      Citation Excerpt :

      In fact, the recent process of public-academic partnership in Malaysia for RTI prevention provides a model for further engagement in Pakistan.43 What is also surprising is that other countries and region, even middle and high income countries, might be in similar situation to Pakistan.44 It is critical for Pakistan to stop this loss of healthy life from injuries, especially since it involves the young, productive, and vulnerable portions of the population.

    View all citing articles on Scopus
    View full text