Road safety: more than reducing injuries

ROAD SAFETY: A MAJOR PUBLIC HEALTH ISSUE

NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4

Formula One and global road safety: Response by the FIA Foundation

BackgroundRoad traffic injuries (RTIs) are a major public health threat that disproportionately affects low-and-middle income countries. As a response to this escalating public health problem, Bloomberg Philanthropies initiated the Global...

Sustainable Development Goal (SDG) Target 3.d focuses on measuring a country’s strengthening of self-contained early warning, risk assessment and management, and health risk reduction through core International Health Regulations (IHR). IHR is an instrument of international law, adopted pursuant to Article 21 of the World Health Organisation (WHO) Constitution, and is legally binding on 196 States Parties, including all 194 Member States of WHO. This paper examines how Nepal endeavours to achieve this target in the context of the country’s transition to a federal governance system. A performance audit was conducted, utilising data from secondary sources (2016 onwards), including government publications, reports from international agencies, and peer-reviewed academic articles. A specific case study on the response to COVID-19 was included. Analysis was conducted in accordance with the International Organisation of Supreme Audit Institutions (INTOSAI) guidelines for self-contained report evaluations, focusing on possible divergence and convergence, the Leave No One Behind (LNOB) principles, cross-domain considerations, and structural finance. Progress is undermined by a controlled information vacuum. Since the last IHR was issued in 2015, the country has been in a state of stagnation, albeit self-sustaining. Although the country has a constitutional basis for health, policy and implementation levels are characterised by widespread vertical and horizontal misunderstandings among federal, provincial, and local governments. The COVID-19 response relegated the issue of ‘proliferated temporary control mechanisms’ or missing rational command systems. Financial analysis showed what appeared to be “firefighting” models, which allocated declining investments to the core preparedness functions like epidemic control, which fell to 2% of the federal health budget in 2021/22, and spending for COVID-19 emergencies, which constituted 36% of the federal health budget in 2021/22. The overarching Target 3.d monitoring and evaluation mechanisms were weak and lacked specified operations for subnational units. The systemic governance and financing issues inherent to transition federalism, which are inescapable for Nepal, pose acute challenges to achieving SDG Target 3.d by 2030. Scaling the governance system while strengthening IHR financing and core systems, and monitoring discretion through proactive mechanisms, is imperative for the resilience of the National Public Health System.

Sustainability has become an indispensable core consideration when nations formulate their development policies. This study delves into the dynamic correlations between ecosystem services (ESs) and localized Sustainable Development Goals (SDGs) in a typical hilly region in southern China. Various ESs were computed using the InVEST model, while spatial econometric models were employed to assess ES responses to SDG targets at the county, sectoral, and overall spatial levels. The findings revealed the following. (1) From 2005 to 2020, there were differences in the development rates of various SDG targets in Ganzhou. Except for SDG 15, which declined, the development of the other targets showed an overall increasing trend. The development of the various SDG targets was relatively balanced, but SDG 9 and SDG 7 had the highest growth rates, ranging from 9.4% to 10.7% and 9.4% to 10.3%, respectively. The comprehensive SDG assessment index exhibited significant spatiotemporal variation, with a general trend of higher values in the north and lower values in the south. (2) The local ES showed a delayed response to SDG 1 and SDG 2, but there was a significant positive response to SDG 3, SDG 4, SDG 6, SDG 8, and SDG 9. However, responses to SDG 7, SDG 11, SDG 13, and SDG 15 showed regional differences. This study not only provides valuable insights for sustainable development in Ganzhou and other regions of China but also offers Chinese perspectives and experiences that may inform global efforts towards SDG implementation. This study fills the gap in existing research by constructing a localized SDG indicator system and quantifying each SDG indicator, further exploring the response of the ES to each SDG in the region. Looking ahead, we anticipate further research to deepen the understanding of the relationship between ESs and SDG targets on a broader geographical scale and over longer timeframes, aiming to provide a more robust scientific foundation for building a harmonious coexistence between humans and nature in the future.

<h3></h3> The UN Sustainable Development Goal (SDG) on decent work and economic growth dovetails with recently published work to develop a comprehensive approach to assess the burden of work-related injury, disease, and distress. Overall, decent work is work that has a low burden of morbidity, mortality, disability, cost, and psychosocial impacts. Generally, this burden has been incompletely portrayed and underestimated. To address this underestimation a comprehensive framework for burden has been developed. The framework includes four elements: utilising multiple domains, including the individual worker, the worker's family, the community in which the workplace is located, the employer, and society as a whole; taking a broader view of the work–relatedness of disease; assessing the impact of the entire working–life continuum; and applying the comprehensive concept of 'well–being' as an indicator in addressing contemporary change in the nature of work, the workforce, and the work place. Measuring the burden in these elements and their composite may serve as benchmarks to gauge progress on meeting SDG targets for decent work. For this to be practical there needs to research on developing and measuring these individual elements of burden and determining the means to integrate them. This may involve looking beyond the traditional sources of surveillance data. Various concepts in the proposed burden elements are resonant with the SDG goals and targets. For example, underemployment and unemployment which appear to have similar health effects are resonant with the target of full and productive employment. Similarly, full and productive employment should be considered across the whole working-life continuum. Taking a comprehensive view of burden and applying it to the SDG targets is worth considering and this presentation will establish that proposition. <h3>Disclaimer</h3> The opinions in this presentation are those of the author and not necessarily of the National Institute for Occupational Safety and Health.

BackgroundIn 2017, the G20 health ministers convened for the first time to discuss global health and issued a communiqué outlining their health priorities, as the BRICS and G7 have done for years. As these political clubs hold considerable political and economic influence, their respective global health agendas may influence both global health priorities and the priorities of other countries and actors.MethodsGiven the rising salience of global health in global summitry, we analyzed the health ministerial communiqués issued by the BRICS, G7 and G20 after the SDGs were adopted in 2015. We compared the stated health priorities of the BRICS, G7 and G20 against one another and against the targets of SDG 3 on health, using a traffic light system to assess the quality of their commitments.ResultsWith regard to the SDG 3 targets, the BRICS, G7 and G20 priorities overlapped in their focus on emergency preparedness and universal health coverage, but diverged in areas of environmental pollution, mental health, and maternal and child health. Health issues with considerable associated burdens of disease, including substance use, road traffic injuries and sexual health, were missing from the agendas of all three political clubs. In terms of SDG 3 principles and ways of working, the BRICS, G7 and G20 varied in their emphasis on human rights, equity and engagement with non-state actors, but all expressed their explicit commitment to Agenda 2030.ConclusionsThe leadership of BRICS, G7 and G20 on global health is welcome. However, their relatively narrow focus on the potential impact of ill-health primarily in relation to the economy and trade may not be sufficiently comprehensive to achieve the Agenda 2030 vision of promoting health equity and leaving no-one behind. Recommendations for the BRICS, G7 and G20 based on this analysis include: 1) expanding focus to the neglected SDG 3 health targets; 2) placing greater emphasis on upstream determinants of health; 3) greater commitment to equity and leaving no-one behind; 4) adopting explicit commitments to rights-based approaches; and 5) making commitments that are of higher quality and which include time-bound quantitative targets and clear accountability mechanisms.

The success of the 2030 Agenda hinges on mobilization at the local level. The localization of sustainable development goals (SDGs) and their targets involves adapting them to local contexts. This case study of Quebec City, Canada, illustrates how the use of a systemic sustainability analysis tool can help integrate SDGs in the building of a sustainable development strategy at the local level. Our approach focuses on the use of an SDG target prioritization grid (SDGT-PG) and begins with the mobilization and training of a group of officers representing various city services. We first used an original text-mining framework to evaluate SDG integration within existing strategic documents published by the city. The result provides a portrait of existing contributions to SDG targets and identifies potential synergies and trade-offs between services and existing policies. A citywide prioritization workshop was held to assess the relative importance of SDG targets for the city. Priorities were then identified by combining the importance of the targets as viewed by stakeholders, the current level of achievement of SDG targets as determined by the analysis of existing documents, and the jurisdiction and responsibilities given to Quebec City in regard to federal and provincial legislation. We identified the main focus areas and related SDG targets. Furthermore, we observed whether actions needed to be consolidated or new actions needed to be implemented. The identification of synergies and trade-offs within the city service actions provides information on the links to be made between the different municipal services and calls for partnerships with other organizations. The use of the SDGT-PG allows the vertical and horizontal integration of the SDG targets and demonstrates how participation and inclusion facilitate stakeholders’ appropriation of the applied sustainable development strategy.

The Paris Agreementʼs nationally determined contributions (NDCs) provide an excellent point of entry to simultaneously address climate change and the 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs). This study sets out to explore the connections between climate action plans (NDCs) and each of the 17 Sustainable Development Goals (SDGs). In this study, we used four levels of visibility, that is, present, generic, implied and absent to provide a broad perspective of the extent to which South Africaʼs NDC is aligned with the targets of the SDGs. Our results revealed that South Africaʼs NDC has 12% present level of visibility to the SDG targets, with SDG 7 Affordable and Clean Energy and SDG 13 Climate Action showing the highest representation of present level of visibility. By contrast, the absent level of visibility NDC showed 53% in the SDG targets, with SDG 5 Gender Equity, SDG 16 Peace, Justice and Strong Institutions and SDG 3 Good Health and Well‐Being, showing the highest representation of absent level of visibility. These results indicate that there is scope to improve the alignment of South Africaʼs NDCs with the SDG targets. To this end, we have identified areas that may benefit with further elaboration in the countryʼs second NDC.

This paper evaluates how bioeconomy activities, stated in the concepts of the European Union, Organisation for Economic Co‐operation and Development, and the German government, potentially affect the targets of the Sustainable Development Goals (SDGs). The aim of the bioeconomy is to substitute the use of fossil resources by renewable resources, while the SDGs set targets for a holistic sustainable global development. A literature‐based influence analysis on empirical studies is employed to derive three bioeconomy scenarios (business as usual, bioeconomy, and sustainable bioeconomy) and to quantify their effects on the individual SDG targets. It is shown that the bioeconomy scenario has positive as well as negative effects on the SDG targets. While targets for cleaner industrial production are strongly supported, socioeconomic targets are subject to mixed effects and environmental targets significantly hurt. This paper outlines which SDGs need special attention when implementing a bioeconomy according to the above‐mentioned concepts. The results add to the debate on SDG trade‐offs and on the substitutability of SDG targets. Without regulations, policies, and investments ensuring sustainability, or in case the substitutability of SDG targets is not allowed, the bioeconomy concepts have the potential to jeopardize the achievement of several SDGs. In contrast, the sustainable bioeconomy scenario assumes strong sustainability measures that reveal the extensive potential of the bioeconomy to support the achievement of the SDGs.

The World Health Organization (WHO) adopted a global noncommunicable disease monitoring framework in 2013 with a target of a 25% reduction in premature mortality from four noncommunicable diseases (NCDs) such as cancer, diabetes, cardiovascular disease (CVD) and chronic respiratory disease (CRD) by 2025 compared to 2010. The Sustainable Development Goals (SDGs) target to reduce premature deaths from the four major NCDs by one‐third from 2015 to 2030. The objective of this study was to estimate the trend and reduction in premature mortality in India due to 4 major NCDs combined and separately between 2001 and 2030 and compare its progress toward the WHO and SDG target achievement. The publicly available data from the census for population and the Sample Registration System (SRS) for cause of death by 5‐year‐age groups were extracted. Age standardized premature mortality rates, unconditional probability of dying and annual percent change (APC) were computed. The premature mortality for four major NCDs decreased by −13.9% from 2010 to 2025 and by −15.6% from 2015 to 2030. The percentage changes in premature mortality from 2010 to 2025 were −33.9%, −17.4%, −9.3%, and 6.9% for CRD, cancer, CVD and diabetes respectively. For 2015–2030, these changes were −21.7%, −11.5%, −15.4%, and −15.1%. A significant reduction trend was observed for CRD with an average APC of −5.2%. The current reduction trend in premature mortality indicates that either the 25% reduction by 2025 or a one‐third reduction by 2030 will require intensive implementation of policies and program for NCD reduction.

Stillbirth prevention is a global health priority and a crucial step towards better maternal and newborn health and wellbeing.1de Bernis L Kinney MV Stones W et al.Stillbirths: ending preventable deaths by 2030.Lancet. 2016; 387: 703-716Summary Full Text Full Text PDF PubMed Scopus (204) Google Scholar In 2019, 2 million babies were stillborn, with over three-quarters of these stillbirths occurring in sub-Saharan Africa and south Asia.2Hug L You D Blencowe H et al.Global, regional, and national estimates and trends in stillbirths from 2000 to 2019: a systematic assessment.Lancet. 2021; 398: 772-785Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar However, progress has been slow, and unless there is a substantial acceleration in progress, the Sustainable Development Goal target 3.2 and Every Newborn Action Plan target of 12 stillbirths per 1000 births will not be met by 2030.3WHOReaching the every newborn national 2020 milestones: country progress, plans and moving forward. World Health Organization, Geneva2017Google Scholar Slow progress is partly due to the limited emphasis on stillbirth reduction in maternal and child health programmes and a paucity of accurate, complete, and actionable information on stillbirths, particularly in high-burden areas.1de Bernis L Kinney MV Stones W et al.Stillbirths: ending preventable deaths by 2030.Lancet. 2016; 387: 703-716Summary Full Text Full Text PDF PubMed Scopus (204) Google Scholar, 4Kiguli J Kirunda R Nabaliisa J Nalwadda CK Inadequate evidence on stillbirths: rethinking public health.Lancet. 2021; 398: 727-729Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar In The Lancet Global Health, Elizabeth M McClure and colleagues5McClure EM Saleem S Goudar SS et al.The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe).Lancet Glob Health. 2022; 10: e970-e977Summary Full Text Full Text PDF Scopus (1) Google Scholar present the findings of a large prospective observational study on the causes of stillbirth in India and Pakistan (the PURPOSe study). In this study, prospective surveillance was used to identify all women with fetal deaths or stillbirths attending the participating facilities during the study period. The causes of death of stillborn babies weighing more than 1000 g were identified using multiple sources of information, including interviews with mothers, hospital records review, physical examination, laboratory tests, placental pathology, minimally invasive tissue samples, and other microbiological methods. Using standard operating procedures, a panel of experts ascertained the primary maternal, fetal, and placental biomedical causes of death for 611 stillborn babies. The authors found that intrauterine hypoxia (72%) and congenital infections (13%) were the two predominant causes of stillbirth. This ascertainment was largely based on evidence of placental malperfusion (47%), abruption (15%), or infection (14%). The most important maternal causes were hypertensive disorder (36%), anaemia (11%), and infection (5%); a third of stillbirths did not have any associated maternal condition. A key limitation of the study was the exclusion of stillbirths weighing <1000 g, which implies that the causes among very preterm and severely growth-restricted babies were under-represented. Compared with previous studies,6Lawn JE Blencowe H Waiswa P et al.Stillbirths: rates, risk factors, and acceleration towards 2030.Lancet. 2016; 387: 587-603Summary Full Text Full Text PDF PubMed Scopus (783) Google Scholar, 7Ahmed I Ali SM Amenga-Etego S et al.Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study.Lancet Glob Health. 2018; 6: e1297-e1308Summary Full Text Full Text PDF PubMed Scopus (103) Google Scholar PURPOSe adds precision to determining the causes of fetal death. The large sample size of this study, coupled with the prospective surveillance and the high rate of success in doing placental pathology, contributes to making PURPOSe a crucial source of evidence on the biomedical causes of fetal mortality, particularly in south Asia. As with maternal and newborn mortality, biomedical causes often represent the embodiment of the complex interplay of ecosocial forces with individual factors.8Krieger N Embodiment: a conceptual glossary for epidemiology.J Epidemiol Community Health. 2005; 59: 350-355Crossref PubMed Scopus (452) Google Scholar, 9Souza JP Bellissimo-Rodrigues F Santos LLD Maternal mortality: an eco-social phenomenon that calls for systemic action.Rev Bras Ginecol Obstet. 2020; 42: 169-173Crossref PubMed Scopus (3) Google Scholar As a product of this interplay, stillbirths result from a long multifactorial process with missed opportunities to interrupt the pathway to death. In this pathway, the health system has the unique role of delivering quality and effective interventions to promote health and prevent and treat complications. PURPOSe and the body of evidence surrounding stillbirths point to the importance of primary prevention, early detection, and treatment of hypertensive disorders of pregnancy, maternal anaemia, and infections. Quality intrapartum care is crucial to reducing intrapartum stillbirths, which still contribute to at least a third of the burden of stillbirths in low-income and middle-income countries. Respectful antepartum and intrapartum care programmes are essential platforms for delivering effective health interventions.10WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization, Geneva2016Google Scholar, 11WHOWHO recommendations: intrapartum care for a positive childbirth experience. World Health Organization, Geneva2018Google Scholar Health system interventions to provide continuity of care across programmes and services (eg, midwife-led care models to ensure continuity of care between antenatal care and intrapartum care) should not be overlooked.12Miller S Abalos E Chamillard M et al.Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.Lancet. 2016; 388: 2176-2192Summary Full Text Full Text PDF PubMed Scopus (516) Google Scholar The contribution of PURPOSe to understanding the causes of stillbirths in south Asia calls for a similar large study in sub-Saharan Africa, including stillbirths weighing less than 1000 g. Research to develop improved methods for early identification of placental malperfusion and placental infection is needed. Most importantly, a series of intervention trials addressing the major causes maternal, placental, and fetal causes of stillbirth in south Asia and sub-Saharan Africa are urgently needed. The global burden of stillbirths is a silent disaster that has long-term consequences for women, families, and their communities. Many stillbirths are preventable, and the interventions needed to prevent stillbirths are integrated into efforts to improve the quality of care during pregnancy, childbirth, and the postnatal period. The health-care community need intentional leadership and a greater commitment to efforts to implement and scale-up existing and new solutions to reduce stillbirths within health systems in low-resource settings. Purposefully aiming to reduce stillbirths will ultimately improve maternal and newborn health and wellbeing. By tackling stillbirths, the health-care community will achieve an acceleration toward the Sustainable Development Goals. We declare no competing interests. The causes of stillbirths in south Asia: results from a prospective study in India and Pakistan (PURPOSe)In south Asia, fetal asphyxia is the major cause of stillbirth. Several placental lesions, especially those associated with maternal and fetal vascular malperfusion and placental abruption, have an important role in asphyxia and fetal death. Maternal hypertension, and especially pre-eclampsia, is often the primary maternal condition associated with this pathway. Full-Text PDF Open Access

BackgroundRoad traffic crashes and resultant injuries and fatalities have become a major global problem as countries develop and rapidly acquire motorised vehicles. The United Nations launched the UN Decade of...

Tuberculosis at the United Nations: a missed chance