Потерянные годы здоровой жизни в результате дорожно-транспортных происшествий в России
In Russia road-traffic accidents are one of the main causes of injury of the population. In 2016 more than 220,000 people were injured in road accidents, whereas 20,000 people died. Published review of injury epidemiology in the UK and Europe found that many studies relied solely on mortality rates from injury to describe epidemiology while deaths comprise only the top of the injury pyramid. It could lead to erroneous estimates of the total burden of injury.
This study is designed to assess both the years of life lost due to premature mortality and disability caused by road traffic fatal and non-fatal injuries, using integrated indicators of the population health. We use methodology of disability-adjusted life years (DALY), as well as an empirical database of the State Traffic Safety Inspectorate, medical statistics (№ 57) and statistics on deaths from vital registration system.
In the most Russian papers the years of life lost due to premature mortality were estimated, whereas in this study we estimated the whole burden of road-traffic accidents caused by fatal and non-fatal injuries in Russia in 2012. Our estimates of DALY due to road-traffic accidents in Russia in 2012 are close to WHO’s estimates, exceeding them by 4.5%. It indicates the ability of using Russian medical statistics to assess DALY without using different international models.
The two major methodological approaches to quantify the health of populations and the burden of disease globally and regionally are (1) exposure-based methods and (2) expert opinion-based methods. In exposure-based methods the relationships between exposure and response to specific risk factors are defined through epidemiologic studies and the estimated attributable fractions are used to generate disease burden expressed quantitatively. The Disability-Adjusted Life Years (DALYs), a composite measure of morbidity and mortality associated with risk factors, is a widely used has become a universal index of disease burden. Detailed assessment of disease burden using this approach has been produced for at least six environmental risk factors and five occupational risk factors at the global level. Expert opinion-based methods rely on systematic literature reviews and surveys of experts across disciplines and geopolitical regions, who are asked to judge which fraction of the total burden of disease can be attributed to environmental a specific factors. This approach has been used to estimate the fraction of disease burden that can be attributed to the environment within 85 out of 102 major disease categories identified by World Health Organization (WHO). While global burden of disease quantifies the amount of disease due to specific causes, global Environmental Burden of Disease (EBD) estimates which fraction of the total burden of disease can be attributed to environmental risks. Together, these studies are based on both methods have revealed considerable disparities across regions and countries in the Environmental Burden of Disease (EBD), ranging from one-tenth to more than two-thirds of the total burden of disease that can be prevented through improving environmental quality. These differences are not only caused by actual dissimilarities in underlying environmental quality, but also by differences in calculation approaches and assumptions made.
Any road traffic system is very complicated and can be dangerous to health. Elements of this system include motorized transport vehicles, roads, road users as well as physical, social and economic environment. Countries with high automobilization have long ceased to consider traffic accidents as a pure “chance”; furthermore, efforts aimed at preventing and mitigating negative consequences of traffic accidents are thoroughly designed and structured.
In 1972, William Haddon published his study with incorporated approaches that used to be individually applied to trauma epidemiology and transport engineering. Haddon suggested a model to analyze traffic situations that were dangerous to health. Haddon’s approach allowed to achieve a notable progress in understanding factors related to driver’s behavior, vehicle characteristics and road infrastructure conditions affecting emergence of traffic accidents and severity of consequences for participants. Haddon’s approach turned out to be a useful analytical instrument and became widely used in healthcare.
The problem of motor vehicle injuries in Russia nowadays is a common topic of discussion. Motor vehicle accidents as a cause of death are among the most significant causes of premature mortality in Russia. Motor vehicle accidents, the cause of 26,977 deaths in 2013, are an important public health problem, the leading cause of death among young working-age people. In addition to these deaths, annually about 250 thousand people are seriously injured and need hospital treatment. This puts a serious burden on the healthcare system, which must provide medical care for injuries while at the same time solving other priority problems. This paper is devoted to an analysis of the statistical sources of information about road traffic accidents in Russia. The author analyzes Russian and international approaches to the organization of statistics about road traffic accidents. An evaluation is presented of the undercounting of road traffic accidents with injured people and the underestimation of its impact in Russia. Recommendations are made on how to record and compare information from different sources about road traffic accidents.
Abstract. Over more than ten years, Russia has been at the top of the list of the OECD countries by traffic-related death rate per 1000 residents. The death rate in Russia is five- to six-fold greater than in most of the developed countries, given that the number of cars per 1000 residents is much lower. Despite the increased attention and financing, the problem of road traffic injuries remains unresolved. The implementation of the 2006- 2012 Road Safety Federal Target program did not bring about the expected results. Russia`s lagging behind the leading countries in traffic injury prevention is due to the ineffective system of law control and implementation. The problem of corruption in the road safety management is of special attention. According to a number of experts, today the political efforts to tackle the road safety problem is only aggravate the situation and contribute to the increase in corruption cases which shows the ineffectiveness of the policies. Effective road traffic safety policy requires a good knowledge of the situation. With the lack of scientific studies and regular publications devoted to this problem, there is nothing left but taking impulsive and random decisions.
Several approaches to the concept of fatherhood present in Western sociological tradition are analyzed and compared: biological determinism, social constructivism and biosocial theory. The problematics of fatherhood and men’s parental practices is marginalized in modern Russian social research devoted to family and this fact makes the traditional inequality in family relations, when the father’s role is considered secondary compared to that of mother, even stronger. However, in Western critical men’s studies several stages can be outlined: the development of “sex roles” paradigm (biological determinism), the emergence of the hegemonic masculinity concept, inter-disciplinary stage (biosocial theory). According to the approach of biological determinism, the role of a father is that of the patriarch, he continues the family line and serves as a model for his ascendants. Social constructivism looks into man’s functions in the family from the point of view of masculine pressure and establishing hegemony over a woman and children. Biosocial theory aims to unite the biological determinacy of fatherhood with social, cultural and personal context. It is shown that these approaches are directly connected with the level of the society development, marriage and family perceptions, the level of egality of gender order.