INJURY EPIDEMIOLOGY & PREVENTION

1. INJURY EPIDEMIOLOGY & PREVENTION

2. DefinitionsInjury • “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) NCD Epi

3. DefinitionsViolence • “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) NCD 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 NCD Epi

5. The Epidemiological Model Host Environment Vector Agent NCD Epi

6. The Ecological Model Society Community Individual Relationship Complex Linkages NCD Epi Source: Krug E et al., eds., 2002.

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9. VIP Public Health Approach Defining Characteristics • Population-based • Multidisciplinary • Evidence-based • Collective action • Prevention NCD Epi

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

11. Categorizing Injury NCD 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 NCD Epi

13. Types of data and potential sources of information NCD Epi

14. Source: adapted from Krug et al., eds., 2002 NCD Epi

15. % Ischaemic heart disease 12.2 Cerebrovascular disease 9.7 Lower respiratory infections 7.1 COPD 5.1 Diarrhoeal diseases 3.7 HIV/AIDS 3.5 Tuberculosis 2.5 Trachea, bronchus, lung cancers 2.3 Road traffic accidents 2.2 Prematurity, low birth weight 2.0 % Lower respiratory infections 6.2 Diarrhoeal diseases 4.8 Depression 4.3 Ischaemic heart disease 4.1 HIV/AIDS 3.8 Cerebrovascular disease 3.1 Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma 2.7 Road traffic accidents 2.7 Neonatal infections and other 2.7 Leading Causes of Mortality and Burden of Diseaseworld, 2004 Mortality DALYs NCD Epi

16. Source: WHO, 2004 NCD Epi

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

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

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