Европейские факты и Доклад о состоянии безопасности дорожного движения в мире 2015

В 2013 г. в Европейском регионе ВОЗ от травм, полученных в дорожно-транспортных происшествиях, погибли почти 85 000 человек. Хотя в сравнении с другими регионами ВОЗ этот региональный показатель смертности является наиболее низким (9,3 случая смерти на 100 000 населения), между европейскими странами наблюдаются значительные различия в уровнях дорожно-транспортной смертности. Для того чтобы к 2020 г. достичь заявленной цели общемирового сокращения дорожно-транспортной смертности на 50%, необходимы более систематические усилия. В настоящей публикации анализируются законы и практические действия в отношении основных факторов риска – например, введение ограничений скорости в зависимости от типа дороги, управление транспортным средством в состоянии алкогольного опьянения, использование ремней безопасности, мотоциклетных шлемов и детских удерживающих устройств – с точки зрения их эффективности в плане снижения риска травматизма. Анализ показывает, что многим странам необходимо совершенствовать свое законодательство и правоприменение в области безопасности дорожного движения с тем, чтобы защитить население, изменить поведение участников дорожного движения и сократить число дорожных аварий. Например, несмотря на то, что 95% населения Региона охвачено всеобъемлющим и соответствующим передовой практике законодательством в отношении ремней безопасности, лишь 47% населения должным образом защищены законами о скорости, 45% – законами об использовании шлемов, 33% – законами в отношении вождения в состоянии алкогольного опьянения, и 71% – законами об использовании детских удерживающих устройств. Можно добиться значительных результатов путем повышения безопасности транспортных средств, улучшения дорожной инфраструктуры и пропаганды использования физически активных видов передвижения, служащих альтернативой использованию автотранспорта. Для того чтобы защитить всех участников дорожного движения в Регионе, нужно соединить политические усилия с системными подходами.

Growing inequalities in child injury deaths in Europe.

In this short report, we describe and compare mortality data for injuries in children aged <15 years in the WHO European region as estimated by the WHO Global Health Estimates for 2000 and 2011. Child injury deaths have decreased overall. Mortality rate ratios between low- and middle-income countries (LMIC) and high-income countries in the region show an increase in relative inequalities for childhood deaths from unintentional injuries and a narrowing from intentional injury. This growing inequality in unintentional injury is a public health concern and calls for renewed efforts to reduce childhood injuries in LMIC the region.

Progress in preventing injuries: a content analysis of national policies in Europe.

The aim of this paper is to provide a content analysis of national policies to address violence and injury prevention in the World Health Organization (WHO) European Region so as to inform where future improvements can be made. Multiple search methods were used to identify national policies for violence and injury prevention. Application of a framework based on a WHO guide was used for policy analysis. A multiple correspondence analysis (MCA) was additionally conducted. One hundred and twenty-three national policies were identified; of these, 80 were available in English language and analysed further. Most national policies had been developed after 2003. The majority of policies fulfilled most of the WHO criteria for effective policy-making. Policy areas requiring improvement include quantifying objectives, targeting the socio-economic gap in injury burden and increased focus on primary prevention. Results from the MCA confirmed the ones obtained with the descriptive statistics. Encouraging progress is being made in formulating national policy for violence and injury prevention within the WHO European Region. There are specific areas that warrant increasing attention in future policy development.

European facts and the Global status report on road safety 2015

In 2013, there were almost 85 000 deaths from road traffic injuries in the WHO European Region. Although the regional mortality rate is the lowest when compared to other WHO regions, with 9.3 deaths per 100 000 population, there are wide disparities in the rates of road traffic deaths between countries of the Region. This requires more systematic efforts if the global target of a 50% reduction in road crash death sis to be achieved by 2020. Laws and practices on key risk factors such as regulating speed appropriate to road type, drink–driving, and use of seat belts, motorcycle helmets and child restraints are assessed to reduce the risk of road traffic injury. Many countries need to further strengthen their road safety legislation and enforcement in order to protect their populations, improve road user behaviour and reduce the number of crashes. While 95% of the population in the Region is covered by comprehensive laws in line with best practice for seat belts, only 47% of the population is adequately protected by laws for speed, 45% for helmet use, 33% for drink–driving and 71% for use of child restraints. Much can be gained from improving the safety of vehicles, having better road infrastructure and promoting sustainable physically active forms of mobility as alternatives to car use. Concerted policy efforts with systems approaches are needed to protect all road users inthe Region.

European facts and the Global status report on violence prevention 2014

This regional fact sheet is published with the first Global status report on violence prevention 2014 and assesses measures countries are taking to prevent violence. Data were collected in 41 of the 53 countries of the WHO European Region and new global, regional and national estimates of homicide were computed. The findings show that nearly 35 000 people were victims of homicides in 2012. Those most at risk are males aged 30–59 years. The non-fatal effects of violence are enormous and far-reaching and pose a strain on health systems and societies. More data-informed national plans need to be developed in the Region. Countries are investing in solutions to prevent violence, but scaling-up is urgently required. Laws to protect against violence have been widely enacted, but reported enforcement is inadequate and needs to be improved. Health systems need to take the lead on developing quality services to identify, refer, protect and support victims. Policy-makers and practitioners from different sectors need to work together to implement evidence-informed solutions that focus on equity and the life course approach.

Европейские факты и доклад о положении дел в мире в сфере профилактики насилия за 2014 г.

Этот региональный новостной бюллетень публикуется одновременно с Докладом о положении дел в мире в сфере профилактики насилия за 2014 г. и содержит оценку мер, принимаемых странами в области предупреждения насилия. Данные были собраны в 41 из 53 стран Европейского региона ВОЗ. Были также рассчитаны новые примерные оценки уровня убийств на глобальном, региональном и национальном уровне. Полученные результаты свидетельствуют о том, что в 2012 г. жертвами убийств стали почти 35 000 человек. Наибольшему риску подвергаются мужчины в возрасте 30–59 лет. Несмертельный эффект насилия огромен и тяжким грузом ложится на системы здравоохранения и общество. Региону требуется разработка большего числа национальных планов, опирающихся на фактические данные. Страны инвестируют в программы предупреждения насилия, но необходимо срочное увеличение масштабов такой работы. Широко развернуто введение законов, призванных защитить от насилия, но текущий уровень правоприменения не достаточен и требует повышения. Системы здравоохранения должны взять на себя ведущую роль в разработке качественных услуг по выявлению, направлению к специалистам, защите и поддержке жертв. Руководителям и практикам из различных секторов следует работать сообща, применяя научно-обоснованные решения, направленные на обеспечение равенства и здоровья на протяжении всей жизни.

European report on preventing child maltreatment

Child maltreatment is a leading cause of health inequality, with the socioeconomically disadvantaged more at risk. It worsens inequity and perpetuates social injustice because of its far-reaching health and development consequences. Inspite of child maltreatment being a priority in most countries in the WHO European Region, few have devoted adequate resources and attention to its prevention. This report outlines the high burden of child maltreatment, its causes and consequences and the cost−effectiveness of prevention programmes. It makes compelling arguments for increased investment in prevention and for mainstreaming prevention objectives into other areas of health and social policy, reflecting the whole-of-society approach promoted by Health 2020 and the need for increased intersectoral working and coordination. The report offers policy-makers a preventive approach based on strong evidence and shared experience to support them in responding to increased demands from the public to tackle child maltreatment. Prevention programmes that stop maltreatment from occurring in the first place and reduce children’s exposure to adversity have wide-ranging public health and societal benefits.

Европейские факты и Доклад о состоянии безопасности дорожного движения в мире: 2013 г.

Данный информационный бюллетень отражает состояние безопасности дорожного движения в Европейском регионе ВОЗ и содержит исходнуюоценку того, насколько далеко продвинулась 51 страна в осуществлении рекомендаций, изложенных во Всемирном докладе о предупреждениидорожно-транспортного травматизма. Он также содержит обновление результатов, вошедших в Доклад о состоянии безопасности дорожногодвижения в мире. В Европейском регионе дорожно-транспортные происшествия (ДТП) ежегодно уносят жизни 92 492 человек. За последние тригода этот показатель снизился на 25%. Бремя не приводящего к смерти травматизма и инвалидности велико, так же как и экономические потери.Травмы, полученные в результате ДТП, продолжают оставаться ведущей причиной смертности людей в возрасте 5 – 29 лет. Уязвимые участникидорожного движения, такие как пешеходы, велосипедисты и водители двух- и трехколесного мототранспорта, составляют 43% от общего числалюдей, гибнущих в результате ДТП. Показатели смертности вследствие травм, полученных в ДТП, в странах существенно различаются. В среднем,для стран с низким и средним уровнем доходов они более чем в два раза выше, чем в странах с высоким уровнем доходов. Данный отчет содержитанализ законодательных мер и деятельности полиции применительно к пяти основным факторам риска: скорости, вождению в нетрезвомсостоянии, использованию мотошлемов, использованию детских удерживающих устройств и использованию ремней безопасности. Хотя половинастран располагает всеобъемлющим законодательством по всем пяти факторам риска, определены приоритетные направления работы на будущее,а именно: снижение разрыва между странами с наиболее низким и наиболее высоким уровнем смертности, обеспечение более надежной защитыуязвимых участников дорожного движения, увеличение числа стран, имеющих всеобъемлющее законодательство, и совершенствованиеправоприменения в отношении имеющегося законодательства, улучшение систем сбора данных, особенно по ДТП, не повлекшим смертельногоисхода, а также разработка национальных политик, направленных на достижение целей Десятилетия действий по обеспечению безопасности дорожного движения 2011-2020.

European facts and global status report on road safety 2013

This fact sheet presents the status of road safety in the WHO European Region and provides a baseline assessment of how far 51 countries have come in implementing the recommendations of the World report on road traffic injury prevention. It also updates the results of the Euro-pean status report on road safety. In the Region, road crashes annually kill 92 492 people, a 25% decline in the past three years. The burden from nonfatal injury and disability is large, as are the economic costs. Road traffic injuries are still the leading cause of death among people 5–29 years old. Vulnerable road users such as pedestrians, cyclists and users of motorized two- and three-wheelers constitute 43% of the people dying from road traffic injury. Countries differ greatly in mortality rates for road traffic injuries; the average in low- and middle-income countries is more than twice as high as in high-income countries. This report analyses the legislative response and policy action of countries on five main risk factors: speed, drink-driving, use of helmets, use of child car restraints and use of seat-belts. Although half the countries have comprehensive legislation on all five risk factors, areas of future priority action have been identified: narrowing the gap between coun-tries with the lowest and highest mortality rates; providing better protection for vulnerable road users; increasing the number of countries with comprehensive legislation and improving the enforcement of existing legislation; improving data collection systems, especially for non-fatal cases; and developing national policies with targets to reach the goals of the Decade of Action for Road Safety 2011–2020.

Ecological studies of cancer incidence in an area interested by dumping waste sites in Campania (Italy).

Cancer incidence was investigated in an area which has been affected by the illegal practices of dumping hazardous waste and setting fire to mismanaged waste. For the 35 municipalities of this area that are served by a Cancer Registry, municipal standardized incidence ratios (SIR) and hierarchical Bayesian estimators (BIR) were computed. Moreover, municipal spatial clustering and a Poisson regression by municipality index of waste-related exposure were performed for 10 cancer types. Increased municipality SIRs were found for some cancer types. The BIRs confirmed the increases for liver cancer in two municipalities. Statistically significant clusters were detected for liver, lung, leukaemia and soft tissue sarcomas. In the regression analysis, testis cancer showed significant trend with the index of waste-related exposure (RR = 1.18).

Health impact assessment of waste management facilities in three European countries.

BACKGROUND: Policies on waste disposal in Europe are heterogeneous and rapidly changing, with potential health implications that are largely unknown. We conducted a health impact assessment of landfilling and incineration in three European countries: Italy, Slovakia and England. METHODS: A total of 49 (Italy), 2 (Slovakia), and 11 (England) incinerators were operating in 2001 while for landfills the figures were 619, 121 and 232, respectively. The study population consisted of residents living within 3 km of an incinerator and 2 km of a landfill. Excess risk estimates from epidemiological studies were used, combined with air pollution dispersion modelling for particulate matter (PM10) and nitrogen dioxide (NO2). For incinerators, we estimated attributable cancer incidence and years of life lost (YoLL), while for landfills we estimated attributable cases of congenital anomalies and low birth weight infants. RESULTS: About 1,000,000, 16,000, and 1,200,000 subjects lived close to incinerators in Italy, Slovakia and England, respectively. The additional contribution to NO2 levels within a 3 km radius was 0.23, 0.15, and 0.14 µg/m3, respectively. Lower values were found for PM10. Assuming that the incinerators continue to operate until 2020, we are moderately confident that the annual number of cancer cases due to exposure in 2001-2020 will reach 11, 0, and 7 in 2020 and then decline to 0 in the three countries in 2050. We are moderately confident that by 2050, the attributable impact on the 2001 cohort of residents will be 3,621 (Italy), 37 (Slovakia) and 3,966 (England) YoLL. The total exposed population to landfills was 1,350,000, 329,000, and 1,425,000 subjects, respectively. We are moderately confident that the annual additional cases of congenital anomalies up to 2030 will be approximately 2, 2, and 3 whereas there will be 42, 13, and 59 additional low-birth weight newborns, respectively. CONCLUSIONS: The current health impacts of landfilling and incineration can be characterized as moderate when compared to other sources of environmental pollution, e.g. traffic or industrial emissions, that have an impact on public health. There are several uncertainties and critical assumptions in the assessment model, but it provides insight into the relative health impact attributable to waste management.

European report on preventing elder maltreatment

Elder maltreatment is pervasive throughout the WHO European Region: at least 4 million elderly people are estimated to experience maltreatment in any one year and 2500 of them will die each year. Most countries in the Region have an ageing population, putting increasing numbers of people at risk. This report highlights the biological, social, cultural, economic and environmental factors that influence the risk of being a victim or perpetrator of elder maltreatment, as well as the protective factors that can help prevent it. There is some evidence of effective interventions, including psychological programmes for perpetrators and programmes designed to change attitudes towards older people, improve the mental health of caregivers and, in earlier life, to promote nurturing relationships and learn social skills. The evidence base needs to be strengthened, but surveys show that the public and policy-makers are already concerned about the problem. This report proposes a set of actions for Member States, international agencies, nongovernmental organizations, researchers, practitioners and other stakeholders to strengthen the policy response and devote adequate resources to the issue.

Inequalities, inequities, environmental justice in waste management and health.

BACKGROUND: The scientific evidence on the health effects of waste-related exposure is not conclusive. Differential exposure to waste by socio-economic status (SES) is often documented, but the interplay between environmental and social factors, crucial for policy making, is not well known. This review aims at investigating the role of health inequalities and inequities in waste management. METHODS: Grey and peer-reviewed literature, published after 1983, was reviewed from Europe and the USA. RESULTS: Available data provide consistent indications that waste facilities are often disproportionally more located in areas with more deprived residents, or from ethnical minorities. This applies to waste incinerators, landfills, hazardous waste sites, legal and illegal. In studies considering health effects (mainly from Europe), risks are estimated with standardization for SES. Such standardization almost always decreases risk estimates for several cancers and reproductive outcomes. However, effect modification is not investigated in these studies. CONCLUSIONS: The patterns of association between waste-related environmental pressures and SES suggest that some of the observed inequalities in exposure and health represent a case of environmental injustice as they are the result of social processes and may be prevented, at least partly. Disentangling the possible health effects remains difficult, due to limitations in the methodology. It seems important to investigate if disadvantaged people are more vulnerable, i.e. risks differ in different social groups living in the same area. Notwithstanding these open questions, public health officers and decision makers should identify waste management policies to minimize their potential health impacts and their unequal distribution.

Preventing inuries in Europe: from international collaboration to local implementation

Injuries and violence are the third leading cause of death in the WHO European Region and pose a threat to economic andsocial development. This publication presents the results of a three-year collaborative project between WHO and the EuropeanCommission, funded by SANCO in the framework of the Public Health Programme (2003–2008), on progress achieved by Europeancountries in implementing resolution EUR/RC 55/R9 and the European Council Recommendation on the prevention of injury andthe promotion of safety. A web-based database of country profiles was developed using a questionnaire survey completed byhealth ministry focal people for preventing injury and violence. Information was provided on progress in delivering on key items ofresolution EUR/RC 55/R9, on the implementation of 99 selected evidence-based programmes to prevent unintentional injuries andviolence and on the cross-cutting risk factors of alcohol and socioeconomic inequality. There were responses from 47 of the 51WHO European Member States that have focal people. Good progress is taking place, and resolution EUR/RC 55/R9 has catalysedchange in 75% of the countries responding. The development of national policies for individual types of injury and violence variedfrom 95% for road safety to 40% for preventing drowning. Implementation of evidence-based programmes for preventing all typesof injury and violence varied in countries, and the median score was 73% for all these together. This progress report documentsthat the health sector needs to commit more to the widespread implementation of effective programmes both in number andcoverage and to engage with other stakeholders in a multisectoral response to prevent injuries and violence.

Предупреждение травматизма в Европе: oт международного сотрудничества к реализации на местах

Травматизм и насилие являются третьей ведущей причиной смертности в Европейском регионе ВОЗ, ставя под угрозу экономическое и социальное развитие. В настоящей публикации представлены результаты трехлетнего совместного проекта ВОЗ и Европейской комиссии по мониторингу прогресса,достигнутого европейскими странами в выполнении резолюции EUR/RC55/R9 и Рекомендаций Европейского совета по предупреждению травматизмаи содействию безопасности. Финансирование проекта осуществлялось SANCO в рамках Программы общественного здравоохранения (2003–2008). Спомощью анкетирования составлена интернет-база данных с профилями стран. Вопросники заполнялись национальными координаторами от министерств здравоохранения, ответственными за вопросы предупреждения травматизма и насилия. Получена информация о прогрессе в реализацииключевых положений резолюции EUR/RC55/R9 и о ходе осуществления выбранных 99 программ, основанных на фактических данных и направленныхна предупреждение насилия, непреднамеренного травматизма и таких общих факторов риска, как алкоголь и социально-экономическое неравенство.Были получены ответы от 47 из 51 государства-члена Европейского региона ВОЗ, где имелись национальные координаторы. Отмечается значительныйпрогресс, а 75% стран-респондентов сообщили, что резолюция EUR/RC55/R9 стала стимулом для позитивных сдвигов. Уровень разработки национальных стратегий по предупреждению отдельных видов травматизма и насилия, находится в диапазоне от 95% по безопасности дорожного движения до40% в отношении предупреждения утоплений. Степень осуществления основанных на фактических данных программ по предупреждению всех видовтравматизма и насилия варьирует в зависимости от страны; медианный показатель для всех программ в совокупности составил 73%. Настоящий отчето ходе выполнения работ указывает на необходимость для сектора здравоохранения направить более активные усилия на внедрение большего числаэффективных программ и обеспечение более широкого охвата ими, а также на укрепление межсекторного взаимодействия с другими заинтересованными сторонами по вопросам предупреждения травматизма и насилия.

[Geographic epidemiologic descriptive study on the national priority site for remediation "Laguna di Grado e Marano"]. / Studio epidemiologico geografico descrittivo del sito di interesse nazionale per le bonifiche "Laguna di Grado e Marano".

OBJECTIVE: to describe the mortality profile of the population resident in the polluted area of national concern (SIN) "Laguna di Grado e Marano" Friuli-Venezia-Giulia region, in the period 1997-2001 and to examine mortality temporal trends between 1981 and 2001. DESIGN: a small-area epidemiological study based on descriptive statistics, socioeconomic deprivation variables, analysis of spatial heterogeneity disease mapping and time trend analysis was carried out. MAIN OUTCOME MEASURES: age-standardised rate, standardised mortality ratios (SMRs), SMRs adjusted by socioeconomic deprivation, spatial heterogeneity test results, empirical and hierarchical Bayesian estimators, and temporal trends of selected causes are shown. RESULTS: compared to regional averages, SMRs in the SIN were significantly higher for lung (25.3%) and stomach (54.1%) cancer in men and for ovarian cancer (82.6%) in women. SMRs were instead significantly lower for all causes of death (8.7%), respiratory (26.6%) and cardiovascular (13.7%) diseases, liver (51.3%) and pancreas (46.9%) cancer in men and for cardiovascular diseases (22.1%) in women. These results did not change after adjustment by socioeconomic status. Spatial distribution of risks was homogeneous among municipalities and no groups of high risk municipalities were identified. A significant increasing temporal trend was observed for ovarian cancer. CONCLUSION: following these results, we suggest to carry out a cohort incidence and mortality study to verify the potential role of occupational exposures on cancer mortality in men. We also recommend an in depth analysis in women to clarify the role of potential iron replacement by pollutants, such as cadmium and lead that are present in the area.

Cluster analysis of mortality and malformations in the Provinces of Naples and Caserta (Campania Region).

The possible adverse health effects associated with the residence in the neighbourhood of toxic dump sites have been the object of many epidemiological studies in the last two decades;some of these reported increases of various health outcomes. The present study reports the cluster analysis of mortality and malformations at municipality level, standardized by socioeconomic deprivation index, in an area of the Campania Region characterized by a widespread illegal practice of dumping toxic and urban waste. Clusters have been observed with significant excess of mortality by lung, liver, gastric, kidney and bladder cancers and of prevalence of total malformations and malformations of limb, cardiovascular and urogenital system. The clusters are concentrated in a sub-area where most of the illegal practice of dumping toxic waste has taken place