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Lessons for injury epidemiology and control learned from the COVID-19 pandemic
  1. Louis-Rachid Salmi
  1. ISPED/Inserm U-1219/Injury Epidemiology Transportation Occupation Team, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France
  1. Correspondence to Professor Louis-Rachid Salmi, ISPED/Inserm U-1219/Injury Epidemiology Transportation Occupation Team, Université de Bordeaux Collège Sciences de la Santé, Bordeaux 33076, Aquitaine, France; louis-rachid.salmi{at}

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In October 2021, the Organisation for Economic Co-operation and Development organised a virtual event on ‘Priority setting and coordination of research agendas: lessons learnt from the COVID-19 pandemic’.1 Over 4 days, the event addressed key issues around data collection, development of an evidence base, coordination and preparedness for crises. Other international or national public health agencies (eg, see reference 2 for France) have taken similar initiatives. Many of the issues raised during the workshops question the ability of national and international public health systems to tackle acute catastrophic events such as pandemics. Although the focus was clearly transmissible diseases, issues are also relevant to the impact of such catastrophes on the ability of a society to continue dealing with other health problems. For the readership of Injury Prevention, these include the endemic occurrence of injuries, but also the impact of a crisis and subsequent policies and interventions on mental health, addictions and violence, and on the availability of healthcare resources for people with injuries.

Dealing with such catastrophes requires changing from the traditional vision, where each disease, disorder or injury are seen and addressed as separate entities, to a ‘syndemic’ approach to population health, disease control and policy.3 The syndemic theory considers the negative interaction between health conditions of all types (transmissible, chronic disorders, injury, etc) and the key role of inequality drivers such as poverty, stigmatisation and structural violence.3 Adverse interactions can occur between simultaneously or sequentially occurring events. This systemic approach also implies reconsideration of the way we gather data regarding population health and evidence on interventions and policies.

To address catastrophes and the adverse interactions with and within the health system, I submit that we reconsider intelligence and information gathering on injuries, violence and other conditions to better support decision makers. Functions of such a goal-oriented integrated system can be grouped in four major components: surveillance, investigation, research and expertise (figure 1). Integrating 11 functions to support decision making and to orient interventions and policies and communication, however, is challenging in many regards. First, the four components should cover the whole spectrum of injuries and other acute events (individual events, outbreak and clusters), circumstances (hazards and exposures) and interventions. Second, a timely transfer of newly gathered information or evidence is difficult to reconcile with the time needed to carry sound research and expertise, and assuring the quality of the information. Third, skills and competencies needed for different functions are many and various, and are often not regrouped in institutions in charge of rapid responses to public health crises—for instance, too few academic researchers are involved, or even interested, in field investigation of clusters. Fourth, the expertise needed to support decisions should consider all pillars of evidence-based policy: (1) technical and scientific evidence; (2) experience resulting from systematic and sound evaluations of the implementation and impact of previous policies; and (3) the perspective of all people potentially impacted by the decision (populations at risk, professionals, the economy, the society, etc).

Figure 1

Functions needed to support public health decision making (adapted from Flahault et al 4).

The ongoing COVID-19 pandemic can teach us another major lesson. Even if we were able to convince politicians of industrialised countries—for instance, those in France or the European Union—that such information system is necessary to deal with future crises, it is unlikely that all needed resources would be made available to cover all disorders, including injuries and violence. The situation is even more dramatic in low-income countries where the healthcare system is chronically depleted from needed resources. From a syndemic perspective, however, injury epidemiology and control will remain insufficiently considered if we do not help all countries address all public health problems, including transmissible and chronic diseases. Local and national contexts must be considered, of course, but we remain passengers of the same planet.

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  • Contributors RS conceived, wrote and edited the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.