According to a map of violence produced by the Institute for Applied Economic Research (IPEA) and the Brazilian Forum of Public Security (FBSP), the homicide rate in Brazil was 30 times higher than that in Europe in 2016 (62,517 murders). Considering only the last decade, 553,000 Brazilians lost their lives through violent death (153 deaths per day). Such deaths represent almost 10% of all deaths in the country and affect mainly young men: 56.5% of the deaths of Brazilians aged between 15 and 19 are from violent deaths. Young victims represent 53.7% of the total number of deaths in the country (that is, 33,590 deaths), 94.6% of whom are males. The number of violent deaths also reflects great racial inequality: 71.5% of the people murdered are black or mixed race (Institute for Applied Economic Research, 2018).

Despite the alarming numbers at the national level, the disparity between the Federation Units draws attention. There was a reduction of homicide rates in the last decade in states such as São Paulo (-46.7%), Espírito Santo (-37.2%) and Rio de Janeiro (-23.4%), and a growth in others, such as Rio Grande do Norte (256.9%), Acre (93.2%), Rio Grande do Sul (58.8%) and Maranhão (121.0%). By 2016, the homicide rate per 100,000 inhabitants had reached almost 45 in the states of the Northeast and the North. In the Southeast, on the other hand, the value was in the 20’s, slightly below the 25 reached by the Southern states (Institute for Applied Economic Research, 2018).

Most homicides in Brazil are caused by fire guns: from 1980 to 2016, almost one million Brazilians lost their lives because of fire guns. A total of 71.1% of homicides was committed with the use of fire guns (a rate that grew for decades until 2003, the year of the creation of the disarmament statute) (Institute for Applied Economic Research, 2018). Currently the Brazilian new government is starting to allow more sectors of the population to have a fire gun.

References:

Institute for Applied Economic Research. (2018). Atlas da violência.

According to the Injury Survey 2008 conducted by the Centre for Health Protection, 6.2% of the Hong Kong population (415,200 persons) reported at least one unintentional injury that limited their normal activities in the past 12 months. The prevalence rate was similar for both genders and was found to be highest for those aged 75 and over (8.9%). The most common causes of injury episodes were falls (32.2%), sprain (25.8%) and sports (14.1%). Falls were found to be most common cause of injury episodes in females (40.8%) and among those aged 75 and over (74.3%) (Centre for Health Protection, 2010). The average cost of the total medical expenses incurred in each injury episode was HK$1,929 (median HK$300). The total cost incurred as a result of injuries was estimated at HK$838.6 million (95% CI HK$473.9 million to HK$1,203.4 million) in 2008. The cost was increasing with age and the highest in persons aged 65 and over (median for those aged 65 and over: HK$500). More than half of the injury episodes (51.3%) sustained by employed persons caused them to be absent from work temporarily for an average of 19.8 days (median 7.0 days). The mean and median of paid sick leaves taken were 13.5 and 5.0 days respectively. About 36.2% of the injury episodes caused the victims to change their normal daily activities and 1.4% caused them to develop residual disabilities for 6 months or longer. 13.0% of the injury episodes were reported to cause a decline in usual household income (Centre for Health Protection, 2010; 2015). The next round of such survey, namely Unintentional Injury Survey 2018, was conducted by the Centre for Health Protection and completed in 2019. Survey results are yet to be released.

In 2013, there were 1,860 registered deaths related to injuries, which made injuries the 5^th leading cause of death in Hong Kong. Among the deaths related to injuries, the top 3 leading causes were intentional self-harm (53.7%), falls (12.5%) and transport accidents (7.5%). For the potential years of life lost at age 75, injuries ranked second among all causes of death (after cancer) and accounted for 15.7% of the total potential year lost  (Centre for Health Protection, 2015).

References:

Centre for Health Protection. (2010). Injury Survey 2008. Hong Kong Retrieved from https://www.chp.gov.hk/files/pdf/injury_survey_eng.pdf

Centre for Health Protection. (2015). Action Plan to Strengthen Prevention of Unintentional Injuries in Hong Kong. Hong Kong: Department of Health, HKSAR. Retrieved from https://www.change4health.gov.hk/filemanager/common/image/strategic_framework/injuries_action_plan/injuries_action_plan_e.pdf

As per the National Crime Records Bureau’s Accidental Deaths and Suicides report (National Crime Records Bureau [NCRB], 2020a) there were 3,74,397 accidental deaths and 1,53,052 deaths from suicide reported in 2020. The Crime in India report (NCRB, 2020b) states that there were 29,193 cases of violence related deaths (homicide) in 2020.

State wise variations in injuries:

As per GBD 2019 data, the prevalence of injuries of various types varies across the states. In 2019, the lowest prevalence rate was in Meghalaya, which had a prevalence rate of 16,545.72 cases per 100,000 people (15,672.39 – 17,471.5) and the highest was in Tamil Nadu with 29,116.16 prevalent cases per 100,000 people (27,570.69 – 30,738.74) (ICMR, PHFI and IHME, 2019). In terms of burden, the number of deaths and DALYs are described. The least number of deaths was in Meghalaya with 30.62 deaths per 100,000 people (22.93 – 43.12) and the highest number of deaths was in Tamil Nadu with 99.41 deaths per 100,000 people (70.01-121.01) (ICMR, PHFI and IHME, 2019). With respect to DALYs, Meghalaya had the lowest number of DALYs with 2,057.27 per 100,000 people (1664.38 – 2618.95) and Tamil Nadu had the highest number of DALYs with 5,055.08 per 100,000 people (4,054.81 – 5,944.4) (ICMR, PHFI and IHME, 2019).

References:

Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation (ICMR, PHFI and IHME). (2019). GBD India Compare Data Visualization. Available from: https://vizhub.healthdata.org/gbd-compare/

National Crime Records Bureau. (2020a). Accidental Deaths and Suicides in India.

Due to Indonesia’s location on the Pacific Ring of Fire, the country experiences natural disasters in relatively high frequency. These include tsunamis, earthquakes, and volcanic eruptions (Agustina et al., 2019, p.77; International Organization for Migration, 2018). In 2004, natural disasters including ‘294 floods, 54 landslides, 11 earthquakes, two tsunamis, and five volcanic eruptions’ were accountable of 10.2 per cent of total mortality and the leading cause of injury and disability. In 2018, two earthquakes led to more than 2,000 deaths over 1,000 missing people, more than 4,000 injured people, over 223,000 displaced people as well as the destruction or damage of approximately 50 health centres. The implications of natural disasters on health infrastructure is substantial. More than 4,500 health facilities were damaged between 1990 and 2015 (Agustina et al., 2019, p.80). In addition, Indonesia has experienced several acts of terrorism over the last two decades (Agustina et al., 2019, p.78). Finally, road injuries accounted as the main cause of death among the populated aged 10 to 25 years (Agustina et al., 2019, p.80).

References:

Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K. A., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., Soewondo, P., Ahmad, S. A., Kurniawan, M., Hidayat, B., Pardede, D., Mundiharno, … Khusun, H. (2019). Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7

International Organization for Migration. (2018). Indonesia 2018. Humanitarian Compendium. https://humanitariancompendium.iom.int/appeals/indonesia-2018

According to the JHLS-III survey (2016-2017), unintentional injuries were the most common cause of injuries which required medical attention among Jamaicans. As per the universal trend, more men (1.8%) than women (0.4%) reported sustaining major injuries, including those sustained during road traffic accidents, which peaked among the 25–34-year-old age group (Ministry of Health Jamaica, 2018).

However, the prevalence of unintentional injuries not related to road traffic accidents were most prevalent among the 65–74-year-olds at 3.4% and were largely due to falls in both, the workplace and the home (Ministry of Health Jamaica, 2018).

Regarding violence, on average, almost 8% of Jamaicans 15 years or older have witnessed a violent act, with more men (8.8%) than women (6.9%) reporting this. In addition, more than half of Jamaicans 15 years and older had a history of child abuse, with 13% reporting experiences of daily abuse. 7.4% of Jamaicans reported a lifetime history of sexual abuse as well, mainly perpetrated by a neighbour, friend, or acquaintance (Ministry of Health Jamaica, 2018).

Elder Abuse

There is a dearth of information on the prevalence of elder abuse in Jamaica. Though the National Council of Senior Citizen (NCSC) has a toll-free number where individuals may report such cases, it has been reported that gathering this statistics relies exclusively on direct reporting via telephone. Additionally, there has been no consistent publication on elder abuse statistics, apart from what is reported by the NCSC. In 2015, there were 17 reported cases (14 females & 3 males). The actions taken following reported incidents were not reported (Eldemire-Shearer, et al., 2020).

STRiDE Jamaica contacted the NCSC in April 2020 to gather more recent data on elder abuse. It was reported that NCSC currently does not have the jurisdiction to handle cases of elder abuse and are only allowed to record, assess, and report such cases to law enforcement. NCSC outlines the reporting procedures as follows: after a report is made, a social worker arranges to visit the alleged residence of abuse and then completes an Elder Abuse Report form with the requisite information gathered from the assessment and observations made. Should the suspected abuse be confirmed, the social worker refers the case to law enforcement for further investigation. Other recommendations and referrals to other agencies, where applicable, are made to services such as the Victim Support Unit, Medication and Family Counselling, Mental Health Assessment, and inter alia may also be made by the Social worker.

In the event social workers are unable to enter the premises of a suspected victim due to perpetrator refusal, and, among others, the location and/or circumstances are dangerous, the case is automatically handed over to the police.

The STRiDE team anticipates that this injury landscape may have implications for issues like head injury and brain damage among the affected 65-74 year old age group, while the violence and mental health landscape may have implications for mental health of the population as it ages.

References:

Eldemire-Shearer, D., Willie-Tyndale, D., Robinson, C., McKoy Davis, J. (2020). Elder Abuse – An Examination of the situation in Jamaica. In: Shankardass, M. (eds). International Handbook of Elder Abuse and Mistreatment. Springer, Singapore. https://doi.org/10.1007/978-981-13-8610-7_10

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

In Kenya, the leading causes of injury include assault (42%), road traffic accidents (28%), unspecified soft tissue injury (11%), and less than 10% for cut-wounds and dog-bites, falls and burn and poisoning each (MoH-Kenya et al., 2015). According to the Kenya Health and Demographic survey 2008/9, 39% and 20.6% of women have experienced physical and sexual violence, respectively (Kenya National Bureau of Statistics (KNBS); ORC Macro, 2010). There has been an increase in transport injuries with pedestrians comprising 43% of fatalities (Kenya National Bureau of Statistics (KNBS); ORC Macro, 2010). Other vulnerable road users include motorcyclists and cyclists. More than 75% of deaths on the roads are males and about 50% of the total deaths are children or young adults. The major killer has been consistently identified as speed and lack of use of safety equipment such as helmets, seat-belts and child-restraints (World Health Organization (WHO), 2010).

References:

Kenya National Bureau of Statistics (KNBS); ORC Macro. (2010). Kenya Demographic and Health Survey 2008-09. Health (San Francisco), 1–314. https://dhsprogram.com/pubs/pdf/fr229/fr229.pdf

MoH-Kenya, KNBS, & WHO. (2015). Kenya STEPwise Survey for Non Communicable Diseases Risk Factors 2015 Report. MoH-Kenya. https://www.health.go.ke/wp-content/uploads/2016/04/Executive-summary-6-2.pdf

World Health Organization (WHO). (2010). Road Safety in Ten Countries: Kenya. Nairobi, Kenya. https://www.who.int/violence_injury_prevention/road_traffic/countrywork/rs10_kenya_en.pdf

Accidents and violence

In 2013, there was a reported rate of 13 deaths due to traffic accidents and 18.3 homicide deaths, both per 100 inhabitants. Types of vehicles studied in traffic accidents are bicycles, motorcycles, and motor vehicles. Also included are hit-and-run vehicles, which account for 41% of the load associated with all traffic accidents.

The risk of premature loss of life from intentional and accidental injury is 92% (almost double) higher for people living in the north than those living in the south (Soto-Estrada et al., 2016).

According to data reported by ENSANUT 2012, from a survey among adolescents (10-19 years) and young adults (20-29 years), 4% reported health damages or health issues due to interpersonal violence. This would represent approximately 1,712,485 cases at national level. The prevalence of interpersonal violence is higher among men (5.0%) than women (3.3%) and the most vulnerable age group is that of men aged 20 to 29 years. For women, the household is still the space where one of the highest proportions of violence is suffered, with one in four women (24.5%) reporting violent incidents in their own home (Valdez-Santiago et al., 2013).

Table 8. Prevalence of young people who suffered damage to their health due to interpersonal violence

Source: Own estimates from ENSANUT 2012 data

Disability and Disability-free life expectancy

Indicators of healthy life expectancy are useful to monitor effectively whether the years of life gained with the increase in life expectancy are spent in a good state of health or not. In Mexico there are a few sources of data in older adults: the 10/66 study, the Mexican Health, the Aging Survey (MHAS), and SAGE.

The healthy life expectancy is the estimate expected years of life in good health for persons at a given age. In 2010-2015 life expectancy was 74 years for men, but healthy life expectancy was 65 years, while for women was 78.9 and 69 respectively, which means that there are almost 10 years with disease. This may be related to two factors: the decrease in premature mortality, which has an important effect on improving life expectancy at birth, and the increase in people with disabling sequelae. In other words, there are fewer premature deaths but more disability.

The 10/66 study is a large cohort study, examining health, social, and biological characteristics of older adults living in eight countries (China, Cuba, Dominical Republic, India, Mexico, Peru, Puerto Rico, and Venezuela). In this study, disability was assessed using the more than 15 disability days in the past (assessed through WHODAS 2.0 (WHO, 2010)) month criteria, and dependence was assessed by needing some or much care (Prina et al., 2019). Table 9 reports the prevalence of disability and dependence in the total sample (n=2002), both increased with older age, and women had higher prevalence in the oldest age group.

 Table 9. Prevalence of disability and dependence, stratified by age group and sex.

Source: (Prina et al., 2019)

Table 10 reports estimated disability-free life expectancy, which gradually declines with increasing age. Women tend to spend a longer period of time with disability and the proportion of remaining life spent disability-free is lower than among men. In the same way, dependence-free life expectancy, which is fundamental to achieve active life expectancy, also declined with increasing age, women had longer periods of dependence.

Table 10. Disability free life expectancy and proportion of remaining life spent in disability and dependence free, by age group and sex

Source: (Prina et al., 2019)

While in the 10/66 study, Mexico reports the highest disability free life expectancy at age 65 (compared with China, Cuba, the Dominican Republic, India, Peru, Puerto Rico, and Venezuela).

In 2018, Payne reported estimations of the rates of transitions between life without disability, life with disability, and death with data from longitudinal surveys of older adult populations in Costa Rica, Mexico, Puerto Rico, and the United States populations, and he reported that the growing older adult populations in Costa Rica, Puerto Rico, and Mexico are not experiencing a substantially higher burden of disability than the disability experienced by people of the same age in the United States (Payne, 2018).

For all these reasons, Mexico must direct its efforts to address the problems associated with the gap that still exists in relation to infectious diseases, the increase in chronic degenerative diseases and those related to injuries and violence, as well as disability and dependence that arise from all of them.

References:

Payne, C. F. (2018). Aging in the Americas: Disability-free Life Expectancy among Adults Aged 65 and Older in the United States, Costa Rica, Mexico, and Puerto Rico. Journals of Gerontology – Series B Psychological Sciences and Social Sciences, 73(2), 337–348. https://doi.org/10.1093/geronb/gbv076

Prina, A., Wu, Y., Kralj, C., Acosta, D., Acosta, I., Guerra, M., Huang, Y., Amuthavalli, T., Jimenez-Velazquez, I., Liu, Z., Llibre Rodriguez, J., Salas, A., Sosa, A., & Prince, M. (2019). Dependence- and Disability-Free Life Expectancy Across Eight Low- and Middle-Income Countries: A 10/66 Study. Journal of Aging and Health. https://doi.org/10.1093/geronb/gbv076

Soto-Estrada, G., Moreno-Altamirano, L., Pahua Díaz, D., Soto-Estrada, G., Moreno-Altamirano, L., & Pahua Díaz, D. (2016). Panorama epidemiológico de México, principales causas de morbilidad y mortalidad. Revista de La Facultad de Medicina (México), 59(6), 8–22. http://www.scielo.org.mx/pdf/facmed/v59n6/2448-4865-facmed-59-06-8.pdf

Valdez-Santiago, R., Hidalgo-Solórzano, E., Mojarro-íñiguez, M., Rivera-Rivera, L., & Ramos-Lira, L. (2013). Violencia interpersonal en jóvenes mexicanos y oportunidades de prevención. Salud Publica de Mexico, 55(SUPPL.2), 259–266. http://www.scielo.org.mx/pdf/spm/v55s2/v55s2a24.pdf

WHO. (2010). WHODAS 2.0 12-item version, interviewer-administered.

As described in the preceding tables, injuries account for 14% of DALYs and 5% of mortality. This is predominantly due to unintentional injury, with intentional self-harm/violence contributing ~2% to each of total DALYs and mortality.

South Africa’s injury burden, particularly homicide, is reportedly 6 times higher than the global average (Jabar & Matzopoulos, 2017). Interpersonal violence ranked 8^th on the top ten causes of premature death in South Africa in 2015, followed by road injuries and accidental gunshots (Groenewald et al., 2017). Injury related deaths moderately increased from 11% in 2006 to 14.6% in 2015 (Groenewald et al., 2017).

References:

Groenewald, P., Bradshaw, D., Day, C., & Laubscher, R. (2017). 14 Burden of disease. October 2012, 206–226. Availabe from: https://www.hst.org.za/publications/District%20Health%20Barometers/14%20(Section%20A)%20Burden%20of%20Disease.pdf

Jabar, A., & Matzopoulos, R. (2017). Violence and injury observatories Reducing the burden of injury in high-risk communities. SA Crime Quarterly, 59(59), 47–57. https://doi.org/10.17159/2413-3108/2017/v0n59a1547