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

Department of International Health, and Center for Injury Research & Policy, Bloomberg School of Public Health, Johns Hopkins University, 615N. Wolfe Street, Baltimore, MD 21205, USA.
Health Policy (Impact Factor: 1.91). 07/2008; 89(1):1-13. DOI: 10.1016/j.healthpol.2008.05.001
Source: PubMed


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.

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    • "As shown, there are reasonable clusters of good-quality economic evaluations for some interventions, sometimes in a range of different countries, but for some other aspects of road safety the pattern of economic evidence on preventing road injuries is dogged by a paucity of recent studies and extensive heterogeneity. Additionally, there is a scarcity of evaluative and economic evidence generated in low-and middle-income countries (Hyder & Aggarwal, 2009). This raises challenges in the potential transferability of cost-effective interventions across the European region. "
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    ABSTRACT: Executive summary A core question for policy-makers will be the extent to which investments in preventive actions that address some of the social determinants of health represent an effi cient option to help promote and protect population health. Can they reduce the level of ill health in the population? How strong is the evidence base on their effectiveness and, from an economic perspective, how do they stack up against investment in the treatment of health problems? Are there potential gains to be made by reducing or delaying the need for the consumption of future health care resources? Will they limit some of the wider costs of poor health to society, such as absenteeism from work, poorer levels of educational attainment, higher rates of violence and crime and early retirement from the labour force due to sickness and disability? This policy summary provides an overview of what is known about the economic case for investing in a number of different areas of health promotion and non-communicable disease prevention. It focuses predominantly on addressing some of the risk factors for health: tobacco and alcohol consumption, impacts of dietary behaviour and patterns of physical activity, exposure to environmental harm, risks to mental health and well-being, as well as risks of injury on our roads. It highlights that there is an evidence base from controlled trials and welldesigned observational studies on the effectiveness of a wide range of health promotion and disease prevention interventions that address risk factors to health. Moreover, the cost–effectiveness of a number of health promotion and disease prevention interventions has been shown in multiple studies. Some of these interventions will be cost-saving, but most will generate additional health (and other) benefi ts for additional costs. In many cases combinations of actions, for example in the areas of tobacco, alcohol and road injury prevention, are often more cost-effective than relying on one action alone. In terms of individual actions the use of taxes to infl uence individual choices on the use of tobacco and alcohol, as well as the consumption of food, is consistently seen as a cost-effective intervention to promote better lifestyle choices. Media-based campaigns, in contrast, are not always effective or cost-effective. Interventions targeted at children often have the most potential to be cost-effective because of the longer time-frame over which health benefi ts can be realized. While some interventions may take several decades to be seen to be costeffective, for example impacts on the risk of obesity, there are some health promotion and disease prevention actions that are cost-effective in the short term, for instance related to the protection of mental health in the workplace. There are opportunities to invest in cost-effective health promoting interventions that can be delivered universally as well as to target population groups, for instance in schools or workplaces. However, this evidence base must be treated with caution, given that many interventions have only been assessed in a small number of settings, and different economic methods and assumptions are made in different studies. Most of the economic evidence identifi ed has been undertaken in highincome countries, with very few studies applied to other settings in the WHO European Region. Moreover, much of the evidence on the long-term costs and benefi ts of interventions has been estimated using simulation modelling approaches synthesizing data on effectiveness, epidemiology and costs. This refl ects the lack of long-term observed effectiveness data for many public health and health promoting interventions. It also means that policy-makers need to be cautious on assumptions made about the persistence of effect of health promoting interventions, for example the likelihood of long-term behaviour change. The issue of equity is also a particularly important consideration. If the uptake of a public health intervention is higher in more affl uent groups in society then one unintended consequence of investment in a public health programme could be to inadvertently widen health inequalities. We have little data from our review on the impact of interventions on health inequalities. Finally there are also challenges to be met to in order to help encourage the implementation of cost-effective health promotion and disease prevention actions. Notwithstanding these caveats, it is clear that there is an economics evidence base for health promotion and disease prevention. The challenge now is to strengthen this evidence base further and look at ways in which it may be used to translate evidence-based knowledge into routine everyday practice across all of the WHO European Region. For instance, given that these actions are often delivered outside of the health system it is helpful to speak the same language and highlight the economic benefi ts of most interest to the sectors that are responsible for funding each action.
    Full-text · Book · Dec 2013
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    • "Injury is a large public health burden common to many LMIC. Hyder and Aggarwal (2009) describe the much greater toll of injury observed in the LMIC of Eastern Europe and Eurasia, compared with the high-income countries of Western Europe. Similar issues have been highlighted in LMIC in Asia (Consunji and Hyder 2004), and Latin America (Perel et al. 2006). "
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    ABSTRACT: Injury is a major public health issue, responsible for 5 million deaths each year, equivalent to the total mortality caused by HIV, malaria and tuberculosis combined. The World Health Organisation estimates that of the total worldwide deaths due to injury, more than 90% occur in low- and middle-income countries (LMIC). Despite the burden of injury sustained by LMIC, there are few continuing injury surveillance systems for collection and analysis of injury data. We describe a hospital-based trauma surveillance instrument for collection of a minimum data-set for calculating common injury scoring metrics including the Abbreviated Injury Scale and the Injury Severity Score. The Cape Town Trauma Registry (CTTR) is designed for injury surveillance in low-resource settings. A pilot at Groote Schuur Hospital in Cape Town was conducted for one month to demonstrate the feasibility of systematic data collection and analysis, and to explore challenges of implementing a trauma registry in a LMIC. Key characteristics of the CTTR include: ability to calculate injury severity, key minimal data elements, expansion to include quality indicators and minimal drain on human resources based on few fields. The CTTR provides a strategy to describe the distribution and consequences of injury in a high trauma volume, low-resource environment.
    Full-text · Article · Oct 2010 · Global Public Health
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    ABSTRACT: Injury and violence cause five million deaths annually in the world which is around 9% of the global mortality. Eight out of fifteen leading causes of deaths in the age group 15-25 years are injury related. The objective of this study was to assess the incidence, severity and socio-economic burden of injuries and violence in two cities of Nepal. Relevant data was collected from 17th August 2008 to 16th September 2008 from injured patients attending emergency departments at six health centres in two cities. In total, 505 injury cases were reported. 42.5% of the injuries occurred in roads and 34.1% at home. 65% of road traffic injuries involved motorcycles. The majority (60%) of the injured subjects were economically active. A single injury case cost 126.2 US$ including all the expenses and the loss due to inability to work. The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation.
    Full-text · Article · Oct 2009 · Kathmandu University Medical Journal
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