By:
Adriana Lein
Brian Meier, MD
“Accidents
happen.” We’re all likely familiar with this adage that suggests unfortunate
happenings are unpredictable and unavoidable. While it may be true to some degree
that tragedy strikes in unexpected ways, a closer look at the global burden of
disease reveals that events such as road traffic injuries, which are
significant contributors to global mortality and morbidity, are anything but
unpredictable and unavoidable. In fact, all of the primary contributors to what
the World Health Organization has termed Global Injury Burden follow patterns
that disproportionately affect certain groups based on demographic differences,
whether gender-based, grounded in socioeconomic inequality, or specific to
regional and political factors. Among these contributors to Global Injury
Burden are road traffic injuries, suicide, homicide and war (a breakdown shown
in the below chart of World Health Organization).
Source: http://www.who.int/violence_injury_prevention/key_facts/en/
Delivering
a guest lecture to the first-year Master’s in Global Health cohort at Duke
University on October 20th, 2015, Dr. Catherine Staton explained why she doesn’t like to
use the word “accident” in her work. An Emergency Medicine physician and an
expert on road traffic injuries, Dr. Staton has worked extensively abroad, in
places including South Africa, Georgia, Armenia, and, recently, Brazil and
Tanzania. According to Dr. Staton, the word “accident” implies a spontaneous and
independent incident. Such levity towards serious phenomena overlooks the
potential for injury and violence prevention by addressing risk factors through
interventions at the community and policy levels. Dr. Staton went on to outline
the clear patterns of predictability that road traffic injuries follow, a theme
central to her work. Dr. Staton and her colleagues have conducted mapping of deemed road traffic “hotspots”
on Brazilian highways and found that crash occurrences could be modeled after
variables related to regional differences and built-environmental analyses and
mainly fell into 5 different patterns. However, traffic accidents are not the
only component of injury burden that could be reduced through understanding
ecological determinants.
Consider
interpersonal violence, a subject that receives considerable attention due to
politicized discussions of mass shootings and gun control. Returning to the
above example of Brazil, homicides were the leading causes of premature
mortality in 2010
(reported in Years of Life Lost). As the Los
Angeles Times highlighted in a recent profile, Brazil’s homicide rate actually
increased between 2000-2012, despite that
"in the same
period…the world overall got about 16% safer from murder, while developed
countries saw a drop of 40%." The profile continued, noting that violence,
not surprisingly, disproportionately affects the economically disadvantaged regions
of the Northeast and its victims are overwhelming young, black males. Emphasizing
the link between violence and social injustices, Christopher Mikton, a
technical officer of the WHO team on Violence Prevention stated, "all else
being equal, we expect that if there is a major drop in inequality, homicide
rates go down."
So is there really such a thing as an “accident”
when it comes to health or can the global injury burden best be understood
through the application of Paul Farmer’s well-known extension of structural violence
theory to health outcomes? The evidence points to the latter.
