Accidents at world level result in millions of fatalities and serious injuries and constitute one of the most widespread causes of human distress. Of course fatal accidents cause the most distress and shock but several times the injuries caused by accidents are so serious, painful, disabling or unbearable due to various reasons and circumstances that victims consider their situation to be even worse than that of a fatal case. Some of even those accidents which are listed as relatively less serious or even minor accidents can be quite disruptive for some victims depending on circumstances. Hence the frequent analysis of various accidents based only on the number of fatalities seriously understates the problem.
An important aspect of the distress related to accidents is that by definition it is sudden and unexpected and the victim as well near and dear ones find it more difficult to accept this. In a matter of minutes or even seconds a life full of joy and achievement can be changed to one of endless stress, distress and pain and this can be quite a traumatic experience. The problem increases in poorer societies and in those with privatized health care systems as the difficulties of patients and their families increase greatly when they cannot afford the treatment and hospitalization costs. In such cases the threat of permanent disability also increases considerably. If the victim happens to be a child and if the injury is a very painful one then the distress of the victim as well as the parents and other nearest ones is beyond description.
Despite all this, efforts and precautions to prevent accident prevention fall far below what is achievable. Moreover the existing efforts are confined mainly to traffic accidents. Even though the data for some countries suggest that the number of occupational accidents and domestic accidents can also be quite high, organized action to prevent these accidents is much lesser compared to traffic accidents. Even in the case of road accidents where there is greater public discussion unfortunately this has not checked the highly irresponsible attitude which many people have towards road safety.
There is thus clearly the need for a very strong public campaign to reduce all kinds of accidents. Such a campaign has the potential to prevent millions of deaths, disabilities and other serious injuries within the next decade, apart from preventing massive economic loss. Apart from its main contribution of reducing human distress in a very big way, even in purely economic terms this can be a very cost effective campaign as the economic losses reduced by such an effective campaign can be many times more than the costs incurred in such a campaign
While prevention of accidents should be the main focus of such a campaign at the same time this campaign should also aim at significantly improving the availability of timely and proper medical care to accident victims. This also has immense possibilities of saving human lives.
For the sake of this campaign accidents can be classified mainly in five categories- all transport and traffic accidents, domestic accidents, occupational accidents, accidents relating to crowds and special gatherings including stampedes, and misc. accidents. Perhaps we can have a separate category for educational institutions and for high hazard and catastrophic accidents.
The classification followed by the WHO is different as accidents are classified on the basis of the type of accident like falls, drowning, fires and burns, road accidents, electric shocks etc. but from the point of view of a public campaign as well as a government program resulting from it the classification proposed above may be more useful.
Such a national campaign should on the one hand try at various levels to increase people’s awareness about the potential scope and need of accident reduction and mobilize various people’s initiatives for prevention of accidents. On the other hand such a campaign should strive to influence government policy in such a way that the government allocates more resources for accident prevention and is also motivated to frame a comprehensive policy for reduction of all kinds of accidents. The national campaign should prepare policy drafts to help and motivate the government to move quickly and effectively in this direction. One of the specific proposals can be the creation of a National Accident Prevention Authority at the country level with state chapters as also a plan to subsequently have branches at the district level as well.
The national campaign should also seek to have branches in all states and subsequently sub-branches in all districts. It should build up linkages with other like- minded campaigns which exist already. In addition efforts can be made to have linkages with other such campaigns in various countries with the spirit of sharing achievements and problems as well as learning experiences. Media can play a very useful role in the success of such a campaign.
Over 3.5 million people die in a typical year in the entire world from various kinds of accidents, while the number of serious injuries caused by accidents is many times more. Taking the average for some recent years, the available statistics suggest that the number of fatalities from all accidents is much higher than total deaths from homicides, suicides, war and civil strife all combined. The latest available factsheet prepared on this subject by the World Health Organisation (WHO) tells us that among the various causes of death by injuries, over 50% were caused by accidents while 29% were caused by suicides, homicides and war combined together. 21% were caused by other injuries (these again include some accidental deaths).
Of course the situation can change in a particular year if war and strife related fatalities go up suddenly, but then we should not forget that in the case of catastrophic accidents (like Bhopal and Chernobyl), accident related fatalities too can increase very suddenly.
Exact comparisons become a little difficult as the category of ‘other unintentional injuries’ in WHO data is not well defined. If we assume that about one-third are accidental deaths (such as deaths caused by choking, asphyxiation, injuries from machinery etc.) then we have the startling statistics that at the world level, over 3.5 million deaths in a year are caused by all accidents taken together, while the number of deaths from suicides, homicides and war together is about 1.6 million. (Table 1 ).
Table 1
Approximate Number of Accident Deaths in one year (in millions).
Road Accidents 1.3
Falls 0.5
Drowning 0.5
Fires 0.4
Poisoning 0.4
Others 0.4
Total 3.5
This is just one indication of the high distress levels caused by accidents. In addition we should remember that serious injuries caused by accidents are many times greater than fatalities. As the WHO says, “The millions of deaths that result from injuries represent only a small fraction of those injuries. Tens of millions of people suffer injuries that lead to hospitalization, emergency department or general practitioner’s treatment, or treatment that does not involve formal medical care.”
Serious injuries apart from being very painful can cause disability for varying lengths of time. Their treatment can be very expensive in countries lacking good public health facilities. These can impose a heavy burden on family members and caretakers, apart from the pain and disability suffered by the victim.
In the case of occupational injuries, the number of injuries is particularly higher compared to fatalities. For all accidents taken together we may take the conservative estimate of 40 serious injuries per fatality. This assumption is less than what the factual data for Britain tells us – 50 injuries for one fatality. This gives us a figure of 140 million serious injuries caused by all kinds of accidents in a year.
A serious accident affects not just the direct victim but also the victim’s family, close friends and dependents. As a conservative estimate, we may say that about 5 persons are affected indirectly to a lesser or greater extent per fatality and serious injury. Thus about 720 million people, including actual victims, are likely to be affected directly or indirectly in a serious way by accidents in a typical year. This may well be an under-estimate. Thus counting both direct and indirect victims, in a typical year about 10 per cent of the world’s population is likely to be affected by accidents.
As the mortality or serious injury caused by accidents is so sudden, this is likely to be much more painful, traumatic and difficult to come to terms with compared to mortality and disability caused by long-term illness and disease. The emotional distress and coping problems are likely to be much more in the case of accidents.
Unbearable Distress For Children And Youth
An important and related factor that greatly increases distress and mental health problems is that the percentage of younger people affected by accident related mortality is very high. This is evident from Tables 2,3,4 and 5
Table 2
Children killed in Various Accidents (Age-group 0-4)
Type of accident Number of deaths
Road traffic injuries 56,778
Drowning 58,467
Fire related burns 46,656
Table 3
Children killed in Various Accidents(Age group 5-14)
Road traffic injuries 1,09,905
Drowning 77,117
Fire related/ burns 26,703
Falls 17,862
The cruel tragedy is revealed most shockingly in the case of accidents related to children. It is unbearably sad to know, for example, that in the category of children below 4 years of age, as many as 46,656 children die from fire related burns (Table 2). As just a single death of a child caused in this way can be extremely painful to comprehend, it is unbearably painful to multiply this tragedy 46,000 times to have an idea of the tragedy caused among children by a single type of accident alone. It is again extremely hard to accept the fact that as many as 1,66,000 children (0-14 age group) are killed in road accidents in a year (Tables 2 and 3).
Accidents also take a very heavy toll of young lives, as is evident from tables 4 and 5. It is disturbing to note that in the age group 15-29 years, road accidents constitute the number one cause of mortality. As many as 3,35,805 youths in this age group die in one year from road traffic injuries alone. In the same age group 89,434 youths die from drowning while 84,983 youths die even more painfully from fire related burns. In addition, 55,139 die from poisoning.
Table 4
Deaths caused by Some Types ofAccidents
(Age group 15-29)
Type of accident Number of deaths
Road traffic injuries 3,35,805
Drowning 89,434
Fire related burns 84,983
Poisoning 55,139
Table 5
Deaths caused by Some Types of Accidents
(Age group 30-44)
Road traffic injuries 3,29,142
Poisoning 87,576
Fire related- burns 67,338
Drowning 62,683
It is also disturbing to know that while in the age group 5-14 there are 26,703 deaths from fire related burns, in the age group 15-29, these increase by more than 3 times to 84,983. One would have thought that maturity in age would equip them better to protect themselves from serious burn injuries but this is evidently not the case as mortality escalates rapidly (to over three times) in the course of transition from age group 5-14 years to 15-29 years. The explanation for this is probably in high rate of industrial accidents.
In the course of this transition between two age groups, road traffic deaths also increase sharply by more than three times. Mortality related to drowning also increases but less steeply.
In the age group 30-44 road accidents mortality remains at about the same high level as the age group 15-29 while the deaths caused by poisoning increase dramatically from 55,139 to 87,576.
These statistics also indicate that regarding all deaths caused by road traffic accidents almost three fourths of the deaths are in the age groups below 45 years. This draws attention to the greater distress and economic costs of these accidents due to the victims (of mortality, serious injuries and disability) being more concentrated in the younger age groups.
Higher risks to Poorer People
According to the WHO, more than 90% of deaths that result from accidents as well all other injuries occur in low and middle income countries.
Within various countries, poorer people are more at risk. A child from the lowest social class in the UK is 16 times more likely to die in a house fire than one from a wealthy family. In countries like India poorer people including pedestrians and migrant workers and their family members are more exposed to road accidents- many homeless people and footpath dwellers have been hit repeatedly by speeding vehicles. Many slum-dwellers including children live in very close proximity to busy vehicular traffic.
Clearly accidents are responsible for very large scale and traumatic distress. Perhaps the most important aspect of this distress is that this can be reduced to a very significant extent by careful planning and effective implementation. As the WHO says, “Evidence from many countries shows that dramatic successes in preventing injuries (including accident related injuries) and violence can be achieved through concerted efforts that involve, but are not limited to the health sector.” This tremendous potential to reduce accidents should be pursued with great care and determination.
The often repeated data on road accidents in India is horrible enough but it really begins to look unbearable if the data for all accidents is added up. In several countries the number of domestic and occupational accidents can be even higher than that of road accidents. In India hardly any reliable estimates for domestic accidents are available but some of the preliminary research indicates a serious situation. The data on occupational accidents is again very scarce for the unorganized sector but quite a few scattered reports are available which reveal an overall serious situation and an alarming situation in some occupations like quarrying and stone crushers. Add to this the frequent cases of stampedes and the widely suspected presence of some highly toxic storage (Remember Bhopal?) and one begins to get an idea of the real burden of accidents
The proportion of younger people and main income earners is likely to be much higher in fatal accidents than in deaths caused by disease. Even relatively minor injuries can result in skilled workers either abstaining or being unable to carry out their work. The cost of treatment of accident victims can be quite high. Accidents can result in long drawn out and expensive litigation sometimes even leading to temporary or even permanent closure of some units.
In the case of government action on safety this is mostly of a departmental kind as various government departments or ministries such as road transport, railways, labor, mines, industries etc. have their own safety programs. However in several departments the safety programs are very inadequate while in others these may be almost non-existent. No comprehensive approach to safety and accident prevention has been able to emerge so far from the government because of the highly segregated attitude towards safety.
One effect of this has been that safety and accident prevention could never become a big issue and only remained a peripheral issue-even this only at the segregated level of various departments. All this can change if a National Authority for Prevention and Management of Accidents can be created with branches in all states and union territories ( and in due course of time sub-branches in districts).Such an organization will be able to evolve a comprehensive approach to the reduction and prevention of all kinds of accidents.
In all this, of course, the role of a people’s movement for safety and accident prevention remains very important. Firstly of course it is unlikely that this kind of important changes at the government level can be brought without adequate public pressure building up as a result of a sustained people’s movement. The government will not move from its highly compartmentalized approach to a comprehensive approach on its own. People’s movement has an important role in not only mobilizing citizens’ support for such changes but also facilitating consultations so that the best possible suggestions can be submitted to the government for effective action.
Bharat Dogra is Honorary Convener, Campaign to Save Earth Now.
