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Pedestrians, cyclists among main road traffic crash victims

Half of 1.27 million people who die in road traffic crashes every year are pedestrians, motorcyclists and cyclists, finds new WHO study.

15 JUNE 2009 | GENEVA/NEW YORK —
The first global assessment of road safety finds that almost half of the estimated 1.27 million people who die in road traffic crashes every year are pedestrians, motorcyclists and cyclists. While progress has been made towards protecting people in cars, the needs of these vulnerable groups of road users are not being met.

The Global status report on road safety published today provides the first worldwide analysis of how well countries are implementing a number of effective road safety measures. These include limiting speed, reducing drink-driving, and increasing the use of seatbelts, child restraints and motorcycle helmets. Funded by Bloomberg Philanthropies, the report presents information from 178 countries, accounting for over 98% of the world’s population. It uses a standardized method that allows comparisons between countries to be made.

“We found that in many countries, the laws necessary to protect people are either not in place or are not comprehensive. And even when there is adequate legislation, most countries report that their enforcement is low,” said WHO Director-General Dr Margaret Chan. “We are not giving sufficient attention to the needs of pedestrians, cyclists and motorcyclists many of whom end up in clinics and hospitals. We must do better if we are to halt or reverse the rise in road traffic injuries, disability and deaths.”

“Traffic crashes are a leading cause of death, particularly among young people 5 to 44 years of age,” said Mr Michael R. Bloomberg. “For the first time, we have solid data to hold us accountable and to target our efforts. Road safety must be part of all transport planning efforts, particularly at this moment of focus on infrastructure improvements and road building by many countries around the globe.”

Road traffic death rates increasing

While road traffic death rates in many high-income countries have stabilized or declined in recent decades, research suggests road deaths are increasing in most regions of the world and that if trends continue unabated, they will rise to an estimated 2.4 million a year by 2030. In addition, road crashes cause between 20 million and 50 million non-fatal injuries every year and are an important cause of disability. In many countries support services for road traffic victims are inadequate. These avoidable injuries also overload already stretched health-care systems in many countries.

The report documents numbers of registered motorized vehicles in each country and action being taken to invest in public transport and encourage non-motorized travel such as walking and cycling. Vehicle manufacturing standards and requirements for road safety audits were also reported, as well as the existence of formal pre-hospital care systems, including emergency telephone numbers.

Accurate statistics are crucial for understanding the state of road safety and measuring the impact of efforts to improve it. The report found that underreporting of deaths occurs in many countries, and that few countries have completely reliable data on road traffic injuries. The highest death rates are seen in the Eastern Mediterranean and African regions. The lowest rates are among high-income countries, such as the Netherlands, Sweden and the United Kingdom.

Other highlights of the report include:

• Less than a third of countries meet basic criteria for reducing speed in urban areas.
• Less than half of countries use the recommended blood alcohol concentration limit of 0.05 grams per decilitre as a measure to reduce drink-driving.
• While helmet laws exist in more than 90% of countries, only 40% have a law that covers both riders and passengers while also requiring that helmets meet a specified standard.
• Only 57% of countries have laws that require all car occupants to wear seat-belts. This figure is only 38% in low-income countries.
• Half of all countries do not have laws requiring the use of child restraints (e.g., child seats and booster seats). This figure masks considerable variation, with relevant laws in 90% of high-income countries but only 20% of low-income countries.
• Only 15% of countries have comprehensive laws which address all five of these risk factors.
• Where laws on these risk factors are in place they are often inadequately enforced, particularly in low-income countries. For example, only 9% of countries rate their enforcement of speed limits as over 7 on a scale of 0 to 10, while the corresponding figure for enforcement of seat-belt laws is 19%.

“More than 90% of the world’s road deaths occur in low-income and middle-income countries, while these countries only have 48% of the world’s vehicles,” said Dr Etienne Krug, Director of WHO’s Department of Violence and Injury Prevention and Disability. “Our roads are particularly unsafe for pedestrians, cyclists and motorcyclists who, without the protective shell of a car around them, are more vulnerable. These road users need to be given increased attention. Measures such as building sidewalks, raised crossings and separate lanes for two wheelers; reducing drink-driving and excessive speed; increasing the use of helmets and improving trauma care are some of the interventions that could save hundreds of thousands of lives every year.”

The report also shows that road traffic injuries remain very relevant in high-income countries. “Even the top performers globally are often stagnating and still have considerable room for improvement in achieving a truly safe road transport system,” Dr Krug said.

For further information contact:

Laura Sminkey
WHO Geneva
Telephone: +41 22 791 4547
Mobile: +41 79 249 3520
E-mail: sminkeyl@who.int

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Greater equity in health should be a progress indicator

15 JUNE 2009 | NEW YORK —
With a growing recognition that “blind faith in economic growth and gain as the be-all, end-all, cure-for-all has been misplaced,” WHO Director-General Dr Margaret Chan today responded to leaders who have been calling for a redesign of international systems.

Speaking at the United Nations Headquarters in New York today, Dr Chan said that it is time to build policies based on fairness – using differences in the health status of populations within and between countries – as the “key measure of how we, as a civilized society, are making progress.”

“The world is in such a great big mess,” she said at the UN Secretary-General’s Forum on Advancing Global Health in the Face of Crisis on Monday. The meeting was attended by senior government officials and experts in health and international development.

In the last year, this warming world has suffered a fuel crisis, a food crisis and a financial crisis. This list of challenges grew last week with the addition of pandemic influenza.

The impact of these crises is not felt equally. Pandemic influenza, for example, will hit hardest in developing countries, which have large vulnerable populations. With their weak health systems, these struggling countries will take longer to recover. In many ways, developing countries facing the pandemic are virtually empty-handed, said Dr Chan.

“Fairness, I believe, is at the heart of our ambitions for global health,” she told the world’s ambassadors. But fairness is in short supply. Differences in income, life expectancy, and opportunities are greater now than at any time in recent history. These extremes of privilege and misery, Dr Chan noted, are often “a precursor for social breakdown.”

The soul-searching following the financial crisis has led to a questioning of “blind faith in economic growth.” From this self-examination, leaders are calling for a restoration of other values, especially fairness, to a central role in policy formation.

“We hear clear calls, from leaders around the world, to give the international systems a moral dimension,” said Dr Chan, “to redesign them to respond to social values and concerns… A focus on health as a worthy pursuit for its own sake is the surest route to the moral dimension, the surest route to a value system that puts the welfare of humanity at its heart. Greater equity in the health status of populations, within and between countries, should be regarded as key measure of how we, as a civilized society, are making progress.”

One method for achieving fairness, she suggested, would be for more countries to embrace primary health care. As she noted, a primary health care approach introduces greater fairness as well as efficiency, and allows health systems to reach their potential as cohesive, stabilizing social institutions.

For more information contact:

Dick Thompson
WHO Geneva
Mobile: +41 79 594 2876
E-mail: thompsond@who.int

Thomas Abraham
WHO Geneva
Mobile: +41 79 516 3136
E-mail: abrahamt@who.int

WHO (2009)

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Office of Prime Minister of Norway (2009)

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Eliminating world poverty: Building our common future

Publisher/Organizer: DFID
Publication date: 2009
Language: English

Download the full report from the Department for International Development web site

Overview

This background paper was prepared for the DFID annual conference “Securing our Common Future: A Conference on the Future of International Development” (9-10 March 2009, London)

“According to the paper, the current global recession seriously threatens the achievement of the Millennium Development Goals, and may push more than 90 million people into poverty. Times are uncertain, because the scale of the downturn is not yet known, and the impact could be even more serious. Combined with other huge challenges already happening, or on the horizon, including the demands of a growing population and the onset of climate change, this is an important moment to reaffirm our commitment to international development and to review priorities.”

Part one briefly reviews recent progress in developing countries. Part two sets out the emerging challenges, both immediate and longer term. Part three sets out a series of questions for consideration in priority policy areas in response to the emerging challenges.”

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Innovations in primary health care in the Americas

Publisher/Organizer: Journal of Ambulatory Care Management
Publication date: April/June 2009, Volume 32, Issue 2
Language: English

Read the Special issue of the Journal of Ambulatory Care Management online

Overview

“For readers of this journal, it is no surprise that primary care has a long history of innovation both in the United States and elsewhere. In recent years, primary care has received increased attention worldwide, from the proliferation of interest in the concept of the medical home in the United States to the commemoration of the 30th anniversary of the Alma Ata Declaration in 2008 (American Academy of Family Physicians et al., 2007). This special edition of Journal of Ambulatory Care Management comprises a series of articles highlighting several innovative approaches to addressing primary care challenges in a variety of countries throughout the Americas.

The recent World Health Report 2008 summarized several steps necessary to revitalize a primary healthcare approach to health systems’ strengthening, including:

• enhancing universal access to primary care,
• reforming the way primary care services are organized and delivered,
• integrating primary care with public health and public policy approaches to tackling the upstream determinants of health inequalities, and
• strengthening leadership and oversight of health systems and services to make them more relevant and responsive to population needs (World Health Organization, 2008). Each of the articles responds to one or more of these priority areas.

Several articles assess innovations in enhancing access to primary care services. Ruiz Chiriboga evaluates Ecuador’s experience in expanding access to primary care through a national health insurance approach to providing free maternal and child care, finding that it was effective in increasing use of primary care services and effective in improving some outcomes, such as neonatal mortality. Báscolo and Yavich analyze the ways local governance structures helped determine variations in the effectiveness of the province of Buenos Aires’ plan to provide health insurance to its citizens.

In terms of organizational reforms, Rubinstein and colleagues find that the use of pay-for-performance approaches can be effective in improving some aspects of primary care delivery but are careful to discuss how “generic” performance indicators adapted from countries such as the United Kingdom may need to be adapted to local contexts of their Buenos Aires–based health plan. Guanais and Macinko assess how the expansion of a community-based primary care program in Brazil may have altered hospital utilization patterns by reducing a number of ambulatory care–sensitive hospitalizations. Puig et al. address the challenges of assessing the quality of ambulatory care from the user’s perspective, especially in the context of a health system with multiple payers and providers in the public, private, and nonprofit sectors in Mexico.

In addressing governance in primary healthcare, Shimizu and colleagues discuss an innovative feature of primary care in Brazil: local health councils. Their study suggests that such councils can improve public accountability but are still limited in their ability to affect health policy at the local level. Solicitation of public opinion on the development of health policies is another way to help align primary care with population health needs. White and Nanan discuss the results of British Colombia’s attempts to engage the public in discussing the purpose and scope of primary healthcare and in prioritizing areas for reform efforts.

Finally, Macinko and colleagues review the evidence base for the effectiveness of primary healthcare on the health of populations living in low- and middle-income countries. They find that although the literature generally supports the contention that a strong primary healthcare approach enhances health outcomes, there is still considerable work to be done in systematically assessing experiences and building a more comprehensive evidence base on primary care and health outcomes.

Our intention for the issue is to provide a forum for facilitating international dialogue and exchange of experience on primary care organization, management, and effectiveness. Taken together, these articles show that primary care is alive and well in many countries of the Americas, and there are likely to be many additional experiences and lessons learned in other countries that have not been included here. Thus, this collection of articles should be viewed as the beginning of a process rather than a report on its conclusion.

We hope that the edition will help facilitate discussion and accelerate the exchange of information and practical tools to help strengthen primary care planning, practice, and policy in the United States and throughout the Americas. We encourage readers to reach out to contributors and begin to build this global primary care network. The many challenges faced by proponents of a primary care approach to strengthening health systems are more common than might first be imagined, and the diversity of ways to surmount such challenges provides a rich laboratory for innovation and cross-national learning.”

James Macinko, PhD, Guest Editor

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Canada’s international leaders on maternal mortality congratulate Canadian Government

9 JUNE 2009 | OTTAWA - Today in Parliament, an all-party resolution was unanimously passed renewing
Canadas commitment to reducing maternal and newborn morbidity and mortality
both at home and abroad. Support was expressed for Canadian leadership within
government and civil society to work within the G-8 and as partners with UN
agencies and appropriate global initiatives to achieve this goal.

Leaders of the International Federation of Obstetrics and Gynecology, the
International Confederation of Midwives, the White Ribbon Alliance, and the
Society of Obstetricians and Gynaecologists of Canada made compelling
presentations at a Parliamentary briefing meeting Tuesday morning, chaired by
Senator Wilbert Keon. Leaders of all parties, in both the House and Senate,
responded immediately and demonstrated leadership in addressing these
preventable tragedies. Over half a million women each year die during pregnancy
or birth, as well as 7 million newborns and stillbirths due to poor maternal health
and a lack of skilled professionals attending birth globally. The resolution is timely
as the G8 leaders will meet in Italy in July and next year, here in Canada.
Coordinated global efforts are building the necessary political will to ensure
success.

The President of the International Confederation of Midwives (ICM), Bridget
Lynch, in Toronto said:

“This is a great day for Canada and I am proud of the leadership role our
government is taking to end the needless deaths of women and their newborns in
the poorest countries. Today, Canada has committed to working with the other
G8 nations to find solutions to save these lives and to ensure that all women
globally have access to family planning. When a woman survives childbirth, her
children are more likely to survive childhood. They are more likely to get an
education. They are more likely to be well nourished and, thus, they are more
likely to make positive contributions to the development of their societies. When a
woman has access to family planning, she is more likely to have fewer children
who are better educated and provided for. She is able to contribute not only to
the well-being of her family, but the well being of her society. It makes sense to
save the lives of women in pregnancy and childbirth in order to build strong
families and stable societies. We know what to do to save the lives of women in
pregnancy and childbirth. We know what to do to save the lives of newborns.
Until now, what has been lacking is a political will on the part of the G8 and the
G20 to make it happen. Today, Canada joins with resolutions from the European
Parliament, the US Congress and the African Parliamentary Union, all of whom
have passed similar resolutions in the past few months. This global political will is
what is needed to finally end the needless deaths of mothers and their newborns, to help build functioning health systems in developing countries and to create
innovative global financing systems to fund these needs.”

The President of the International Federation of Gynecology and Obstetrics
(FIGO), Dr. Dorothy Shaw, at the University of British Columbia said:

“This resolution confirming Canada’s renewed commitment to a goal set in 2000
for all member states of the UN shows leadership at a critical time - the lack of
progress to date in preventing maternal and newborn morbidity and mortality is
difficult to live with when the solutions are not expensive and not high-tech and
require political commitment from all governments. Our Canadian government
has shown significant leadership in child health through the Catalytic Initiative
and the recognition of the critical importance of maternal health for women and
their children will have far-reaching impact. Millennium Development Goal 5 is
the only goal that has seen little if any progress, yet it represents a woman’s right
to life. Partnerships between global leaders, UN agencies, health professionals
and civil society will produce results that none can manage in isolation.
Development of nations is dependent on how much the lives of its women are
valued.”

Maureen McTeer, representing the White Ribbon Alliance in Canada said: “With
this resolution, Canada’s Parliamentarians have committed to helping us save
women’s lives. I am delighted that our message has been heard and we will work
together to achieve the Millennium Development Goals on maternal and child
health.”

In Ottawa, the Executive Vice President of the Society of Obstetricians and
Gynaecologists of Canada, Dr. André Lalonde, said: “This unanimous call for
Canada to assume a leadership role in reducing maternal mortality in the poorest
countries of the world is an important first step. The SOGC and its Canadian
partners (midwives, nurses, family physicians, and pharmacists) are ready and
willing to work with Canada foreign aid to bring quality maternity care and
emergency obstetrical care to partner countries. Canada has the potential to play
a leading role and we must respond to this human tragedy. Too many women are
dying without basic care. Governments can work with NGOs to maximize our
nation’s efforts to reduce this global burden. With one woman dying every minute
during childbirth, we need action now. This resolution gives us the momentum we
need to join forces to make the world a safe place for our mothers.”

Both the Canadian Association of Midwives (CAM) and the Society of
Obstetricians of Gynecologists of Canada (SOGC) have supported this effort to
bring a resolution to Parliament. In May, CAM initiated a nationwide ‘Mothers and
Midwives’ Campaign informing all Parliamentarians of this issue and asking for a
resolution from Parliament. Today, a tangible and important step was taken.
Canada’s international leaders on maternal mortality congratulate Canadian
Government.

Media Contact

To arrange an interview with these Canadian leaders in the field of international women’s health, please contact:
Mike Haymes
Media Relations Officer
Tel : (800) 561-2416 ext. 325
<a href=”mailto:haymes@sogc.com”<haymes@sogc.com