Injuries and Violence Prevention: WHO's · PDF fileInjuries and Violence Prevention:...

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

Self-inflicted injuriesOesophagus cancerHypertensive heart diseaseLiver CancerRheumatic heart diseaseLeishmaniasisFires15

Hypertensive heart diseaseLiver cancerBreast cancerDrowningsLeukaemiaViolenceEndocrine disorders14

Malaria Cirrhosis of the liverDiabetes mellitusWar injuriesFallsPoisoningsTuberculosis13

Diabetes mellitusAlzheimer and other dementias

Lower respiratory infectionsFiresPoisoningsFallsRoad traffic injuries12

Childhood diseasesNephritis and nephrosisLiver cancerPoisoningsIschaemic heart diseaseCongenital anomaliesDrownings11

Road traffic injuriesColon and rectum cancersStomach cancerCirrhosis of the liverWar injuriesLeukaemiaMeningitis10

Trachea, bronchus, lung cancersTuberculosisSelf-inflicted injuriesLower respiratory

infectionsFiresMeningitisSyphilis9

TuberculosisStomach cancerRoad traffic injuriesCerebrovascular diseaseDrowningsProtein-energy malnutrition

Protein-energy malnutrition8

Diarrhoeal diseasesHypertensive heart diseaseCirrhosis of the liverViolenceLower respiratory

infectionsTuberculosisHIV/AIDS7

Perinatal conditionsDiabetes mellitusTrachea, bronchus, lung cancersSelf-inflicted injuriesViolenceFiresCongenital anomalies6

Chronic obstructive pulmonary disease

Trachea, bronchus, lung cancers

Chronic obstructive pulmonary diseaseIschaemic heart diseaseTuberculosisChildhood diseasesMalaria5

HIV/AIDSLower respiratory infectionsTuberculosisMaternal conditionsSelf-inflicted injuriesDrowningsChildhood diseases4

Lower respiratory infections

Chronic obstructive pulmonary diseaseHIV/AIDSRoad traffic injuriesMaternal conditionsHIV/AIDSDiarrhoeal diseases3

Cerebrovascular diseaseCerebrovascular diseaseCerebrovascular diseaseTuberculosisRoad traffic injuriesRoad traffic injuriesLower respiratory infections2

Ischaemic heart diseaseIschaemic heart diseaseIschaemic heart diseaseHIV/AIDSHIV/AIDSLower respiratory infectionsPerinatal conditions1

All Ages≥60 years45-59 years30−44 years15−29 years5−14 years0−4 yearsRank

Source: Global Burden of Disease Project for 2002, Version 5

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

Police Labour

Education

Transport

Public health

Public health

Research

AdvocacyEpidemiology

Prevention

Evaluation

Policy

Services

Road traffic

FallsBurns Drowning WarInter -personal violence

Suicide

Health

Transport

Interior

Police

Road traffic

FallsBurns Drowning WarInter -personal violence

Suicide

Health

Transport

Interior

Police

Health

Transport

Interior

Police

Health

Welfare

Interior

Police

Health

Interior

Police Health

Health

Justice

Interior

Police

Health

Diplomacy

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 traffic

FallsBurns Drowning WarInter -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 SafetyUnited Nations General Assembly

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

Road traffic

FallsBurns Drowning WarInter -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 traffic

FallsBurns Drowning WarInter -personal violence

Suicide

Child injury preventionChild injury prevention

Apr

il 20

05

Nov

embe

r 20

05

Mar

ch 2

006

Good Practices

booklet

May

200

7

2008

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: kruge@who.int