Injuries and Violence Prevention: WHO's approach Injuries and Violence Prevention: WHO's approach Etienne Krug, MD, MPH Director, Department of Injuries.

Injuries and Violence Prevention:WHO's approach

Injuries and Violence Prevention:WHO's approach

Etienne Krug, MD, MPHDirector, Department of

Injuries and Violence Prevention,World Health Organization

Leading causes of death, both sexes, 2002

Rank 04 years 514 years 1529 years 3044 years 45-59 years ≥60 years All Ages

1 Perinatal conditions Lower respiratory infections HIV/AIDS HIV/AIDS Ischaemic heart disease Ischaemic heart disease Ischaemic heart disease

2Lower respiratory infections Road traffic injuries Road traffic injuries Tuberculosis Cerebrovascular disease Cerebrovascular disease Cerebrovascular disease

3 Diarrhoeal diseases HIV/AIDS Maternal conditions Road traffic injuries HIV/AIDS Chronic obstructive pulmonary disease

Lower respiratory infections

4 Childhood diseases Drownings Self-inflicted injuries Maternal conditions Tuberculosis Lower respiratory infections HIV/AIDS

5 Malaria Childhood diseases Tuberculosis Ischaemic heart disease Chronic obstructive pulmonary disease

Trachea, bronchus, lung cancers

Chronic obstructive pulmonary disease

6 Congenital anomalies Fires Violence Self-inflicted injuries Trachea, bronchus, lung cancers Diabetes mellitus Perinatal conditions

7 HIV/AIDS Tuberculosis Lower respiratory infections Violence Cirrhosis of the liver Hypertensive heart

disease Diarrhoeal diseases

8Protein-energy malnutrition

Protein-energy malnutrition Drownings Cerebrovascular disease Road traffic injuries Stomach cancer Tuberculosis

9 Syphilis Meningitis Fires Lower respiratory infections Self-inflicted injuries Tuberculosis Trachea, bronchus, lung

cancers

10 Meningitis Leukaemia War injuries Cirrhosis of the liver Stomach cancer Colon and rectum cancers Road traffic injuries

11 Drownings Congenital anomalies Ischaemic heart disease Poisonings Liver cancer Nephritis and nephrosis Childhood diseases

12 Road traffic injuries Falls Poisonings Fires Lower respiratory infections

Alzheimer and other dementias Diabetes mellitus

13 Tuberculosis Poisonings Falls War injuries Diabetes mellitus Cirrhosis of the liver Malaria

14 Endocrine disorders Violence Leukaemia Drownings Breast cancer Liver cancer Hypertensive heart disease

15 Fires Leishmaniasis Rheumatic heart disease Liver Cancer Hypertensive heart disease Oesophagus cancer Self-inflicted injuries

Source: Global Burden of Disease Project for 2002, Version 5> 5,000,000 Deaths p

er year

InequalitiesInequalities

More exposed to risks

Less exposed to prevention

Less access to quality trauma care and rehabilitation

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths

• drowning: fencing, swimming pools

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths

• drowning: fencing swimming pools

• drowning: swimming lessons

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths

• drowning: fencing swimming pools

• drowning: swimming lessons

• burns: safer stoves

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths drowning: fencing swimming pools

• drowning: swimming lessons

• burns: safer stoves

• child abuse and neglect: e.g. home visitation contributed to a median reduction of 40% of cases

Injuries are preventable

• Child restraints: 35% reduction in fatal traffic injuries among children (US)

• Speed : for 1 km/hr less, 2-3% less fatal collisions

• motorcycle helmets: Thailand: 41% less head injuries and 21% less deaths drowning: fencing swimming pools

• drowning: swimming lessons

• burns: safer stoves

• child abuse and neglect: e.g. home visitation contributed to a median reduction of 40% of cases

• alcohol related violence: e.g. reduction of 43% of assault related ED visits

Injuries are preventable

Public health

Justice

Diplomacy

PoliceLabour

Education

Transport

Public health

Public health

Research

AdvocacyEpidemiology

Prevention

Evaluation

Policy

Services

Road

trafficFallsBurns Drowning War

Inter -

personal

violence

Suicide

Health

Trans

port

Interior

Police

Road

trafficFallsBurns Drowning War

Inter -

personal

violence

Suicide

Health

Trans

port

Interior

Police

Health

Trans

port

Interior

Police

Health

Welfare

Interior

Police

Health

Interior

Police Health

Health

Justice

Interior

Police

Health

Diplo

macy

Defense

Health

Welfare

Police

Consultative process

World report

Technical support(guidelines, best practices)

Regional/country

programsAdvocacy

Political support(WHA, UN GA, etc)

Funding Model region/country

programs

Road

trafficFallsBurns Drowning War

Inter -

personal

violence

Suicide

2003 - Implementing the recommendations of the

World report on violence and health, WHA56.24

2004 - Road traffic safety and health, WHA57.10

Traffic injury preventionTraffic injury prevention

UN passes historic resolution on Road Safety

United Nations General Assembly

2005 - Resolution A/60/L.8 "Improving global road safety"

Road

trafficFallsBurns Drowning War

Inter -

personal

violence

Suicide

Policy

Data

Research

Prevention

Services

Advocacy

– Preventing violence

– Handbook for documenting violence prevention programmes

– Framework for child maltreatment prevention (upcoming)

– Road safety best practice documents• Helmets

• Seat-belts

• Drinking and driving

– Best practices on child injury prevention (upcoming)

PreventionPrevention

Cross-cutting: Capacity buildingCross-cutting: Capacity building

Road

trafficFallsBurns Drowning War

Inter -

personal

violence

Suicide

Child injury preventionChild injury prevention

Ap

ril

200

5

No

vem

be

r 2

005

Mar

ch

2006

Good

Practices

booklet

May

200

7

200

8

Collaborating Centres

PartnershipsPartnerships

Network of Ministry of HealthFocal Persons

– Lead injury/violence prevention in the country

– Be a catalyst

– Coordinate public health efforts

– If needed and appropriate, coordinate multi-sectoral efforts

– Promote scientific approach

Role of Focal Persons: in the countryRole of Focal Persons: in the country

– Fund raising

– Make sure the different elements of a system are being developed:• National report National plan• Data collection• Primary prevention• Services• Capacity building

– Contribute to regional and global policy making

– Contribute to regional and global estimates

– Share best practice

– Mentor

Role of Focal Persons: internationallyRole of Focal Persons: internationally

Network of Ministry of Health

Focal PersonsWHO

– an enormous public health challenge– more attention from policy makers– Important recent WHA and UN GA resolutions– Ministries of health and WHO have an important role to play and

can gain from collaboration– sometimes "all injury" approaches are best, sometimes approaches

should be by "injury type"– Whatever the approach, there are common elements – Key role in setting priorities and catalysing action – We lack indicators – A major priority is to develop successful prevention programmes

ConclusionsConclusions

Dr Etienne KrugDirectorInjuries and Violence PreventionWorld Health Organization20 Avenue Appia1211 Geneva, Switzerland

Tel: 41 22 791 3480E-mail: [email protected]