Injuries and violence in the Eastern Mediterranean Region: a review of the health, economic and social burden
This paper published in “Eastern Mediterranean Health Journal” in 2014 on the World Health Organization (WHO) website, and wrote by Abdulgafoor M. Bachani, Xiaoge Julia Zhang, Katharine A. Allen and Adnan A. Hyder, review the current literature and data on the burden of injuries in the Eastern Mediterranean Region (EMR) – as designed by the WHO – with a special focus on the health, economic and social burden they impose on individuals, families and society.
The EMR is composed by 21 Member States and the occupied Palestinian territory (West Bank and Gaza strip) with a population of 583 million people. The region presents differences inside the countries themselves since some are high-, middle- or low-income countries.
The scholars came up with the following explanations and conclusions.
According to the WHO, road traffic crashes are the leading cause of unintentional injuries and are estimated to contribute to more than 3 600 deaths on the world’s roads every day. Unless action is taken, estimates from WHO suggest that road traffic injuries will become the fifth leading cause of death by 2030.
Health burden of injuries & violence in EMR
According to a WHO’ report from 2012, the proportion of road traffic injury deaths in EMR (3%) is greater than the global estimate (2%). Moreover, the proportion of injury and violence deaths due to road traffic injuries in EMR is slightly higher (27%) than the global proportion (24%).
The region doesn’t have the highest overall injury mortality rate but the second highest road traffic injuries-related mortality rate with 21.8 dead per 100 000 population (this number is only slightly lower than the African region that has a rate of 22.5 per 100 000).
One of the issue of the EMR is to have accurate data on the number of people who survive injury or violence with some form of permanent disability. Though, estimates suggest that for every RTI-related death, between 20 and 50 more individuals suffer some form of disability.
Moreover, road traffic injuries are the leading cause of death for individuals aged 19-25 years worldwide, with almost 400 000 young people under the age of 25 years dying from road traffic each year – this translates into about 1 049 persons a day.
Young males are especially vulnerable in EMR, where more than 75% of all road traffic injury-related deaths are male. In this way, a study from Qatar illustrates the high burden of road traffic injuries among young males in Qatar: males between the ages of 10 and 29 years have a road traffic injury mortality rate that are 5 to 10 times higher than those experiences by the general population. Their road traffic injury death rate is 5.4 times higher than that of similarly aged males in the US.
This paper also highlights the high rate of death due to road traffic injuries for the vulnerable road users (pedestrians, cyclists and motorcyclist).
On a global level, half of road traffic deaths occur among these vulnerable road users – motorcyclists (23%), pedestrians (22%) and cyclists (5%).
In EMR, few, if any, interventions were set up to protect these vulnerable road users, which according to the WHO’ 2013 Global Status Report on Road Safety account for 45% of all road injury fatalities (pedestrians (28%), motorcyclists (14%) and cyclists (3%)).
Moreover, there are variations inside the region between high-income countries such as Gulf countries – where occupants of four-wheel vehicles account for the vast majority of RTI deaths – and middle-income countries such as Morocco or Tunisia – where pedestrians and those on motorized two and three-wheel vehicles are responsible for the majority of deaths.
Economic burden of injuries and violence
Road traffic injuries lead to profound economic costs at the individual, familial and societal level. But the accurate quantifying of these costs is difficult. Indeed, the tangible costs of injuries or violence – such as direct costs (medical or mental health care coasts, legal and social services) and indirect costs (e.g. lost productivity and economic opportunity) – can be estimated in economic terms. But the intangible costs, for example, those associated with pain and suffering are not straightforward and often difficult to assess.
One large 21-country study estimated the global cost of road traffic injuries worldwide to be US$ 518 billion, while the costs of road traffic injuries at the national level generally exceed 1% of a country’s gross national product (GNP).
In the EMR, of the total cost, almost half was spent on medical services followed by 34% on productivity losses.
Estimates show that road traffic injuries in low- and middle-income countries cost approximately US$ 65 billion, or 1-2% of a country GNP.
Social and long-term impact of injuries and violence
This paper highlights the significant research gap that exists to understand the long-term impact of injuries and violence; and especially in low- and middle-income countries.
Indeed, injuries and violence often have far reaching implications, which need to be understood to better address the burden. Study examining the social impact of injuries in low- and middle-income countries are almost nonexistent. But those that do exist show that road traffic crashes and resultant death or disability can place a heavy toll on the family and friends of the injured person, many of whom experience adverse financial, physical, social and psychological stress.
For example, families and friends of the injured reallocate work or change work pattern to take care of the injured person. Often debts are incurred because of the expensive rehabilitation services and reduced income. Children in these households can be pressured to leave school or suffer from decreased supervision.
A 2010 study from Gaza Strip in Palestine showed that the majority of all traumatic brain injuries were due to road traffic injuries. As a result, over 60% of the caregivers of these injured individuals were mothers, with the majority stating their care-giving activity deprived them of community involvement. Additionally, these mothers were unable to work or engage in other economically productive activities outside of the home.
Addressing the burden of injuries and violence
Most injury and violence deaths can be prevented since the risk factors involved largely predict their occurrence. There are many measures targeting the risk factors of injury and violence that have been shown to be effective in a variety of settings. It can help lower fatalities but also have economic benefits: reduction of direct costs on medical, social and legal services associated with injury and violence as well as the indirect costs of lost productivity and economic opportunities.
Conclusion
The paper concludes that the road traffic injuries pose a significant challenge, especially in the Eastern Mediterranean Region.
It also reminds the importance of understanding the differing risk profiles across the countries inside the region.
