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Health priorities: violence and injuries

The first of three videos discussing key health priorities for adolescents. Watch Dr David Meddings talk about violence and injuries in adolescents.
DAVID MEDDINGS: Violence and injuries among adolescents are one of the major leading causes of death in this age group. In the year 2012, three of the top five causes of death were either violence or unintentional injury related in the form of road traffic injuries, interpersonal violence, and self-directed violence. This is a major problem that governments and NGOs and communities need to begin to deal with. It’s not particularly useful to try and put a specific number on the exact figure of number of lives that are lost in the adolescent population each year because each year, this changes. And in any event, all of these numbers are typically derived from estimates.
However, in any given year, the number of adolescents who lose their lives to either acts of violence or to unintentional injuries numbers in the hundreds of thousands. There are important differences in homicide, suicide, unintentional injury-related deaths across the world’s regions and within specific regions amongst different risk populations. So for example, homicide rates vary fully 13-fold between the highest recorded in the world, in the Americas region, and the lowest recorded rates of homicide, in the low and middle income areas of the Western Pacific region.
You see similar rates of variation or similar magnitudes of variation in rates across unintentional injuries, typically with low and middle income countries having the vast burden of mortality and disability-adjusted life-years that are lost to intentional injury or unintentional injury causes. Within specific subgroups within populations, there are again important differences. And once more, we see that socioeconomic factors are one of the major determinants that shape the risk, either for acts of violence or for unintentional injury. There are a range of different approaches that can be put into place to prevent both violence and unintentional injury.
For example, if you consider the prevention of violence among adolescents, some very important and very effective programmes have revolved around different forms of community development, different strategies to improve interpersonal relationships during the younger part of the lifecycle. So positive parenting programmes, for example, or going back to my earlier example of community-based programmes, programmes that have been targeting weapon carrying in certain parts of the world. And nightlife in bars and other drinking establishments– so ordinances that require drinking establishments to close earlier and to educate people who work within those environments about deescalating potentially violent situations– these types of approaches have been shown to be effective.
If you go more broadly at the societal level, there are also strong indications that effective control over access to lethal means, such as firearms, is associated with reductions in firearm-related mortality. So if we shift the focus and consider unintentional injury prevention, we’re looking at quite a different set of mechanisms, things like road traffic injuries, burns, drowning, falls. These are some of the most important mechanisms in the unintentional injury category. Here again, we see that important steps can be taken at national levels. So regulatory frameworks that require motorcycle helmets to be worn, blood alcohol concentration for drivers, graduated driver’s licencing programmes for young or novice drivers– these are important strategies to prevent road traffic injury fatalities.
In terms of drowning prevention, we’re seeing some countries, such as Bangladesh now, actually instituting a requirement for swim lessons to be taught as part of the school curriculum. In association with that, community awareness programmes that raise awareness around the dangers of consuming either drugs or alcohol in association with swimming– these can be an important means of intervening with high rates of drowning that are associated with substance use around water bodies. Looking forward, there are some positive indications that things are moving in a good direction.
The Sustainable Development Goals are a normative mechanism that is going to help us shape the direction of a whole range of areas, not just global public health, but other development practises over the next 15 years. And within that context, we’re seeing some important indications that the area of violence and injury prevention is indeed being taken into account. That being said, there is an important challenge that faces the world in terms of the future of public health in this particular area because it is not a particularly traditional area of public health.
It’s not particularly well-funded by donors and the people who can bring the necessary resources to help create the multi-sectoral programmes that are so necessary for either violence or for unintentional injury prevention. So much more work needs to be done. Things are moving in a good direction, but there needs to be an increased emphasis on raising awareness of the magnitude, the size of this public health problem, and the awareness that approaching it is technically feasible. There’s nothing particularly complicated about preventing violence or preventing unintentional injury.
It’s a matter of putting the programmes in place, getting the necessary collaboration and cooperation across a range of sectors, and standing back and monitoring and evaluating the programmes to see where adjustments need to be made.

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, Dr David Meddings discusses the impact of violence and injuries on adolescent health.

Violence and injuries are a major leading cause of mortality in adolescents, occupying three of the five top causes of death. There are important differences between the types of deaths in this category, e.g. homicide, suicide, accidents, and in the rates of each type in regions across the world.

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

Many different approaches can be used to reduce the numbers of these types of deaths, ranging from improving interpersonal relationships to restricting access to weapons to community awareness programmes. Now as a part of the Sustainable Development Goal (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?

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Improving the Health of Women, Children and Adolescents: from Evidence to Action

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