Newspaper article International New York Times

Fatal Accidents as a Global Health Crisis ; Worldwide Study Tracks Causes of Death to Help Countries Find Solutions

Newspaper article International New York Times

Fatal Accidents as a Global Health Crisis ; Worldwide Study Tracks Causes of Death to Help Countries Find Solutions

Article excerpt

A worldwide study that tracked accidental deaths shows countries where they can improve relative to their peers.

Worried about what to worry about? Accidents should move higher up your list.

Worldwide, road injuries kill more people than AIDS. Falls kill nearly three times as many people as brain cancer. Drowning claims more lives than mothers dying in childbirth. Both fire and poisonings have many times more fatal victims than natural disasters. In 2013, the combined death toll from all unintentional injuries was 3.5 million people. Only heart disease and stroke were greater killers.

These findings, published late last year in the British medical journal The Lancet, are from the "Global Burden of Disease" study, an international collaboration led by the Institute for Health Metrics and Evaluation at the University of Washington, which tracks the annual toll of 240 causes of death for men and women in 20 age groups across 188 countries. The study isn't mere morbid fascination. Look beneath the top-level results and you also see huge variations among countries that are economic peers. This is actually encouraging news: It means that some countries have figured out a much better way to curb accidental deaths -- and that other countries might be able to follow suit.

In France and Spain, according to the study's authors, people die from transport injuries at roughly the same rate, but the French are twice as likely to die from falls, even when you adjust for the country's older population. In Britain and the United States, deaths from falls are almost equivalent, but Americans are twice as likely to die from poisonings, again adjusted for age differences. Why?

If Russia could emulate Brazil, it would cut age-standardized deaths per capita from fire by 80 percent. If India could copy China, it would cut age-standardized deaths per capita from drowning by 30 percent. How?

The Global Burden of Disease study does not answer these questions directly, but it makes clear where to start looking for best practices. Individual countries can see in what areas they're leading or lagging, often for the first time, then look to peers for advice or vice versa. Injury prevention may get one of the biggest boosts because global public health leaders have often ignored injuries as health risks, focusing instead on major diseases.

Take drowning. For decades, it has been one of the 20 biggest killers worldwide, but the World Health Organization issued its first report dedicated to drowning only in November 2014.

Effective prevention strategies include teaching swimming, providing life jackets, fencing off open water and training emergency medical responders. Drowning deaths also tend to decline as countries urbanize and when income and education increase. China, which both urbanized and started prevention programs, saw drowning deaths decrease from 190,000 in 1990 to 64,000 in 2013, Global Burden found. In India, drowning deaths barely budged, falling from an estimated 91,000 to 88,000 in the same period. David Meddings, an epidemiologist who was executive editor of the W.H.O. report, noted that China's gains may partly reflect changes in the way deaths are reported, but that the improvement was still powerful.

"I don't know why in India there has been economic development but drowning has not declined," Dr. Meddings said.

Progress in reducing the 237,000 global deaths a year from fire is equally variable. It makes sense that more Russians than Brazilians die from fire: Russia has fearsome winters, and many fires are caused by heaters. But climate does not explain why the age-standardized death rate from fire was halved from 1990 to 2013 in Brazil, according to Global Burden figures, while in Russia, where more than 10,000 people die every year from fire, it did not decline at all.

"Outdated infrastructure" -- wooden buildings with barred windows and sparking heaters -- "is the major cause," said Vasiliy Vlassov, an epidemiologist at the National Research University Higher School of Economics in Moscow and a contributor to the report. …

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