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time›
‹footer›
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250;
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TEACH-VIP
T rainin=
g,
E ducating,
A dvancing
C ollaboration in
H ealth on
V iolence and
I njury
P revention
=
Core curriculum
Lesson 19
=
The
materials in this lesson are based on an injury prevention and control curriculum originally =
developed by the World Health =
Organization and a global network =
of injury experts.
![](3D"slide0035_image003.gif")
The role of education, the law, economics and other =
di=
sciplines
- Communication across divides.
The inter-disciplinary nature of injury prevention research=
and
practice
Session Time: 60 Secti=
on
VII. Inter-disciplinary approach to injury prevention
Main objective for this
lesson:
To address the importance of the
interaction of multiple disciplines to achieve =
measurable goals for injury prev=
ention
and control.Core competencies that studen=
ts
should attain by the end of the session:
=
To understand the:
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1.
importance and effectiveness of inter-disciplinary approaches to in=
jury
prevention.
2. contributions of the various
disciplines to the field of injury prevention and control
including:
=
Health sciences
Social sciences
Education
Engineering
3. role the various government and
non-government sectors play in the injury
prevention control an=
d the
promotion of safety.
![](3D"slide0016_image004.gif")
The multidisciplinary
nature of
injury prevention
research and practice
=
TEACH-VIP
![](3D"slide0003_image005.gif")
Many approaches, one goal
<=
span
style=3D'font-family:Arial;font-size:117%'>• Injuries affect populations in many
ways
<=
span
style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<=
/span>
<=
span
style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<=
/span>
<=
span
style=3D'font-family:Arial;font-size:117%'>• Many approaches for dealing with t=
he
problem
<=
span
style=3D'font-family:Arial;font-size:117%;visibility:hidden'>•<=
/span>
•<=
/span> Linking approaches through researc=
h and
policy
Prevention
![](3D"slide0017_image006.gif")
The
inter-disciplinary nature of injury studies
Engineering
![](3D"slide0017_image007.gif")
Economics
Injury prevention
Law
Social sciences
Health
sciences
Education
Public health
Contributions from education
• Curricula development
•
•<=
/span> Educational techniques in clinical
settings
•
•<=
/span> Educational programmes aimed at
preventing
specific injuries
=
- Bicycle
helmets
- Car seats&#=
13;
- Occupational
settings
Contributions from engineering
•<=
/span> Design of products
- Seat belts
- Motor vehicles
- Helmets
- Home products
-=
• Workplace settings
•<=
/span>
•<=
/span> Home settings
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•<=
/span>
•<=
/span> Urban modifications<=
/div>
Contributions from social sciences
•<=
/span> Sociology
- Analysis of social
structure, interactions and factors
associated with injuries
<=
/div>
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•<=
/span> Anthropology
- Ethnographic studies =
of
injuries
- Analysis of cultural
responses to injuries and
social interpretations of injurie=
s
•<=
/span> History
- Analysis of historical
factors and events
associated to injuries
- Historical evaluation=
of
injury prevention and
control
Contributions from law
<=
span
style=3D'font-family:Arial;font-size:133%;visibility:hidden'>•<=
/span>
<=
span
style=3D'font-family:Arial;font-size:133%'>• Ruling=
on
enforcement measures
<=
span
style=3D'font-family:Arial;font-size:133%;visibility:hidden'>•<=
/span>
<=
span
style=3D'font-family:Arial;font-size:133%'>• Design=
of
legal safety nets for victims of
certain injuries
•<=
/span> Development of legal codes for
occupational
injuries
Contributions from economics
•<=
/span>Estimation of cost of injury:
–<=
/span>direct (treatment) and
–<=
/span>indirect costs (lost production &
intangibles
•
•<=
/span>Cost-effectiveness (cost utility), cost-
<=
/span>
• minimization and
cost-benefit analyses
•
•Evaluations of the effect of economic <=
/span>changes on the incidence of injuries
Contributions from health sciences
•<=
/span> Behavioural sciences
- Psychology
- Psychiatry
•<=
/span> Biological sciences
- Pædiatrics
- Emergency medicine=
3;
- Surgery
- Neurology
=
- Orthopædics
- Pharmacology
- Infection control
•<=
/span> Genetics
- Genetic factors assoc=
iated
with specific injuries
Contributions from public health
•<=
/span> Application of multidisciplinary
approaches to
health problems of populations=
3;
•<=
/span>
•<=
/span> Surveillance systems design
<=
/span>
•<=
/span>
•<=
/span> Epidemiology
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- Design of measurement
techniques
- =
Design
of epidemiologic studies
- Interventions
=
- Evaluations
•<=
/span> Bio-statistics
<=
/div>
-=
Quantitative analytical techniques=
-=
Development of measurement tools
The
inter-sectoral nature of injury prevention
![](3D"slide0004_image009.jpg")
Source: Pedden et al. 2004
The role of public health
![](3D"slide0029_image011.gif")
The role of government
•Institutional development<=
span
lang=3DEN-GB style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bi=
di-font-family:
"Times New Roman";display:none'>
•<=
/span>Make road safety a political priority.
•<=
/span>Appoint a lead agency for road safety
•<=
/span>Develop an inter-disciplinary approach
•Set appropriate road safety targets and establish national road safety plans to =
achieve them.
•Support the creation of safety advocacy groups.
•Create budgets for road safety and invest in demonstrably effective road safety activities.
•<=
/span>=
The role of government
Policy, legislation and enforcement
•Enact =
and
enforce legislation regulating risk =
behaviors
•Set and enforce strong and uniform vehicle safety standards=
<=
span
style=3D'font-family:Arial'>•Set appropriate design standards for roads
<=
span
style=3D'font-family:Arial'>•Establish data collection systems
• Manage infrastructure to promote safety
•Provide efficient, safe and
affordable public transp=
ort
services
<=
span
style=3D'visibility:hidden'>•=
The role of industry
<=
/span>
•Ensure that all motor vehicles meet safe=
ty
standards set for high-income countries
•Begin manufacturing vehicles with safer
vehicle fronts, so as to reduce injury to vulnerable road users.
•Continue to improve vehicle safety by
ongoing research and development.
•Advertise and market vehicles responsi=
bly by emphasizing safety The role of donor organizations
•
•&=
#13;
•
•&=
#13;
The role of communities and individuals
•Encourage governments to m=
ake
the roads safe.
•Identify local safety
problems.
•Help plan safe and efficie=
nt
transport systems that
accommodate vulnerable road users as well=
as
drivers
•Demand the provision of sa=
fety
features in cars.
•Encourage enforcement of
traffic safety laws and
campaign for firm and swift punishment for traffic offenders.
•<=
/span>Behave responsibly
•
The Costa Ri=
can
experience =
•National road safety plan aimed at reducing mortality by 19% between 2001-2005.
=
;
Action through:
<=
span
style=3D'font-family:Arial'>•Traffic laws and enforcement
<=
span
style=3D'font-family:Arial'>•Education
<=
span
style=3D'font-family:Arial'>•Infrastructure development
<=
/span>
<=
span
style=3D'font-family:Arial'>•Research
=
Injury
Prevention, control, safety promotion
Injury prevention,=
control
and safety promotion
activities need to=
be
based on evidence.
Evidence of positi=
ve
effect of interventions must
be transformed int=
o policy
‹header›
‹date/time›=
=
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
‹footer›
‹#›
=
General lesson
description:
This lesson explor=
es
the importance of inter-disciplinary approaches to injuries and violence prevention and
briefly outlines the contributions of different fields to the control and
prevention of injuries and the promotion of safe behaviours and practices. It also provides existi=
ng examples of collaboration between
disciplines for the overall benefit of individuals, communities and globally a=
nd
addresses the importance of building networks and partnerships to achieve common goals.<=
/div>
The inter-disciplinary nature of injury prevention research and
practice
Many approaches, one goal=
As seen throughout
this course, injuries can affect populations in many ways, places and at any point in
people’s lives. The approaches to understanding and controlling, or
preventing, injuries have come from
a number of
disciplines. It is relatively
recently that serious and institutionalised efforts to link these disciplines and approaches =
have
begun. The
contribution of inter-profes=
sional
approaches towards injury prevention and control will be outlined. The inter-disciplinary nature of inj=
ury
studies
=
Different discipli=
nes
that have provided major inputs to the field of injuries include the fields of educatio=
n,
engineering, law, health sciences, social sciences and economics. The knowledge derived from these disciplines is applied by various
sectors in the development of policy and interventions designed to prevent or control injury.Contributions from education
Education may invo=
lve
formal activities within an institution such as a school but may also involve the marketi=
ng
of safety behaviours through media campaigns to the general public.
Education is particularly important in
helping to change values and developing a climate of social acceptance for interventions. An example is the role of education and ot=
her
activities in paving the way for the introduction of mandatory bicycle helmet wearing laws (eg <=
/span>Vulcan et al, 1980)
Education may incl=
ude
the,:
use of curricula a=
nd
education programs aimed at preventing injuries,
use of educational
tools to promote safe behaviours at home, in school environments, and at work and at
leisure,
establishmen=
t of
specific educational programs aimed at persons at higher risk of injuries,
Contributions from engineering
The field of engineering has greatly contributed to the design,
re-design and producti=
on
of products and environments aimed at preventing, or ameliorating the effects of, injuries.
In the road traffic area, these include seat belts, or child safety
seats, the developm=
ent
of other vehicle occupant protection measures and changes in the design and materials of
motor vehicles front-ends to reduce the effects of an impact on pedestrians and other vulnerable=
road users.
The development of appropriate helmets for protecting against head =
trauma in a variety of situations (e.g.
sport, cycling, and motorcycling) and other protective
devices such as child-proof caps for medications to prevent accidental poisonings have h=
ad a
significant impact on reducing injuries.
Many engineering modifications following the principles of ergonomi=
cs have lead to the design of equipment th=
at
minimizes the effects of repeated exposures in the workplace. Interventions include noise reduction, protective wear, and reducti=
on
of vibrations in settings ranging from industry to logging, to office work materials.
In home settings, the use of floor materials for preventing injurie=
s to
the elderly shou=
ld
they fall are one of many examples as well as the creation and design of smoke detectors =
to
prevent fires. Other interventions, on a wider scale, include the design of transport
systems that enable =
all
users to travel more safely.=
In leisure settings, engineering and design solutions have been app=
lied
to issues such as
safety systems for fairground rides and children’s climbing frames.
Contributions from social sciences
The social sciences
have also contributed greatly to the field of injury prevention by addressing complex aspects
related to social structures, beliefs, attitudes and knowledge about specific problems or about <=
/span>behaviours.
Ethnographic studies of different types=
of
populations can explain the belief systems and conceptualisations about injury its causes, consequences and prevention. This
information is important for the design and development of interventions aimed at changing behaviour=
s or modifying social practices.
Other fields such as history and sociol=
ogy
provide invaluable ideas as to why and how injury problems have or have not developed in some settings. Understanding the contribution from these fields is
essential in order to
contextualize injury problems and to allow for adequate implementation of programmes at communi=
ty
levels but also at institutional and governmental levels.
The issue of who controls power in the
community, and their influence on policy development, also needs to be analysed critically, becaus=
e this can contribute to the success or
failure of any injury prevention legislation, programme initiatives and their implementation and evaluation.Contributions from law
The legal disciplines make a significant contribution t=
o the
prevention of injuries through the development of
legislation. Legislation may
relate to standards
for products or the regulati=
on of
risk behaviours.
Others contributions inclu=
de the
legal definition of rape, the establishment of p=
unishments
and rehabilitation schemes for perpetrators of defined crimes within societies.
Attitudes tow=
ards the
development and implementation of successful laws and behaviour
changes need to be considered within the social and cultural context in which they are being developed, implemented and evaluated.=
Contributions from economics
The area of econom=
ics
has contributed mainly to the evaluation of the burden of injury or the evaluation of t=
he
costs of programmes and interventions.
Some costs known as direct costs, relate to the actual money spent =
by health systems for the treatment and
rehabilitation of injured people. <=
/span>Indirect costs relate to less tangible
measures such as lost productivity, premature mortality or absenteeism among others.
Different types of economic analyses ma=
y be
applied to injury problems depending on the type of question one wishes to answer. These include cost-effectiveness analyses, co=
st
minimization analyses and cost-benefit analyses.
A cost-benefit analysis explores the impact of an intervention (or =
interventions) by comparing the cost of=
the
intervention program with the cost of the benefits derived (e.g. the savings in treatment cos=
ts
of injuries
averted). Both benefits and costs are measured in monetary terms (dollars).
Cost-effectiveness analyses measure the
cost of preventing a certain outcome. The units used to measure the consequences or outcomes are defined as natural units (such as l=
ives
saved or number of injuries averted).
A cost-utility analysis is a form of cost-effectiveness analysis in
which the outcome =
is
measured in non-natural units such as quality adjusted life years (QALYs).
A cost-minimization analysis compares
interventions that produce the same type and amount of consequences but have different costs.Contributions from health sciences
Health sciences have contributed to the study of injury prevention =
and its consequences from a number of
disciplines and
perspectives.
The field of psychology for example, has addressed important risk a=
nd protective factors associated to behavi=
ours
that lead to injuries. It has also developed measurement tools for multiple behaviours and conditions. Psychology also informs us about =
the
reasons why people behave in the ways they do and what interventions are more likely t=
o be
successful in the
promotion of safety and the prevention of injury.
It also enables us to understand people’s emotional responses=
to violence – both intentional and
unintentional. It has also contributed to the development of successful negotiati=
on
and conflict resolution skills by addressing different levels and intentions of interpersonal communication.
Other fields have contributed to defining specific risk and protect=
ive factors for injuries among certain
populations, among them children, older persons, youth populations, overall gender differences and psychiatric populations. Basic sciences
have studied the pathophysiol=
ogy
of trauma and healing in relation to multiple mechanisms of injury and some have expl=
ored
the potential relationship of genetics with some violent behaviours.
Other health sciences have focused in developing the best possible =
treatments and rehabilitation schemes f=
or
injured people. In conjunction with administrative
disciplines, both have contributed to create the most appropriate systems of =
care
for injured people.
Infection control and the prevention of its spread is integral to t=
he success of inter-professional support o=
f,
and care for, injured people and in secondary and tertiary prevention e.g. following rape or
traumatic injury.
Contributions from public health=
From the perspecti=
ve
of public health, many disciplines have contributed to the developments in the
field of injury prevention. =
The promotion and integration of multiple
disciplines in the design of preventive interventions are essential in successful in public
health Initiatives.
Public health has also contributed to t=
he
development of surveillance systems for monitoring injuries and evaluating interventions and policies.
The field of epidemiology has addressed
issues related to risk and protective factors for injuries through the design of studies, and the evaluation of interventions.
The field of bio-statistics has also contributed to evaluatio=
n by developing appropriate methodologies for
assessment of interventions and the establishment of important associations between certain fac=
tors
and injuries.The inter-sectoral nat=
ure
of injury prevention
Many=
of
the activities of these disciplines need to occur with the collaboration of
many these disciplines, to pre=
vent
and control injury requires the involvement of several sectors. These sectors are
usually represented by a number of different interested parties or stakeholders in government,The role of public hea=
lth
While the health sector is only one of many fields
involved in road safety – and usually not even the leading one – it nonetheless has
important roles to play. These include:
discovering, through injury surveillance and surveys,=
as
much as possible about all scop=
e,
characteristics and consequences of road traffic crashes;
researching the causes of traffic crashes and injuries, and in doing so tryi=
ng
to dete=
rmine:
causes and correlates of road crash injury,
factors that increase or decrease risk,
factors that might be modifiable through
interventions;
exploring ways to prevent and reduce the severity of
injuries in road crashes – by designing, implementing, monitoring and evaluating
appropriate interventions;
helping to implement, across a range of settings,
interventions that appear promising, especially in the area of human behavior, disseminati=
ng
information on the outcomes,
working to persuade policy-makers and decision-makers=
of
the necessity to address approaches to road traffic safety;
translating effective science-based information into
policies and practices that protect pedestrians, cyclists and the occupants of vehicles;<=
/span>
Promote capacity building in all areas of road safety=
and
the management of survivors Include road safety in health promotion and disease
prevention activities.
Set goals for the elimination of unacceptable health
losses arising from road traffic crashes.
Strengthen pre-hospital and hospital care as well as
rehabilitation services for all trauma victims.
Develop trauma care skills of medical personnel at the
primary, district and tertiary health care levels.
Campaign for greater attention to road safety, based =
on
the known health impact and (Peden et al. 2004)
The role of
government
=
What governments
can do
Institutional development=
Make road safety a political priority.<=
/span>
Appoint a lead agency for road safety, =
give
it adequate resources, and make it publ=
icly
accountable.
Develop an inter-disciplinary approach =
to
road safety.
=
Set appropriate road safety targets and
establish national road safety plans to achieve them.
Support the creation of safety advocacy
groups.
=
Create budgets for road safety and incr=
ease
investment in demonstrably
effective road safety activities.
The role of
government
What governments
can do
Policy, legislation and enforcement<=
/b>
Enact and enforce legislation requiring=
the
use of seat-belts and child restraints, =
and
the wearing of motorcycle helmets and bicycle helmets.
Enact and enforce legislation to prevent
alcohol-impaired driving.
Set and enforce appropriate speed limit=
s.
Set and enforce strong and uniform vehi=
cle
safety standards.
=
Ensure that road safety considerations =
are
embedded in environmental and other
assessments for new projects and in the evaluation of transport policies and plans.Set appropriate design standards for ro=
ads
that promote safety for all.
Manage infrastructure to promote safety=
for
all.
=
Provide efficient, safe and affordable
public transport services.
Encourage walking and the use of
bicycles.
The role of
industry
What vehicle manufacturers can do:
Ensure that all motor vehicles meet saf=
ety
standards set for high-income count=
ries
– regardless of where the vehicles are made, sold or used – including the provision of
seat-belts and other basic safety equipment.
=
Begin manufacturing vehicles with safer
vehicle fronts, so as to reduce injury to vulnerable road users.
Continue to improve vehicle safety by ongoing research and <=
span
style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bidi-font-famil=
y:
Arial;mso-hansi-font-family:Arial'>development.
Advertise and market vehicles responsib=
ly
by emphasizing safety.
<=
/div>
Slide 17
What donors can do
Highlight the improvement of road safety
outcomes as a global development
priority.
=
Include road safety components in grants
for health, transport, environmental
and educational programs.
Promote the design of safe infrastructu=
re.
Support research, programs and policies=
on
road safety in low-income and
middle-income countries.
Make funding for
transport infrastructure projects conditional on the completion of a safety audit and any
follow-up required.
Set up mechanisms =
to
fund the sharing of knowledge and the promotion of road safety in developing countries.
Facilitate safety management capacity building at regional and nati=
onal
levels.
<=
/div>
What communitie=
s,
civil society groups and individuals can do
Encourage governme=
nts
to make the roads safe.
Identify local saf=
ety
problems.
=
Help plan safe and
efficient transport systems that accommodate drivers as well as vulnerable road users, such as bicyclists and pedestrians.
Demand the provisi=
on
of safety features, such as seat-belts, in cars.
Encourage enforcem=
ent
of traffic safety laws and regulations, and campaign for firm and swift punishment for traffic offenders.
Behave responsibly
by:
abiding by the spe=
ed
limit on roads;
=
never driving when
over the legal alcohol limit;
always wearing a
seat-belt and properly restraining children, even on short trips;
wearing a crash he=
lmet
when riding a two-wheeler.
The
construction of inter-sectoral institutional capacity, both in the
governmental and non-governmental sph=
eres,
is a key to developing road safety, and can only be delivered by a nationa=
l,
political commitment (see figure abov=
e). As
Wesemann observes, there is sufficient evidence to show that free-market <=
/span>mechanisms are no substitute for government interv=
ention
when it comes to providing greater safety (Wesemann
2000).
Co=
sta Rica
has a population of around 4 million, some 900 000 vehicles and a road net=
work
of 29 000 km, 9000 km of which are
surfaced. Only 20% of the surfaced roads are in a satisfactory state of
repair.
In=
Costa
Rica, traffic crashes and their consequences are clearly a public health
problem. They are the leading cause of
violent deaths, the leading cause of death in the 10–45 years age gr=
oup,
and the third leading cause of years =
of
life lost due to premature death. The cost to the country of traffic crash=
es amounts to almost 2.3% of gross domestic product.&=
#13;
Be=
cause of
the seriousness and complexity of the road safety problem, a set of
coordinated interventions, cutting ac=
ross
many sectors and disciplines, has been formulated. The National Road Safety
Council, attached to the Ministry of =
Public
Works and Transport, has been in existence for 23 years. A national road safety plan, aimed at reducing the mortality =
rate
by 19% during the period 2001–2005, is being implemented, providing for action in the fields of
traffic laws, police surveillance, education, infrastructure and research.&=
#13;
Th=
e law
has been changed so as to better protect pedestrians, and new laws have be=
en
introduced making the wearing of
safety-belts by drivers and passengers compulsory. The police have stepped=
up
operations to check for excess alcohol
among drivers, to control speeding and to check on the wearing of seat-bel=
ts.
On=
going
campaigns emphasize the importance of observing speed limits and wearing
seat-belts, and discourage drinking a=
nd
driving, in support of police enforcement campaigns. Special campaigns tak=
e place during the Easter week, when large numbers of
people take to the roads. A specific safety campaign is aimed at pedestrians. The medical examination t=
hat
drivers require has been updated and strengthened. Within primary and secondary schools at all levels=
, the
national plan provides for educational modules on road safety.<=
b>
Un=
der
Costa Rica’s road safety plans, new infrastructure is being put in p=
lace
to protect vulnerable road users, inc=
luding
pedestrian bridges, cycle tracks, and protective railings and pavements al=
ong
dangerous portions of roads. New and =
better
road signs and traffic lights are being installed.
Sy=
stematic
data on road traffic crashes and on the victims of crashes are compiled.
Studies are also under way Nationally=
on a
range of issues, including:
&#=
8212;
the safety of road travel to and from schools;
&#=
8212;
risk behavior among drivers and pedestrians;
&#=
8212;
the wearing of safety-belts;
&#=
8212;
the vulnerability of road users visiting health centers;
&#=
8212;
safety audits of roads, and the identification of high-risk crash sites;&#=
13;
&#=
8212;
the financial costs and economic consequences of traffic crashes.
Although the examples provided in the previous slides are based on =
road safety, the general principles can=
be
applied to any area of injury prevention and control.
A final message explicit in the examples provided is that
effective interventions
are based on evidence and much of this evidence comes from appropriately designed, implemented
and carefully evaluated research. Once this evidence has been obtained, it needs to be transformed into policy.
' + ENDSHOW_MESG + '
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