Implementation of Prevention and Control Strategies
Investments in the health sector to address specific problems are a critical indicator of political commitment, sectoral efforts, and priorities at the national and international levels. In some cases, investments are so low that they provide a useful reference point for assessing the returns on additional investments in the future. Such a situation has been described as a null point in health systems, and current expenditures on injury prevention and control in LMICs approximate this concept (Murray and others 2000).
This concept can be illustrated by considering investments in preventing RTIs, which are responsible for the majority of the burden of unintentional injuries and about which much is known regarding effective interventions, even though such interventions have not been examined in the context of rigorously controlled studies in LMICs (see box 39.1).
[Box 39.1]
Peden and others (2004) recognize that, despite the global burden of RTIs, the levels of investment are pitifully small, largely because of a lack of awareness of the scale of the problem and a lack of awareness that interventions can prevent and reduce the levels of harm. As a consequence, the report directs a number of recommendations at governments and communities in the hope that these recommendations will enable countries, particularly LMICs, to begin a sustainable process that will eventually lead to the adaptation and implementation of effective preventive strategies. The recommendations include the following:
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Identify a lead government agency to guide the national road safety effort.
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Assess the problems, policies, and institutional settings relating to RTIs and the capacity for preventing RTIs in each country.
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Prepare a national road safety strategy and plan of action.
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Allocate financial and human resources to address the problem.
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Implement specific actions to prevent crashes, minimize injuries and their consequences, and evaluate the effect of those actions.
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Support the development of national capacity and international cooperation.
Although few data are available to show the levels of investment in other areas of unintentional injury prevention, those levels are no doubt considerably lower than for RTIs. With increases in the proportions and numbers of older people in many LMICs, the burden of fall-related injuries is likely to increase significantly in the coming years. Recognition of the changing demographics in countries such as China, Mexico, and Thailand plus a growing body of evidence on effective interventions to prevent falls suggest that investments in this area could lead to significant benefits. Similarly, increasing recognition of the significance of the burden of drowning in children is leading to growing awareness of the need to invest in that area. However, the absence of any effective evidence-based interventions may be a barrier to further investment, suggesting that research into the burden of drowning must be a priority.
Investment in prevention and control activities in other areas of unintentional injuries is minimal in most LMICs, in large part because the burden of those injuries is unrecognized and because evidence of effective interventions is lacking. Therefore, there is clearly a need to consider the development, implementation, and evaluation of prevention strategies in combination, so that effective interventions can be identified and promulgated and so that ineffective interventions can be identified and discarded.
