The Socioeconomic Challenges and Costs of Trauma

Trauma is a global disease that must be addressed like other leading causes of death, according to a presenter at the 15th EFORT Congress – a combined program in partnership with the British Orthopaedic Association.

“Trauma is a low hanging fruit. It has biggest bang for the buck because rather than looking at all the processes, if we just got people to wear these two things [seatbelts and helmets], then we do way more than every cancer publication in the past 10 years. We still haven’t been successful at doing it,” Edward J. Harvey, M.D., MSc, FRCSC, said. Harvey, MSc, FRCSC, is a professor of surgery, Hornstein Chair in Surgical Excellence and director of Orthopaedic Trauma Service at McGill University in Montreal, Canada.

He said trauma is a disease hiding in plain sight and carries a huge economic burden on society in terms of mortality, morbidity and lost productivity. He said three leading causes of death globally are from injuries, and trauma is increasing in rank compared with other causes of death. However, he said, other medical problems, such as cancer, cardiovascular disease and respiratory ailments, are seen as more important in terms of research funding.

According to the World Health Organization’s Global Status Report on Road Safety 2013 report, 1.24 million road traffic deaths occur every year and is the top cause of death for people between the 15 years to 29 years old. The five major risk factors of trauma are speed, alcohol, helmets, seatbelt usage and use of child restraints. Only 111 countries have comprehensive seatbelt laws covering all car occupants, which covers 4.8 billion people or 69 percent of the world’s population. Fifty-nine countries have comprehensive urban speed laws. While 35 countries have passed laws that cover all five risk factors, this only reflects about 7 percent of the world’s population. Road safety and risk factor data sets are incomplete in almost every country, Harvey said.

Harvey said societal concepts need to change. The Canadian Orthopaedic Trauma Society (COTS) is currently working to build better trauma research program trials in an effort to make societal changes through better research. In Canada, trauma accounts for more potential years of life lost than any other health related problem, including cardiovascular diseases, cancer and diabetes. It has an annual health care cost to Canada of $19.8 billion, of which $10.72 billion is in direct hospital costs and $9.06 billion is in lost productivity and premature death.

Orthopaedic surgeons, he said, need to redesign relationships with government and industry. He spoke about the experiences of the COTS as they work at the national level to build better a trauma research program trials and make a societal change through better research.

“We needed to change the processes so we decided we were going to optimize research programs to change the processes,” he said.

He said information is paramount, and targeted or even hidden money has to be found. The COTS has made university-level changes in musculoskeletal research, provincial changes in data management and research priorities. They looked for funding for national programs, established advocacy programs, international support and partnerships and had industry involved as early partners.