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WHO focuses on violence - strong link with alcohol

Half a million lives could be saved in Europe every year

Every year, in Europe, injuries kill some 800,000 people (accounting for 8.3% of all deaths in Europe), an average of nearly 2,200 per day or 90 per hour. Alcohol comes high in the list of risk factors. For every death, injuries send an estimated 30 people to hospital and 300 others to hospital emergency departments for outpatient treatment. Nevertheless, two out of three of these deaths, and most non-fatal injuries, could be prevented, and if all countries in the Region had the same death rate from injuries as the countries with the lowest rates, some 500,000 lives could be saved each year.

The figures are staggering; for example, in 1999, hospital admissions for injuries in the home and from leisure activities cost about 10 billion Euros for the 15 countries of the European Union before May 2004, or about 5.2% of total inpatient expenditure. For the Region, the annual health care cost of treating patients who
subsequently die is estimated at about 1-6 billion Euros and that of non-fatal injuries about 80-290 billion Euros.

This is the picture presented by the publication ‘Injuries and violence in Europe. Why they matter and what can be done’, launched by the WHO Regional Office for Europe at the 1st European Conference on Injury Prevention and Safety Promotion, Austria, June 2006. Because action to stem the injuries epidemic is needed from a variety of sectors, this book identifies unique opportunities to improve health through a pioneering multisectoral approach driven by the health sector.

The report documents the magnitude of the problem and the key interventions available to address it. It aims at supporting policy-makers, health-sector professionals and civil-society organiszations in making the case for injury prevention, advocating safety and working with other sectors to develop preventive plans and action. Beyond health care costs, the economic costs are vast and have only begun to be mapped. Studies suggest that RTIs alone account for the loss of 1-3% of countries’ gross domestic product (GDP) each year. Most of these costs relate to injury and the resulting loss of productivity. In England and Wales, a study estimated that violent crime had total costs of 34 billion Euros; this includes both direct costs, such as those of the police, judicial system and health services, and indirect costs, including lost productivity and physical and emotional costs. Moreover, economic valuations underestimate the real cost paid by society, as they do not cover the suffering caused to victims’ families and social support networks, or to communities, workplaces and schools.

Reasons for concern about unintentional injuries and violence

  • Every year nearly 800,000 people die from injuries in the European Region.
  • They are the leading cause of death for people under the age of 45 years.
  • The costs to the health sector and society run into billions of Euros.
  • There are inequalities in the burden between and within countries in the region.
  • The risk of dying from injuries in the Region’s low and middleincome countries is nearly four times that in high-income countries.
  • Inequality of risk is due to differences in socio-economic determinants of health and environmental exposures.
  • Many high-income countries are among the safest in the world, indicating great opportunities to prevent unintentional injuries and violence.
  • The public health and societal responses to the risk factors for injuries have been inadequate.
  • The countries with low injury mortality have demonstrated many cost-effective strategies, which require intersectoral collaboration and community participation.

Opportunities for prevention

As the costs of injuries are enormous, so are the potential economic benefits of effective prevention strategies. Analysis of the costs and benefits of selected safety measures reveals that they give significant value for money, as shown in Table 1. Investing in the primary prevention of injuries is, therefore, very worthwhile for society.

Injuries can be either unintentional (caused by road-traffic crashes, poisoning, drowning, falls and fires)or intentional (caused by violence directed at oneself or others). Both types combined are the leading cause of death in people under the age of 45 years. In particular, injuries kill 28,000 children under 15 (accounting for 36% of all deaths in this age group) per year.

Nevertheless, rates of death from injury vary more widely betweenpoorer and wealthier countries in the WHO European Region than in any other WHO region in the world. People living in low- and middleincome countries are nearly four times more likely to die from injury than those in high-income countries. In addition, regardless of a country’s wealth, children, older people and the poorest people have a higher risk of injury death; in particular, socioeconomically deprived children have 3-4 times the risk of children from better-off families.

Much can be gained by adapting and transferring the experience of the best performing countries. First, injury prevention should be acknowledged as a society’s responsibility, a great change from the view that assigns responsibility solely to individuals. Some risk factors, such as alcohol consumption and poverty, are common to all types of injury. Addressing these would produce the greatest benefits for people’s health.

The health sector can play a central role in leading a multisectoral approach to injury prevention, not limiting its activities to treatment and rehabilitation. It can engage and support other sectors in injury prevention by providing evidence on the burden of death and disease, shedding light on the risk factors, identifying effective interventions and promoting action.

Figures on injuries in the WHO European Region

Unintentional injuries are responsible for two thirds of injury deaths in the WHO European Region per year.

  • Road-traffic injuries kill 127,000 people (55% are aged 15-44 years) and injure or disable 2.4 million.
  • Poisoning causes 110,000 deaths, with alcohol use responsible for up to 70%, especially in the eastern part of the Region.
  • Drowning results in 38,000 deaths and is the third leading cause of death in children aged 5-14 years.
  • Falls kill 80,000 people, with the highest mortality in those over 80 years.
  • Fires cause 24,000 deaths, and burns are a major cause of disfigurement.

Risk factors: alcohol and drugs

Alcohol and drugs are risk factors for all unintentional injuries and violence. A lot of the excess adult mortality in the CIS and eastern European states has been attributed to alcohol use (29-34). Alcohol consumption is influenced by socioeconomic factors. Some of the key facts on alcohol and injuries are summarized here:

  • Between 40% and 60% of all unintentional and intentional injury deaths are attributed to alcohol consumption (33).
  • Alcohol is a crosscutting risk factor for both unintentional injuries and violence.
  • Many countries have strong drinking traditions, and binge drinking is a concern.
  • Much of the excess adult mortality in the CIS and eastern European countries has been attributed to alcohol.
  • Aggressive marketing strategies of alcohol manufacturers have contributed to large increases in consumption by young people.
  • Another factor in the hazardous use of alcohol is a lack of regulatory control of its production and smuggling, resulting in unprecedented levels of unintentional injuries and violence.