From injury epidemiology to injury prevention: Lithuanian experience

1. 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

2. Introduction (1) • Rapid development of the country is inevitably associated with an initial deterioration of health and increasing inequalities. • There are about 400 000 admissions to health care institutions and more than 5000 deaths due to external causes registered per year in Lithuania.

3. Introduction (2) • 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.

4. 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.

5. Methods • 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. • International comparisons were performed using Health for all Database, WHO/Europe, January 2005.

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

7. 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

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

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

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

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

12. Trends in mortality from external causes of death in selected European countries, 1988-2003 Source: Health for all Database, WHO/Europe, January 2005

13. Mortality from external causesin selected European countries Mortality per 100 000 Source: Health for all Database, WHO/Europe, January 2005

14. Mortality from suicides in selected European countries Mortality per 100 000 Source: Health for all Database, WHO/Europe, January 2005

15. 170701 +Road traffic accidents involving alcohol per 100000 Greece 2001 Slovenia 2001 Croatia 2001 Monaco 1999 Belgium 1999 Estonia 2001 Latvia 2001 Luxembourg 2001 Czech Republic 2001 Switzerland 2000 Austria 2001 Germany 2001 Lithuania 2001 EU average 2000 Poland 2000 Slovakia 2001 CSEC average 2001 Russian Federation 2001 Portugal 1999 Denmark 2001 Hungary 2001 EUROPE 2001 United Kingdom 1996 Finland 2001 Andorra 2000 Road traffic accidents involving alcoholin selected European countries per 100 000 population Iceland 1998 Nordic average 2001 CIS average 2001 Netherlands 2001 Per 100 000 Source: Health for all Database, WHO/Europe, January 2005 Kazakhstan 2001 Sweden 2001 Spain 1992 Republic of Moldova 2001 Kyrgyzstan 2001 Belarus 2001 Ukraine 2001 Italy 2000 Bulgaria 2001 Israel 2001 TFYR Macedonia 2001 CARK average 1999 Turkey 2001 Georgia 2000 Romania 2000 Uzbekistan 1999 Turkmenistan 1999 Azerbaijan 2001 Armenia 2001 Albania 2001 Tajikistan 2001 Malta 1997 0 50 100 150 200 Last Available

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

17. Structure of external causes of death among children and adolescents (0-19 years old) in Lithuania, 1988-2000 Source: Starkuviene S. 2003

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

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

20. Frequency of accidents, requiring medical attention, among 11-15 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)

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

22. 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 2001 • 26 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 Baubinas H. et al 2003

23. What are the reasons? (1) • 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 - socio-economic level and inequalities within the country

24. What are the reasons? (2) • Unsafe behaviour, poor safety culture, perceiving risks and injury as unpredictable and inevitable • 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

25. Lithuanian Health Program 1998 – 2010, approved by the Parliament of Lithuania Target:by the year 2010 to reduce rate of accidents, accidentrelated deaths and disabilities by 30%. Strategy • To develop complex program for accident prevention • 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 • Research should be aimed at accident prevention and mechanogenesis of injury

26. National Accident Prevention Program (2000-2010), 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 • Accident prevention or active prevention • Prevention of the harm on health or passive prevention • Prevention of the death and disability However… • The focus is on the health care in cases of injuries • Poorly funded

27. 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. • 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.