1. 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

2. Leading causes of death, both sexes, 2002 Rank 0  4 years5  14 years15  29 years30  44 years 45-59 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

4. Inequalities More exposed to risks Less exposed to prevention Less access to quality trauma care and rehabilitation

5. Child restraints: 35% reduction in fatal traffic injuries among children (US) Injuries are preventable

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Public health

14. Justice Diplomacy Police Labour Education Transport Public health

15. Research Advocacy Epidemiology Prevention Evaluation Policy Services

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

17. 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

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

19. Road traffic Falls BurnsDrowning War Inter - personal violence Suicide

21. 2003 - Implementing the recommendations of the World report on violence and health, WHA56.24 2004 - Road traffic safety and health, WHA57.10

22. Traffic injury prevention UN passes historic resolution on Road Safety United Nations General Assembly 2005 - Resolution A/60/L.8 " Improving global road safety"

23. Road traffic Falls BurnsDrowning War Inter - personal violence Suicide Policy Data Research Prevention Services Advocacy

24. –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

25. Cross-cutting: Capacity building

26. Road traffic Falls BurnsDrowning War Inter - personal violence Suicide

27. Child injury prevention April 2005 November 2005 March 2006 Good Practices booklet May 2007 2008

28. Collaborating Centres Partnerships Network of Ministry of Health Focal Persons

29. –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

30. –Contribute to regional and global policy making –Contribute to regional and global estimates –Share best practice –Mentor Role of Focal Persons: internationally

31. Network of Ministry of Health Focal Persons WHO

32. –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

33. Dr Etienne Krug Director Injuries and Violence Prevention World Health Organization 20 Avenue Appia 1211 Geneva, Switzerland Tel: 41 22 791 3480 E-mail: kruge@who.int