1. INJURY EPIDEMIOLOGY & PREVENTION

2. Definitions Injury “Acute exposure to physical agents such as mechanical energy, heat, electricity, chemicals, and ionising radiation interacting with the body in amounts or at rates that exceed the threshold of human tolerance. In some cases, injuries result from the sudden lack of essential agents such as oxygen or heat.” (Source: Gibson, 1961; Haddon, 1963) 2 June 20162NCD Epi

3. Definitions Violence “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” (Source: WHO, 1996) 2 June 20163NCD Epi

4. The Global Injury Problem 5 million deaths worldwide = 9% of all deaths (2000) 12% of global burden of disease Road traffic “incidents” are the leading cause of injury deaths worldwide 90% of injury deaths occur in low- and middle- income countries Highest number of deaths in S.E. Asia & Western Pacific regions 2 June 20164NCD Epi

5. The Epidemiological Model VectorAgent Host Environment 2 June 20165NCD Epi

6. The Ecological Model IndividualCommunity Relationship Society Complex Linkages Source: Krug E et al., eds., 2002. 2 June 20166NCD Epi

7. VIP Temporal primary secondary tertiary Targeted universal selective indicated Approach passive active 2 June 20167NCD Epi

8. VIP strategies Engineering Environmental modification Enforcement Education /empower ment Evaluation 2 June 20168NCD Epi

9. VIP Public Health Approach Defining Characteristics  Population-based  Multidisciplinary  Evidence-based  Collective action  Prevention 2 June 20169NCD Epi

10. (1) Surveillance What is the problem? (2) Risk factor identification What are the causes? (4) Implementation How is it done? (3) Develop and evaluate interventions What works? The Public Health Approach 2 June 201610NCD Epi

11. Severity Setting Activity Mechanism Intent Nature Categorizing Injury 2 June 201611NCD Epi

12. Injury Pyramid Deaths Injuries resulting in hospitalization Injuries resulting in ambulatory and emergency treatment Injuries resulting in treatment in Primary care settings Injuries treated by paramedics only (school nurse, physiotherapist, first aid) Untreated injuries or injuries which were not reported 2 June 201612NCD Epi

13. Types of data and potential sources of information Mortality Death certificates Reports from mortuaries Morbidity and Health-related Hospitals Medical records Self Reported Surveys Media 2 June 201613NCD Epi

14. Community-based Demographic records Local government records Law enforcement Police records Prison records Economic-social Institutional or agency records Special studies Source: adapted from Krug et al., eds., 2002 2 June 201614NCD Epi

15. Leading Causes of Mortality and Burden of Disease world, 2004 % 1.Ischaemic heart disease 12.2 2.Cerebrovascular disease 9.7 3.Lower respiratory infections 7.1 4.COPD 5.1 5.Diarrhoeal diseases 3.7 6.HIV/AIDS 3.5 7.Tuberculosis 2.5 8.Trachea, bronchus, lung cancers 2.3 9.Road traffic accidents 2.2 10.Prematurity, low birth weight 2.0 % 1.Lower respiratory infections 6.2 2.Diarrhoeal diseases 4.8 3.Depression4.3 4.Ischaemic heart disease 4.1 5.HIV/AIDS3.8 6.Cerebrovascular disease 3.1 7.Prematurity, low birth weight 2.9 8.Birth asphyxia, birth trauma 2.7 9.Road traffic accidents 2.7 10.Neonatal infections and other 2.7 MortalityDALYs 2 June 201615NCD Epi

16. Source: WHO, 2004 2 June 201616NCD Epi

17. Ten leading causes of burden of disease, world, 2004 and 2030 2 June 201617NCD Epi

18. References 1 1.Last J. A dictionary of epidemiology. 5 th Edition. Oxford, New York, Toronto: Oxford University Press, 2008. 2.Remington PL, Brownson RC, Wegner MV. Chronic disease epidemiology and control. 3 rd Edition. Washington, D.C.: American Public Health Association, 2010. 3.WHO. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. Geneva: WHO, 2008 2 June 201618NCD Epi

19. References 2 4.Fadhil I. Diabetes and other non- communicable diseases: An Eastern Mediterranean Perspective. WHO, 2009 5.Kuh D, Ben Shlomo Y. A life course approach to chronic disease epidemiology. Oxford, New York, Toronto: Oxford University Press, 1997. 6.Newcomer RJ, Benjamin AE. Indicators of chronic health conditions. Baltimore, London: The Johns Hopkins University Press, 1997. 2 June 201619NCD Epi