Health priorities: violence and injuries

In the previous step, we identified a number of major health priorities that can either manifest for the first time during adolescence or have a major effect at that time of life. Here we will discuss the impact of violence and injuries on adolescent health, and current strategies to address these health priorities.

Why is it a priority?

Violence and injuries are a major leading cause of mortality in adolescents. Unintentional injuries are ranked as the leading cause of disability and death amongst adolescents ages 10-19 years old. Interpersonal violence and self-harm are ranked within top 5 leading causes of death amongst adolescent males 15-19 years old ^{1, 2}.

There are important differences between the types of deaths in this category, e.g. homicide, suicide, accidents. The nature and burden of these categories vary in their impact depending on sex, age and other factors including socio-economic status. Particularly vulnerable are adolescents living with disabilities, in humanitarian and fragile settings, and those marginalised and stigmatised within the population they reside in.

What is the impact?

Unintentional injuries

• Road traffic: 135,000 deaths among adolescents occurred globally in 2016 due to road traffic incidents ¹.

-Prevention strategy examples: Comprehensive road safety laws and enforcement; Strict enforcement of laws prohibiting driving under the influence of drugs and alcohol ³.

• Drowning: 50,000 adolescent deaths occurred due to drowning in 2016. Nearly 2/3rd of these deaths were amongst boys ².

-Prevention strategy examples: Lessons for children and adolescents to swim; Improved community infrastructure such as barriers to water supply or bridges; Awareness raising campaigns; Policies enforcing a water safety plans ³.

Violence

• Homicide: Each year there are 200,000 homicides among adolescents, representing 43% of all homicides globally. Most victims (5 out of 6) and perpetrators in this age group are male.

-Prevention strategy examples: Community programmes with home visits and support to families where there is an increased risk of maltreatment, such as in highly deprived settings.

• Gender-based violence: Gender-based violence takes many forms including violence by family member or intimate partner, trafficking, female genital mutilation, early or forced marriage and sexual violence. Gender-based violence is mainly perpetrated against girls and women but men and boys can also be victims ³.

-Prevention strategy examples: School-based emotional and social skills development programmes alongside messaging for prevention of dating violence ³.

• Suicide and self-harm: In 2016, an estimated 62,000 adolescents globally died due to self-harm. Nearly 90% of these suicides happen in low-or middle-income countries. These figures are likely to be underestimated due to stigma surrounding reporting. Risk factors for suicide include stigma against help-seeking, harmful use of drugs or alcohol, and barriers to care. Suicide and self-harm can result from not addressing adolescent mental health ⁴.

-Prevention strategy examples: Mental health promotion using social media to raise awareness about suicidal behaviour; School-based prevention such as mentoring programmes or peer leadership ³.

What can we do to reduce the number of these deaths?

Many different approaches can be used to reduce deaths and disability related to violence and injuries ranging from improving interpersonal relationships to restricting access to weapons to community awareness programmes.

In order for any strategy to be effective, it is essential to have a comprehensive approach and to collaborate and co-operate across sectors including the justice, social welfare and education sectors. Let’s take a look at a case study from Brazil where a multi-pronged, multi-sectoral approach was used to successfully reduce alcohol related violence.

Reducing alcohol related violence in Brazil: A case study

In Diadema, Brazil, a community wide strategy was implemented to address alcohol-related violence. The strategy provided work placements and vocational training for high-risk youths; organised activities during school holidays when youth crime normally peaks; provided life skills training to reduce drug use; introduced laws enforcing closure of bars by 11:00p.m; and installed security cameras to monitor high crime areas³. Alongside these initiatives, the city also established the Integrated Operation Project which placed the state police and Diadema municipal guards to take responsibility for surveillance of deserted areas, vehicles, bars and other spaces seen as a risk priority area for violence.

Homicides in Brazil decreased from 1999 with 389 cases to 167 in 2003. Robbery cases also fell from 5192 to 4368 from 1999 to 2003. These changes are in part attributed to this programme aimed at high-risk youths to reduce alcohol-related violence.

What next? Discuss!

As we accelerate through the last decade of the SDG era, how can we reach these targets, secure the necessary collaboration and co-operation across sectors, and decrease mortality rates for adolescents in relation to violence and injuries? Do you have any ideas and examples from your context? Discuss with other learners what can we do more of, and what can we do differently?