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A World of Hurt: Global Injuries

Illustration by Kevin Ghiglione

A World of Hurt: Global Injuries

In the developing world, children sustain injuries largely unfamiliar in high-income countries: They’re burned while cooking on unsafe stoves, they drown by falling into uncovered wells, and they’re poisoned by the kerosene used for lamp fuel.

“Globally, the high burden of injuries has been neglected,” says Adnan Hyder, associate professor in International Health. “Injury prevention has been difficult to integrate into public health in a meaningful way because it’s not considered a ‘disease.’” Additional obstacles to reducing injuries in developing countries include a lack of data and advocates, as well as a traditional perception of injuries as acts of fate beyond human control. The word “accident” itself implies a lack of control, which is why experts in injury prevention don’t like to use it. But injury ranks high among killers of children, alongside diarrhea, pneumonia, tuberculosis and malaria, and Hyder wants injury prevention mainstreamed into the public health agenda.

Hyder, MD, PhD ’98, MPH ’93, believes there is another essential element to injury prevention—increasing awareness of injury as a social justice issue. “The poorer you are, the more likely you are to get injured, and the care for your injury is worse,” he says. Children in Africa, for example, suffer unintentional injury at a rate of 53 per 100,000; in countries such as Australia, Sweden, United Kingdom and Canada, the rate is about five per 100,000.

WHO and UNICEF published the first World Report on Child Injury Prevention in December 2008. The report, which Hyder co-edited, outlines intervention strategies—well covers, window guards, motorcycle helmets and nontip lanterns—and policies such as speed limits, playground standards and urban design that mandates sidewalks. Already, the report has generated discussion about interventions. For example, in Vietnam, where many children ride motorcycles but few wear helmets, there is research under way to produce affordable child helmets that meet safety standards.

As director of the International Injury Research Unit (IIRU) in International Health, and a core faculty member of the Center for Injury Research and Policy (CIRP), Hyder touts the cost-effectiveness of interventions. A recent IIRU study of poisoning among South African children looked at kerosene stored in old soda or juice bottles. It found that distributing child-resistant containers for kerosene storage was effective at preventing poisoning. “People think you can’t do anything about injury, and that it’s too expensive,” says Hyder, “but that is a myth.”

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