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

Leading causes of death, both sexes, 2002 Rank 0  4 years5  14 years15  29 years30  44 years years≥60 years All Ages 1 Perinatal conditions Lower respiratory infections HIV/AIDS Ischaemic heart disease 2 Lower respiratory infections Road traffic injuries TuberculosisCerebrovascular disease 3 Diarrhoeal diseasesHIV/AIDSMaternal conditionsRoad traffic injuriesHIV/AIDS Chronic obstructive pulmonary disease Lower respiratory infections 4 Childhood diseasesDrowningsSelf-inflicted injuriesMaternal conditionsTuberculosis Lower respiratory infections HIV/AIDS 5 MalariaChildhood diseasesTuberculosisIschaemic heart disease Chronic obstructive pulmonary disease Trachea, bronchus, lung cancers Chronic obstructive pulmonary disease 6 Congenital anomaliesFiresViolenceSelf-inflicted injuries Trachea, bronchus, lung cancers Diabetes mellitusPerinatal conditions 7 HIV/AIDSTuberculosis Lower respiratory infections ViolenceCirrhosis of the liver Hypertensive heart disease Diarrhoeal diseases 8 Protein-energy malnutrition DrowningsCerebrovascular diseaseRoad traffic injuriesStomach cancerTuberculosis 9 SyphilisMeningitisFires Lower respiratory infections Self-inflicted injuriesTuberculosis Trachea, bronchus, lung cancers 10 MeningitisLeukaemiaWar injuriesCirrhosis of the liverStomach cancer Colon and rectum cancers Road traffic injuries 11 DrowningsCongenital anomaliesIschaemic heart diseasePoisoningsLiver cancerNephritis and nephrosisChildhood diseases 12 Road traffic injuriesFallsPoisoningsFires Lower respiratory infections Alzheimer and other dementias Diabetes mellitus 13 TuberculosisPoisoningsFallsWar injuriesDiabetes mellitusCirrhosis of the liverMalaria 14 Endocrine disordersViolenceLeukaemiaDrowningsBreast cancerLiver cancer Hypertensive heart disease 15 FiresLeishmaniasisRheumatic heart diseaseLiver Cancer Hypertensive heart disease Oesophagus cancerSelf-inflicted injuries Source: Global Burden of Disease Project for 2002, Version 5 > 5,000,000 Deaths per year

Inequalities 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

Research Advocacy Epidemiology Prevention Evaluation Policy Services

Road traffic Falls BurnsDrowning War Inter - personal violence Suicide Health Trans port Interior Police

Road traffic Falls BurnsDrowning War Inter - personal violence Suicide Health Trans port Interior Police Health Trans port Interior Police Health Welfare Interior Police Health Interior Police Health Justice Interior Police Health Diplo macy Defense Health Welfare Police

Consultative process World report Technical support (guidelines, best practices) Regional/ country programs Advocacy Political support (WHA, UN GA, etc) Funding Model region/ country programs

Road traffic Falls BurnsDrowning War Inter - personal violence Suicide

Implementing the recommendations of the World report on violence and health, WHA Road traffic safety and health, WHA57.10

Traffic injury prevention UN passes historic resolution on Road Safety United Nations General Assembly Resolution A/60/L.8 " Improving global road safety"

Road traffic Falls BurnsDrowning 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) Prevention

Cross-cutting: Capacity building

Road traffic Falls BurnsDrowning War Inter - personal violence Suicide

Child injury prevention April 2005 November 2005 March 2006 Good Practices booklet May

Collaborating Centres Partnerships Network of Ministry of Health Focal 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 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: internationally

Network of Ministry of Health Focal Persons WHO

–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 Conclusions

Dr Etienne Krug Director Injuries and Violence Prevention World Health Organization 20 Avenue Appia 1211 Geneva, Switzerland Tel: