Case study: descriptive epidemiology.

1. Injury as Major Public
Health Problem:
Lithuanian Data
Raimundas Lunevicius
Johns Hopkins University,
Bloomberg School of Public Health,
Humphrey Fellow, 2008 - 2009
11 Dec, 2008

2. Topics
n Definitions / common knowledge
n Country Profile in terms of PH
n Injury in details
¨ problem
¨ historic and current situation assessment
¨ risk factors
¨ distribution by cause
n Social responses to controlling injury
n Summary
Guidelines: outline for 2nd term presentation (45-60 min.), Humphrey program, JHSPH

3. Definitions: injury, causes
n INJURY: any damage to the human being
body resulting from acute exposure to
thermal, mechanical, electrical, or
chemical energy or from the absence of
such essentials as heat or oxygen
n Causes are named as ‘external causes’
and can be categorized according to type
of event

4. Events from external causes:
public health approach
n Unintentional events:
¨ Road traffic events (crashes, accidents)
¨ Burns / fire
¨ Drowning / sinking
¨ Poisoning
¨ Falls
¨ Frosts, bites, etc.
n Intentional events:
¨ Suicide (hanging, poisoning, etc)
¨ Homicide (violence: shots by firearms, blasts, cut /
pierce etc.)

5. NB! Injuries are not accidents
Accident Injury
An event (crash, fall..) Human damage,
a pathological condition
Unpredictable Predictable
Preventable (pre-event, event)
Controllable (post-event)

6. Other terms
n SDR
¨ Age standardised death rate (SDR) was computed by
direct standardisation, using the European population
n YPLL (HEALYs)
¨ Years of Potential Life Lost; Σdi(N-i): N - 65 years
(premature deaths), di – death cases in age i, i – age
during death
n PYLL75 (YPLL75)
¨ The potential years of life lost before 75 years-old
n Injury cost:
¨ Direct (treatment, disability)
¨ Indirect (disapperance of workforce, taxpayers, etc.)

7. SDR
Source: Atlas of health in Europe, p.3, 2008

8. Country Profile: Demographics
n LT has a population of
3.4 million with negative
growth rate
n Male life expectancy at
birth is low at 65 years.
Female life expectancy is
higher than the European
Region but lower than the
EU.

9. Country Profile:
Leading causes of death (expressed as SDR)
n Injuries are the 3rd leading cause of death.
n Rates for all injuries, both intentional and unintentional are higher
than the European Region and almost 4 times as high as the value
for the EU.
n Injury death rates irrespective of the cause are higher than those of
the Region.
Source: Progress in the prevention of injuries in the WHO European Region - LITHUANIA; WHO
Regional Office for Europe, Health for All database http://www.euro.who.int/hfadb

10. Country Profile:
leading causes of death expressed as %, 2005 http://www.stat.gov.lt
1. Cardiovascular 50 % (23.800)
2. Cancer 20 % (8.000)
♀ breast, colorectal, gastric
♂ prostate, lungs, gastric
3. Injury 13 % (5.500) (2000-2005: > 9 %)
¨ Suicides 1319
¨ Traffic accidents 885
¨ Falls 506
¨ Poisoning 454
¨ Sinking 390
¨ Frost 376
Leading cause of death among children, teenages, and
able-bodied people till 44 y. (mortality is more > than in Nordic
countries, EU)

11. Injury-related mortality:
in Baltic countries and Sweden
n Age-standardized death rates (per
100 000) due to injury in Estonia,
Latvia, Lithuania and Sweden,
1990 to 2002
International Journal of Injury Control and Safety
Promotion, Ekman, 2007
n Mortality from injuries in Lithuania,
the European Union and the WHO
European Region. Time trend
1980-2005
Progress in the prevention of injuries in the WHO
European Region, LITHUANIA

12. Injury: a major public health
problem
n MORTALITY is
highest in 1-44
¨ MVI is 1st mortality
cause in age gr.0-34
n INCIDENCE
n MORBIDITY
n DISABILITY
n COST / burden

13. INJURY from external causes
n Historic and Current
SITUATION ASSESSMENT

14. Injury-related mortality from
external causes: historically
n 1990s: rapid increase of
mortality in the newly
independent BALTIC STATES
with peak in 1994
n Time-trends in the mortality
from all external causes, from
injuries and accidents
(Tamosiunas, 2005)
n The average increase in
mortality during the period of
1991–1994 reached 4.1% per
year, while in 1995–2000
similar decreasing trend was
observed (Petrauskiene, Kalediene,
2003)

15. INCIDENCE of injuries per 1000 in adult, child, and all populations
Data source: Lithuanian Health Information Center , ICD 10th ed, V01-Y98
Year
Incidence
per 1000
adults /
year
Cases in
adult
population
Incidence
per 1000
childs /
year
Cases in
child
population
*
Overall
incidence
per 1000 /
year
1998 75,61 222875 78,01 58750 76,10
1999 94,46 280258 87,45 63976 93,07
2000 107,43 300848 107,06 73506 107,36
2001 110,62 311497 112,66 74318 111,01
2002 118,1 334176 113,2 71651 117,21
2003 118,54 341833 119,63 72809 120,04
2004 120,13 336687 117,92 68989 118,43
2005 122,55 349757 114,01 63878 121,15
• Per cent of childs in all population is the following:
• 20.35 in 1998, 19.78 in 1999, 19.69 in 2000, 18.98 in 2001, 18.28 in 2002, 17.62 in 2003, 17.08 in 2004, and 16.41 in 2005.

16. OVERALL MORTALITY from external causes in each year
Data source: European Mortality Dababase, ICD 10th ed, V01-Y98 codes
Year
Age-
standartized
death rate
per 100.000
Crude death
rate per
100.000
Number of
deaths
% of all
deaths
1998 152.480 150.958 5358 13.146
1999 149.674 149.479 5268 13.169
2000 145.748 145.791 5102 13.109
2001 157.275 157.930 5498 13.609
2002 149.673 152.202 5280 12.856
2003 147.710 151.728 5241 12.786
2004 142.954 147.777 5077 12.281
2005 156.321 162.522 5549 12.669
2006 149.889 157.333 5340 11.916

17. Mortality from external causes in
Europe and Lithuania: current
Atlas of health in Europe, p. 55, 2008; http://www.euro.who.int/Document/E91713.pdf

18. Mortality from external causes in
Europe and Lithuania: current
Atlas of health in Europe, p.54, 2008
http://www.euro.who.int/Document/E91713.pdf

19. The “Injury iceberg” in Lithuania
1 death
14 hospitalizations
79 admissions to
outpatient clinics
Source: Lithuanian Health Information Center, 2004
Presented by: S. Starkuviene, Scientific networking and the global health supercourse, LT, 2005
????? thousands of
injuries treated at home

20. Cost
n The YPLL per 100000
due to all external
causes increased
from 4598 in 1990 to
5297 in 1997 for
males and
n from 940 to 1106 for
females.
Source: Jakuboniene, Public Health, 2003

21. Injury costs: 20% + 80%
The structure of expenditure from health
insurance fund for the treatment of injuries
11.3%
7. 7%
4.2%
77.1%
Hospital care Outpatient care
Emergency care Rehabilitation
ü 37 million Euro or 9.2% of the
total budget of Lithuanian Health
Insurance Fund was spent on the
treatment of injuries, poisonings
and certain other consequences
of external causes in 2001
ü 26 million Euro was spent from
the Social Insurance Fund for the
temporal and permanent
disability caused by the injuries in
2001
ü Indirect injury costs were about
300 million Euro in 2000
Baubinas H. et al 2003
From: Starkuviene S, 2005

22. Injury related mortality: it is a huge
public health problem in Lithuania

23. INJURY from external causes
n RISK FACTORS (2)
¨ General and Specific (i.e. cause type related)
¨ Socioeconomic / environmental
¨ Demographic
¨ Behavioral / psychological

24. Socioeconomic risk factors:
postulated to be risk factors for increased injury
rate and mortality from all ExC
Ekman, 2007
n Major transitions in society life,1990-2000:
¨ Quick socio-economic change (planning / free market)
¨ Quick political changes (closed / open)
¨ That affected health of the population through period-
related effects:
n Unexpected high unemployment (up to 17% in 1990s)
n Quick stratification of society in terms of wealth and capital
n Urban / rural inequalities (Kalediene, 2004)
n Loss of savings due to collapse of several banks
n Growth of delinquency due to temporary lawlessness
n Poor educational achievement:
¨ low-educated gr. (in rural population)
Kalediene, Soz Praventiv Med, 2006

25. Demographic risk factors
n Living location (urban, suburban, rural)
n Gender
n Age groups
n Family status
¨ divorse vs married
¨ single vs married

26. Trends in mortality from ExC (demographic factors):
1. among males and females
2: among urban and rural population (Source: Kalediene, 2004)

27. Injury-related risks factors
results of population-based study among middle age men : Tamosiunas, 2005
n THE RISK OF DEATH FROM ExC WAS
ASSOCIATED WITH
1. FAMILY STATUS,
2. EDUCATION,
3. ARTERIAL BLOOD PRESSURE,
4. SMOKING HABITS,
5. FIELD OF EMPLOYMENT,
6. BLOOD CHOLESTEROL LEVEL

28. Injury-related risk factors
results of population-based study among middle age men : Tamosiunas, 2005
n The risk of death from an ExC
¨ among divorced men was 3-fold that of married men (and 9-fold for
suicide)
¨ among widowers men was 2.7-fold that of married men
n A lower education level is associated with a higher risk of death
n Among men with arterial hypertension, the risk of death from injuries
was higher by 63.4%
n Smoking habits had increased the risk of death from injuries at an
average of 25.8%
n Risk of suicide among workers was 3.6-fold that among employees
n Risk of death was 2.0-fold higher among men with a total cholesterol
level in the lowest quintile (1.37-5.02 mmol.l)

29. Behavioral risk factors
n Risky behavior related with alcohol
drinking
n Risky behavior in the road related with
¨ alcohol use,
¨ not using seat belts,
¨ baby chair,
¨ speedy driving, etc.

30. Lifestyle: Alcohol
Source: Atlas of health in Europe, p. 99,101, 2008

31. Lifestyle: Alcohol
Source: Atlas of health in Europe, p. 100, 2008

32. Behavioral and psychological injury-related
risks factors among children and teens
(population-based study among 11-15 years children: Starkuviene, 2005)
n Behavioral factors (risk taken behavior):
¨ Smoking, alcohol and drug consumption, premature sexual
acitivity, frequent participation in sport activities, involvement in
physical fights, longer time spent away from home with friends,
experienced bullying,
n Psychological factors:
¨ poor self-assessed health and academic achievement,
unhappiness, feeling unsafe at school (high suicidal risk)
n (Lower socio-economic status and risk of injury are not associated)

33. Mortality distribution by cause
n The leading causes of unintentional injury
death are transport injuries, followed by
poisoning, falls, drowning and burns/fires
n The leading causes of intentional injury
death are suicide followed by homicides.
n SUICIDE rates in all age groups are higher
than the regional value (No.1)

34. Deaths distribution by five unintentional and two intentional (suicide, homicide) causes, 1998-2007*
Year
Deaths Traffic injuries Falls Drowning Poisoning Burns Suicide Homicide
1998 5358 1002 (18.7) 418 (7.8) 405 (7.6) 627 (11.7) 238 (4.4) 1554 (29.0) 303 (5.7)
1999 5268 903 (17.1) 432 (8.2) 526 (10.0) 529 (10.0) 202 (3.8) 1552 (29.5) 297 (5.6)
2000 5102 769 (15.1) 420 (8.2) 362 (7.1) 580 (11.4) 207 (4.1) 2245 (44.0) 345 (6.7)
2001 5498 847 (15.4) 469 (8.5) 454 (8.3) 664 (12.1) 244 (4.4) 1535 (27.9) 356 (6.5)
2002 5280 828 (15.7) 484 (9.2) 410 (7.8) 622 (11.8) 236 (4.5) 1551 (29.4) 248 (4.7)
2003 5241 879 (16.8) 444 8.5) 358 (6.8) 680 (13.0) 255 (4.9) 2159 (41.2) 332 (6.3)
2004 5077 863 (17.0) 434 (8.5) 307 (6.0) 639 (12.6) 233 (4.6) 2073 (40.8) 293 (5.8)
2005 5549 885 (15.9) 506 (9.1) 390 (7.0) 694 (12.5) 295 (5.3) 2072 (37.3) 314 (5.7)
2006 5340 898 (16.8) 555 (10.4) 335 (6.3) 745 (14.0) 305 (5.7) 1836 (34.4) 254 (4.8)
2007 5246 877 (16.7) 518 (9.9) 381 (7.3) 483 (9.2) 296 (5.6) 1025 (19.5) 242(4.6)
* other deaths should be considered to be deaths from other external causes
Source of data: European Mortality Dababase, ICD 10th, V01-Y98 codes

35. Traffic events with injuries

36. Mortality from MVI in Europe: place of
Lithuania Atlas of health in Europe, p. 56, 2008

37. ASDR by sex in Lithuania

38. 1: Trends in the road traffic deaths, injury deaths and deaths from all causes
2: Road traffic deaths as a percentage of injury deaths and road traffic deaths
percentage of deaths from all causes (Strukcinskiene, Acta Paediatrica, 2008)

39. Risk factors for MTI and mortality
n Environment
n Human-related
n Technical

40. Human and environmental risk
factors for death in urban RTI
Vorko-Jović, Kern, Biloglav, Journal of Safety Research, 2006
ATRIBUTES RISK-FACTOR Odds Ratio 95% CI
Gender Male 2.69 1.24-5.84
Time of day 0-6 am. 3.78 2.08-6.85
Weekdays Fr,St,Su 1.89 1.06-3.34
Type of road Junctions ‘T’, ‘Y’
‘+’
5.27 2.21-12.57
Type of road Road links 2.33 1.30-4.19
Bad visibility Night, sunset,
sunrise
2.29 1.28-4.08
Speed Speed over upper
limit
2.56 1.43-4.61
Seat belt Not used 2.33 1.22-4.45

41. Combinations of risk factors for death for
male road users: dead vs injured (pedestrians exc)
Vorko-Jović, Kern, Biloglav, Journal of Safety Research, 2006
Combinations of risk
factors for death
Numbers
(%)
OR 95% CI
Male +hours (0-6 am) 20 (42.5)
56 (17.2)
3.56 1.9-6.8
Male + high speed 33 (70.2)
134 (44.1)
2.99 1.5-5.8
Male + no using seat
belt
34 (73.9)
100 (39.5)
4.34 2.1-8.8
Male + high speed + no
using seat belt
25 (75.7)
40 (38.1)
5.08 2.1-12.3

42. No SR association was found for:
Vorko-Jović, Kern, Biloglav, Journal of Safety Research, 2006
1. The state of road surface
2. Public light(ing)
3. Bad weather condition
4. Type of motor vehicle
5. Vehicle’s years, and
6. Summer and winter months
¨ (problem: drivers under the influence of alcohol;
underreported)
¨ Data from other report: ABS (Anti-lock Braking
System) (Chipman, Traffic Inj Prev, 2004)

43. Other risk factors for increased risk
of death from RTI
n Age (≥ 65)
n Age-related medical conditions (e.g.,
dementia)
n Drivers under the influence of alcohol
n Rural area (conflicting data; Italy)
n Disparity in the size of the two vehicles in
crash

44. Lifestyles: Alcohol consumption and road traffic
events involving alcohol
Atlas of health in Europe, p. 98-99, 2008

45. Pancreas trauma: complete rupture

46. Unitentional injury: road traffic
event; huge lacerated wound (2004)

47. TRI of the rectum and diffuse necrotizing mixed
type infection (non-clostridial / clostridial)
(Fourner gangrene)

48. Prevention and interventions are based on understanding
of major risk factors that influence the frequency, severity of
motor-vehicle collision, injury and death
n ENGINEERING
n ENFORCEMENT
n EDUCATION

49. Interventions: examples
n Environmental modification:
¨ Street closures
¨ Streets with one way direction
¨ Speed reducing devices (in small roundabouts)
¨ Traffic roundabouts and other traffic control devices?
¨ Street improvements
¨ Construction of beltways
¨ Further development of EMS system and its’ elements
n Law enforcement
¨ Enforcement of traffic code
¨ Limitation of working hours per day (8) for commercial drivers in
EU
n Behavioral change
¨ Using baby chairs, seat belts, air bags (lateral more important)
¨ No alcohol for drivers program

50. Burns-related injury

51. Burns-related injury
INCIDENCE per 1000 popul. in 1991-2004
Source: Rimdeika, Medicina (Kaunas), 2008

52. Burns: cause for childern and for
adult hand burn
Maslauskas, 2004; Rimdeika 2004; Klebanovas 2002;
n Fire: 11 % and 72 %: adults!
n Scalds: 85 % and 15 %: children!
n Electricity: 2 % and 4 %
n Chemical: 0.3 % and 1 %
n Contact: 2 % and 7 %

53. Death rates from fire/burns among children and
adolescents in Lithuania (1971–2005) (Strukcinskiene, 2008)

54. Risk factors for burns-related injury
and mortality
Klebanovas, 2002
n Age: 0-3 year children (scalds)
n Poor socioeconomic conditions of family
n Life style of family (alcohol + smoking +sleep)
n …….

55. Drowning-related injury

56. Drowning:
definition of deaths related to drowning
n Death from accidental drowning was considered
as any death reported to Eurostat with an
underlying cause of death coded W65 to W74
(table 1) in the 10th revision of ICD (ICD-10).
n Deaths due to drowning whatever the intent
were processed including in addition to deaths
from accidental drowning, suicide by drowning
(X71), homicide by drowning (X92) and drowning
from undetermined intent (Y21).
Drowning-related deaths in an enlarged European Union. Collection: European Project ANAMORT
Monographs. Institut de veille sanitaire Aug 2008

57. Situation regarding accidental
drowning (Anamort study, 2008)
n in 26 European countries: 6,156
deaths from accidental drowning
(2005)
n 3.4% of deaths due to external causes
n SDR for accidental drowning was 1.8
for 100,000 inhabitants in 2005
n Variations between 0.2 and
11.2/100,000/year
n the risk of death by accidental
drowning: 3.8 times > among men
n The highest SDRs: in Lithuania, Latvia,
Romania and Estonia
n Deaths from AD were responsible for
5% of the PYLL75 by ExC of death.
n non accidental drownings represented
30 to 96% of all drownings (74% on
average for all these countries)

58. Rate of drowning deaths among children and
adolescents in Lithuania (1971–2005) (Strukcinskiene, 2008)

59. Risk factors for drowning-related
mortality: alcohol (!)
n Toxicological analysis for alcohol was positive in
70% females, and in 77% males
n Most accidents occurred in the age interval 40–
49 y. (91%)
n In 58% of drowning cases BAC exceeded 2.5‰.
n Alcohol intoxication level of more than 4.0‰ was
observed in 8% of instances.
Source: Benosis, Rybalko. Forensic Science International, 2007

60. Poisoning-related injury

61. Poisoning:
Definition of deaths related to poisoning
n Death from poisoning was considered as any death due
to poisoning, whatever the intent was; in addition to
death from accidental poisoning, it included suicide by
poisoning, homicide by poisoning, poisoning from
undetermined intent, and death from contact with
venomous animals and plants.
n Death from accidental poisoning was considered as any
death reported to Eurostat, with an underlying cause of
death coded X40 to X49 (table 1) in the 10th revision of
ICD (ICD-10).
Poisoning-related deaths in an enlarged European Union. Collection: European Project ANAMORT
Monographs. Institut de veille sanitaire Aug 2008

62. Situation regarding accidental
poisoning
n The number of deaths from accidental
poisoning in EU25 was 10,2 in 2005
n Represents 4.4% of deaths due to ExC
n SDR for accidental poisoning was 2.1
for 100,000 inhabitants in 2005,
among the 25 countries of the EU
n Variations between 0.2 and
20.0/100,000/year according to the
countries were observed in Europe
n The highest risks of death from
accidental poisoning were observed in
northeastern countries (Lithuania,
Estonia, Latvia, Finland, Norway and
Poland)
n The risk of death by accidental
poisoning was 3.1 times higher among
men
n The highest CDRs were observed
among people between 30-59 y.-old

63. Interpretation and limitations of observed
differences in deaths by poisoning in Europe
n Increased rates of death related to accidental poisoning in northern and eastern
European countries had been attributed to acute poisoning by alcohol
n Misclassifications of deaths from accidental poisoning due to inappropriate
selection of underlying causes of death were described by 22 out of the 36 countries
questioned during the Anamort project. The combined effect of these
misclassifications was considered to lead to underestimation of the magnitude of
the deaths due to accidental poisonings in most of these countries.
n Lack of investigation and low rates of autopsy can have an impact on
underestimation of cases of accidental poisoning. These cases would therefore be
coded as mental and behavioural disorders due to psychoactive substance use
(ICD-10 codes: F10-F19), suicides or poisoning with undetermined intent.
n On the opposite, overestimation of deaths by accidental poisoning might be
observed when the intent is not clearly reported.
Poisoning-related deaths in an enlarged European Union. Collection: European Project ANAMORT Monographs. Institut de veille
sanitaire Aug 2008

64. Behavioral risk factor for:
n poisoning-related
injury and mortality
is ALCOHOL

65. Intentional injury: suicide

66. Methods of Suicides
Tamosiunas, 2006
n Hanging, Strangulation, Suffocation (♂ > ♀):
¨ 87.4% among all suicide deaths in male
¨ 68.3 % among all suicide deaths in female
n Poisoning with solid or liquid substances (pesticides),
gases, vapors (♀ > ♂)
n Handgun, rifle, shotgun, larger firearm, unspecified
firearm discharged (♂ > ♀)
n Jumping from high places (♀ > ♂)
n Drowning and submersion (♀ > ♂)
n Lying before a moving object
n Crashing a motor vehicle
n Self-harm by smoke, fire, flames, steam, sharp objects

67. Incidence

68. Mortality from suicides in Europe:
Lithuanian data Atlas of health in Europe, p. 58, 2008

69. Suicide: risk (influence) factors
Tamosiunas, 2005, 2006
n Socio-economic factor: transition from socialism to a market
economy
¨ Population started to adopt new social, political and economic
changes (from 1993)
n Urban-rural inequalities (rural residents)
n Low levels of education (Starkuviene, 2006)
n Unemployment rate
n Increase of alcohol consumption
n Male (Starkuviene, 2006)
n Older people (Starkuviene, 2006)
n Change in Lithuanian law enabling easier access to firearms – it is
possible for each citizen to obtain a handgun legally for self-
protection
n Other: Mental health, alcohol etc.

70. SUICIDE IN LITHUANIA
Lithuania Takes the Dubious Honor of Having Highest Suicide
Rate in World
By LEYLA ALYANAK © Earth Times News Service, VILNIUS, Lithuania
n Suicide cannot be explained using only individual
reasons. It is the consequence of a complex process (Dr.
D. Gailiene)
n That process includes
¨ decades of Soviet domination
¨ a dramatic transition period in 1990s (poverty; new emigration;
poor HC facilities)
¨ the amount of media coverage given to suicides
¨ a certain perceived helplessness toward all of the above
n These factors are intensified by the absence of a
national suicide prevention strategy
n A lack of in-depth research into the problem of suicide

71. The period effect: suicide rate
n Suicide rates
¨ of Kaunas men
¨ aged 25– 64 years
¨ from 1971 to 2000
Source: Tamosiunas, 2006

72. Risk factors for suicide-related
injury and mortality
n According to a study on suicides by the
Estonian-Swedish Suicidology Institute:
¨ socioeconomic disruptions in nearby Estonia
are key factors affecting suicides and also
cause depression and anxiety
¨ in Lithuania, these factors appear to have an
even stronger effect

73. Homicide: definition of deaths
related to homicides
n Death from homicide was considered as
any death reported to Eurostat with an
underlying cause of death coded X85 to
Y09 (table 1) in the 10th revision of ICD
(ICD-10).
Homicide-related deaths in an enlarged European Union. Collection: European Project ANAMORT Monographs. Institut de veille
sanitaire Jun 2008

74. Situation regarding deaths from
homicide in Europe
n The number of deaths from homicide
in EU25 was 4 743 in 2005, which
represents 2.1% of deaths due to
external causes.
n SDR for homicide was 1.0 for 100 000
inhabitants in 2005, among the 25
countries of the European Union
(figure)
n Variations between 0.2 and 10.0 /100
000/year according to the countries
were observed in Europe
n Actually, SDRs by homicide in 2005
were lower than 2.5/100 000 in 29
countries.
n Much higher SDRs were observed in 4
countries: Albania (4.3), Estonia (8.8),
Lithuania (8.8) and Latvia(10.0).
n The risk of death by homicide was 2.3
times higher among men

75. Situation regarding deaths from
homicide in Europe
n In almost all European countries, no
particular trend could be noticed due to
small variations of low SDR over time
(Fig.)
n Only the three Baltic countries
experienced important decreases of
their SDR by homicide, especially
Estonia with a 70% decrease between
1994 and 2005 (37% for Lithuania and
36% for Latvia).
n In EU25, deaths from homicide were
responsible for 3% of the PYLL by
external causes of death.
n The highest impact was among people
between 20 and 49 years-old (Fig.).

76. INJURY
n SOCIAL RESPONSES TO
CONTROLLING HEALTH
PROBLEM (3)

77. Lithuanian Health Program
1998 – 2010, approved by the Parliament
of Lithuania
Target: by the year 2010 to reduce rate of accidents,
accident related deaths and disabilities by 30%.
Strategy
ü To develop complex program for accident prevention
ü Prevention of accidents should be carried out on national and
regional levels
ü On the regional level more cities should be involved into
programs of healthy and safe cities. Activities of individuals,
communities and non-governmental organizations aimed at
safe environment should be promoted and supported
ü Research should be aimed at accident prevention and
mechanogenesis of injury
Source: S. Starkuviene, Scientific networking and the global health supercourse, LT, 2005

78. National Accident Prevention Program
(2000-2010), approved by the Lithuanian
Government in 2000
The aim of the Program – to develop sustained, well-
coordinated safety system, which could help to prevent deaths and
health impairments due to injuries.
Strategy of the Program targeted at the three types
of the prevention
ü Accident prevention or active prevention
ü Prevention of the harm on health or passive prevention
ü Prevention of the death and disability
However…
ü The focus is on the health care in cases of injuries
ü Poorly funded
Source: S. Starkuviene, Scientific networking and the global health supercourse, LT, 2005

79. Partnership
n WHO/Europe has been engaged in supporting
focal persons and is working with the Ministry of
Health in the areas of injury surveillance and
national policy development as part of biennial
collaborations.
n Lithuania participated in the advocacy events of
the First UN Global Road Safety Week and is
taking part in the Global Status Report on Road
Safety project.
Source: Progress in the prevention of injuries in the WHO European Region
- LITHUANIA

80. Interventions
n 69 interventions
n Issues:
¨ Relationship with national policy
¨ Intervention effectiveness (as a %)
n Country score comparison with the European
region median score
n Mortality data: http://www.euro.who.int
Source: WHO/Europe and the European Commission on preventing injuries
and promoting safety in Europe

81. Cause SDR-LT
(2005)
SDR-EU
(2005)
National
policy
Intervention
effectiveness
(%) (regional)
All injuries 156.3 66.3 N/A 37 (56)
UNINTENTIO
NAL INJURY
98.2 27.1 √ 40 (65)
RTI 24.8 10 √ 73 (80)
Burns 5 0.8 × 0 (60)
Poisoning 20 2.2 × 40 (80)
Drowning 11.2 1.4 × 25 (63)
Falls 13.6 6.5 × 14 (71)

82. Cause SDR-LT
(2005)
SDR-EU
(2005)
National
policy
Intervention
effectiveness
(%) (regional)
INTENTIONAL
INJURY
× 34 (55)
Interpersonal
violence
8.8 1.0 × N/A(N/A)
Youth violence
6.8 1.1 √ 40 (60)
Child abuse and
neglect
0.8 0.4 √ 50 (100)
Intimate partner or
domestic violence
N/A N/A √ 50 (50)
Elder abuse and
neglect
N/A N/A × 0 (67)
Self-directed
violence
37 11.1 × 38 (63)

83. NATIONAL POLICIES
Overall national policy on injury prevention √
Overall national policy on violence prevention ×
Commitment to develop national policy √
POLITICAL SUPPORT for injury / violence prevention √ (?)
EASY ACCESS TO SURVEILLANCE DATA ×
INTERSECTORAL COLLABORATION
Key stakeholders identified √
Secretariat to support the intersectoral committee ×
Can WHO help achieve intersectoral collaboration in the country? √
CAPACITY BUILDING
Process in place √
Exchange of evidence-based practice as part of this process √
Promotion of research as part of this process ×
EMERGENCY CARE
Evidence based, quality assessment prog., process to build capacity identified √ (?)

84. Assessment (conclusion)
n …….
n ‘INCREASE IN INJURY MORTALITY IS CONSIDERED
TO BE THE MOST SENSITIVE HEALTH INDEX
REACTING TO SOCIAL CHANGES IN SOCIETY’
Ekman, 2007
Thank you for your attention