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Injury and Violence PUBHLTH 350 Matthew L. Boulton, MD, MPH November 4, 2015

Injuries Physical damage caused to a person by an acute transfer of energy (mechanical, thermal, electrical, chemical, or radiation energy) Can also be caused by sudden absence of heat or oxygen Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Global burden of injuries 5.1 million deaths from injuries globally during 2010 Accounts for 9% of the world’s deaths Total number of deaths exceeded by 1.7 times the combined number of deaths from HIV-AIDS, tuberculosis, and malaria Burden of injuries is projected to decrease in high-income countries, but become increasingly important and more common in low- and middle-income countries

Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Worldwide distribution of injuries 89% of the deaths due to injuries occurred in low- and middle-income countries 68% of all injury related deaths occurred in males 40% of injury related deaths occurred in individuals aged between years Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Geographical distribution of injuries worldwide

Unintentional injuries: Transportational injuries Injuries from road traffic incidents are the leading cause of death among year olds. Road traffic incidents have highest occurrence in low and middle income countries Africa has lowest motorization rate, but similar fatality rates compared to other world regions Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Unintentional injuries: Falls, Poisonings and Drownings Rate of death from falls is highest in the low- and middle- income countries of Southeast Asia Rate of death from poisoning is highest in low- and middle-income countries of Europe More than 90% of deaths from drownings and fires occur in low- and middle-income countries Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Intentional injuries: Self Harm and Interpersonal Violence Self-harm causes disproportionately more deaths in high- income countries. Rates of death from self-harm are highest in low- and middle-income countries. 95% of the deaths and DALYs due to interpersonal violence and almost all the deaths and DALYs due to war and conflict occur in low- and middle income countries. Five times as many people die from homicide each year than from war-related injury. Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Consequences of injury and violence Only a small fraction of the injuries result in death. Many of those who survive injuries are left with temporary or permanent disabilities Factors such access to health care services, or the quality of data available influence the distribution of the consequences of injuries. Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

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Prevention of injuries and violence Most of the injuries and much of the violence are preventable. Despite the high magnitude of incidence, attention to injury and violence by policy makers and funding by global health problems is disproportionately low. jury_violence_facts_2014/en/

Prevention of unintentional injuries Campaigns aimed at implementing legislation to prevent unintentional injuries Efforts to reduce drinking and driving Efforts to increase the use of motorcycle helmets, seat belts, and child safety restraints Multisectoral approach required to prevent unintentional injuries because most of the preventive strategies lie outside the traditional health sector Primary health care sector plays an important role in preventing falls among young children and the elderly. Majority of the research about preventive strategies conducted in high income countries, and may have low impact in low- and middle-income countries. Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Prevention of intentional injuries Educating clinicians about timely identification and treatment of individuals with mental health or mood disorders Restricting access to means of suicide, such as pesticides, guns, and unprotected heights Interventions that combine sex-equity with financial improvement and life-skills training in low- and middle-income countries to prevent violence against women Reducing child maltreatment by interventions such as Positive Parenting Program in USA Norton, Robyn, and Olive Kobusingye. "Injuries." New England Journal of Medicine (2013):

Question of the day Michigan repealed its motorcycle helmet law within the last two years. How strongly should public health focus on passing helmet laws here and in other states? How might we mitigate the increase in injuries associated with motor vehicle accidents in middle income countries?