Economic Costs of Children's Injuries and Violence

Economic Costs of Children’s
Injuries and Violence
Dr. Mahendra Sheth
Regional Health Advisor
UNICEF Regional Office for Middle
East and North Africa

Definitions
Violence
• Intentional use of physical
force or power,
– threatened or actual, against
oneself, another person,
– or against a group or
community,
– that either results in or has a
high likelihood of resulting
in injury, death,
psychological harm,
maldevelopment or
deprivation (WHO)
Injury
• Physical damage that
results when
– a human body is suddenly
subjected to energy in
amounts that exceed the
threshold of physiological
tolerance –
– or else the result of a lack of
one or more vital elements,
such as oxygen

Violence
• interpersonal violence
• suicidal behaviour and armed conflict.
• threats and intimidation
• less obvious :
– psychological harm,
– deprivation and maldevelopment
– compromise well‐being of
• individuals,
• families
• communities

Injuries
Unintentional Injuries:
• RTA
• Burns
• Electrocution
• Falls
• Poisoning
Intentional injuries:
• Physical
• Sexual
• psychological
• Deprivation or neglect

Interpersonal Violence
• Disproportionately affects LIC and MIC
• Scarcity of data LIC/MIC
• Comparisons with HIC complicated
– economic loses with productivity undervalued in
LIC/MIC
• Homicide –
– $15,319 in S. Africa;
– $602,000 in Australia
– $829,000 in NZ
– >2 million in USA

Cost of Violence in Latin America
Country
• Brazil
• Columbia
• El Salvador
• Mexico
• Peru
• Venezuela
• 10.5
• 24.7
• 24.9
• 1.3
• 5.1
• 11.8
% GDP loss

Importance of Injuries
Injuries
• Responsible for 950,000
child deaths
• millions require hospital
care
• Many left with disabilities,
often lifelong.
• The burden of injury on
children falls unequally.
– heaviest among the poor with
greatest burden on children
in the poorer countries w/
lower incomes
Violence
• Over 1.6 m deaths /yr
• Many are injured and
suffer physical, sexual,
reproductive and mental
health problems.
• Violence major burden on
national economies
costing billions of dollars.
• Largely ignored as a public
health problem

Economic costs ‐ injuries
Injuries
• Enormous – 1‐2% of GDP
= 100 billion USD in
developing countries
• Medical costs and loss of
productivity – 0‐14 yrs
from all injuries = 50
billion USD
• More research is needed in
cost and cost analysis of
injuries
Violence
• USA 3.3% of GDP.
• $40.2 billion annually –
England and Wales
• Scarcity of studies and
data from Low & MIC
• Cost of violence depends
on its impact
– lead to loss of productivity
– psychosocial trauma
– treatment, etc.

Child Injury Deaths

Road Traffic Accidents (RTA)

RTA
• >40% of deaths HIC (also poor countries)
• Some750 child deaths /day(pedestrians,
cyclists, passengers)
• In HIC ‐ mortality declining (safety belts,
child safety seats, bike helmets, tougher law
enforcement and better health care).
• >95% of all injury deaths in children in low
and MICs

RTA facts
• >1.2 million deaths/yr
• > 50 m injured or disabled every year
• 50% of victims ‐ vulnerable road users such
as pedestrians, cyclists, and motorcyclists
• cost countries up to 4% of GNP
• Correctly used seat‐belts reduce the risk of
death in a crash by 61%

Economic costs of RTA
• Global loses – 518 billion/year
– Low & MICs – 65 ‐100 billion per year (3% GNP)
– Cost of injuries among children alone not known
• Direct and Indirect costs:
– permanent disabilities;
– loss of schooling;
– medical care;
– legal costs;
– vehicle repair costs;
– loss of income to parents,

Long term economic costs
• Premature death
• Rehabilitation
• Loss of healthy years
• Inability to work to full extent
• Poorest –
– hardest hit – further decline into poverty
(India/ Bangla Desh studies)
– Caring for injured – costs, workload, etc.
– Sale of assets

RTA facts
• Mandatory use of child restraints can reduce
child deaths by 35%
• Helmets reduce fatal and serious head injuries
by up to 45%
• Enforcing a drinking and driving law around
the world could reduce alcohol‐related crashes
by 20%
• Cost of SMS and use of mobile phones when
driving???

Drowning
• 28% of unintentional injury deaths in
children
• 388,000 deaths in 2004
• 45% ‐ children under 20
• 1‐4 year age groups greatest at risk
• Significant regional variations
• 6x higher in LIC/MICs than HIC

Fatal Drowning Rates per 100,000 children by age and
by country income level, World 2004
12
10
8
6
4
HIC
LIC
2
0

Risk factors
• Densely populated countries with large
open waters
• Gender – boys more affected than girls
• Age –

Economic Costs
• Non fatal drowning costs depend on
severity of injury
• Range from 13‐14 thousand USD per case
• Severe cases with long term damage – USD
100,000 or more
• Indirect costs to the family not computed
• More data is required to determine true
extent

Burns
• >310,000 people died in 2004
• 96,000 (30%) children fatally injured
• Fire related deaths high cause of mortality
in children 1‐9 yrs
• Death rate 11x higher in LIC & MICs
• 10% of all unintentional injury deaths

Fatal fire‐related burns

Child Related factors
• Gender 4.9/100,000 in girls vs 3/100,000 in
boys
• Age –

Agent related factors
• Unsafe equipment – heat/light sources;
cooking equipment
• Flammable substances
• Fireworks
• Environmental factors :
– Cooking and living areas
– Socioeconomic factors
– Time of incident
– Lack of access to water

Economic Costs
• Short term and long term costs
– Treatment costs
– Caring costs
– Rehabilitation costs
– Psychological trauma
– Impact on families and communities
– Loss of school days
• Cost of treatment varies – $ 1187 ‐ $4102

Falls
• 424,000 of all ages died in 2004
• 47,000 children and youth

Related factors
• Age: highest in

Economic costs
• Most of the data is from HIC
• 630 m C$ in 1995
• 95 billion in USA
• Data from LIC and MIC is missing.
• More work is needed in getting accurate and
up to date data and economic ramifications

Poisoning
• 346,000 deaths in all ages in 2004
• 45,000 deaths annually in children and young
people
• Global rate

Key Approaches to Addressing Childhood Injuries

Conclusions
• Child injuries/violence area major public
health issue
• Injuries affect child survival
• Children are susceptible to injuries
• Child injuries and violence can be prevented
• Cost of doing nothing is unacceptable
• Few countries have good data

Conclusions
• Research is limited
• Too few practitioners
• Child injury and violence prevention is
responsibility of many sectors
• This area of child survival is underfunded
• Awareness needs to be created and maintained
• Unless these emerging issues are addressed,
the gains towards MDGs may be reversed

Recommendations
• Develop and implement a prevention policies
and plan of action
• Implement specific actions
• Strengthen systems
• Enhance quality and quantity of data
• Define priorities for research
• Raise awareness

Involve
• International org and donors
• Governments
• Private sector
• Media
• Teachers and community leaders
• Parents
• Children and young people

References
• 2002 World Report on Violence and Health –
WHO
• The Economic Dimensions of Interpersonal
Violence –WHO 2004
• 2005, WHO and UNICEF call for expanded
global effort to prevent child injury
• UN Secretary General’s Study on Violence
Against Children 2006
• 2009 joint WHO/UNICEF World report on child
injury prevention