Conclusions: Promises and Pitfalls
Unintentional injuries are an important contributor to global death and disability burdens, especially in LMICs. However, the significance of the burden is not matched by substantive knowledge about risk factors or effective interventions in LMICs. Nevertheless, the models outlined in this chapter indicate that several interventions for preventing unintentional injuries are highly cost-effective and in some cases could result in significant cost savings.
Recent evidence shows that public efforts in injury control, such as traffic safety, are poorly funded in developing countries (Bishai and others 2003). The low expenditure compares unfavorably with expenditure on other health conditions and with expenditures in more developed nations, where government efforts in relation to such issues as traffic safety are well funded. Even adjusting for the 20-fold to 30-fold difference in gross domestic product per capita between HICs and LMICs, the investment disparities suggest that LMICs attach a low priority to injury prevention.
Given the current low level of investment, initial investments in safety, if chosen with care, could turn out to be extremely beneficial to public health and welfare. If, in the first instance, investments were to be made only in the interventions modeled here, then injury reductions would likely be significant. The next step would be to modify other interventions that have proven effective in HICs and to combine the introduction of such interventions with evaluations of their effects. Policy makers will be concerned that many of the cost-effective interventions are not low-cost interventions. They save many lives but require an extensive upfront investment. Using cost-effectiveness analyses of these interventions to document high returns would encourage financing of these interventions and widespread replication efforts.
Policy makers would be unwise to wait for advanced stages of economic development to attend to the problem of road safety or other unintentional injuries. Indeed, given the limited but growing knowledge that low-cost, effective interventions exist, for governments not to intervene would be unethical. Even though institutional obstacles are formidable in developing countries, governments routinely overcome them to address other perceived threats to public well-being—such as crime, terrorism, and war—that disrupt fewer lives than unintentional injuries. The real enigma is that such a profound loss of life can take place each year in LMICs without an outcry that would trigger sustained and effective political commitment by governments and civil society.