Reducing violence and injury in the WHO European region
Authors: Yongjie Yon, Lucía Hernández-García, Gianluca Di Giacomo, Ivo Rakovac, Jonathon Passmore, Bente Mikkelsen
Journal: The Lancet Public Health (2020)

Violence and injury kill nearly half a million people in the WHO European region every year. That figure is equivalent to one death per min and represents more than 5% of all deaths in the region. Over 60% of deaths are due to self-harm (140 000), falls (83 000), and road traffic injuries (80 000).1WHOGlobal health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000–2016. World Health Organization, Geneva2018https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlDate accessed: July 9, 2020Google Scholar Deaths, however, are just the tip of the iceberg and for every person who is killed, thousands more are injured. The direct health-care cost of violence and injury was estimated at €80 million annually, in the European Union.2EuroSafeInjury data collection: an effective tool for helping to cut the societal costs of injuries. European Association for Injury Prevention and Safety Promotion, Amsterdam2013http://www.eurosafe.eu.com/uploads/inline-files/IDB%20as%20effective%20tool%20for%20cost%20saving%20measures.pdfDate accessed: July 9, 2020Google Scholar However, the actual cost could be higher when considering the cost for treatment outside of hospital, including costs for rehabilitation. Moreover, a disproportionate share of the burden of violence and injury fall on the most vulnerable groups: adults aged 60 years and older, children aged 5–14 years, and economically deprived individuals. In 2016, older adults had the highest death rates from violence and injury of any group and almost half of those aged 15–29 years died from violence and injury.1WHOGlobal health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000–2016. World Health Organization, Geneva2018https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlDate accessed: July 9, 2020Google Scholar Beyond these preventable deaths, many of those who are injured might endure long rehabilitation and many others might be permanently disabled. Moreover, families might be pushed to poverty because of the loss in earning capacity as well as the diminished income from the provision of informal and formal care for those who are injured, which in turn, expedite the cycle of poverty. The latest WHO report that assessed the magnitude of violence and injury in 50 of the 53 countries in the European region provides data for member states to make a strong case for investment in prevention. Data show a wide disparity in mortality rates indicating a 4·5-times difference between countries with the highest and lowest rates. If all countries in the region had the same mortality rates as those with the lowest did, then the lives of nearly 290 000 people could have been saved every year.1WHOGlobal health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000–2016. World Health Organization, Geneva2018https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlDate accessed: July 9, 2020Google Scholar In other words, nearly 3 in 5 injury deaths could have been averted and many thousands of non-fatal injuries could be avoided. Since 2000, the number of deaths due to violence and injury has reduced by 29%. The greatest reductions during this period occurred in the numbers of deaths due to poisoning (56%), drowning (52%), and burns (43%).1WHOGlobal health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000–2016. World Health Organization, Geneva2018https://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.htmlDate accessed: July 9, 2020Google Scholar Although this is a welcome success, the reduction is not equally distributed. Since 2000, the number of falls among older adults and road-traffic injuries among children has increased. This increase in fatalities raises questions about why so many preventable deaths and injuries continue to occur. One answer is the unrelenting misperception that violence and injury are accidents that are unavoidable and random. But, after more than 50 years of public health and implementation research, we know that violence and injury are not accidents. Established risk factors exist that can be predicted and prevented. The untold anguish and costs of violence and injury have garnered increased policy attention. For the first time, violence and injury prevention has been included in the UN 2030 Agenda on Sustainable Development,3UNTransforming our world: the 2030 Agenda for Sustainable Development. United Nations General Assembly, New York2015https://sustainabledevelopment.un.org/post2015/transformingourworldDate accessed: July 9, 2020Google Scholar providing a framework for intersectoral action for violence and injury prevention. We were involved in the preparation of the report discussed here. The views expressed in this Correspondence are those of the authors and do not necessarily represent the stated policy of WHO.