Enforcing driving laws, restricting access to pesticides and teaching children to swim

October 19, 2008

The May 2008 earthquake in Wenchuan drew attention to the important but largely unrecognised problem of injury-related death and disease in China. Low-cost prevention measures that are most likely to produce large reductions in injury mortality are enforcement of laws for drinking and driving and for seat belt and helmet use, restriction of potent pesticides, and teaching children to swim. These are the conclusions of the fourth paper in The Lancet Series on Health System Reform in China, written by Professor Michael Phillips, Beijing Long Guan Hospital, China and Columbia University, New York, USA, and colleagues.

Injuries account for more than 10% of all deaths and more than 30% of all potentially productive years of life lost due to premature mortality in China. Traffic-related injuries (mainly among cyclists and pedestrians), suicide, drowning, and falls account for 79% of all injury deaths. Rural injury death rates are double those of urban rates and male rates are double those of female rates. Despite an 81% increase in traffic-related mortality from 1987 to 2006, overall injury mortality decreased by 17%, largely due to a surprising and unexplained 57% reduction in the suicide rate during this time. Possible reasons for the decreased suicide rate include improved financial prospects for the country's poor and reduced access to lethal pesticides. Ingestion of pesticides is the most common method of suicide, but, due to rapid urbanization and massive rural to urban migration for work, both the rates and case-fatality of pesticide-related suicidal behaviour could have decreased. The probable reason for relatively high female suicide rates is that suicidal acts in which the individual has a low intent to die, which are more common in women, often result in death if the method employed is pesticide ingestion.

The close proximity of much of the Chinese population to its waterways, combined with a very small proportion of the population knowing how to swim, leads to many deaths by drowning. In children under 15 years, 54% of all injury deaths are due to drowning. Drowning rates are three times higher in rural than urban areas.

The authors conclude: "China has the financial resources, organizational infrastructure, and public support to rapidly apply lessons from high-income countries to achieve international best practice standards for injury prevention and control, and to become a model for other low-income and middle-income countries that have similar difficulties...Low-cost prevention measures that are most likely to produce large reductions in injury deaths include enforcement of laws for drinking and driving and for seatbelt and helmet use, restriction of access to the most potent pesticides, and teaching children to swim. China needs to improve monitoring of fatal and non-fatal injuries, promote intersectoral collaboration, build institutional capacities, and, most importantly, mobilise community support and political will for investment in prevention."
Professor Michael Phillips, Beijing Long Guan Hospital, China and Columbia University, New York, USA T) +86 10-6271-2471 E) phillipschina@yahoo.com

Full paper: http://press.thelancet.com/china4.pdf


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