Injuries (Road Traffic Accidents and Alcohol)
In this chapter, we will be looking at one of the major rising causes of death and disability in the world which are injuries, especially road traffic accidents and alcohol which is Frequently related to these accidents and injuries. The global burden of disability study which looked at the contribution of different diseases to death and disability in 1990 as well as in 2010 categorized diseases and causes of death and disability into three major groups. First is the grouping of communicable diseases or infectious diseases with deaths related to pregnancy, early childhood, later childhood, and nutritional conditions which often result in death or disease because of severe under-nutrition in many forms. These are generally considered diseases associated with under-developed economies and are generally expected to decrease in terms of their contribution to the global burden of disease as countries advance economically and socially. The second category is one of non-communicable diseases, which are actually diseases of mal-adapted modernity and which have been rising quite a lot as a result of countries advancing economically, urbanizing and industrializing without appropriate balancing measures to prevent unhealthy lifestyles from becoming established as a pattern in society. These two are now a major cause of concern in the 21st Century. The third category is one of injuries. These can be intentional or unintentional. Of course injuries have been found as causes of death right from times immemorial. People could have died by being mauled by a wild animal, or being thrown off a horse, or being struck by an arrow fired by an enemy. But in modern times, you find many more people dying by being mauled by a speeding truck or a car or being shot by a bullet. And as we now see injuries rising in contribution, the major categories of injuries which are rising are those related to road traffic accidents, suicides as well as homicide. And these are contributing to a rising burden which now exceeds the burden contributed by HIVAIDS, tuberculosis, and malaria put together. About 5.8 million people die each year as a result of injuries. This accounts for about 10% of the world’s deaths and is considerably more than the number of deaths resulting from some of these major infectious diseases like HIV, TB and malaria. Men are the major victims of intentional as well as unintentional injuries in a variety of forms, whether it is homicide or suicide or drowning or falls or poisoning. And of course markedly in terms of being road traffic accident victims. But women seem to be outnumbering men in terms of being victims of fire related injuries. That’s mostly because they are the ones mostly in the, cooking. In terms of the global burden, male sustained about 68% of all injury related deaths in 2010. But what is really disconcerting is the fact that many of these injuries strike young. About 40% of all deaths in the age group of 15 to 24 years were accounted for by injuries. Fifty-two percent of deaths in males, age 15 to 29 years were due to injuries. Again, like in case of many of the non-communicable diseases, a large fraction of these injury related deaths occurs in low and middle income countries. Eighty-nine percent of all injury related mortality is in these countries. South Africa has injuries as the second leading cause of death in that country. And about 95% of deaths and disability adjusted life year loss from interpersonal violence that is often due to fights or homicide. All of these occurring between people, these are found in low and middle income countries. And we know that war and conflict causes a huge number of deaths, almost exclusively in the low and middle income countries, even if the conflicts, geopolitical causes of those conflicts arise from other parts of the world. We also recognize that transportation related injuries and intentional injuries are among the leading causes of death worldwide, among the entire injury spectrum. And of these, road traffic accidents really are at the very top. And they’re rising in different parts of the world which are particularly now on the faster development trajectory. And we find that in Africa and the Middle East, the rates of road traffic accident related deaths per 100,000 population are among the highest in the world. In terms of unintentional injuries, we can actually take a large number of public health measures which have been shown to be very effective, like compulsory helmets, use of seatbelts, imposition of speed limits, improved built environments and road conditions. All of these actually help mitigate some of the disease burdens. In terms of intentional injuries we do require a fair amount of counseling from the healthcare system to people who are likely to be having suicidal intent. So treatment of depression, preventing suicidal attempts and providing psychological support systems and counseling to prevent self-harm, all of these are going to be important. Also, conflict resolution and means to prevent interpersonal violence are also part now of the public health agenda. And gun control becomes a very important area. And we now recognize that in countries with poor levels of gun control, homicidal and other interpersonal violence related injuries are very high indeed. In terms of preventing injuries, we also have to look at the response systems, particularly in terms of the emergency healthcare response. We need to look at the pre-hospital stage where for example a traffic accident victim needs to be immediately attended to by first responders, we need improved communications and provision of appropriate emergency transport. At the same time, in the hospital, we need again, a multidisciplinary trauma team to look after the person who is injured, who may have multiple injuries which might require different specialized care. But we also require to train nonprofessional caregivers to provide care when trained staff are not available. We also need rehabilitation of people who have had injuries and have survived them and a large number of people living with disabilities, post-injury need sufficient rehabilitation support now. We recognize that road traffic accidents are indeed the major preventable cause of injuries. And about 1.3 million people die on the roads every year. That is about 3,500 every day. Something like ten jumbo jets crashing every day. Now 50 million people are left with injuries, many with severe disabilities. And particularly in the young population of 10 to 24 years age, we find road traffic accidents are the single biggest cause of fatality in that young age group. We recognize that in high income countries some progress is being made by a decline in the rate of road traffic accident related death rates. But in low and middle income countries the death rates are rising. And when we look at the middle income countries in comparison with the high income countries, while the vehicular numbers are almost comparable across these two income groups, the deaths are far, far higher in the middle income group. So these are countries which are modernizing with a higher vehicular density, but are still unable to implement adequate safety measures which can bring down the road traffic accidents and the fatalities associated with it. Now half of the deaths related to road traffic accidents are unfortunately among the very vulnerable road users like pedestrians, cyclists, motorcyclists. That means it’s not just the car drivers and the truck drivers who die because of careless driving, but also the innocents who fall victim are the people who use the roads in other ways. Now we need to take very effective measures in, in order to control the road traffic accident related damage to health and prevent the death and disability in different settings. The five factors that can be controlled for by effective legislation. Speed of the vehicles can be controlled by speed laws. Drinking and driving has to be strictly curbed. And testing alcohol content in the breath and blood of drivers who are suspected to be driving under the influence of alcohol is a very important measure. Applying child restraints in cars prevents them from tossing around and getting injured in a speeding vehicle. And motorcycle helmets must be made mandatory everywhere to prevent head injuries. Again, seatbelts have made a great difference to the degree and number of injuries obtained during road traffic accidents. But very few countries implement all of these laws. If you take any single one of them, you find that the use of these is still limited only to some countries among the huge number of countries across the world. For example, when you look at drunk driving laws, then these are in fact applied very, in very few places. Urban speed laws are also applied in very few places. So also child restraint laws. While seatbelt laws and motorcycle helmet laws are more frequently applied, how well they’re enforced is also a big question. When we look at what are the contributory causes to some of this, drink driving comes out as one of the top causes of road traffic accidents. Now in South Africa, about 50% of those involved in road traffic accidents had elevated blood alcohol concentrations in 2001. And this is true of many rapidly urbanizing cities in low and middle income countries now. About 3.3 million people die every year due to harmful use of alcohol. In the age group of 20 to 39 years, about 25% of all deaths are attributable to alcohol. This is of course not only because of road traffic accidents, but because of the other harmful effects of alcohol as well. And we know that alcohol is the cause of cirrhosis that is a liver problem which because of alcohol gets fibrosis in the liver. Cancers which are again, attributable to alcohol particularly gastrointestinal cancers. All of these are growing problems now. But alcohol consumption, especially immoderate alcohol consumption is also associated with mental illness. And that can lead to intentional injuries, particularly alcohol provoked interpersonal conflict. Alcohol consumption, especially heavy drinking has been linked to both suicide as well as violence. And all of these can aggravate the number of injury related deaths and disability. We also know that there are huge economic costs apart from the social costs of alcohol. We have direct costs like costs for healthcare services, costs related to law enforcement, costs related to increased crime and accidents, costs related to domestic violence. Now there are indirect costs from loss of productivity, reduced output and earnings as a result of alcohol use. Absenteeism. Or even people being away from productive occupations because they’re under the influence of alcohol. Then intangible costs which are assigned to pain and suffering and poor quality of life. So given all of this, alcohol has become a major public health challenge again, not only in the context of non-communicable diseases, but in the overall context of development. Many countries have started looking at ways by which they can control the problem of excessive alcohol consumption which is deleterious to health. And taxation has been shown to be one of the very important elements by which public health can address the problem of alcohol, by raising prices and reducing the demand. And the, the taxation in different countries has been linked to the quality of alcohol, quantity of alcohol, the concentration of alcohol and so on. But taxing adequately is important as a measure. Now restricting availability of alcoholic beverages is also an important element. Not only age related restrictions but some countries have also imposed restrictions on the total amount of alcohol that can be sold to individuals over a period of time. Implementing bans on alcohol advertisements is absolutely critical. Both direct and indirect forms of alcohol advertisement and sponsorship and promotion must be banned. The other effective measures are measures against drunk driving. The word ‘drink driving’ itself is very suggestive. It suggests that it’s not the human being who is driving, it is the drink that is actually driving the vehicle when the alcohol concentration has exceeded a particular limit. So we do need to enforce that kind of legislation where we have random breath-testing and people who are driving under the influence alcohol are taken off the street and are also stripped of their licenses to drive. And strict penalties are imposed in order to inhibit such practices. We also need of course support systems by way of de-addiction counseling and other support systems, the health system as well as social support systems can provide. And all of these measures can reduce the problem of alcohol in our society and remove one of the important contributory causes to road traffic accidents.
OpenEdition sugere que esta publicação seja citada da seguinte forma:
Pedro Pereira Leite (18 de Maio de 2015). Non-Communicable Diseases X. Global Heritages. Recuperado em 13 de Novembro de 2025 de https://doi.org/10.58079/p2p3