From injury epidemiology to injury prevention: Lithuanian experience Skirmante Starkuviene MD, PhD Department of Social Medicine Kaunas University of Medicine Lithuania SCIENTIFIC NETWORKING AND THE GLOBAL HEALTH SUPERCOURSE FOR THE PREVENTION OF THREAT FROM MAN MADE AND NATURAL DISASTERS, Kaunas, Lithuania, August 8-10, 2005

Introduction (1) Rapid development of the country is inevitably associated with an initial deterioration of health and increasing inequalities. Rapid development of the country is inevitably associated with an initial deterioration of health and increasing inequalities. There are about admissions to health care institutions and more than 5000 deaths due to external causes registered per year in Lithuania. There are about admissions to health care institutions and more than 5000 deaths due to external causes registered per year in Lithuania.

Although mortality from external causes have a decreasing tendency in Lithuania, increasing number of non- fatal injuries and several times higher injury rates, if compared with other European countries, demonstrates the great need for the definite, well- coordinated and competent injury prevention strategy. Although mortality from external causes have a decreasing tendency in Lithuania, increasing number of non- fatal injuries and several times higher injury rates, if compared with other European countries, demonstrates the great need for the definite, well- coordinated and competent injury prevention strategy. Introduction (2)

The aim of the presentation - to highlight the burden of injury in Lithuania and examine injury prevention activities in order to assess what may work in prevention of injuries.

Methods The patterns and trends of external causes mortality and injury prevention activities and programs in Lithuania were studied. The patterns and trends of external causes mortality and injury prevention activities and programs in Lithuania were studied. The data was derived from Lithuanian Department of Statistics, Lithuanian Health Information Center, and different studies conducted at the Kaunas University of Medicine, Lithuania. The data was derived from Lithuanian Department of Statistics, Lithuanian Health Information Center, and different studies conducted at the Kaunas University of Medicine, Lithuania. International comparisons were performed using Health for all Database, WHO/Europe, January International comparisons were performed using Health for all Database, WHO/Europe, January 2005.

The “Injury iceberg” 1 death 14 hospitalizations 79 admissions to outpatient clinics Source: Lithuanian Health Information Center, 2004 ????? thousands of injuries treated at home

Proportion of the external causes of death in the overall mortality structure by sex and age in Lithuania, 2003 Source: Lithuanian Health Information Center, 2004

Mortality from external causes of death by sex and age in Lithuania, 2002 Source: Kalediene R. et al 2003

Mortality from external causes of death by place of residence and age in Lithuania, 2002 Source: Kalediene R. et al 2003

Comparison of external causes mortality of Lithuanian population with university and primary/lower education in 1989 and 2001 Mortality of the university educational group = 1 * p<0.05 compare to university educational group Source: Starkuviene S. et al 2004

Comparison of external causes mortality of Lithuanian population by marital status in 1989 and 2001 Mortality of the married = 1 Source: Kalediene R. et al 2005 * p<0.05 compare to married

Trends in mortality from external causes of death in selected European countries, Source: Health for all Database, WHO/Europe, January 2005

Mortality from external causes in selected European countries Mortality per Source: Health for all Database, WHO/Europe, January 2005

Mortality from suicides in selected European countries Source: Health for all Database, WHO/Europe, January 2005 Mortality per

Greece 2001 Slovenia 2001 Croatia 1999 Monaco 1999 Belgium 2001 Estonia 2001 Latvia 2001 Luxembourg 2001 Czech Republic 2000 Switzerland 2001 Austria 2001 Germany 2001 Lithuania 2000 EU average 2000 Poland 2001 Slovakia 2001 CSEC average 2001 Russian Federation 1999 Portugal 2001 Denmark 2001 Hungary 2001 EUROPE 1996 United Kingdom 2001 Finland 2000 Andorra 1998 Iceland 2001 Nordic average 2001 CIS average 2001 Netherlands 2001 Kazakhstan 2001 Sweden 1992 Spain 2001 Republic of Moldova 2001 Kyrgyzstan 2001 Belarus 2001 Ukraine 2000 Italy 2001 Bulgaria 2001 Israel 2001 TFYR Macedonia 1999 CARK average 2001 Turkey 2000 Georgia 2000 Romania 1999 Uzbekistan 1999 Turkmenistan 2001 Azerbaijan 2001 Armenia 2001 Albania 2001 Tajikistan 1997 Malta Road traffic accidents involving alcohol per Last Available Source: Health for all Database, WHO/Europe, January 2005 Road traffic accidents involving alcohol in selected European countries per population Per

Number of killed persons in traffic accidents per 1 million inhabitants in selected European countries, 2001 Source: ECMT, 2002

Structure of external causes of death among children and adolescents (0-19 years old) in Lithuania, Source: Starkuviene S. 2003

Mortality from external causes among 0-4 years old children in selected European countries

Mortality from external causes among 5-19 years old children in selected European countries

Frequency of accidents, requiring medical attention, among years old Lithuanian schoolchildren during one year in 1994, 1998, and 2002 Source: WHO Cross-National Study on Health Behaviour in School-Aged children (HBSC)

Safety habits among Lithuanian schoochildren in 2002 Source: WHO Cross-National Study on Health Behaviour in School-Aged children (HBSC)

Injury costs 37 million Euro or 9.2% of the total budget of Lithuanian Health Insurance Fund was spent on the treatment of injuries, poisonings and certain other consequences of external causes in million Euro or 9.2% of the total budget of Lithuanian Health Insurance Fund was spent on the treatment of injuries, poisonings and certain other consequences of external causes in million Euro was spent from the Social Insurance Fund for the temporal and permanent disability caused by the injuries in million Euro was spent from the Social Insurance Fund for the temporal and permanent disability caused by the injuries in 2001 Indirect injury costs were about 300 million Euro in 2000 Indirect injury costs were about 300 million Euro in 2000 Baubinas H. et al 2003

What are the reasons? (1) Political, social and economic transition during last decades in Lithuania Political, social and economic transition during last decades in Lithuania - exposure to risks (increased availability of motor vehicles and greater traffic flows etc.) - insufficient policy development, legislation, implementation and enforcement to manage effectively the changing environment - insufficient policy development, legislation, implementation and enforcement to manage effectively the changing environment - socio-economic level and inequalities within the country - socio-economic level and inequalities within the country

What are the reasons? (2) Unsafe behaviour, poor safety culture, perceiving risks and injury as unpredictable and inevitable Unsafe behaviour, poor safety culture, perceiving risks and injury as unpredictable and inevitable Hazardous environment Hazardous environment However, we cannot determine how far high injury rates in Lithuania are due to unsafe behaviour, lack of regulations, absence of enforcement, unsafe environment, lack of safety training, or even weaknesses in emergency services or trauma care However, we cannot determine how far high injury rates in Lithuania are due to unsafe behaviour, lack of regulations, absence of enforcement, unsafe environment, lack of safety training, or even weaknesses in emergency services or trauma care

Lithuanian Health Program 1998 – 2010, approved by the Parliament of Lithuania Target: by the year 2010 to reduce rate of accidents, accident related deaths and disabilities by 30%. Strategy To develop complex program for accident prevention To develop complex program for accident prevention Prevention of accidents should be carried out on national and regional levels Prevention of accidents should be carried out on national and regional levels On the regional level more cities should be involved into programs of healthy and safe cities. Activities of individuals, communities and non-governmental organizations aimed at safe environment should be promoted and supported On the regional level more cities should be involved into programs of healthy and safe cities. Activities of individuals, communities and non-governmental organizations aimed at safe environment should be promoted and supported Research should be aimed at accident prevention and mechanogenesis of injury Research should be aimed at accident prevention and mechanogenesis of injury

National Accident Prevention Program ( ), approved by the Lithuanian Government in 2000 The aim of the Program – to develop sustained, well- coordinated safety system, which could help to prevent deaths and health impairments due to injuries. Strategy of the Program targeted at the three types of the prevention Strategy of the Program targeted at the three types of the prevention Accident prevention or active prevention Accident prevention or active prevention Prevention of the harm on health or passive prevention Prevention of the harm on health or passive prevention Prevention of the death and disability Prevention of the death and disability However… However… The focus is on the health care in cases of injuries The focus is on the health care in cases of injuries Poorly funded Poorly funded

Conclusions It can be expected that entering society into more stable period of development, mortality and morbidity from external causes will level off and inequalities will gradually decline. It can be expected that entering society into more stable period of development, mortality and morbidity from external causes will level off and inequalities will gradually decline. Multisectoral commitment to educational, engineering, environmental, legislative and enforcement interventions and ensuring a proper allocation of resources to prevention efforts are highly desirable at the national level as much as at the community level to prevent accidents, violence and suicides. Multisectoral commitment to educational, engineering, environmental, legislative and enforcement interventions and ensuring a proper allocation of resources to prevention efforts are highly desirable at the national level as much as at the community level to prevent accidents, violence and suicides.