The estimated annual burden of injury
The estimated annual burden of injury in rural Bangladesh revealed by this study was striking; 44 050 deaths and 21 million people suffering major injury events annually that were severe enough for them either to be unable to go to work or school for a day, or severe enough for them to seek treatment for their injury. Some of these injuries will have lifelong consequences for the individual and the family concerned. Not only are poorer MG 149 more likely to suffer injuries, but injuries can also tip families into poverty, both because the individual or their family need to pay for health care that they cannot afford, and because the individual might no longer be able to work, thereby reducing long-term income for the family. Additionally, such vast numbers of patients with injuries place an avoidable burden on the health-care services of these countries.
Global patterns of injury are broadly transferable to many countries, but this study shows the need for local data to identify country-specific issues for injury prevention. Road traffic has been highlighted as one of the most preventable and important causes of ill health, such that there is a Sustainable Development Goal target to halve the number of global deaths from road traffic by 2020. But although road traffic is an important cause of injury in Bangladesh, more people die from drowning, especially pre-school children, adults with occupations on the water, and people of all ages at times of natural disasters such as monsoons and flooding. Other challenges highlighted by Alonge and colleagues\' study included falls in the elderly, suicide in young women, and significant seasonal variations and sex inequalities in injury incidence. These local data provide Bangladesh with the evidence to enable targeted action to priority areas.
As the UK Chief Medical Officer put it in her 2013 annual report, which focussed on preventable ill health in children, “prevention pays”. The economic argument for concerted public health actions to prevent injuries is clear. Unfortunately, the preventability of injury is often unrecognised and neglected, but Alonge and colleagues have shown that any country can generate the evidence to enable the actions needed. Their challenge will now be to ensure that this valuable evidence is acted upon through programmes for injury prevention and disaster resilience, and that there is a system established to enable monitoring of ongoing trends in injury occurrence.
In this issue of , Jean-Francois Trani and colleagues present findings on access to health care for people with disabilities in Afghanistan. Using a multilevel modelling approach, they assess data from two large-scale studies carried out in 2005 and 2013 to understand the impact that a decade of international intervention and investment in the Afghan health-care sector has had on a population that has consistently been identified as having significantly less access to health care than the general population. Their conclusion is striking. People with disabilities report that the availability of health care and positive experiences in the health-care system did not improve between 2005 and 2013. In fact, health services were reported to be less available and less equipped to address their needs than a decade before. These findings are particularly of note because Afghanistan is reported to be making progress in ensuring access to health care. After decades of conflict, which left the health-care system in a poor condition, initiation of a Basic Package of Health Services (BPHS) in 2002 has led to significant improvement in overall population health outcomes. A key component has been subcontracting non-governmental organisations (NGOs) to provide essential health services, which has been shown to be effective in fragile states. How such efforts affect people with disabilities, however, is little understood. And despite the fact that the right to health is guaranteed under the UN Convention on the Rights of Persons with Disabilities (CRPD), a growing body of research shows that people with disabilities continue to be a low priority in general health-care delivery.