Violence and injuries in Europe: burden, prevention and priorities for action

The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 33 70 00 Fax: +45 33 70 01 Email: eurocontact@who.int Website: www.euro.who.int Violence and injuries in Europe: burden, prevention and priorities for action An analysis of the 2016 WHO Global Health Estimates Violence and injuries in Europe: burden, prevention and priorities for action

Violence and injuries in Europe: burden, prevention and priorities for action An analysis of the 2016 WHO Global Health Estimates ABSTRACT The WHO Global Health Estimates show that nearly half a million deaths (493 471) occurred in the WHO European Region due to violence and injuries in 2016. This represents a decline of 29% from 2000. Injuries account for 5.3% of all deaths and 9.6 of all years of life lost. They are a leading cause of death in people aged 15–29 years and the second leading cause of death for young people aged 5–14. The three leading causes of injury deaths are self-directed violence (141 089), falls (83 325) and road-traffic injuries (78 198). Inequalities in injury deaths exist in the Region, with mortality rates 2.4 times higher in males than in females and 1.5 times higher in middle-income compared to high-income countries. When all ages are considered, there has been a convergence in mortality since 2000 between middle-income and high-income countries, but the gap has widened for children under 15 years. Public health action is needed to reduce inequalities in injuries in the Region. Keywords VIOLENCE WOUNDS AND INJURIES: PREVENTION AND CONTROL PUBLIC POLICY EUROPE ISBN 978 92 890 5510 9 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 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Printed in Denmark Text editing: Alex Mathieson Design: Damian Mullan, soitbegins.co.uk iii ACKNOWLEDGEMENTS iv ABBREVIATIONS v KEY MESSAGES vi BACKGROUND 1 Aim 3 Methods 3 VIOLENCE AND INJURIES 5 Leading causes of violence and injuries in the WHO European Region, 2016 6 Differences in violence and injury mortality by sex and age 8 Higher violence and injury death rates in males compared to females 11 Progress in violence and injury prevention 2000–2016 12 Increase in deaths from falls in older people over time 13 Changes in rank of leading causes of death in people aged 5–49 years from 2000 to 2016 16 Inequalities in violence and injury deaths by geography in the Region 17 Inequalities in violence and injury mortality by country income in the Region 19 Inequalities in violence and injury deaths in childhood by country income 20 Violence and injury-related health burden 21 Policy framework 23 Interventions to prevent violence and injuries 25 REFERENCES 29 COUNTRY PROFILES 33 ANNEX. OTHER UNINTENTIONAL INJURIES 137 CONTENTS iv ACKNOWLEDGEMENTS This report was written by: Lucía Hernández-García, intern, Violence and Injury Prevention Programme, WHO Regional Office for Europe; Gianluca Di Giacomo, intern, Violence and Injury Prevention Programme, WHO Regional Office for Europe; Yongjie Yon, Technical Officer, Violence and Injury Prevention Programme, WHO Regional Office for Europe; Ivo Rakovac, Programme Manager, WHO European Office for the Prevention and Control of Noncommunicable Diseases; and Jonathon Passmore, Programme Manager, Violence and Injury Prevention Programme, WHO Regional Office for Europe. The authors warmly acknowledge the administrative support of Nina Blinkenberg and Jesus Castro Izquierdo of the WHO Regional Office for Europe. The authors also extend thanks to the interns from the Violence and Injury Prevention Programme of the WHO Regional Office for Europe who supported the analysis and development of the report: Gabriella Sutton, University of Malta, and Julia Mutevelli, University of Bonn, Germany. vABBREVIATIONS CIS Commonwealth of Independent States EU European Union EuroSafe European Association for Injury Prevention and Safety Promotion ICOPE integrated care for older people HICs high-income countries ICD10 International Classification of Diseases, 10th revision MICs middle-income countries SDGs (United Nations) Sustainable Development Goals SDR standardized death rate YLL years of life lost vi KEY MESSAGES • Nearly 500 000 people were killed due to violence and injuries in the WHO European Region in 2016. • Violence and injuries are responsible for 5.3% of all deaths and 9.6% of all years of life lost. • Violence and injuries cause half of all deaths in young people aged 15–29 years, a third in children of 5–14 years, and a quarter in adults of 30–49 years. • Sixty-eight per cent of violence and injury deaths are among males, which is 2.4 times higher than in females. • Overall, the number of violence and injury deaths in the Region has declined by 29% since 2000. • Deaths represent only a fraction of the problem; there are many non-fatal incidences of violence and injuries for each death, often with far-reaching and lifelong health and social consequences. • Sixty-one per cent of violence and injuries are due to self-harm, falls and road-traffic injuries. • Fatal falls have increased in older people of 70 years and over, in whom 67% of fatal falls occur. • The burden of violence and injury is unequally distributed, with mortality rates in middle-income countries 1.5 times higher than in high-income countries. Male injury mortality rates are 2.0 times higher in middle-income countries than in high-income countries. • Inequalities in violence and injury deaths in children under 15 years have widened between middle-income and high-income countries. • Violence and injuries are not accidents, but rather predictable and preventable events. Public health action and safety-for-all policies through, for example, legislation, regulation, enforcement and community-based programmes are needed to prevent, reduce or mitigate injuries. BACKGROUND 2VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION With almost half a million fatalities each year and at about one death per minute, violence and injuries are one of the leading causes of death and disability in the WHO European Region (1,2). Survivors of severe violence and injuries often endure life-long impairments, leading to significant losses in healthy life years that represent a profound drain on health and societal resources and pose a threat to economic and social development in the Region (2–5). The 2030 Agenda for Sustainable Development has given renewed attention to the health and developmental threat of injuries. Several goals and targets for violence and injury prevention have been included in the United Nations Sustainable Development Goals (SDGs), which provide a governance framework for intersectoral preventive action (6). Injuries are not simply random and unavoidable accidents; rather, they are highly predictable and preventable public health problems. To support the reduction of injuries, WHO’s database of global, regional and country-level cause-specific mortality estimates for the years 2000, 2005, 2010, 2015 and 2016 (referred to as the 2016 Global Health Estimates) provide a comprehensive assessment of mortality and loss of health due to diseases and injuries (1). Fig. 1 illustrates the cycle of action for injury prevention where data are essential for informing public health decision-making and provide an opportunity to assess the burden of injuries and argue for preventative action (2–5). The estimates are critical tools to: • conduct essential assessment of injury and health burden at national and regional levels; • identify and target risk factors related to gender, specific age groups and other policy domains; • prioritize and facilitate the decision-making process for injury prevention; • target risk factors and identify preventative measures; and • monitor, measure and evaluate prevention policies to reduce injuries. Source: adapted from European Association for Injury Prevention and Safety Promotion (EuroSafe) (7). Injury data Information about risks Priorities and target groups Prevention actions Evaluation Fig. 1. Cycle of action for injury prevention VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 3 BACKGROUND Aim This briefing aims to: • inform stakeholders in relevant policy sectors on the significance and burden of intentional and unintentional injury deaths in the WHO European Region by demonstrating the magnitude of the problem through an overview of mortality and inequalities due to different mechanisms of injuries by age, sex, geography and income groups; and • emphasize the continued need for prevention programmes. The main target groups are policy-makers and practitioners in public health, professionals working in health information and health promotion, and those working in specific policy areas such as road safety and prevention of interpersonal violence and self-harm. The briefing highlights throughout significant WHO technical packages and guidance relevant to violence and injury prevention. Methods The primary source of data is the 2016 Global Health Estimates for the Region, which provides data for 50 of the 53 WHO European Region countries (1,8).1 Data on absolute numbers and mortality rates for different violence and injury mechanisms were obtained for the Region. Comparisons for middle-income countries (MICs)2 and high-income countries (HICs)3 used individual country data from the 2016 Global Health Estimates. Years of life lost (YLL) was used to calculate the burden of injuries due to premature death. The 2016 Global Health Estimates are comparable for five points in time – 2000, 2005, 2010, 2015 and 2016 (1) – but not with previously published global health estimates (8–12). 1 Member States of the WHO European Region are: Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Montenegro, the Netherlands, North Macedonia, Norway, Poland, Portugal, the Republic of Moldova, Romania, the Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, Turkey, Turkmenistan, Ukraine, the United Kingdom and Uzbekistan. 2 MICs with gross national income of US$ 1006–12 235 in 2016 (World Bank Atlas Method classification) are: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, North Macedonia, the Republic of Moldova, Romania, the Russian Federation, Serbia, Tajikistan, Turkey, Turkmenistan, Ukraine and Uzbekistan. 3 HICs with gross national income greater than US$ 12 236 in 2016 are: Andorra, Austria, Belgium, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Latvia, Lithuania, Luxembourg, Malta, Monaco, the Netherlands, Norway, Poland, Portugal, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.

VIOLENCE AND INJURIES 6VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION An injury is the damage caused by acute transfer of energy, whether physical, thermal, chemical or radiant, that exceeds the physiological threshold, or by the deprivation of a vital element. Injuries can be unintentional, such as those caused by road-traffic injuries, poisonings, falls, fire, heat and hot substances, drowning or submersion, or intentional. Intentional injuries can be self-directed (suicide or self-harm), interpersonal (intimate-partner violence, youth violence, violence against children or elder abuse), collective (war) or perpetrated through legal intervention. The injury categories used in the 2016 Global Health Estimates are described in Table 1 (4). “Violence and injury” is used throughout this briefing to denote both intentional and unintentional injuries. Leading causes of violence and injuries in the WHO European Region, 2016 Nearly every minute in the Region, someone dies as the result of violence and injury, representing nearly half a million (493 471) deaths in 2016 and accounting for 5.3% of all deaths. The three most prevalent causes of violence and injury-related mortality were self- directed injuries (141 089), falls (83 325) and road-traffic injuries (78 198), constituting 61% of all violence and injury deaths in the Region (Fig. 2). Other unintentional injuries, including accidental threats to breathing (suffocation, strangulation and choking), contact with venomous animals and plants, and complications of medical and surgical care accounted for 20% of violence and injury-related mortality in 2016. Injury category Types of injury Unintentional injuries Road-traffic injuries Drowning Falls Fire, heat and hot substances Poisonings Other unintentional injuriesa Intentional injuries Interpersonal violence Violence against children Intimate-partner and sexual violence Youth violence Elder abuse Self-directed violence Collective violence a Please refer to the Annex for a full description of other unintentional injuries (by International Classification of Diseases, 10th revision (ICD10) codes). Source: Sethi et al. (4). Table 1. Typology of injuries VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 7 The burden due to violence and injury resulted in a loss of 18 million YLL in 2016, which represents 9.6% of all YLL. When ranking YLL by cause of death (Table 2), unintentional injuries take third place (11 169 539) and intentional injuries sixth (7 462 986), higher than respiratory diseases and infectious and parasitic diseases. Younger people (aged 15–49 years) had a greater proportion of YLL from injuries (as opposed to deaths) than older people (Fig. 3). VIOLENCE AND INJURIES a Please refer to the Annex for a full description of other unintentional injuries (by International Classification of Diseases, 10th revision (ICD10) codes). Source: WHO (1). Collective violence and legal intervention Drowning Fire, heat and hot substances Other unintentional injuriesa Falls Interpersonal violence Poisonings Road injury Self-harm 16 23 5 29 6 1 17 3 Fig. 2. Proportion of violence and injury deaths in the WHO European Region by cause, 2016 (%) Rank Cause of death YLL All causes 192 483 056 1 Cardiovascular diseases 67 143 725 2 Malignant neoplasms 48 784 557 3 Unintentional injuries 11 169 539 4 Digestive diseases 10 073 080 5 Neurological conditions 8 307 880 6 Intentional injuries 7 462 986 7 Respiratory diseases 7 225 552 8 Infectious and parasitic diseases 6 133 051 9 Respiratory infections 5 239 344 10 Mental and substance-use disorders 4 215 419 Table 2. Number and rank of the 10 leading causes of death by YLL 8VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION Differences in violence and injury mortality by sex and age Sixty-eight per cent of all violence and injury deaths are in males, despite males having a slightly larger fall in the absolute number of deaths between 2000 and 2016 (33%, from about 514 000 to 343 000, as opposed to 19% (about 185 000 to 150 000) for females). A J-shaped curve describes age- and sex-specific violence and injury mortality, with the lowest rates in children aged 5–14 years, slightly higher rates in those under 5 years, and increasing rates with age; the highest for both sexes occurs in people aged 70 years and over (Fig. 4). Death due to injuries in older adults frequently is associated with their frailty, highlighting the importance of prevention in older adults. The magnitude of violence and injury, however, becomes more apparent when the proportion of deaths from violence and injury is considered by age group. Compared to all other causes, violence and injuries are the leading cause of death in young people aged 5–49 years (Fig. 5). Violence and injuries cause nearly half of all deaths in young people aged 15–29, over a third in children of 5–14 and nearly a quarter in adults of 30–49 years. Most violence and injury-related deaths – 65% – are unintentional; intentional injuries account for 35%. Ninety-two per cent of all injury deaths in children aged 0–4 years are due to unintentional injury; the proportion is 84% in children of 5–14 and 56% in young people aged 15–29 years. The highest proportion of intentional injury deaths (44%) occurs in those aged 15–29. The vulnerability of children and young adults signals a need for urgent action and greater emphasis on violence and injury prevention in the child and adolescent health agenda. Because of the greater impact on the young and economically active population, prevention of violence and injury must be recognized as a priority issue. Source: WHO (1). YLLDeaths 0–4 5–14 15–29 30–49 Age groups (years) 50–59 60–69 70+ 0 5 10 15 20 25 30 35 40 2 4 1 3 13 23 27 37 14 14 12 9 31 10 Fig. 3. Age distribution of deaths and YLLs lost from all violence and injuries (%) VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 9 VIOLENCE AND INJURIES People across the age groups are at varying degrees of risk for different mechanisms of violence and injury. Table 3 ranks the number of deaths by age by different causes, with violence and injury mechanisms highlighted in colour. Road-traffic injuries are the leading cause of death in young people aged 5–14 years and the second leading cause of death for young people aged 15–29. Much is known about preventing road-traffic deaths and injuries (see Box 1 for Source: WHO (1). FemaleMale All ages0–4 5–14 15–29 30–49 Age groups (years) De at hs p er 1 00 0 00 p op ul at io n 50–59 60–69 70+ 0 50 100 150 200 250 77 32 14 11 8 5 57 14 85 18 97 23 97 29 191 129 Fig. 4. Age- and sex-specific violence and injury mortality rates in the WHO European Region, 2016 Source: WHO (1). Other causes of deathIntentional injuries Unintentional injuries 0–4 5–14 15–29 30–49 Age groups (years) 50–59 60–69 All ages70+ 0 10 20 30 40 50 60 70 80 90 100 Fig. 5. Proportion of deaths from unintentional and intentional injuries and all other disease causes by age group in the WHO European Region, 2016 (%) 10 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION Table 3. Number and rank of the 15 leading causes of death for both sexes in the WHO European Region, 2016 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 23 805 Road injury 2 206 Self-harm 21 522 Ischaemic heart disease 62 700 Ischaemic heart disease 147 778 Ischaemic heart disease 306 723 Ischaemic heart disease 1 821 402 Ischaemic heart disease 2 342 283 2 Congenital heart anomalies 11 688 Drowning 1 434 Road injury 18 557 Self-harm 48 904 Trachea, bronchus, lung cancers 69 550 Trachea, bronchus, lung cancers 131 898 Stroke 784 213 Stroke 986 364 3 Lower respiratory infections 10 578 Lower respiratory infections 1 270 Drug-use disorders 6 773 HIV/AIDS 37 932 Stroke 53 506 Stroke 121 560 Alzheimer's disease and other dementias 464 861 Alzheimer's disease and other dementias 480 863 4 Birth asphyxia and birth trauma 10 403 Leukaemia 1 206 Interpersonal violence 5 743 Cirrhosis of the liver 37 547 Cirrhosis of the liver 44 050 Colon and rectum cancers 57 584 COPD a 280 356 Trachea, bronchus, lung cancers 419 231 5 Other congenital anomalies 9 393 Brain and nervous system cancers 1 107 Other unintentional injuries b 5 667 Road injury 25 398 Breast cancer 27 844 COPD a 46 835 Other circulatory diseases 278 746 COPD a 348 870 6 Other neonatal conditions 5 842 Other unintentional injuries b 907 HIV/AIDS 4 435 Stroke 24 255 Colon and rectum cancers 26 971 Cirrhosis of the liver 45 983 Trachea, bronchus, lung cancers 200 021 Other circulatory diseases 341 605 7 Neonatal sepsis and infections 5 000 Other neurological conditions 798 Drowning 3 983 Cardiomyopathy, myocarditis, endocarditis 23 471 Self-harm 25 626 Breast cancer 36 534 Lower respiratory infections 175 962 Colon and rectum cancers 264 536 8 Diarrhoeal diseases 3 392 Other malignant neoplasms 772 Ischaemic heart disease 3 619 Alcohol-use disorders 20 131 Cardiomyopathy, myocarditis, endocarditis 21 260 Stomach cancer 35 348 Colon and rectum cancers 169 443 Lower respiratory infections 244 927 9 Other unintentional injuries b 2 431 Congenital heart anomalies 655 Lower respiratory infections 3 286 Drug-use disorders 17 576 Stomach cancer 20 095 Other circulatory diseases 34 106 Diabetes mellitus 133 959 Diabetes mellitus 179 284 10 Sudden infant death syndrome 1 972 Self-harm 649 Cardiomyopathy, myocarditis, endocarditis 3 253 Trachea, bronchus, lung cancers 17107 Alcohol-use disorders 17 666 Pancreas cancer 31 679 Hypertensive heart disease 130 142 Cirrhosis of the liver 177 465 11 Other chromosomal anomalies 1 671 Other congenital anomalies 529 Cirrhosis of the liver 3 123 Other unintentional injuries b 16 979 Other malignant neoplasms 17166 Other malignant neoplasms 29 287 Kidney diseases 110 591 Breast cancer 164 577 12 Other infectious diseases 1 602 Epilepsy 477 Falls 2 600 Breast cancer 16 684 Other circulatory diseases 16 328 Diabetes mellitus 27 329 Prostate cancer 97 416 Hypertensive heart disease 157 039 13 Other neoplasms 1 296 Other endocrine, blood and immune disorders 452 Other malignant neoplasms 2 515 Lower respiratory infections 16 162 Lower respiratory infections 15 948 Lower respiratory infections 21 721 Breast cancer 83 137 Stomach cancer 141 488 14 Neural tube defects 1 257 Exposure to mechanical forces 381 Stroke 2 417 Interpersonal violence 13 181 COPD a 15 771 Cardiomyopathy, myocarditis, endocarditis 21 336 Other digestive diseases 76 528 Cardiomyopathy, myocarditis, endocarditis 141 195 15 Other endocrine, blood and immune disorders 1 227 Lymphomas, multiple myeloma 379 Exposure to mechanical forces 2 297 Other circulatory diseases 10 364 Pancreas cancer 15 031 Liver cancer 20 736 Stomach cancer 76 219 Self-harm 141 089 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 6.7 (7 189) 37.4 (6 865) 49.4 (62 849) 23.0 (131 084) 9.0 (72 222) 4.3 (58 401) 2.5 (154 861) 5.4 (493 471) a COPD: chronic obstructive pulmonary disease. b Please refer to the Annex for a full description of other unintentional injuries (by International Classification of Diseases, 10th revision (ICD10) codes). Source: WHO (1). BOX 1. SAVE LIVES: A ROAD SAFETY TECHNICAL PACKAGE Road traffic injuries are not “accidents”. Much is known about preventing road-traffic deaths and injuries. Based on this knowledge, a WHO road-safety technical package, Save LIVES (13), has been developed to support decision-makers and practitioners in their efforts towards reducing road-traffic deaths and injuries and achieving SDG targets 3.6 and 11.2. Save LIVES: a road safety technical package is an evidence-based inventory of priority interventions with a focus on: Speed management; Leadership; Infrastructure design and improvement; Vehicle safety standards; Enforcement of traffic laws; and post-crash Survival. The six strategies and 22 interventions recommended in the package are interrelated and should be implemented in an integrated manner to effectively address road-traffic deaths and injuries. Since countries are at varying stages of addressing the problem, this road-safety policy package should not be seen as a one-size-fits-all solution, but rather as a guide to support decisions for scaling up road-safety efforts. The Save LIVES technical package is available in multiple languages. VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 11 VIOLENCE AND INJURIES a description of the WHO technical package on road safety). Drowning is one of the leading causes of death in those under 30, interpersonal violence is very significant for people between 15 and 29, and self-harm is among the top 15 causes of death in people of all ages. The leading causes of death for children aged 5–14 include road-traffic injury, drowning, other unintentional injury and self-harm. For young people aged 15–29, self-harm, road-traffic injury, interpersonal violence, other unintentional injuries, drowning, falls and exposure to mechanical forces were among the top 15 causes of death in 2016. Self-harm, road-traffic injuries, interpersonal violence and other unintentional injuries (as defined in the International Classification of Diseases, 10th revision (ICD10) (14) (see the Annex) ranked high as frequent causes of death in young adults aged 30–49 years. Higher violence and injury death rates in males compared to females Males are 2.4 times more likely to die from violence and injury than females (Fig. 6). The highest mortality-rate ratios for males versus females are for drowning and self-harm, with ratios of 4.5 and 3.7 respectively. The lowest are for falls (1.4) and fire, heat and hot substances-related injuries (2.1). Male-to-female mortality ratios are higher in Commonwealth of Independent States (CIS) countries compared to European Union (EU) countries for every specific injury. The difference is particularly high for poisonings, falls, interpersonal violence and drowning. Source: WHO (1). 6 5 4 3 2 1 0 M al e- to -fe m al e m or ta lit y ra tio 2.4 : 1 3.0 : 1 2.3 : 1 1.4 : 1 2.1 : 1 4.6 : 1 3.7 : 1 2.8 : 1 All injuries Road injury Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Fig. 6. Male-to-female mortality-rate ratios of injury deaths in the WHO European Region, 2016 12 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION Progress in violence and injury prevention 2000–2016 Deaths from violence and injury fell from 700 000 (7.4% of all deaths) in 2000 to nearly 500 000 (5.3% of all deaths) in 2016 – a reduction of 29.4% (Table 4). Premature mortality due to violence and injuries fell by 40% during this 16-year period, from 31 million YLL in 2000 to 19 million in 2016. Similar rates of reduction can be observed for unintentional (26%) and intentional (36%) injuries. The greatest reductions occurred in collective violence and legal intervention (82%), interpersonal violence (57%) and poisoning (56%). Box 2 provides effective strategies for drowning prevention. Falls have seen almost no change since 2000, but rather a slight increase since 2010 (9.7%). Cause of death 2000 (deaths) 2010 (deaths) 2016 (deaths) Change (%) (2000–2016) Injury 699 367 555 299 493 471 –29.4 Unintentional injuries 431 086 355 904 320 700 –25.6 Road injury 118 734 90 332 78 198 –34.1 Poisonings 14 873 8 009 6 606 –55.6 Falls 84 227 75 947 83 325 –1.1 Fire, heat and hot substances 28 100 20 457 15 918 –43.4 Drowning 48 283 30 636 23 093 –52.2 Other unintentional injuriesa 136 868 130 523 113 560 –17.0 Intentional injuries 268 281 199 395 172 771 –35.6 Self-harm 189 466 160 368 141 089 –25.5 Interpersonal violence 70 156 36 677 30 139 –57.0 Collective violence and legal intervention 8 659 2 350 1 542 –82.2 a Please refer to the Annex for a full description of other unintentional injuries (by International Classification of Diseases, 10th revision (ICD10) codes). Source: WHO (1). Table 4. Deaths due to injuries in the WHO European Region, 2000, 2010, 2016 BOX 2. EVIDENCE-BASED PREVENTION OF DROWNING Building on WHO’s 2014 Global report on drowning (15), Preventing drowning: an implementation guide (16) provides practical, step-by- step guidance on how to implement 10 effective measures to prevent drowning. The 10 effective measures range from community-based solutions, such as day care for children and barriers controlling access to water, to effective national policies and legislation around water safety, including setting and enforcing boating, shipping and ferry regulations. These measures are designed to help drowning- prevention practitioners – from nongovernmental organizations and researchers to government officials and policy-makers – approach drowning prevention in a strategic, evidence-based and multisectoral way. The guide also highlights ways to harness public awareness and engagement to strengthen drowning- prevention interventions. VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 13 VIOLENCE AND INJURIES Increase in deaths from falls in older people over time The combination of low birth rates and high life expectancy in the Region has led to a transition towards an older population, dramatically altering the population pyramid (17). It is expected that this trend will continue, with the number of working-age people declining steadily and the proportion of older people increasing: estimates suggest, for example, that the number of people aged 60 years will reach approximately 250 million by 2030 in the WHO European Region (18). Older adults have higher death rates from violence and injuries than other age groups, with falls as the leading cause of injury death, followed by self-harm and road-traffic injuries (Fig. 7). Source: WHO (1). Falls Poisonings Road injury Exposure to mechanical forces Fire, heat and hot substances Interpersonal violence Self-harmDrowning 0–4 All ages5–14 15–29 30–49 Age groups (years) 50–59 60–69 70+ 100 90 80 70 60 50 40 30 20 10 0 Fig. 7. Age mortality rates by injury in the WHO European Region, 2016 (%) 14 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION Age is a key determinant in whether falls are fatal or not, and fatality is highest in older people (19). Despite a reduction in overall mortality from falls in people of all ages in the Region between 2000 and 2016, the rate in people aged 70 years and over increased by 25%. The percentage of fatal falls rises considerably with increasing age. Sixty-seven per cent of all deaths from falls in the Region were among people aged 70 and older, with the death rate being higher among males. A combination of factors related to declining physical capacity of older people, including health conditions associated with older age, frailty and the environments in which older people live, increase the risk for falls and fall-related injuries. Once injuries occur, older adults are more susceptible to fatal complications and have longer ill health due to diminished capacity. There are proven strategies to reduce the risks for falls (Box 3), such as strength and balance exercise, physical therapy and the withdrawal of psychotropic medications, as well as home-hazard assessments and adaptations to remove barriers in living environments (20). Fig. 8 shows mortality rates for falls in the Region by income classification. It can be observed that fall fatality rates differ greatly between HICs and MICs, with HICs appearing to have higher injury fatality rates than MICs. Differences in coding practices for death certification can influence injury fatality rates. For older age groups, a fall-related injury often triggers a sequence of health-related conditions that ultimately leads to death. In some coding practices, the initial cause of death (the fall) may be recorded, while other practices may record the health condition prior to the fall incident as cause of death. Rates of fall-related injury therefore can be underreported, and the true extent of the problem could be higher. BOX 3. CARING FOR OLDER ADULTS AND FALLS PREVENTION The provision of integrated care is key for older people and for falls prevention. The WHO Guidelines on integrated care for older people (ICOPE) (20) propose evidence-based recommendations for health- care professionals to prevent, slow or reverse declines in the physical and mental capacities of older people. The ICOPE guidelines offer evidence-based direction on: comprehensive assessment of health status in an older person; delivery of the integrated health care that will enable an older person to maintain their physical and mental capacities, and/or to slow or reverse any declines; and delivery of interventions to support caregivers. Included in ICOPE are recommendations for falls prevention that include: medication review and withdrawal; multimodal exercise; home modifications to remove environmental hazards; and multifactorial interventions with individually tailored programmes to reduce the risk and incidence of falls. VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 15 VIOLENCE AND INJURIES 0 20 40 60 80 100 120 140 160 180 Slovenia Croatia Switzerland Slovakia Netherlands Finland Hungary Norway Germany Belgium Luxembourg Poland Turkey Malta Sweden France United Kingdom Denmark Austria Lithuania Iceland Ireland Portugal Spain Latvia Italy Belarus Serbia Georgia Cyprus Estonia Montenegro Czechia Russian Federation North Macedonia Romania Greece Armenia Bosnia and Herzegovina Ukraine Kazakhstan Bulgaria Israel Tajikistan Republic of Moldova Albania Turkmenistan Azerbaijan Kyrgyzstan Uzbekistan Falls mortality rate per 100 000 population 170.5 170.2 154.0 147.1 143.0 124.9 106.4 96.6 90.0 88.1 80.7 78.9 77.3 70.0 65.8 62.9 61.9 60.2 57.3 53.1 45.9 40.6 38.0 37.0 35.2 33.0 32.9 31.5 29.9 29.2 28.6 25.9 25.1 25.0 25.0 24.3 23.9 20.6 19.5 19.4 17.7 17.5 17.1 16.3 15.2 13.0 10.4 10.4 6.6 1.6 HICsMICs Fig. 8. Falls mortality rates for people aged 70+ years by country in the WHO European Region, 2016 16 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION Changes in rank of leading causes of death in people aged 5–49 years from 2000 to 2016 Table 5 shows the change in rank between 2000 and 2016 of the 15 leading causes of death in age bands from 5 to 49 years. Violence and injury remained an important leading cause of mortality. The rankings for falls, drowning and interpersonal violence reduced compared to 2000, but no such change was seen for self-harm and road-traffic injury. People aged 30–49 have had some improvement in rank for road-traffic injury and interpersonal violence since 2000, but none for self-harm. Box 4 provides a step-by-step guide for suicide prevention. Table 5. Changes in leading causes of death in people aged 5–49 years in the WHO European Region, 2000–2016 5–14 years 15–29 years 30–49 years 2000 2016 2000 2016 2000 2016 1 Drowning Road injury Self-harm Self-harm Ischaemic heart disease Ischaemic heart disease 2 Road injury Drowning Road injury Road injury Self-harm Self-harm 3 Lower respiratory infections Lower respiratory infections Drowning Drug-use disorders Stroke HIV/AIDS 4 Other unintentional injuriesa Leukaemia Interpersonal violence Interpersonal violence Road injury Cirrhosis of the liver 5 Leukaemia Brain and nervous system cancers Other unintentional injuriesa Other unintentional injuriesa Alcohol-use disorders Road injury 6 Congenital heart anomalies Other unintentional injuriesa Drug-use disorders HIV/AIDS Tuberculosis Stroke 7 Epilepsy Other neurological conditions Ischaemic heart disease Drowning Interpersonal violence Cardiomyopathy, myocarditis, endocarditis 8 Other neurological conditions Other malignant neoplasms Falls Ischaemic heart disease Cardiomyopathy, myocarditis, endocarditis Alcohol-use disorders 9 Self-harm Congenital heart anomalies Tuberculosis Lower respiratory infections Drowning Drug-use disorders 10 Meningitis Self-harm Exposure to mechanical forces Cardiomyopathy, myocarditis, endocarditis Trachea, bronchus, lung cancers Trachea, bronchus, lung cancers 11 Exposure to mechanical forces Other congenital anomalies Lower respiratory infections Cirrhosis of the liver Cirrhosis of the liver Other unintentional injuriesa 12 Falls Epilepsy Cardiomyopathy, myocarditis, endocarditis Falls Lower respiratory infections Breast cancer 13 Brain and nervous system cancers Other endocrine, blood and immune disorders Fire, heat and hot substances Other malignant neoplasms Other unintentional injuriesa Lower respiratory infections 14 Fire, heat and hot substances Exposure to mechanical forces Alcohol-use disorders Stroke Falls Interpersonal violence 15 Stroke Lymphomas, multiple myeloma Stroke Exposure to mechanical forces Breast cancer Other circulatory diseases a Please refer to the Annex for a full description of other unintentional injuries (by International Classification of Diseases, 10th revision (ICD10) codes). Source: WHO (1). VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 17 VIOLENCE AND INJURIES Inequalities in violence and injury deaths by geography in the Region The WHO European Region covers 53 countries with vastly differing social, economic, commercial, physical, climatic, environmental, geographical and political determinants. This results in inequalities in injuries between and within countries (22–24). An overall decline in violence and injury mortality and burden has been seen across the entire Region in recent decades, along with reductions in inequality between subregions. Fig. 9 shows the trends since 1990 in the standardized death rate (SDR) in the Region, the EU and the CIS, one that peaked in 1994 and then had a second start in 1999 during periods of political, economic and social transition to market economies. The Region as a whole has shown a similar pattern, mainly driven by changes in countries belonging to the CIS. The SDR for the Region in 1990 of 74.7 per 100 000 population had decreased to 50 by 2015 (25). Mortality rates from injuries have been in steady decline in CIS countries since 2004, but while there has been some convergence, rates remain considerably higher than in other parts of the Region. EU countries fare better, with an overall steady decline from a SDR of 58.6 per 100 000 in 1990 to 32.9 in 2015 (25). Large discrepancies remain within the Region: the death rate from injuries in the CIS in 2014 (96 per 100 000) was three times higher than in the EU (Fig. 9). Despite the downward trends, the higher burden of deaths in the CIS constitutes an issue of equity in which income and socioeconomic status become social determinants of both fatal and non-fatal injuries (26,27). The map of SDRs from injuries (Fig. 10) highlights inequality in the Region. Mortality is far higher in the eastern part, where most countries have death rates from violence and injuries that are in the upper fifth of highest SDRs. There is a six-fold difference between countries with the highest and lowest mortality rates (25). If all countries in the Region had the same mortality rates as those with the lowest rates, nearly 290 000 lives could have been saved. BOX 4. SUICIDE PREVENTION WHO’s Preventing suicide: a community engagement toolkit (21) is a step- by-step guide for people who would like to initiate suicide-prevention activities in their community. It describes a participatory bottom-up process through which communities (including community leaders, health workers, parliamentarians, teachers, social workers, police and firefighters, and business leaders) can work together to identify, prioritize and implement activities that are important and appropriate to their local context and that can influence and shape policy and services. Advice and practical tools to help with goal-setting, stakeholder mapping and development of an action plan are included, as are examples of successful initiatives in Canada, India, Kenya, Nepal, Trinidad and Tobago, and the United States of America. 18 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION The magnitude of inequity gaps is much larger and more evident in relation to specific causes of violence and injuries. Deaths due to interpersonal violence, for instance, are seven times more frequent in the CIS subregion than the EU subregion (1). The death rate for road-traffic crashes in 2016 was 2.8 per 100 000 in Sweden, but in Kazakhstan was about nine times higher (1). In addition to differences across subregions, disparities are also evident within countries. Source: WHO (1). European RegionCIS EU Vi ol en ce a nd in ju rie s m or ta lit y ra te p er 1 00 0 00 p op ul at io n 0 50 100 150 200 1990 1994 1998 2002 2006 2010 20141992 1996 2000 2004 2008 2012 2016 Fig. 9. Trends in SDRs for all violence and injuries in the WHO European Region, the EU and the CIS, 1990–2016 a Data represent 2016 or nearest year. Source: WHO Regional Oce for Europe (25). Lower No data Minimum = 13.67 2nd 3rd 4th Upper Fig. 10. SDRs per 100 000 from all injuries in the WHO European Region (quintiles)a VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 19 VIOLENCE AND INJURIES Inequalities in violence and injury mortality by country income Another way of assessing inequalities in violence and injury is to compare the risks of dying in MICs and HICs. Forty-five per cent of the population of the Region in 2016 resided in countries classified as MICs. Countries under this classification have undergone rapid socioeconomic and political change over the past decades, and the higher violence and injury mortality they have experienced may be associated with this pace of change. MICs have a mortality rate 1.7 times higher than HICs for all violence and injuries. The greatest discrepancy between income groups is from fire, heat and hot substances, which is 8.1 times higher in MICs. Mortality-rate ratios are also high for drowning (6.8), interpersonal violence (5.7), poisoning (3.8) and road- traffic injuries (2.6) (Table 6). When compared separately, MIC-to-HIC mortality-rate ratios are much higher for males than females, suggesting that much of the excess mortality lies in men in MICs. It is well established that poverty and lower socioeconomic status are associated with increased risk for violence and injuries. The links between poverty and inequality as well as violence and injury can be explained in three ways. First, poorer individuals are more vulnerable to injuries due to greater exposure to risky situations, environments and behaviours. They also have less access to services and fewer means of reducing their exposure to risk. Secondly, their access to affordable high-quality emergency medical and rehabilitative services is limited. Lastly, once violence and injury has occurred, health-care costs and loss of earning capacity can severely affect family financial situations which, in turn, lead to further inequalities and increase the burden of violence and injuries for poor people (28). Violence and injury-related deaths in MICs decreased from 457 000 in 2000 to 275 000 in 2016, a decline of 40%. In contrast, the total number of violence and injury deaths in HICs increased by 6%, from 205 000 to 218 000. While a proportionately greater decline Male Female MIC : HIC rate ratios MIC HIC MIC HIC Male Female Total All causes 1 198.4 971.6 991.9 952.2 1.2 1.0 1.1 Injuries 121.9 55.3 33.7 33.1 2.2 1.0 1.7 Unintentional injuries 84.8 33.7 24.5 26.2 2.5 0.9 1.8 Road injury 21.1 7.6 6.3 2.7 2.8 2.3 2.6 Poisonings 2.5 0.4 0.9 0.5 6.3 1.9 3.8 Falls 15.1 10.9 4.9 10.7 1.4 0.5 0.9 Fire, heat and hot substances 8.3 0.9 3.1 0.5 9.6 6.1 8.1 Drowning 12.9 1.7 2.3 0.5 7.7 4.4 6.8 Other unintentional injuriesa 24.8 12.2 6.9 11.3 2.0 0.6 1.3 Intentional injuries 37.1 21.6 9.1 6.9 1.7 1.3 1.6 Self-harm 25.6 20.1 5.9 6.3 1.3 0.9 1.2 Interpersonal violence 9.6 1.5 2.8 0.7 6.6 4.1 5.7 a Please refer to the Annex for a full description of other unintentional injuries (by International Classification of Diseases, 10th revision (ICD10) codes). Source: WHO (1). Table 6. SDRs per 100 000 and rate ratios from all violence and injuries by sex in MICs and HICs in the WHO European Region, 2016 20 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION has occurred in MICs, suggesting some convergence between country income groups, the inequalities between MICs and HICs represent an important issue of social justice. Safety measures and policies need to be in place to ensure affordability and accessibility of proven interventions for all. Mortality rates for all injuries in MICs and HICs converged over the 16-year period between 2000 and 2016. Mortality-rate ratios (MICs to HICs) correspondingly have decreased from 2.2 to 1.5, with the biggest reductions being seen in deaths from drowning, interpersonal violence and fire, heat and hot substances-related injuries (Fig. 11). While the convergence and narrowing of mortality-rate ratios between MICs and HICs for most of the specific causes of violence and injury between 2000 and 2016 constitutes a considerable success in prevention efforts, the mortality-rate ratio for road-traffic injuries remains high; it increased over the period from 1.3 to 2.8. The burden of road-traffic deaths is disproportionately high in MICs in relation to the size of their populations and the number of motor vehicles in circulation. Although only 26% of the Region’s motor vehicles are in MICs, 70% of road-traffic deaths occur in these countries (29). The higher burden of deaths probably reflects inadequate policy responses through road-safety strategies resulting in a slower decline in road-traffic injury mortality compared to HICs (2,26,27,29). Inequalities in violence and injury deaths in childhood by country income Although there has been convergence in mortality rates among MICs and HICs, progress is unequal at all ages. The mortality gap between HICs and MICs in children under 15 years has Source: WHO (1). 20162000 All injuries Unintentional injuries Road injury Poisonings M or ta lit y- ra te ra tio s Falls Fire, heat and hot substances Drowning Intentional injuries Self- harm Interpersonal violence 0 1 2 3 4 5 6 7 8 9 2.2 1.5 1.9 1.4 1.3 2.8 6.3 5.1 0.8 0.9 6.4 5.0 7.3 4.0 2.9 1.0 2.1 1.5 8.4 6.3 Fig. 11. Mortality-rate ratios of MICs versus HICs for specific cause of violence and injury in the WHO European Region, 2000 and 2016 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 21 VIOLENCE AND INJURIES widened, especially when considering specific causes of deaths. Rate ratios for road-traffic injuries (4.4) poisonings (15.4) and fire, heat and hot substances (7.4) have widened due to a greater proportionate improvement in HICs between the two time points (Fig. 12). Violence and injury-related health burden Deaths from violence and injury are only the tip of the iceberg: the number of deaths does not convey the full magnitude of the problem. For every death, there could be many cases of non-fatal injuries resulting in disabilities that impact the lives of people and place a huge burden on health-care systems. Non-fatal violence and injury data in the Region have not consistently been available in all countries. It is estimated, however, that in the EU between 2013 and 2015, there were 22 hospital admissions (5 million) and 144 emergency department attendances (33.1 million) for every death, amounting to 166 non-fatal injuries for each death (Fig. 13a) (30). These estimates amount to over 38 million injuries in the EU per year, of which 0.6% led to death, 13.0% to hospital admission and 86.4% to ambulatory care in emergency departments (Fig. 13b). Extrapolating these estimates and proportions to the entire WHO European Region would suggest that many more individuals have been victims of violence and injuries. Violence and injuries are also costly to society. Data from the European Core Health Indicators on Hospital Discharge Statistics indicate that one in 12 hospital admissions in the EU is related to violence and injury, which is equivalent to at least 50 million days of hospital care (30). Direct medical costs associated with violence and injury amount to at least €80 billion each Source: WHO (1). 20162000 All injuries Unintentional injuries Road injury Poisonings M or ta lit y- ra te ra tio s Falls Fire, heat and hot substances Drowning Intentional injuries Self- harm Interpersonal violence 0 2 4 6 8 10 12 14 16 18 4.8 4.94.4 5.4 1.8 4.4 14.3 15.4 8.9 5.8 6.2 7.4 9.0 7.3 3.4 2.4 3.6 2.7 2.2 1.8 Fig. 12. Mortality-rate ratios in MICs compared with HICs in children under 15 years for all types of violence and injury mechanism, 2000 and 2016 22 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION year, but are likely to be higher, especially considering the additional costs incurred outside of hospitals, including sick pay, costs for rehabilitation and indirect costs (31). Source: adapted from EuroSafe (30). Fig. 13a. Violence and injury pyramid in the EU, 2013–2015 530 000 deaths 12 million hospital admissions 86 million emergency department presentations Emergency department presentations Admissions Deaths 13 86.4 0.6 Fig. 13b. Proportion of injuries in the EU by severity (%) VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 23 VIOLENCE AND INJURIES Policy framework The high human and societal costs of injuries have caused an increase in policy attention to violence and injuries over the last decades. Injuries and violence prevention are included as goals and targets in the United Nations 2030 Agenda on Sustainable Development (Table 7), as they pose a threat to sustainable development. Unlike the Millennium Development Goals, which did not include violence and injury-specific targets (32), the SDGs provide a governance framework for intersectoral action and a whole-of-society approach to violence and injury prevention (6). Violence and injury mechanism Violence and injury-specific targets Risk factors and related goals and targets Self-harm Road-traffic injuries Poisoning Drowning Falls Fire, heat and hot substances 3. Ensure healthy lives and promote well-being for all at all ages 3.4. By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being 3.6. By 2020, halve the number of global deaths and injuries from road-traffic accidents 3.9. By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination 11. Make cities and human settlements inclusive, safe, resilient and sustainable 11.2. By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all, improving road safety, notably by expanding public transport 1. Reduce poverty in all its forms everywhere 3.2. Reduce under-5 child mortality 3.5. Reduce alcohol-related harm 3.7. Access to sexual and reproductive health services 3.8. Achieve universal health coverage 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all 8. Promote sustained, inclusive, sustainable economic growth, full and productive employment and decent work for all 10. Reduce inequality within and among countries 11. Make cities and human settlements inclusive, safe, resilient and sustainable 11.1. Adequate, safe and affordable housing and basic services and upgrade slums 11.7. Safe, inclusive and accessible, green and public spaces Interpersonal violence 5. Achieve gender equality and empower all women and girls 5.2. Eliminate all forms of violence against women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation 5.3. Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels 16.1. Significantly reduce all forms of violence and related death rates everywhere 16.2. End abuse, exploitation, trafficking and all forms of violence against and torture of children Source: United Nations (6). Table 7. SDGs specific to violence and injury prevention or targeting risk factors of violence and injury 24 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION International policy developments, such as World Health Assembly and United Nations General Assembly resolutions, have emphasized the importance of responses to violence and injury by societies in general and health systems in particular. These include: WHA 67.15 on strengthening the role of the health system in addressing violence, in particular against women and girls, and against children (33); the global plan of action on violence (34); WHA 69.7 on addressing the challenges of the United Nations Decade of Action for Road Safety (2011–2020) (35); and WHA 64.27 on child injury prevention (36). Also relevant are United Nations General Assembly resolutions: 70/260 on improving global road safety (37); 71/170 on intensification of efforts to prevent and eliminate all forms of violence against women and girls (38); and 71/195 on combating intolerance, negative stereotyping, stigmatization, discrimination, incitement to violence and violence against persons, based on religion or belief (39). Box 5 identifies WHO technical packages for interpersonal violence. BOX 5. EVIDENCE-BASED INTERVENTIONS FOR THE PREVENTION AND RESPONSE TO INTERPERSONAL VIOLENCE AGAINST WOMEN AND CHILDREN Violence is preventable, and its impacts can be reduced. Interventions to address violence are delivered as part of a four-step public health approach that includes: 1) defining the problem; 2) identifying causes and risk factors; 3) designing and testing interventions; and 4) increasing the scale of effective interventions. Strategies and action are needed to address the underlying causes of violence, such as low levels of education, harsh and inconsistent parenting, concentrated poverty, unemployment and social norms supportive of violence. These strategies can be implemented at community and societal levels. WHO, in partnership with other United Nations agencies and international and national organizations, has developed technical packages to address violence prevention INSPIRE: seven strategies for ending violence against children (40) is an evidence-based technical package to support countries in their efforts to prevent and respond to violence against children aged 0–17 years. The package includes the core document describing what the INSPIRE strategies and interventions are, an implementation handbook that provides details on how to implement the interventions, and a set of indicators to measure the uptake of INSPIRE and its impact on levels of violence against children. RESPECT women: preventing violence against women (41) is a framework aimed at providing policy-makers and health implementers with a set of action-oriented steps to design, plan, implement, monitor and evaluate interventions and programmes using seven strategies to prevent violence against women. The strategies are summarized in the acronym RESPECT, with each letter representing one strategy. VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 25 VIOLENCE AND INJURIES Violence and injury prevention has also received policy priority in the WHO European Region through: the WHO Regional Committee for Europe resolution EUR/RC55/R9 on preventing injuries in the European Region (42); the European Council recommendation on the prevention of injury and promotion of safety (43); the European child maltreatment prevention action plan 2015–2020 (44); resolution EUR/RC64/R6 on investing in children: the European child and adolescent health strategy and the European child maltreatment prevention action plan 2015–2020 (45); the strategy on women’s health and well-being in the Region (46,47); the strategy on the health and well-being of men in the Region (48); the strategy and action plan for healthy ageing in Europe for 2012–2020 (49); the action plan for sexual and reproductive health: towards achieving the 2030 Agenda for Sustainable Development in Europe – leaving no one behind (50); the European policy framework for health and well-being, Health 2020 (51); and the Minsk Declaration on the life-course approach (52). Many of these initiatives correspond with the overarching policy framework for Europe, Health 2020 (51), which focuses on four priority areas: investing in health through a life-course approach and empowering people; tackling Europe’s major health challenges; strengthening people-centred health systems; and creating resilient communities and supportive environments. The initiatives emphasize violence and injuries as public health priorities, providing a policy platform from which a more systematic and coordinated approach towards violence and injury prevention can be implemented at national and local levels. Effective violence and injury prevention is a shared responsibility among a wide range of policy domains. While there is a clear public health component in violence and injury prevention, other policy domains and sectors, including transport, internal affairs, welfare, education and justice, have to work in close partnership to prevent violence and injury. Violence and injury prevention requires a whole-of-government and multisectoral approach at local, regional and national levels. SDG target 17 to “encourage and promote effective public, public–private and civil society partnerships” provides a platform for accomplishing commitments on violence and injury prevention made by Member States. While each sector has a specific role in violence and injury prevention, the health sector can not only provide care and support for victims, but can also collect data on non-fatal injuries of people attending emergency departments and those who are admitted to hospital. Data on non-fatal injuries, together with mortality data, can provide a complete picture of the magnitude of violence and injury and support prevention initiatives, resulting in cost savings to the health sector relative to the costs of data collection (53). Interventions to prevent violence and injuries Prevention can only be achieved if evidence-based interventions are implemented effectively through systematic and organized approaches. Evidence has been collated systematically in a series of European and world reports on preventing violence and injuries (4,14,53–60). WHO 26 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION also has a wide catalogue of technical packages and evidence-based interventions to prevent injuries, including for violence against children (40,61–65), road safety (13), violence against women (41,66), falls (19), drowning (16) and suicide prevention (67). Sustained investments in safe environments (such as road and housing design) and products (like childproof lighters and packaging for medications), together with safety-for-all strategies through, for example, the use of legislation, regulation, enforcement and education for behaviour modification and skills development have proven to be effective and have allowed many countries in the Region to continue to reduce violence and injury-related deaths. Effective prevention strategies for intentional injuries, particularly those due to violence, include developing safe, stable and nurturing relationships between children and their parents, developing life skills in children and adolescents, reducing the availability and harmful use of alcohol, reducing access to guns, knives and pesticides, promoting gender equality to prevent violence against women, changing cultural and social norms that support violence, and ensuring victim identification, care and support programmes (40,57,58,65). Many of these initiatives have proven cost–effective compared to the cost of doing nothing (Table 8). The development of the SDGs and subsequent Region-wide agreement to adopt the 17 goals and 168 targets have provided a useful framework that countries can use to prevent violence and injuries. The SDGs highlight the importance to prevention of intersectoral collaboration to modify the social, economic, environmental and political determinants and risk factors for violence and injuries. It is imperative that countries developing a prevention strategy do so through this whole-of-society approach (5,42). €1 invested in Savings (€) Smoke alarms 69 Random breath-testing of drivers for alcohol 36 Child safety seats 32 Bicycle helmets 29 Home visits and parent education against child abuse 19 Upgrading marked pedestrian crossings 14 Road lighting 11 Alcohol limit of less than 0.02 g/dl for novice drivers 11 Prevention counselling by paediatricians 10 Driving-license suspension for drink–driving 9 Speed cameras 9 Poison-control services 7 Use of daytime driving lights 4 Road design and upgrading 3 Source: Sethi et al. (3,4,59,60); Peden et al. (58). Table 8. Cost–effectiveness of selected violence and injury-prevention interventions VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 27 VIOLENCE AND INJURIES Implementation of evidence-informed strategies has been distributed unequally across the Region, as testified by the differences in violence and injury mortality and burden highlighted in this briefing. The SDGs can provide practitioners and policy-makers with a renewed impetus to take forward violence and injury prevention through developing policies and programmes. The evidence presented in this policy briefing shows that while progress is being made, the burden of death and disability from injuries in the Region remains high, and inequalities between MICs and HICs have widened for children. This calls for stronger public health action. An opportunity for exchanging expertise among Member States to facilitate implementation of evidence-based prevention programmes now exists.

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Updated reprint 2014. Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/en/publications/abstracts/review-of-social-determinants-and-the-health-divide- in-the-who-european-region.-final-report). 23. Vienonen MA, Jousilahti PJ, Mackiewicz K, Oganov RG, Pisaryk VM, Denissov GR et al. Preventable premature deaths (PYLL) in Northern Dimension partnership countries 2003–13. Eur J Public Health 2019;29(4):623–30. doi:10.1093/eurpub/cky278. 24. McKee M, Zwi A, Koupilova I, Sethi D, Leon D. Health policy making in central and eastern Europe: lessons from inaction on injuries. Health Policy Plan. 2000;15:263–9. 25. Mortality indicator database: mortality indicators by 67 causes of death, age and sex (HFA-MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2016 (http://data.euro.who.int/hfamdb/). 26. Sengoelge M, Leithaus M, Braubach M, Laflamme L. Are there changes in inequalities in injuries? A review of evidence in the WHO European Region. Int J Environ Res Public Health 2019;16(4):653. doi:10.3390/ijerph16040653. 27. Gopfert A, Sethi D, Rakovac I, Mitis F. Growing inequalities in child injury deaths in Europe. Eur J Public Health 2015;25:660–2. VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 31 REFERENCES 28. Zambon F, Loring B. Injuries and inequities. Guidance for addressing inequities in unintentional injuries. Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2014/injuries-and- inequities.-guidance-for-addressing-inequities-in-unintentional-injuries-2014). 29. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/ health-topics/disease-prevention/violence-and-injuries/publications/2020/european-regional-status-report-on-road-safety-2019). 30. Injuries in the European Union. Summary of injury statistics for the years 2013–2015. Amsterdam: European Association for Injury Prevention and Safety Promotion (EuroSafe); 2017 (http://www.eurosafe.eu.com/uploads/inline-files/IDB%202013-2015_suppl%20to%206th%20 edition%20Injuries%20in%20the%20EU.pdf). 31. Injury data collection: an effective tool for helping to cut the societal costs of injuries. Amsterdam: European Association for Injury Prevention and Safety Promotion (EuroSafe); 2013 (http://www.eurosafe.eu.com/uploads/inline-files/IDB%20as%20effective%20tool%20for%20 cost%20saving%20measures.pdf). 32. Resolution adopted by the General Assembly. 55/2. United Nations Millennium Declaration. New York (NY): United Nations; 2000 (A/ RES/55/2; https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_RES_55_2.pdf). 33. Resolution WHA67.15. Strengthening the role of the health system in addressing violence, in particular against women and girls, and against children. In: Sixty-seventh World Health Assembly, Geneva, 24 May 2014. Geneva: World Health Organization; 2014 (http://apps.who.int/gb/ ebwha/pdf_files/WHA67/A67_R15-en.pdf?ua=1). 34. Global plan of action to strengthen the role of the health system within a multisectoral response to address interpersonal violence, in particular against women and girls, and against children. Geneva: World Health Organization; 2016 (http://www.who.int/reproductivehealth/ publications/violence/global-plan-of-action/en/). 35. Resolution WHA 69.7. Addressing the challenges of the United Nations Decade of Action for Road Safety (2011–2020): outcome of the second Global High-level Conference on Road Safety – Time for Results. Geneva: World Health Organization; 2016 (http://apps.who.int/gb/ebwha/ pdf_files/WHA69/A69_R7-en.pdf?ua=1&ua=1). 36. World Health Assembly resolution WHA 64.27 on child injury prevention. Geneva: World Health Organization; 2011 (http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R27-en.pdf). 37. Resolution adopted by the General Assembly on 15 April 2016. 70/260. Improving global road safety. New York (NY): United Nations; 2016 (A/RES/70/260; https://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/70/260&referer=/english/&Lang=E). 38. Resolution adopted by the General Assembly on 19 December 2016. 71/170. Intensification of efforts to prevent and eliminate all forms of violence against women and girls: domestic violence. New York (NY): United Nations; 2017 (A/RES/71/170; https://digitallibrary.un.org/ record/858763/files/A_RES_71_170-EN.pdf). 39. Resolution adopted by the General Assembly on 19 December 2016. 71/195. Combating intolerance, negative stereotyping, stigmatization, discrimination, incitement to violence and violence against persons, based on religion or belief. New York (NY): United Nations; 2017 (A/ RES/71/195; https://digitallibrary.un.org/record/1474805?ln=en). 40. INSPIRE: seven strategies for ending violence against children. Geneva: World Health Organization; 2016 (https://www.who.int/violence_injury_prevention/violence/inspire/en/). 41. RESPECT women: preventing violence against women. Geneva: World Health Organization; 2019 (https://www.who.int/reproductivehealth/publications/preventing-vaw-framework-policymakers/en/). 42. WHO Regional Committee for Europe resolution EUR/RC55/R9 on prevention of injuries in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2005 (http://www.euro.who.int/__data/assets/pdf_file/0017/88100/RC55_eres09.pdf). 43. European Council. Council recommendation of 31st May 2007 on the prevention of injury and promotion of safety. OJ C 164, 18.7, p. 1–2 (https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A32007H0718%2801%29). 44. WHO Regional Committee for Europe resolution EUR/RC64/13 on investing in children: the European child maltreatment prevention action plan 2015–2020. Copenhagen: WHO Regional Office for Europe; 2014 (http://www.euro.who.int/en/about-us/governance/regional- committee-for-europe/past-sessions/64th-session/documentation/working-documents/eurrc6413-investing-in-children-the-european-child- maltreatment-prevention-action-plan-20152020). 45. WHO Regional Committee for Europe resolution EUR/RC64/R6 on investing in children: the European child and adolescent health strategy and the European child maltreatment prevention action plan 2015–2020. Copenhagen: WHO Regional Office for Europe; 2015 (http://www. euro.who.int/en/about-us/governance/regional-committee-for-europe/past-sessions/64th-session/documentation/resolutions/eurrc64r6- investing-in-children-the-european-child-and-adolescent-health-strategy-and-the-european-child-maltreatment-prevention-action- plan-20152020). 46. WHO Regional Committee for Europe resolution EUR/RC66/14 on a strategy on women’s health and well-being in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/about-us/governance/regional-committee-for-europe/ past-sessions/66th-session/documentation/working-documents/eurrc6614-strategy-on-womens-health-and-well-being-in-the-who- european-region). 47. Strategy on women’s health and well-being in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/health-determinants/gender/publications/2016/strategy-on-womens-health-and-well-being-in- the-who-european-region-2016). 32 48. Strategy on the health and well-being of men in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/health-topics/health-determinants/gender/publications/2018/strategy-on-the-health-and-well-being-of- men-in-the-who-european-region-2018). 49. WHO Regional Committee for Europe resolution EUR/RC62/10 Rev. 1 on a strategy and action plan for healthy ageing in Europe, 2012–2020. Copenhagen: WHO Regional Office for Europe; 2012 (http://www.euro.who.int/en/health-topics/Life-stages/healthy-ageing/ publications/2012/eurrc6210-rev.1-strategy-and-action-plan-for-healthy-ageing-in-europe,-20122020). 50. Action plan for sexual and reproductive health. Towards achieving the 2030 Agenda for Sustainable Development in Europe – leaving no one behind. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/Life-stages/sexual-and- reproductive-health/publications/2016/action-plan-for-sexual-and-reproductive-health-towards-achieving-the-2030-agenda-for- sustainable-development-in-europe-leaving-no-one-behind-2016). 51. Health 2020: a European policy framework and strategy for the 21st century. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/en/publications/policy-documents/health-2020.-a-european-policy-framework-and-strategy-for-the-21st- century-2013). 52. WHO Regional Committee for Europe resolution EUR/RC66/R3 on the Minsk Declaration on the Life-course Approach in the Context of Health 2020. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/__data/assets/pdf_file/0009/319095/66rs03e_Rev1_ MinskDeclaration_160761.pdf?ua=1). 53. Reports. In: EuroSafe [website]. Amsterdam: European Association for Injury Prevention and Safety Promotion (EuroSafe); 2019 (http://www.eurosafe.eu.com/key-actions/injury-data/reports). 54. World report on road traffic injury prevention. Geneva: World Health Organization; 2004 (http://www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/). 55. World report on violence and health. Geneva: World Health Organization; 2002 (http://www.who.int/violence_injury_prevention/violence/world_report/en/). 56. Sethi D, Bellis M, Hughes K, Gilbert R, Mitis F, Galea G. European report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2013 (http://www.euro.who.int/en/publications/abstracts/european-report-on-preventing-child-maltreatment-2013). 57. Violence prevention, the evidence. Geneva: World Health Organization; 2010 (http://www.who.int/violence_injury_prevention/violence/4th_ milestones_meeting/publications/en/). 58. Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, Fazlur Rahman AKM et al. World report on child injury prevention. Geneva: World Health Organization and UNICEF; 2008 (http://www.who.int/violence_injury_prevention/child/injury/world_report/report/en/). 59. Sethi D. Policy briefing: the role of public health in injury prevention. Copenhagen: WHO Regional Office for Europe; 2007 (http://www.euro.who.int/__data/assets/pdf_file/0010/98803/Policy_briefing_1.pdf). 60. Sethi D, Towner E, Vincenten J, Segui-Gomez M, Racioppi F. European report on child injury prevention. Copenhagen: WHO Regional Office for Europe; 2008 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/pre-2009/european-report- on-child-injury-prevention). 61. School-based violence prevention: a practical handbook. Geneva: World Health Organization; 2019 (https://apps.who.int/iris/handle/10665/324930). 62. Responding to children and adolescents who have been sexually abused: WHO clinical guidelines. Geneva: World Health Organization; 2017 (https://www.who.int/reproductivehealth/publications/violence/clinical-response-csa/en/). 63. Handbook on developing national action plans to prevent child maltreatment. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2016/handbook-on-developing-national- action-plans-to-prevent-child-maltreatment-2016). 64. Measuring and monitoring national prevalence of child maltreatment: a practical handbook. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2016/measuring-and-monitoring- national-prevalence-of-child-maltreatment-a-practical-handbook-2016). 65. Hardcastle K, Bellis M, Hughes K, Sethi D. Implementing child maltreatment prevention programmes: what the experts say. Copenhagen: WHO Regional Office for Europe; 2015 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/ publications/2015/implementing-child-maltreatment-prevention-programmes-what-the-experts-say-2015). 66. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva: World Health Organization; 2010 (https://www.who.int/violence_injury_prevention/violence/activities/intimate/en/). 67. Suicide prevention: toolkit for engaging communities. Geneva: World Health Organization; 2018 (https://www.who.int/publications-detail/suicide-prevention-toolkit-for-engaging-communities). All weblinks accessed 1 March 2020. VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION COUNTRY PROFILES VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION The following 50 country profiles provide key indicators to assess national progress on prevention of violence and injury. The profiles are preceded by a regional overview. Data reported for populations in the country profiles were extracted from the United Nations Population Division database for the year 2016 (1), while gross national income (GNI) per capita for 2016 came from World Bank estimates (2). The 2016 data from these sources have been extracted to align with the latest available 2016 data from the Global Health Estimates, from which the analyses of this briefing has been conducted. The World Bank Atlas method was used to categorize GNI into bands: • low income = US$ 1005 or less • middle income = US$ 1006–12 235 • high income = US$ 12 236 or more. Where data have been available, the country profiles present selected information and data on country situations for road safety and child maltreatment prevention, in addition to the country profiles on violence and injury prevention. All information is based on 2016 data that came from surveys conducted with the support of government- appointed national data coordinators for each participating country. The method comprised a four-stage process which encompassed: 1) a self-administered questionnaire, completed by representatives from relevant government ministries; 2) a multisectoral consultation to identify which data most accurately represented the country; 3) validation of final data submitted by each participating country by WHO regional technical staff; and 4) approval from government officials. In 2016, 51 of the 53 Member States of the WHO European Region participated in the data collection for the Global status report on road safety 2018, which was published in December 2018 (3). The European regional status report on road safety 2019 analysed the reported 2016 data and concluded that road-traffic injuries are still a major health challenge in the WHO European Region and that the United Nations Sustainable Development Goal target 3.6 to halve road deaths and injuries by 2020 will not be met without drastic action (4). Selected core information on the comprehensiveness of legislation on established behavioural risk factors of speeding, drink–driving, not using seat belts, motorcycle helmets and child car restraints, and self-reported enforcement ratings are provided. In 2017, 49 Member States from the Region participated in the survey for the European status report on preventing child maltreatment (5). The report served as a mid-term review for Investing in children: the European child maltreatment prevention action plan 2015–2020 (6). Findings from the report indicated that the Region is on track to meet the target of reducing the prevalence of child maltreatment in the Region by 20% by 2020. The country profiles provide an overview of existing programmes for child maltreatment prevention, enactment and enforcement of laws relevant to child maltreatment prevention, detection and response services for victims of violence in the health, social and legal sectors as well as capacity development activities through training of professionals. References 1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/ development/desa/publications/world-population-prospects-the- 2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/ articles/906519-world-bank-country-and-lending-groups). 3. Global status report on road safety 2018. Geneva: World Health Organization; 2018 (https://www.who.int/violence_injury_ prevention/road_safety_status/2018/en/). 4. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who. int/en/health-topics/disease-prevention/violence-and-injuries/ publications/2020/european-regional-status-report-on-road- safety-2019). 5. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/health-topics/Life-stages/child-and- adolescent-health/publications/2018/european-status-report-on- preventing-child-maltreatment-2018). 6. Investing in children: the European child maltreatment prevention action plan 2015–2020. Copenhagen: WHO Regional Office for Europe; 2015 (http://www.euro.who.int/en/about-us/governance/ regional-committee-for-europe/past-sessions/64th-session/ documentation/working-documents/eurrc6413-investing-in- children-the-european-child-maltreatment-prevention-action- plan-20152020). 1 All weblinks accessed 1 March 2020. 34 Sources: all data sources came from 2016 WHO Global Health Estimates (WHO (2019). Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization (http://www.who.int/healthinfo/global_burden_disease/estimates/en/index1.html)) unless otherwise stated. Leading causes of death in the WHO European Region Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Interpersonal violence Natural disasters Other unintentional injuriesa Poisonings Road injury Self-harm Fire, heat and hot substances 6 29 17 23 5 3 1 16 Deaths (%) Rank Cause of death YLL All causes 192 483 056 1 Cardiovascular diseases 67 143 725 2 Malignant neoplasms 48 784 557 3 Unintentional injuries 11 169 539 4 Digestive diseases 10 073 080 5 Neurological conditions 8 307 880 6 Intentional injuries 7 462 986 7 Respiratory diseases 7 225 552 8 Infectious and parasitic diseases 6 133 051 9 Respiratory infectious 5 239 344 10 Mental and substance-use disorders 4 215 419 No te : t hr ee -y ea r m ov in g av er ag es . S ou rce : E ur op ea n m or ta lit y d at ab as e (M DB ) [ on lin e da ta ba se ]. Co pe nh ag en : W HO R eg io na l O  ce fo r E ur op e; 2 01 9 (h ttp s:/ /g at ew ay .e ur o. w ho .in t/ en /d at as et s/ eu ro pe an -m or ta lit y- da ta ba se /) . 0 20 40 60 80 100 120 140 160 180 Year 33% St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 Commonwealth of Independent States European Union European Region Linear trendline Population 916 165 618 WHO EUROPEAN REGION a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in the WHO European Region, 2016 Trends in violence and injury deaths (0–64 years) Other causes of deathIntentional injuries Unintentional injuries 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 0 10 20 30 40 50 60 70 80 90 100 3.1 : 1 2.3 : 1 1.4 : 1 2.1 : 1 4.5 : 1 3.8 : 1 2.8 : 1 2.4 : 1 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 0 1 2 3 4 5 6 Male-to-female mortality ratios in the WHO European Region, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in the WHO European Region, 2016 (%) Violence and injury proportion by years of life lost (YLL) in the WHO European Region, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 23 805 Road injury 2 206 Self-harm 21 522 Ischaemic heart disease 62 700 Ischaemic heart disease 147 778 Ischaemic heart disease 306 723 Ischaemic heart disease 1 821 402 Ischaemic heart disease 2 342 283 2 Congenital heart anomalies 11 688 Drowning 1 434 Road injury 18 557 Self-harm 48 904 Trachea, bronchus, lung cancers 69 550 Trachea, bronchus, lung cancers 131 898 Stroke 784 213 Stroke 986 364 3 Lower respiratory infections 10 578 Lower respiratory infections 1 270 Drug use disorders 6 773 HIV/AIDS 37 932 Stroke 53 506 Stroke 121 560 Alzheimer's disease and other dementias 464 861 Alzheimer's disease and other dementias 480 863 4 Birth asphyxia and birth trauma 10 403 Leukaemia 1 206 Interpersonal violence 5 743 Cirrhosis of the liver 37 547 Cirrhosis of the liver 44 050 Colon and rectum cancers 57 584 COPD a 280 356 Trachea, bronchus, lung cancers 419 231 5 Other congenital anomalies 9 393 Brain and nervous system cancers 1 107 Other unintentional injuries b 5 667 Road injury 25 398 Breast cancer 27 844 COPD a 46 835 Other circulatory diseases 278 746 COPD a 348 870 6 Other neonatal conditions 5 842 Other unintentional injuries b 907 HIV/AIDS 4 435 Stroke 24 255 Colon and rectum cancers 26 971 Cirrhosis of the liver 45 983 Trachea, bronchus, lung cancers 200 021 Other circulatory diseases 341 605 7 Neonatal sepsis and infections 5 000 Other neurological conditions 798 Drowning 3 983 Cardiomyopathy, myocarditis, endocarditis 23 471 Self-harm 25 626 Breast cancer 36 534 Lower respiratory infections 175 962 Colon and rectum cancers 264 536 8 Diarrhoeal diseases 3 392 Other malignant neoplasms 772 Ischaemic heart disease 3 619 Alcohol use disorders 20 131 Cardiomyopathy, myocarditis, endocarditis 21 260 Stomach cancer 35 348 Colon and rectum cancers 169 443 Lower respiratory infections 244 927 9 Other unintentional injuries b 2 431 Congenital heart anomalies 655 Lower respiratory infections 3 286 Drug-use disorders 17 576 Stomach cancer 20 095 Other circulatory diseases 34 106 Diabetes mellitus 133 959 Diabetes mellitus 179 284 10 Sudden infant death syndrome 1 972 Self-harm 649 Cardiomyopathy, myocarditis, endocarditis 3 253 Trachea, bronchus, lung cancers 17107 Alcohol-use disorders 17 666 Pancreas cancer 31 679 Hypertensive heart disease 130 142 Cirrhosis of the liver 177 465 11 Other chromosomal anomalies 1 671 Other congenital anomalies 529 Cirrhosis of the liver 3 123 Other unintentional injuries b 16 979 Other malignant neoplasms 17166 Other malignant neoplasms 29 287 Kidney diseases 110 591 Breast cancer 164 577 12 Other infectious diseases 1 602 Epilepsy 477 Falls 2 600 Breast cancer 16 684 Other circulatory diseases 16 328 Diabetes mellitus 27 329 Prostate cancer 97 416 Hypertensive heart disease 157 039 13 Other neoplasms 1 296 Other endocrine, blood and immune disorders 452 Other malignant neoplasms 2 515 Lower respiratory infections 16 162 Lower respiratory infections 15 948 Lower respiratory infections 21 721 Breast cancer 83 137 Stomach cancer 141 488 14 Neural tube defects 1 257 Exposure to mechanical forces 381 Stroke 2 417 Interpersonal violence 13 181 COPD a 15 771 Cardiomyopathy, myocarditis, endocarditis 21 336 Other digestive diseases 76 528 Cardiomyopathy, myocarditis, endocarditis 141 195 15 Other endocrine, blood and immune disorders 1 227 Lymphomas, multiple myeloma 379 Exposure to mechanical forces 2 297 Other circulatory diseases 10 364 Pancreas cancer 15 031 Liver cancer 20 736 Stomach cancer 76 219 Self-harm 141 089 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 6.7 (7189) 37.4 (6 865) 49.4 (62 849) 23.0 (131 084) 9.0 (72 222) 4.3 (58 401) 2.5 (154 861) 5.4 (493 471) 35 Albania European Region Rank Cause of death YLL % % All causes 574 948 1 Cardiovascular diseases 260 730 45.3 34.9 2 Malignant neoplasms 136 135 23.7 25.3 3 Unintentional injuries 34 550 6.0 5.8 4 Neurological conditions 22 596 3.9 4.3 5 Respiratory diseases 15 074 2.6 3.8 6 Neonatal conditions 14 901 2.6 2.2 7 Intentional injuries 14 810 2.6 3.9 8 Digestive diseases 13 900 2.4 5.2 9 Congenital anomalies 13 407 2.3 1.5 10 Respiratory infectious 11 670 2.0 2.7 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuriesa Natural disasters Interpersonal violence Poisonings Road injury Self-harm 4 17 12 39 1 11 7 2 7 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 94 Road injury 13 Road injury 100 Ischaemic heart disease 246 Ischaemic heart disease 530 Ischaemic heart disease 927 Ischaemic heart disease 5 676 Ischaemic heart disease 7 418 2 Congenital heart anomalies 89 Lower respiratory infections 8 Self-harm 47 Road injury 110 Stroke 221 Stroke 549 Stroke 4 584 Stroke 5 491 3 Lower respiratory infections 47 Stroke 8 Ischaemic heart disease 35 Stroke 106 Trachea, bronchus, lung cancers 187 Trachea, bronchus, lung cancers 332 Alzheimer's disease and other dementias 1 070 Trachea, bronchus, lung cancers 1 144 4 Birth asphyxia and birth trauma 32 Congenital heart anomalies 8 Interpersonal violence 32 Breast cancer 81 Stomach cancer 129 Stomach cancer 191 Other circulatory diseases 871 Other circulatory diseases 1 132 5 Other congenital anomalies 25 Leukaemia 7 Other malignant neoplasms 21 Stomach cancer 65 Other malignant neoplasms 109 Other malignant neoplasms 162 Trachea, bronchus, lung cancers 567 Alzheimer's disease and other dementias 1 122 6 Other neonatal conditions 23 Epilepsy 6 Stroke 20 Self-harm 58 Brain and nervous system cancers 87 Other circulatory diseases 136 COPDa 523 Stomach cancer 733 7 Other unintentional injuries b 15 Drowning 4 Leukaemia 16 Other malignant neoplasms 58 Breast cancer 86 Brain and nervous system cancers 82 Cardiomyopathy, myocarditis, endocarditis 462 Other malignant neoplasms 661 8 Exposure to mechanical forces 14 Cardiomyopathy, myocarditis, endocarditis 4 Other unintentional injuries b 14 Brain and nervous system cancers 47 Other circulatory diseases 72 Liver cancer 81 Stomach cancer 340 COPDa 624 9 Sudden infant death syndrome 13 Other neurological conditions 4 Brain and nervous system cancers 12 Trachea, bronchus, lung cancers 46 Road injury 67 Cirrhosis of the liver 77 Other malignant neoplasms 310 Cardiomyopathy, myocarditis, endocarditis 622 10 Neonatal sepsis and infections 13 Other unintentional injuries b 4 Kidney diseases 11 Interpersonal violence 44 Cirrhosis of the liver 66 Kidney diseases 74 Lower respiratory infections 299 Kidney diseases 438 11 Road injury 9 Trachea, bronchus, lung cancers 3 Epilepsy 11 Cirrhosis of the liver 38 Other neoplasms 56 Other neoplasms 69 Kidney diseases 258 Lower respiratory infections 431 12 Neural tube defects 7 Other circulatory diseases 3 Exposure to mechanical forces 9 Kidney diseases 38 Kidney diseases 52 COPDa 68 Hypertensive heart disease 167 Road injury 415 13 Drowning 5 Encephalitis 3 Other circulatory diseases 9 Other circulatory diseases 37 Cardiomyopathy, myocarditis, endocarditis 47 Cardiomyopathy, myocarditis, endocarditis 67 Parkinson's disease 164 Cirrhosis of the liver 341 14 Meningitis 5 Exposure to mechanical forces 3 Cardiomyopathy, myocarditis, endocarditis 9 Cardiomyopathy, myocarditis, endocarditis 29 Liver cancer 42 Breast cancer 65 Cirrhosis of the liver 155 Breast cancer 322 15 Interpersonal violence 4 Kidney diseases 3 Drowning 8 Other neoplasms 27 Pancreas cancer 39 Pancreas cancer 65 Prostate cancer 151 Other neoplasms 303 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 11.6 (54) 27.5 (32) 46.7 (218) 20.6 (281) 7.1 (163) 2.9 (109) 1.1 (197) 4.0 (1 055) No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union AlbaniaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 53% Income group (2016) Upper-middle (2) Population (2016) 2 926 348 (1) Gross national income per capita (2016) US$ 4250 (2) ALBANIA Sources: all data sources came from 2016 WHO Global Health Estimates (4), unless otherwise stated. a C O PD : c hr on ic ob st ru ct iv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e An ne x fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 10 th re vi si on (I CD 10 ) c od es ). Leading causes of death in Albania, 2016 Proportion of violence and injury deaths by cause in Albania, 2016 (%) Trends in violence and injury deaths (0–64 years) in Albania Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 2.4 : 1 3.0 : 1 1.3 : 1 2.6 : 1 1.2 : 1 2.4 : 1 1.7 : 1 2.4 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Male-to-female mortality ratios in Albania, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Albania, 2016 (%) a P le as e re fe r t o th e An ne x fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l in ju rie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 10 th re vi si on (I CD 10 ) co de s) . Violence and injury proportion by years of life lost (YLL) in Albania, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . 36 Income group (2016) Upper-middle (2) Prevention of, and response to, violence against children in Albania, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➋ ➂ ➃ Parenting education YES ➀ ➋ ➂ ➃ Against statutory rape YES ➀ ➁ ➌ ➃ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➋ ➂ ➃ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation NO — School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment YES ➊ ➁ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➋ ➂ Source: WHO Regional Office for Europe (6). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 40 km/h Yes < 0.05 g/dl < 0.02 g/dl Yes Yes Yes No Yes Up to 4 years Yes Restricted Member States' reported enforcement effectivenessa 4/10 6/10 8/10 6/10 6/10 ALBANIA contd a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Behavioural risk-factor legislation and enforcement for road safety in Albania, 2017 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 14.8 34.6 Unintentional injuries, 2014a 14.4 31.8 Intentional injuries, 2014a 15.8 39.6 Road injuries, 2016b 32.9 37.7 Standardized mortality from alcohol-attributable disease and injury categories in Albania a Source: WHO Regional Office for Europe (7). b Source: WHO (8). 37 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 4 18 7 40 2 14 8 3 4 Armenia European Region Rank Cause of death YLL % % All causes 630 335 1 Cardiovascular diseases 208 757 33.1 34.9 2 Malignant neoplasms 205 529 32.6 25.3 3 Unintentional injuries 37 071 5.9 5.8 4 Digestive diseases 30 892 4.9 5.2 5 Diabete mellitus 23 911 3.8 1.7 6 Neonatal conditions 20 175 3.2 2.2 7 Respiratory diseases 17 892 2.8 3.8 8 Genitourinary diseases 15 433 2.4 1.6 9 Neurological conditions 15 193 2.4 4.3 10 Congenital anomalies 14 624 2.3 1.5 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 127 Road injury 16 Road injury 106 Ischaemic heart disease 233 Ischaemic heart disease 606 Ischaemic heart disease 1 034 Ischaemic heart disease 6 974 Ischaemic heart disease 8 860 2 Other congenital anomalies 70 Lower respiratory infections 7 Self-harm 29 Road injury 130 Other malignant neoplasms 383 Other malignant neoplasms 570 Stroke 1 616 Stroke 2 130 3 Congenital heart anomalies 60 Other unintentional injuries a 6 Other malignant neoplasms 22 Other malignant neoplasms 129 Trachea, bronchus, lung cancers 309 Trachea, bronchus, lung cancers 448 Alzheimer disease and other dementias 1 021 Other malignant neoplasms 2 006 4 Lower respiratory infections 53 Leukaemia 6 Interpersonal violence 16 Cirrhosis of the liver 82 Stroke 157 Stroke 301 Other malignant neoplasms 891 Trachea, bronchus, lung cancers 1 331 5 Birth asphyxia and birth trauma 44 Brain and nervous system cancers 5 Other unintentional injuries a 15 HIV/AIDS 78 Breast cancer 138 Diabetes mellitus 283 COPD b 858 Diabetes mellitus 1 093 6 Other neonatal conditions 28 Drowning 5 HIV/AIDS 15 Breast cancer 65 Cirrhosis of the liver 127 Breast cancer 150 Diabetes mellitus 659 Alzheimer disease and other dementias 1 058 7 Neonatal sepsis and infections 20 Congenital heart anomalies 4 Drowning 13 Trachea, bronchus, lung cancers 62 Diabetes mellitus 116 Cirrhosis of the liver 145 Cirrhosis of the liver 500 COPD b 1 018 8 Other unintentional injuries a 20 Other malignant neoplasms 4 Leukaemia 13 Self-harm 54 Stomach cancer 93 Colon and rectum cancers 141 Trachea, bronchus, lung cancers 500 Cirrhosis of the liver 861 9 Neural tube defects 11 Other congenital anomalies 4 Ischaemic heart disease 12 Stroke 52 Liver cancer 72 Stomach cancer 137 Other circulatory diseases 454 Other circulatory diseases 595 10 Leukaemia 7 Trachea, bronchus, lung cancers 2 Brain and nervous system cancers 9 Cervix uteri cancer 40 Colon and rectum cancers 72 Pancreas cancer 116 Hypertensive heart disease 445 Breast cancer 558 11 Paralytic ileus and intestinal obstruction 7 Exposure to mechanical forces 2 Lower respiratory infections 6 Diabetes mellitus 30 Pancreas cancer 69 Liver cancer 110 Colon and rectum cancers 291 Stomach cancer 543 12 Other infectious diseases 7 Falls 2 Trachea, bronchus, lung cancers 6 Brain and nervous system cancers 30 Road injury 68 COPD b 107 Other urinary diseases 284 Colon and rectum cancers 523 13 Road injury 7 Kidney diseases 2 Exposure to mechanical forces 6 Stomach cancer 30 Brain and nervous system cancers 63 Other circulatory diseases 82 Stomach cancer 280 Hypertensive heart disease 502 14 Other malignant neoplasms 6 Fire, heat and hot substances 1 Falls 5 Other unintentional injuries a 29 Kidney cancer 59 Bladder cancer 68 Kidney diseases 250 Liver cancer 449 15 Diarrhoeal diseases 6 Cirrhosis of the liver 1 Lymphomas, multiple myeloma 5 Interpersonal violence 26 COPD b 41 Prostate cancer 65 Liver cancer 241 Road injury 439 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 8.7 (46) 39.8 (34) 52.7 (197) 18.8 (279) 5.4 (165) 2.7 (128) 1.3 (239) 3.9 (1 089) No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 13% 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 Commonwealth of Independent States European Union ArmeniaEuropean Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Armenia, 2016 Proportion of violence and injury deaths by cause in Armenia, 2016 (%) Trends in violence and injury deaths (0–64 years) in Armenia Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 3.4 : 1 4.6 : 1 2.3 : 1 1.5 : 1 1.3 : 1 4.3 : 1 3.9 : 1 4.2 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Male-to-female mortality ratios in Armenia, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Armenia, 2016 (%) Violence and injury proportion by years of life lost (YLL) in Armenia, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Income group (2016) Lower-middle (2) Population (2016) 2 924 816 (1) Gross national income per capita (2016) US$ 3760 (2) ARMENIA38 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Armenia, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children NO ➊ ➁ ➂ ➃ Against female genital mutilation NO — School-based antibullying NO ➊ ➁ ➂ ➃ Reporting of suspected child maltreatment YES ➀ ➋ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➊ ➁ ➂ Prenatal risk assessment of violence against children NO Prenatal risk assessment of intimate-partner violence YES ➊ ➁ ➂ Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers YES ➊ ➁ ➂ Identification of victims and referral for support by health-care providers NO Response to violence against children Mental health services for victims NO Mental health services for victims YES ➊ ➁ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➋ ➂ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: Triple P (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Armenia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 29.0 34.6 Unintentional injuries, 2014a 27.5 31.8 Intentional injuries, 2014a 32.8 39.6 Road injuries, 2016b 35.7 37.7 Behavioural risk-factor legislation and enforcement for road safety in Armenia, 2017 NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 90 km/hr No ≤ 0.04 g/dl ≤ 0.04 g/dl Yes Yes Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 8/10 6/10 8/10 9/10 NA ARMENIA contd Income group (2016) Lower-middle (2) Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 39 Austria European Region Rank Cause of death YLL % % All causes 574 948 1 Malignant neoplasms 260 730 45.3 34.9 2 Cardiovascular diseases 136 135 23.7 25.3 3 Digestive diseases 34 550 6.0 5.8 4 Respiratory diseases 22 596 3.9 4.3 5 Unintentional injuries 15 074 2.6 3.8 6 Neurological conditions 14 901 2.6 2.2 7 Intentional injuries 14 810 2.6 3.9 8 Diabetes mellitus 13 900 2.4 5.2 9 Genitourinary diseases 13 407 2.3 1.5 10 Endocrine, blood, immune disorders 11 670 2.0 2.7 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 50 Brain and nervous system cancers 10 Self-harm 156 Self-harm 353 Ischaemic heart disease 647 Ischaemic heart disease 1 505 Ischaemic heart disease 17 071 Ischaemic heart disease 19 424 2 Other congenital anomalies 46 Other malignant neoplasms 9 Road injury 98 Ischaemic heart disease 196 Trachea, bronchus, lung cancers 589 Trachea, bronchus, lung cancers 1 271 Stroke 4 199 Stroke 4 749 3 Other neonatal conditions 34 Other neurological conditions 6 Drug use disorders 76 Cirrhosis of the liver 152 Cirrhosis of the liver 378 COPD a 526 Other circulatory diseases 4 066 Other circulatory diseases 4 616 4 Congenital heart anomalies 32 Other congenital anomalies 4 Other circulatory diseases 17 Breast cancer 140 Self-harm 309 Cirrhosis of the liver 468 COPD a 2 907 Trachea, bronchus, lung cancers 4 105 5 Birth asphyxia and birth trauma 31 Road injury 4 Other unintentional injuries b 14 Trachea, bronchus, lung cancers 105 Breast cancer 199 Colon and rectum cancers 390 Diabetes mellitus 2 887 COPD a 3 585 6 Other chromosomal anomalies 23 Self-harm 4 Other neurological conditions 13 Road injury 103 Pancreas cancer 194 Pancreas cancer 377 Alzheimer disease and other dementias 2 618 Diabetes mellitus 3 402 7 Neonatal sepsis and infections 10 Lower respiratory infections 3 Other malignant neoplasms 13 Drug use disorders 87 Colon and rectum cancers 189 Diabetes mellitus 374 Hypertensive heart disease 2 446 Alzheimer disease and other dementias 2 724 8 Down syndrome 10 Leukaemia 3 Other endocrine, blood and immune disorders 13 Colon and rectum cancers 83 Other circulatory diseases 146 Stroke 341 Trachea, bronchus, lung cancers 2 136 Hypertensive heart disease 2 572 9 Sudden infant death syndrome 7 Drowning 3 Leukaemia 10 Other unintentional injuries b 81 Mouth and oropharynx cancers 145 Breast cancer 313 Kidney diseases 1 797 Colon and rectum cancers 2 306 10 Other endocrine, blood and immune disorders 6 Other endocrine, blood and immune disorders 2 Congenital heart anomalies 9 Other endocrine, blood and immune disorders 80 COPD a 138 Other circulatory diseases 313 Colon and rectum cancers 1 642 Kidney diseases 1 899 11 Other malignant neoplasms 5 Other unintentional injuries b 2 Falls 9 Brain and nervous system cancers 78 Stroke 131 Other endocrine, blood and immune disorders 225 Cardiomyopathy, myocarditis, endocarditis 1 221 Breast cancer 1 761 12 Other neurological conditions 5 Other chromosomal anomalies 1 Cardiomyopathy, myocarditis, endocarditis 9 Other circulatory diseases 73 Other endocrine, blood and immune disorders 119 Mouth and oropharynx cancers 215 Prostate cancer 1 126 Pancreas cancer 1 737 13 Other unintentional injuries b 5 Interpersonal violence 1 Brain and nervous system cancers 8 Stroke 73 Brain and nervous system cancers 111 Liver cancer 206 Pancreas cancer 1 123 Cirrhosis of the liver 1 602 14 Other infectious diseases 4 Kidney cancer 1 Other congenital anomalies 8 Alcohol use disorders 60 Other malignant neoplasms 110 Lymphomas, multiple myeloma 199 Breast cancer 1 105 Cardiomyopathy, myocarditis, endocarditis 1 369 15 Drowning 2 Meningitis 1 Interpersonal violence 8 Other neurological conditions 54 Alcohol use disorders 107 Stomach cancer 172 Lower respiratory infections 1 015 Self-harm 1 363 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.0 (15) 22.5 (15) 53.8 (302) 25.0 (623) 10.9 (553) 4.9 (490) 3.5 (2 187) 5.2 (4 184) Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 11 33 10 1 31 1 1 21 Commonwealth of Independent States European Union AustriaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 26% No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Austria, 2016 (%) Trends in violence and injury deaths (0–64 years) in Austria Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 0 1 2 3 4 5 6 1.7 : 1 2.5 : 1 2.0 : 1 1.1 : 1 1.0 : 1 4.1 : 1 3.1 : 1 1.1 : 1 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Male-to-female mortality ratios in Austria, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Austria, 2016 (%) Violence and injury proportion by years of life lost (YLL) in Austria, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Leading causes of death in Austria, 2016 Income group (2016) High (2) Population (2016) 8 712 137 (1) Gross national income per capita (2016) US$ 45 230 (2) AUSTRIA No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . 40 AUSTRIA contd Income group (2016) High (2) a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Austria, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) – – Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children – – Prenatal risk assessment of violence against children – Prenatal risk assessment of intimate-partner violence – – Prenatal risk assessment of intimate-partner violence – Identification of victims and referral for support by health-care providers – – Identification of victims and referral for support by health-care providers – Response to violence against children Mental health services for victims – Mental health services for victims – – Child protection services for victims – Child protection services for victims – – Medicolegal services for victims – Medicolegal services for victims – – a Programmes: Early head-start (home visiting); Triple P (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Austria Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 38.7 34.6 Unintentional injuries, 2014a 37.8 31.8 Intentional injuries, 2014a 40.0 39.6 Road injuries, 2016b 39.8 37.7 Behavioural risk-factor legislation and enforcement for road safety in Austria, 2017 ND: no data. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.04 g/dl ≤ 0.01 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa ND ND ND ND ND Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 41 Azerbaijan European Region Rank Cause of death YLL % % All causes 1 955 290 1 Cardiovascular diseases 680 184 34.8 34.9 2 Malignant neoplasms 341 078 17.4 25.3 3 Neonatal conditions 229 112 11.7 2.2 4 Unintentional injuries 123 651 6.3 5.8 5 Digestive diseases 94 878 4.9 5.2 6 Infectious and parasitic diseases 93 215 4.8 3.2 7 Respiratory infectious 85 221 4.4 2.7 8 Congenital anomalies 72 268 3.7 1.5 9 Respiratory diseases 41 461 2.1 3.8 10 Diabetes mellitus 40 826 2.1 1.7 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 1 225 Lower respiratory infections 66 Road injury 222 Ischaemic heart disease 1 024 Ischaemic heart disease 2 772 Ischaemic heart disease 3 892 Ischaemic heart disease 15 555 Ischaemic heart disease 23 333 2 Birth asphyxia and birth trauma 755 Road injury 44 Other malignant neoplasms 112 Other malignant neoplasms 467 Other malignant neoplasms 1 143 Stroke 1 340 Stroke 4 646 Stroke 7 150 3 Lower respiratory infections 670 Drowning 26 Tuberculosis 98 Road injury 359 Stroke 862 Other malignant neoplasms 882 Alzheimer disease and other dementias 1 346 Other malignant neoplasms 3 547 4 Congenital heart anomalies 538 Leukaemia 25 Ischaemic heart disease 89 Cirrhosis of the liver 309 Cirrhosis of the liver 570 Cirrhosis of the liver 608 Cirrhosis of the liver 1 257 Cirrhosis of the liver 2 797 5 Neonatal sepsis and infections 389 Other malignant neoplasms 19 Interpersonal violence 74 Stroke 276 Trachea, bronchus, lung cancers 365 Diabetes mellitus 448 COPD a 1 051 COPD a 1 566 6 Diarrhoeal diseases 315 Other unintentional injuries b 18 Self-harm 56 Tuberculosis 241 Diabetes mellitus 330 Trachea, bronchus, lung cancers 347 Other malignant neoplasms 852 Diabetes mellitus 1 475 7 Other congenital anomalies 174 Epilepsy 17 Drowning 49 HIV/AIDS 182 Stomach cancer 243 Stomach cancer 317 Diabetes mellitus 570 Alzheimer disease and other dementias 1 431 8 Other neonatal conditions 125 Kidney diseases 13 Collective violence and legal intervention 49 Trachea, bronchus, lung cancers 141 Breast cancer 187 COPD a 268 Kidney diseases 446 Lower respiratory infections 1 390 9 Other unintentional injuries b 118 Congenital heart anomalies 13 Lower respiratory infections 46 Breast cancer 130 Road injury 181 Kidney diseases 169 Stomach cancer 430 Preterm birth complications 1 225 10 Other infectious diseases 98 Fire, heat and hot substances 11 Kidney diseases 44 Kidney diseases 106 COPD a 162 Liver cancer 169 Hypertensive heart disease 394 Trachea, bronchus, lung cancers 1 163 11 Leukaemia 85 Other endocrine, blood and immune disorders 9 Leukaemia 42 Diabetes mellitus 101 Kidney diseases 156 Oesophagus cancer 127 Other circulatory diseases 376 Stomach cancer 1 099 12 Fire, heat and hot substances 83 Exposure to mechanical forces 9 Cirrhosis of the liver 42 Brain and nervous system cancers 99 Tuberculosis 143 Colon and rectum cancers 112 Lower respiratory infections 326 Road injury 1.020 13 Other endocrine, blood and immune disorders 78 Meningitis 9 Epilepsy 40 Stomach cancer 99 Colon and rectum cancers 132 Breast cancer 106 Trachea, bronchus, lung cancers 265 Kidney diseases 965 14 Other malignant neoplasms 73 Encephalitis 7 Other unintentional injuries b 39 Self-harm 93 Brain and nervous system cancers 132 Lower respiratory infections 105 Parkinson disease 199 Birth asphyxia and birth trauma 755 15 Thalassaemias 65 Cardiomyopathy, myocarditis, endocarditis 7 Fire, heat and hot substances 31 Cardiomyopathy, myocarditis, endocarditis 90 Liver cancer 124 Road injury 97 Cardiomyopathy, myocarditis, endocarditis 185 Tuberculosis 620 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 6.4 (346) 31.7 (128) 37.1 (565) 16.6 (876) 4.9 (451) 2.3 (239) 0.9 (282) 4.6 (2 888) Leading causes of death in Azerbaijan, 2016 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 49 935 13 8 2 5 7 8 Commonwealth of Independent States European Union AzerbaijanEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 2% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Azerbaijan, 2016 (%) Trends in violence and injury deaths (0–64 years) in Azerbaijan Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 2.8 : 1 0 1 2 3 4 5 6 3.5 : 1 2.3 : 1 3.0 : 1 1.5 : 1 3.1: 1 3.9 : 1 3.7 : 1 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Male-to-female mortality ratios in Azerbaijan, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Azerbaijan, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Income group (2016) Upper-middle (2) Population (2016) 9 725 376 (1) Gross national income per capita (2016) US$ 4760 (2) AZERBAIJAN No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Azerbaijan, 2016 42 AZERBAIJAN contd Income group (2016) Upper-middle (2) a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Azerbaijan, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting — ➀ ➁ ➂ ➃ Ban on corporal punishment in all settings — ➀ ➁ ➂ ➃ Parenting education — ➀ ➁ ➂ ➃ Against statutory rape — ➀ ➁ ➂ ➃ Hospital-based parental training (abusive head trauma) — ➀ ➁ ➂ ➃ Against child marriage — ➀ ➁ ➂ ➃ Primary school-based empowering children — ➀ ➁ ➂ ➃ Against female genital mutilation — ➀ ➁ ➂ ➃ School-based antibullying — ➀ ➁ ➂ ➃ Reporting of suspected child maltreatment — ➀ ➁ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — ➀ ➁ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — ➀ ➁ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers — ➀ ➁ ➂ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims — ➀ ➁ ➂ Child protection services for victims — Child protection services for victims — ➀ ➁ ➂ Medicolegal services for victims — Medicolegal services for victims — ➀ ➁ ➂ Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Azerbaijan Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 18.5 34.6 Unintentional injuries, 2014a 17.6 31.8 Intentional injuries, 2014a 21.8 39.6 Road injuries, 2016b 14.3 37.7 Behavioural risk-factor legislation and enforcement for road safety in Azerbaijan, 2017 NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr No No No No Yes No Yes No No No Restricted Member States' reported enforcement effectivenessa 8/10 9/10 7/10 6/10 NA Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. Data not available Data not available Data not available Data not available 43 Belarus European Region Rank Cause of death YLL % % All causes 2 684 222 1 Cardiovascular diseases 1 333 128 49.7 34.9 2 Malignant neoplasms 488 352 18.2 25.3 3 Unintentional injuries 211 942 7.9 5.8 4 Intentional injuries 128 217 4.8 3.9 5 Digestive diseases 127 142 4.7 5.2 6 Mental and substance-use disorders 92 868 3.5 2.2 7 Infectious and parasitic diseases 88 524 3.3 3.2 8 Neurological conditions 67 095 2.5 4.3 9 Respiratory diseases 44 796 1.7 3.8 10 Respiratory infectious 29 660 1.1 2.7 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Congenital heart anomalies 91 Drowning 27 Self-harm 287 Ischaemic heart disease 1 529 Ischaemic heart disease 3 883 Ischaemic heart disease 8 497 Ischaemic heart disease 42 175 Ischaemic heart disease 56 130 2 Preterm birth complications 83 Road injury 19 Road injury 193 Self-harm 957 Stroke 1 229 Stroke 2 552 Stroke 9 721 Stroke 14 008 3 Other congenital anomalies 49 Congenital heart anomalies 9 HIV/AIDS 108 HIV/AIDS 888 Trachea, bronchus, lung cancers 826 Trachea, bronchus, lung cancers 1 155 Alzheimer disease and other dementias 3 811 Alzheimer disease and other dementias 3 980 4 Birth asphyxia and birth trauma 29 Brain and nervous system cancers 7 Drowning 103 Cirrhosis of the liver 621 Cirrhosis of the liver 721 Cirrhosis of the liver 675 Colon and rectum cancers 1 351 Trachea, bronchus, lung cancers 3 196 5 Lower respiratory infections 26 Other unintentional injuries a 7 Drug use disorders 97 Alcohol use disorders 491 Self-harm 572 Colon and rectum cancers 634 COPD b 1 279 Self-harm 2 488 6 Sudden infant death syndrome 16 Leukaemia 7 Falls 64 Stroke 487 Alcohol use disorders 416 Stomach cancer 591 Trachea, bronchus, lung cancers 1 068 Colon and rectum cancers 2 430 7 Other neonatal conditions 16 Self-harm 6 Interpersonal violence 62 Drug use disorders 448 HIV/AIDS 399 Other malignant neoplasms 454 Other circulatory diseases 976 Cirrhosis of the liver 2 412 8 Other unintentional injuries a 14 Falls 6 Other unintentional injuries a 57 Road injury 413 Stomach cancer 397 COPD b 412 Stomach cancer 958 Stomach cancer 2 099 9 Brain and nervous system cancers 9 Other congenital anomalies 5 Ischaemic heart disease 46 Other unintentional injuries a 344 Colon and rectum cancers 352 Breast cancer 355 Hypertensive heart disease 907 COPD b 1 929 10 Neonatal sepsis and infections 9 Fire, heat and hot substances 5 Alcohol use disorders 36 Falls 295 Other unintentional injuries a 341 Self-harm 335 Other malignant neoplasms 803 Other malignant neoplasms 1 624 11 Leukaemia 8 Other malignant neoplasms 5 Cirrhosis of the liver 34 Drowning 280 Breast cancer 327 Pancreas cancer 286 Prostate cancer 556 HIV/AIDS 1 517 12 Neural tube defects 8 Poisonings 5 Fire, heat and hot substances 22 Interpersonal violence 221 Mouth and oropharynx cancers 315 Mouth and oropharynx cancers 279 Parkinson disease 531 Hypertensive heart disease 1 325 13 Other infectious diseases 8 Exposure to mechanical forces 4 Cardiomyopathy, myocarditis, endocarditis 20 Lower respiratory infections 213 Other malignant neoplasms 277 Prostate cancer 257 Breast cancer 434 Other circulatory diseases 1 301 14 Other malignant neoplasms 6 Encephalitis 4 Stroke 18 Cardiomyopathy, myocarditis, endocarditis 186 Falls 252 Hypertensive heart disease 249 Other digestive diseases 418 Breast cancer 1 262 15 Other chromosomal anomalies 6 Lower respiratory infections 3 Lower respiratory infections 18 Fire, heat and hot substances 171 Road injury 246 Other unintentional injuries a 249 Pancreas cancer 406 Alcohol use disorders 1 230 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 8.8 (39) 56.1 (81) 57.2 (821) 29.1 (2 829) 13.5 (1 937) 6.2 (1 320) 1.7 (1 246) 7.0 (8 273) Leading causes of death in Belarus, 2016 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 9 30 8 14 3 6 14 14 2 44% Commonwealth of Independent States European Union BelarusEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Proportion of violence and injury deaths by cause in Belarus, 2016 (%) Trends in violence and injury deaths (0–64 years) in Belarus Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 4.0 : 1 3.0 : 1 3.9 : 1 3.1 : 1 2.9 : 1 5.7 : 1 5.7 : 1 2.8 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Male-to-female mortality ratios in Belarus, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Belarus, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Belarus, 2016 BELARUS Income group (2016) Upper-middle (2) Population (2016) 9 480 042 (1) Gross national income per capita (2016) US$ 5600 (2) 44 BELARUS contd a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Belarus, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES — Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation NO — School-based antibullying NO — Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Belarus Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 60.1 34.6 Unintentional injuries, 2014a 55.1 31.8 Intentional injuries, 2014a 67.8 39.6 Road injuries, 2016b 49.2 37.7 Behavioural risk-factor legislation and enforcement for road safety in Belarus, 2017 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr No ≤ 0.03 g/dl ≤ 0.03 g/dl Yes Yes Yes Yes Yes Up to 5 years Yes Restricted Member States' reported enforcement effectivenessa 7/10 8/10 8/10 8/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 45 Belgium European Region Rank Cause of death YLL % % All causes 1 893 048 1 Malignant neoplasms 592 689 31.3 25.3 2 Cardiovascular diseases 425 109 22.5 34.9 3 Neurological conditions 144 705 7.6 4.3 4 Respiratory diseases 128 474 6.8 3.8 5 Unintentional injuries 99 901 5.3 5.8 6 Digestive diseases 98 785 5.2 5.2 7 Intentional injuries 95 101 5.0 3.9 8 Respiratory infectious 72 725 3.8 2.7 9 Genitourinary diseases 36 844 1.9 1.6 10 Infectious and parasitic diseases 29 660 1.6 3.2 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 88 Brain and nervous system cancers 16 Self-harm 229 Self-harm 722 Trachea, bronchus, lung cancers 901 Trachea, bronchus, lung cancers 2 026 Ischaemic heart disease 12 758 Ischaemic heart disease 15 130 2 Other congenital anomalies 67 Road injury 13 Road injury 168 Ischaemic heart disease 246 Ischaemic heart disease 678 Ischaemic heart disease 1 439 Alzheimer disease and other dementias 8 357 Alzheimer disease and other dementias 8 606 3 Other neonatal conditions 56 Other endocrine, blood and immune disorders 8 Drug use disorders 44 Trachea, bronchus, lung cancers 182 Self-harm 513 COPD a 871 Stroke 6 420 Stroke 7 263 4 Birth asphyxia and birth trauma 50 Other neurological conditions 7 Other malignant neoplasms 28 Road injury 179 Cirrhosis of the liver 411 Colon and rectum cancers 613 Other circulatory diseases 5 755 COPD a 6 856 5 Congenital heart anomalies 44 Leukaemia 6 Other unintentional injuries b 26 Breast cancer 175 Breast cancer 334 Breast cancer 536 COPD a 5 674 Trachea, bronchus, lung cancers 6 790 6 Other chromosomal anomalies 30 Self-harm 5 Other neurological conditions 20 Cirrhosis of the liver 162 COPD a 263 Stroke 505 Lower respiratory infections 5 330 Other circulatory diseases 6 567 7 Sudden infant death syndrome 22 Fire, heat and hot substances 5 Interpersonal violence 18 Other circulatory diseases 121 Colon and rectum cancers 228 Other circulatory diseases 472 Trachea, bronchus, lung cancers 3 680 Lower respiratory infections 5 875 8 Lower respiratory infections 13 Other unintentional injuries b 5 Epilepsy 17 Stroke 103 Stroke 218 Cirrhosis of the liver 466 Colon and rectum cancers 2 359 Colon and rectum cancers 3 279 9 Neonatal sepsis and infections 13 Cardiomyopathy, myocarditis, endocarditis 4 Brain and nervous system cancers 17 Brain and nervous system cancers 95 Other circulatory diseases 202 Pancreas cancer 416 Kidney diseases 2 136 Breast cancer 2 573 10 Other unintentional injuries b 12 Epilepsy 4 Other circulatory diseases 15 Drug use disorders 92 Pancreas cancer 175 Lower respiratory infections 333 Other digestive diseases 1 698 Self-harm 2 351 11 Other endocrine, blood and immune disorders 11 Other malignant neoplasms 3 Other endocrine, blood and immune disorders 14 Alcohol use disorders 86 Mouth and oropharynx cancers 159 Self-harm 312 Other unintentional injuries b 1 524 Kidney diseases 2 325 12 Down syndrome 10 Drowning 3 Leukaemia 14 Other neurological conditions 84 Other neurological conditions 155 Other malignant neoplasms 295 Breast cancer 1 524 Other digestive diseases 2 201 13 Other neurological conditions 9 Interpersonal violence 3 Stroke 12 Other unintentional injuries b 84 Other malignant neoplasms 144 Other digestive diseases 291 Prostate cancer 1 462 Other unintentional injuries b 1 926 14 Other infectious diseases 8 Other congenital anomalies 3 Falls 11 Colon and rectum cancers 76 Other digestive diseases 143 Oesophagus cancer 279 Other neoplasms 1 444 Pancreas cancer 1 772 15 Meningitis 6 Stroke 3 Collective violence and legal intervention 10 Other malignant neoplasms 70 Alcohol use disorders 139 Liver cancer 246 Other respiratory diseases 1 415 Other neoplasms 1 701 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.5 (38) 33.1 (39) 59.0 (483) 31.2 (1 144) 12.8 (894) 5.7 (797) 4.3 (3 680) 6.4 (7 076) Leading causes of death in Belgium, 2016 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 1 1 33 1 10 27 24 2 Commonwealth of Independent States European Union BelgiumEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 21% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Belgium, 2016 (%) Trends in violence and injury deaths (0–64 years) in Belgium Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages 0 1 2 3 4 5 6 2.6 : 1 1.2 : 1 0.9 : 1 1.3 : 1 3.3 : 1 2.0 : 1 1.3 : 1 1.3 : 1 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Male-to-female mortality ratios in Belgium, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Belgium, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Belgium, 2016 BELGIUM Income group (2016) High (2) Population (2016) 11 358 379 (1) Gross national income per capita (2016) US$ 41 860 (2) 46 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Belgium, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings NOa — Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➌ ➃ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES — Primary school-based empowering children NO — Against female genital mutilation YES ➀ ➋ ➂ ➃ School-based antibullying — — Reporting of suspected child maltreatment NO — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers — — Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims — — Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➋ ➂ a Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Belgium Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 36.5 34.6 Unintentional injuries, 2014a 34.1 31.8 Intentional injuries, 2014a 39.8 39.6 Road injuries, 2016b 39.3 37.7 Behavioural risk-factor legislation and enforcement for road safety in Belgium, 2017 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 6/10 7/10 9/10 5/10 BELGIUM contd Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 47 Bosnia and Herzegovina European Region Rank Cause of death YLL % % All causes 762 021 1 Cardiovascular diseases 344 268 45.2 34.9 2 Malignant neoplasms 175 821 23.1 25.3 3 Diabetes mellitus 48 998 6.4 1.7 4 Unintentional injuries 34 467 4.5 5.8 5 Neurological conditions 31 181 4.1 4.3 6 Digestive diseases 29 992 3.9 5.8 7 Respiratory infectious 25 203 3.3 2.7 8 Intentional injuries 16 124 2.1 3.9 9 Genitourinary diseases 14 312 1.9 1.6 10 Neonatal conditions 9 313 1.2 2.2 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.0 : 1 3.4 : 1 1.4 : 1 2.9 : 1 1.6 : 1 1.6 : 1 3.9 : 1 2.9 : 1 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 64 Road injury 5 Road injury 89 Ischaemic heart disease 213 Ischaemic heart disease 675 Ischaemic heart disease 1 417 Ischaemic heart disease 8 436 Ischaemic heart disease 10 747 2 Congenital heart anomalies 34 Leukaemia 2 Self-harm 24 Road injury 129 Trachea, bronchus, lung cancers 366 Stroke 866 Stroke 5 534 Stroke 6 851 3 Other congenital anomalies 20 Other malignant neoplasms 2 Interpersonal violence 18 Stroke 107 Stroke 334 Trachea, bronchus, lung cancers 639 Alzheimer disease and other dementias 1 864 Diabetes mellitus 2 552 4 Birth asphyxia and birth trauma 19 Brain and nervous system cancers 2 Other unintentional injuries a 9 Self-harm 87 Diabetes mellitus 163 Diabetes mellitus 480 Diabetes mellitus 1 861 Alzheimer disease and other dementias 1 944 5 Lower respiratory infections 10 Epilepsy 1 Other malignant neoplasms 8 Breast cancer 64 Cirrhosis of the liver 142 COPD b 203 Other circulatory diseases 1 147 Trachea, bronchus, lung cancers 1 832 6 Neonatal sepsis and infections 9 Other unintentional injuries a 1 Stroke 7 Cirrhosis of the liver 62 Colon and rectum cancers 111 Other circulatory diseases 198 COPD b 1 029 Other circulatory diseases 1 464 7 Other neonatal conditions 9 Self-harm 1 Ischaemic heart disease 6 Trachea, bronchus, lung cancers 60 Breast cancer 107 Colon and rectum cancers 185 Trachea, bronchus, lung cancers 764 COPD b 1 309 8 Childhood-cluster diseases 4 Congenital heart anomalies 1 Leukaemia 6 Diabetes mellitus 45 Road injury 93 Cirrhosis of the liver 181 Cardiomyopathy, myocarditis, endocarditis 602 Colon and rectum cancers 806 9 Down syndrome 3 Interpersonal violence 1 Epilepsy 5 Other malignant neoplasms 43 Other malignant neoplasms 89 Stomach cancer 134 Colon and rectum cancers 484 Cardiomyopathy, myocarditis, endocarditis 797 10 Other unintentional injuries a 2 Lymphomas, multiple myeloma 1 Drug use disorders 4 Interpersonal violence 34 Other circulatory diseases 89 Pancreas cancer 133 Kidney diseases 441 Kidney diseases 654 11 Neural tube defects 2 Liver cancer 1 Lymphomas, multiple myeloma 4 Other unintentional injuries a 31 Stomach cancer 78 Liver cancer 125 Prostate cancer 316 Cirrhosis of the liver 579 12 Other chromosomal anomalies 2 Lower respiratory infections 1 Brain and nervous system cancers 4 Stomach cancer 28 Self-harm 66 Kidney diseases 123 Liver cancer 311 Road injury 564 13 Road injury 2 Drowning 1 Diabetes mellitus 3 Cardiomyopathy, myocarditis, endocarditis 28 Cardiomyopathy, myocarditis, endocarditis 65 Other malignant neoplasms 117 Hypertensive heart disease 280 Other malignant neoplasms 531 14 Other malignant neoplasms 1 Stomach cancer 1 Kidney diseases 3 Other circulatory diseases 28 COPD b 63 Breast cancer 115 Other malignant neoplasms 271 Liver cancer 510 15 Leukaemia 1 Stroke 1 Cardiomyopathy, myocarditis, endocarditis 3 Alcohol use disorders 25 Kidney diseases 61 Cardiomyopathy, myocarditis, endocarditis 98 Lower respiratory infections 266 Stomach cancer 496 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 3.1 (6) 39.6 (10) 61.2 (150) 22.6 (317) 7.6 (249) 3.8 (238) 1.7 (446) 3.7 (1 417) Leading causes of death in Bosnia and Herzegovina, 2016 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 2 22 8 40 1 12 9 3 3 Commonwealth of Independent States European Union Bosnia and Herzegovina European Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Bosnia and Herzegovina, 2016 (%) Trends in violence and injury deaths (0–64 years) in Bosnia and Herzegovina Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Bosnia and Herzegovina, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Bosnia and Herzegovina, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Bosnia and Herzegovina, 2016 BOSNIA AND HERZEGOVINA Income group (2016) Upper-middle (2) Population (2016) 3 516 816 (1) Gross national income per capita (2016) US$ 4880 (2) 48 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Bosnia and Herzegovina, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YESa ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings NOb ➀ ➁ ➂ ➍ Parenting education NO — Against statutory rape YESc ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) — — Against child marriage YESc ➀ ➋ ➂ ➃ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation NO — School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YESc ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children NO — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence NO — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims — — a Programmes: Nurse-Family Partnership (home visiting). b Does not cover: all home, alternative care settings, day care; Covers: schools, penal institutions. c Subnational. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Bosnia and Herzegovina Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 23.8 34.6 Unintentional injuries, 2014a 20.7 31.8 Intentional injuries, 2014a 25.7 39.6 Road injuries, 2016b 28.0 37.7 Behavioural risk-factor legislation and enforcement for road safety in Bosnia and Herzegovina, 2017 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.03 g/dl 0.00 g/dl Yes Yes Yes No No Yes No Restricted Member States' reported enforcement effectivenessa 6/10 6/10 5/10 7/10 8/10 BOSNIA AND HERZEGOVINA contd Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 49 Bulgaria European Region Rank Cause of death YLL % % All causes 2 128 432 1 Cardiovascular diseases 1 148 679 54.0 34.9 2 Malignant neoplasms 476 967 22.4 25.3 3 Digestive diseases 104 033 4.9 5.2 4 Respiratory diseases 86 924 4.1 3.8 5 Unintentional injuries 67 344 3.2 5.8 6 Genitourinary diseases 42 471 2.0 1.6 7 Respiratory infectious 39 938 1.9 2.7 8 Intentional injuries 33 226 1.6 3.9 9 Diabetes mellitus 31 740 1.5 1.7 10 Neurological conditions 24 187 1.1 4.3 0 1 2 3 4 5 6 3.2 : 13.2 : 1 2.0 : 1 2.4 : 1 1.8 : 1 3.8 : 1 3.6 : 1 2.5 : 1 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 144 Lower respiratory infections 15 Road injury 107 Ischaemic heart disease 913 Ischaemic heart disease 2 421 Ischaemic heart disease 5 350 Ischaemic heart disease 28 174 Ischaemic heart disease 36 910 2 Lower respiratory infections 72 Other neurological conditions 13 Self-harm 69 Stroke 311 Stroke 912 Stroke 2 740 Stroke 17 651 Stroke 21 640 3 Congenital heart anomalies 70 Drowning 12 Ischaemic heart disease 51 Cirrhosis of the liver 292 Trachea, bronchus, lung cancers 713 Trachea, bronchus, lung cancers 1 435 Other circulatory diseases 4 142 Other circulatory diseases 5 677 4 Birth asphyxia and birth trauma 46 Road injury 10 Other unintentional injuries a 40 Other circulatory diseases 218 Cirrhosis of the liver 472 Other circulatory diseases 872 COPD b 2 772 Trachea, bronchus, lung cancers 3 778 5 Other congenital anomalies 43 Congenital heart anomalies 10 Cardiomyopathy, myocarditis, endocarditis 29 Trachea, bronchus, lung cancers 210 Other circulatory diseases 410 Colon and rectum cancers 749 Hypertensive heart disease 2 403 COPD b 3 770 6 Other unintentional injuries a 12 Other congenital anomalies 7 Other circulatory diseases 29 Self-harm 196 Colon and rectum cancers 303 COPD b 661 Colon and rectum cancers 1 782 Hypertensive heart disease 3 060 7 Other neonatal conditions 10 Brain and nervous system cancers 6 Drowning 21 Road injury 150 Breast cancer 265 Cirrhosis of the liver 561 Kidney diseases 1 441 Colon and rectum cancers 2 930 8 Neonatal sepsis and infections 10 Other unintentional injuries a 6 Lower respiratory infections 21 Breast cancer 136 COPD b 243 Hypertensive heart disease 449 Trachea, bronchus, lung cancers 1 416 Kidney diseases 2 092 9 Diarrhoeal diseases 9 Cardiomyopathy, myocarditis, endocarditis 5 Stroke 20 Cardiomyopathy, myocarditis, endocarditis 131 Pancreas cancer 170 Breast cancer 398 Diabetes mellitus 1 086 Cirrhosis of the liver 1 723 10 Brain and nervous system cancers 7 Leukaemia 5 Other neurological conditions 19 Other unintentional injuries a 118 Stomach cancer 164 Kidney diseases 389 Lower respiratory infections 915 Diabetes mellitus 1 585 11 Other chromosomal anomalies 6 Other malignant neoplasms 5 Falls 17 Lower respiratory infections 114 Kidney diseases 161 Stomach cancer 367 Prostate cancer 854 Lower respiratory infections 1 549 12 Leukaemia 5 Encephalitis 4 Drug use disorders 16 Colon and rectum cancers 94 Hypertensive heart disease 159 Pancreas cancer 338 Stomach cancer 794 Breast cancer 1 533 13 Meningitis 4 Exposure to mechanical forces 4 Leukaemia 16 Kidney diseases 87 Brain and nervous system cancers 154 Diabetes mellitus 332 Breast cancer 733 Stomach cancer 1 403 14 Other endocrine, blood and immune disorders 4 Kidney diseases 3 Other malignant neoplasms 15 Brain and nervous system cancers 87 Lower respiratory infections 146 Lower respiratory infections 267 Other digestive diseases 678 Pancreas cancer 1 174 15 Exposure to mechanical forces 4 Other respiratory diseases 3 Congenital heart anomalies 15 COPD b 82 Self-harm 135 Other digestive diseases 264 Pancreas cancer 613 Other digestive diseases 1 166 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.9 (30) 28.4 (40) 40.8 (285) 14.2 (656) 4.9 (435) 2.5 (466) 1.1 (809) 2.6 (2 721) Leading causes of death in Bulgaria, 2016 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 5 30 4 19 2 16 14 4 6 35% Commonwealth of Independent States European Union BulgariaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Bulgaria, 2016 (%) Trends in violence and injury deaths (0–64 years) in Bulgaria Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Bulgaria, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Bulgaria, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Bulgaria, 2016 BULGARIA Income group (2016) Upper-middle (2) Population (2016) 7 131 494 (1) Gross national income per capita (2016) US$ 7470 (2) 50 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Bulgaria, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES — Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➋ ➂ ➃ Primary school-based empowering children YES ➀ ➋ ➂ ➃ Against female genital mutilation NO — School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment YES ➀ ➋ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers — — Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims — — Child protection services for victims — Child protection services for victims — — Medicolegal services for victims — Medicolegal services for victims — — Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Bulgaria Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 32.5 34.6 Unintentional injuries, 2014a 31.3 31.8 Intentional injuries, 2014a 34.8 39.6 Road injuries, 2016b 42.5 37.7 Behavioural risk-factor legislation and enforcement for road safety in Bulgaria, 2017 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes Yes No No Yes Yes Restricted Member States' reported enforcement effectivenessa 6/10 6/10 5/10 5/10 6/10 BULGARIA contd Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 51 01 2 3 4 5 6 1.5 : 1 3.6 : 1 1.4 : 1 0.7 : 1 2.9 : 1 2.7 : 1 3.2 : 1 1.4 : 1 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Other neonatal conditions 49 Other malignant neoplasms 6 Road injury 65 Ischaemic heart disease 190 Ischaemic heart disease 610 Ischaemic heart disease 1 411 Ischaemic heart disease 10 671 Ischaemic heart disease 12 888 2 Other congenital anomalies 22 Road injury 5 Self-harm 60 Self-harm 166 Trachea, bronchus, lung cancers 425 Trachea, bronchus, lung cancers 1 052 Stroke 5 718 Stroke 6 654 3 Preterm birth complications 21 Other endocrine, blood and immune disorders 4 Drug use disorders 16 Cirrhosis of the liver 98 Cirrhosis of the liver 224 Stroke 674 Other circulatory diseases 1 628 Trachea, bronchus, lung cancers 2 884 4 Congenital heart anomalies 21 Other congenital anomalies 3 Other neurological conditions 15 Road injury 82 Colon and rectum cancers 206 Colon and rectum cancers 490 Diabetes mellitus 1 586 Colon and rectum cancers 2 294 5 Birth asphyxia and birth trauma 15 Other neurological conditions 3 Other malignant neoplasms 11 Trachea, bronchus, lung cancers 73 Stroke 199 Cirrhosis of the liver 331 COPD a 1 566 Other circulatory diseases 2 005 6 Other chromosomal anomalies 9 Cardiomyopathy, myocarditis, endocarditis 3 Other unintentional injuries b 9 Colon and rectum cancers 69 Self-harm 134 Other circulatory diseases 237 Colon and rectum cancers 1 526 Diabetes mellitus 1 904 7 Lower respiratory infections 7 Congenital heart anomalies 3 Brain and nervous system cancers 8 Breast cancer 63 Breast cancer 123 COPD a 235 Trachea, bronchus, lung cancers 1 333 COPD a 1 867 8 Down syndrome 7 Epilepsy 3 Drowning 7 Stroke 59 Other circulatory diseases 98 Diabetes mellitus 232 Alzheimer disease and other dementias 1 039 Alzheimer disease and other dementias 1 103 9 Sudden infant death syndrome 5 Exposure to mechanical forces 2 Epilepsy 7 Cardiomyopathy, myocarditis, endocarditis 42 Stomach cancer 91 Breast cancer 210 Falls 950 Falls 1 098 10 Neonatal sepsis and infections 5 Drowning 2 Lymphomas, multiple myeloma 6 Other circulatory diseases 41 Mouth and oropharynx cancers 83 Pancreas cancer 199 Kidney diseases 901 Breast cancer 1 068 11 Brain and nervous system cancers 2 Brain and nervous system cancers 2 Leukaemia 6 Brain and nervous system cancers 39 Pancreas cancer 80 Stomach cancer 172 Hypertensive heart disease 756 Kidney diseases 1 005 12 Other unintentional injuries b 2 Leukaemia 2 Cardiomyopathy, myocarditis, endocarditis 5 Drug use disorders 35 Brain and nervous system cancers 76 Liver cancer 160 Breast cancer 672 Cirrhosis of the liver 983 13 Meningitis 2 Encephalitis 1 Ischaemic heart disease 5 Stomach cancer 33 Diabetes mellitus 74 Brain and nervous system cancers 149 Prostate cancer 647 Hypertensive heart disease 858 14 Other endocrine, blood and immune disorders 2 Lower respiratory infections 1 Congenital heart anomalies 5 Alcohol use disorders 33 Liver cancer 61 Self-harm 141 Lower respiratory infections 510 Prostate cancer 806 15 Road injury 2 Upper respiratory infections 1 Interpersonal violence 5 Melanoma and other skin cancers 27 Alcohol use disorders 58 Prostate cancer 133 Stomach cancer 505 Stomach cancer 801 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 3.1 (6) 22.8 (10) 54.6 (154) 22.1 (334) 8.7 (312) 4.6 (368) 4.1 (1 563) 5.3 (2 747) Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 3 25 40 12 2 15 13 24% Commonwealth of Independent States European Union CroatiaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Croatia, 2016 (%) Trends in violence and injury deaths (0–64 years) in Croatia Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Croatia, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Croatia, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Croatia European Region Rank Cause of death YLL % % All causes 943 824 1 Cardiovascular diseases 350 346 37.1 34.9 2 Malignant neoplasms 307 470 32.6 25.3 3 Digestive diseases 47 574 5.0 5.2 4 Unintentional injuries 43 830 4.6 5.8 5 Respiratory diseases 30 787 3.3 3.8 6 Diabetes mellitus 30 161 3.2 1.7 7 Neurological conditions 30 155 3.2 4.3 8 Intentional injuries 26 075 2.8 3.9 9 Genitourinary diseases 19 524 2.1 1.6 10 Mental and substance-use disorders 12 265 1.3 2.2 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Croatia, 2016 CROATIA Income group (2016) Upper-middle (2) Population (2016) 4 213 265 (1) Gross national income per capita (2016) US$ 12 110 (2) Leading causes of death in Croatia, 2016 52 CROATIA contd Behavioural risk-factor legislation and enforcement for road safety in Croatia, 2017 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Croatia, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Triple P, The Incredible Years (parenting education); Stay Safe (primary school-based empowering children); Olweus (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Croatia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 27.9 34.6 Unintentional injuries, 2014a 26.7 31.8 Intentional injuries, 2014a 30.0 39.6 Road injuries, 2016b 35.3 37.7 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl 0.00 g/dl Yes Yes Yes Yes Yes Yes No Restricted Member States' reported enforcement effectivenessa 7/10 8/10 6/10 9/10 5/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 53 Cyprus European Region Rank Cause of death YLL % % All causes 146 526 1 Cardiovascular diseases 44 375 30.3 34.9 2 Malignant neoplasms 42 185 28.8 25.3 3 Respiratory diseases 9 474 6.5 3.8 4 Diabetes mellitus 8 548 5.8 1.7 5 Unintentional injuries 8 029 5.5 5.8 6 Neurological conditions 6 864 4.7 4.3 7 Digestive diseases 5 395 3.7 5.2 8 Genitourinary diseases 3 992 2.7 1.6 9 Intentional injuries 3 612 2.5 3.9 10 Infectious and parasitic diseases 2 931 2.0 3.2 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.7 : 1 2.6 : 1 1.8 : 1 1.9 : 1 0.9 : 1 2.1 : 1 3.5 : 1 2.3 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 716 418 41 11 1 2 28% Commonwealth of Independent States European Union CyprusEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Cyprus, 2016 (%) Trends in violence and injury deaths (0–64 years) in Cyprus Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Cyprus, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Cyprus, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Other neonatal conditions 10 Other neoplasms 2 Road injury 20 Ischaemic heart disease 55 Ischaemic heart disease 103 Ischaemic heart disease 200 Ischaemic heart disease 1 173 Ischaemic heart disease 1 532 2 Preterm birth complications 6 Leukaemia 1 Self-harm 15 Self-harm 21 Trachea, bronchus, lung cancers 38 Trachea, bronchus, lung cancers 133 Diabetes mellitus 516 Diabetes mellitus 591 3 Other congenital anomalies 2 Other malignant neoplasms 1 Drug use disorders 5 Road injury 16 Breast cancer 29 Diabetes mellitus 60 Stroke 508 Stroke 571 4 Congenital heart anomalies 2 Other unintentional injuries a 1 Interpersonal violence 4 Breast cancer 15 Other circulatory diseases 17 Other circulatory diseases 44 COPD b 393 Other circulatory diseases 441 5 Other malignant neoplasms 1 Drowning 1 Other unintentional injuries a 4 Trachea, bronchus, lung cancers 10 Colon and rectum cancers 16 Breast cancer 40 Other circulatory diseases 369 COPD b 433 6 Other endocrine, blood and immune disorders 1 Other digestive diseases 1 Other malignant neoplasms 3 Other circulatory diseases 10 Stroke 15 Stroke 38 Alzheimer disease and other dementias 316 Trachea, bronchus, lung cancers 361 7 Birth asphyxia and birth trauma 1 Interpersonal violence 1 Brain and nervous system cancers 3 Stroke 9 Pancreas cancer 15 Colon and rectum cancers 35 Other respiratory diseases 237 Alzheimer disease and other dementias 331 8 Sudden infant death syndrome 1 Road injury 1 Ischaemic heart disease 2 Brain and nervous system cancers 9 Other neurological conditions 13 COPD b 30 Trachea, bronchus, lung cancers 179 Other respiratory diseases 259 9 Other chromosomal anomalies 1 Congenital heart anomalies 1 Lymphomas, multiple myeloma 2 Cirrhosis of the liver 9 Diabetes mellitus 12 Lymphomas, multiple myeloma 30 Hypertensive heart disease 170 Kidney diseases 188 10 Other unintentional injuries a 1 Other respiratory diseases 0 Leukaemia 2 Pancreas cancer 8 Stomach cancer 12 Stomach cancer 25 Kidney diseases 169 Colon and rectum cancers 181 11 Other neurological conditions 1 Other circulatory diseases 0 Falls 2 Drug use disorders 7 Other malignant neoplasms 11 Pancreas cancer 24 Prostate cancer 138 Hypertensive heart disease 178 12 Down syndrome 1 Brain and nervous system cancers 0 Drowning 2 Cardiomyopathy, myocarditis, endocarditis 7 Brain and nervous system cancers 11 Leukaemia 23 Other unintentional injuries a 131 Breast cancer 166 13 Meningitis 1 Other neurological conditions 0 Other neurological conditions 2 Other unintentional injuries a 6 Liver cancer 11 Other malignant neoplasms 19 Colon and rectum cancers 123 Other unintentional injuries a 159 14 Drowning 1 Parasitic and vector diseases 0 Cardiomyopathy, myocarditis, endocarditis 1 Colon and rectum cancers 6 Cirrhosis of the liver 10 Liver cancer 19 Other urinary diseases 120 Prostate cancer 156 15 Leukaemia 0 Neural tube defects 0 Other endocrine, blood and immune disorders 1 Leukaemia 6 Lymphomas, multiple myeloma 10 Other neurological conditions 19 Lower respiratory infections 112 Lymphomas, multiple myeloma 130 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.3 (2) 23.5 (3) 60.4 (46) 20.9 (61) 6.6 (31) 3.9 (42) 3.3 (205) 4.7 (390) Leading causes of death in Cyprus, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Cyprus, 2016 CYPRUS Income group (2016) High (2) Population (2016) 1 170 125 (1) Gross national income per capita (2016) US$ 23 680 (2) 54 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Cyprus, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Cyprus Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 34.9 34.6 Unintentional injuries, 2014a 34.3 31.8 Intentional injuries, 2014a 37.3 39.6 Road injuries, 2016b 35.3 37.7 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 65 km/hr Yes ≤ 0.05 g/dl 0.02 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 6/10 7/10 6/10 7/10 6/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. CYPRUS contd Behavioural risk-factor legislation and enforcement for road safety in Cyprus, 2017 55 Czechia European Region Rank Cause of death YLL % % All causes 2 050 134 1 Cardiovascular diseases 731 459 35.7 34.9 2 Malignant neoplasms 616 345 30.1 25.3 3 Digestive diseases 114 581 5.6 5.2 4 Unintentional injuries 97 135 4.7 5.8 5 Respiratory diseases 88 394 4.3 3.8 6 Neurological conditions 72 776 3.5 4.3 7 Diabetes mellitus 62 012 3.0 1.7 8 Respiratory infectious 61 765 3.0 2.7 9 Intentional injuries 60 343 2.9 3.9 10 Infectious and parasitic diseases 31 715 1.5 3.2 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 3 27 11 1 43 11 1 2 2 Commonwealth of Independent States European Union CzechiaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 32% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Czechia, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Czechia, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.0 : 1 3.0 : 1 2.3 : 1 1.8 : 1 1.4 : 1 4.0 : 1 4.2 : 1 1.6 : 1 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 91 Other malignant neoplasms 11 Self-harm 186 Self-harm 465 Ischaemic heart disease 1 232 Ischaemic heart disease 4 045 Ischaemic heart disease 25 354 Ischaemic heart disease 31 054 2 Other congenital anomalies 33 Road injury 11 Road injury 112 Ischaemic heart disease 412 Trachea, bronchus, lung cancers 519 Trachea, bronchus, lung cancers 2 102 Stroke 7 524 Stroke 8 915 3 Congenital heart anomalies 31 Other neurological conditions 9 Other unintentional injuries a 58 Cirrhosis of the liver 319 Cirrhosis of the liver 476 Stroke 1 005 Other circulatory diseases 3 520 Trachea, bronchus, lung cancers 5 423 4 Birth asphyxia and birth trauma 31 Other unintentional injuries a 8 Other neurological conditions 40 Road injury 160 Colon and rectum cancers 302 Colon and rectum cancers 971 Diabetes mellitus 3 054 Other circulatory diseases 4 596 5 Other neonatal conditions 26 Brain and nervous system cancers 7 Drug use disorders 30 Other unintentional injuries a 159 Stroke 261 COPD b 900 Alzheimer disease and other dementias 2 894 COPD b 3 930 6 Lower respiratory infections 22 Lower respiratory infections 7 Cardiomyopathy, myocarditis, endocarditis 20 Other circulatory diseases 152 Self-harm 247 Other circulatory diseases 691 Lower respiratory infections 2 779 Colon and rectum cancers 3 854 7 Neonatal sepsis and infections 14 Leukaemia 5 Falls 19 Breast cancer 150 Other circulatory diseases 212 Cirrhosis of the liver 678 COPD b 2 755 Diabetes mellitus 3 818 8 Other unintentional injuries a 12 Other endocrine, blood and immune disorders 4 Other circulatory diseases 19 Brain and nervous system cancers 137 COPD b 209 Pancreas cancer 655 Trachea, bronchus, lung cancers 2 695 Lower respiratory infections 3 571 9 Sudden infant death syndrome 11 Stroke 3 Lower respiratory infections 18 Lower respiratory infections 125 Breast cancer 201 Diabetes mellitus 583 Colon and rectum cancers 2 464 Alzheimer disease and other dementias 3 091 10 Other endocrine, blood and immune disorders 8 Congenital heart anomalies 3 Drowning 16 Alcohol use disorders 114 Pancreas cancer 200 Lower respiratory infections 443 Hypertensive heart disease 1 475 Other unintentional injuries a 2 173 11 Other chromosomal anomalies 8 Other respiratory diseases 3 Brain and nervous system cancers 16 Colon and rectum cancers 113 Mouth and oropharynx cancers 184 Breast cancer 419 Other unintentional injuries a 1 430 Pancreas cancer 2 112 12 Down syndrome 6 Lymphomas, multiple myeloma 3 Other malignant neoplasms 12 Stroke 110 Lower respiratory infections 178 Kidney cancer 338 Pancreas cancer 1 195 Cirrhosis of the liver 1 881 13 Other neurological conditions 5 Other congenital anomalies 3 Interpersonal violence 11 Trachea, bronchus, lung cancers 106 Other unintentional injuries a 173 Other unintentional injuries a 333 Prostate cancer 1 190 Breast cancer 1 868 14 Other malignant neoplasms 5 Other neoplasms 2 Stroke 11 Other malignant neoplasms 89 Diabetes mellitus 136 Other malignant neoplasms 320 Kidney diseases 1 103 Hypertensive heart disease 1 758 15 Brain and nervous system cancers 4 Drowning 2 Lymphomas, multiple myeloma 10 Cardiomyopathy, myocarditis, endocarditis 86 Other malignant neoplasms 135 Mouth and oropharynx cancers 309 Breast cancer 1 094 Prostate cancer 1 546 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 6.9 (24) 24.7 (23) 56.5 (419) 23.4 (970) 9.3 (650) 4.2 (823) 2.9 (2 182) 4.7 (5 091) Leading causes of death in Czechia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Trends in violence and injury deaths (0–64 years) in Czechia Male-to-female mortality ratios in Czechia, 2016 Violence and injury proportion by years of life lost (YLL) in Czechia, 2016 CZECHIA Income group (2016) High (2) Population (2016) 10 610 947 (1) Gross national income per capita (2016) US$ 17 570 (2) 56 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Czechia, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings NOb ➀ ➁ ➌ ➃ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➂ ➍ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — — Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Triple P, Parenting for Lifelong Health (parenting education). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Czechia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 36.1 34.6 Unintentional injuries, 2014a 34.2 31.8 Intentional injuries, 2014a 39.5 39.6 Road injuries, 2016b 46.8 37.7 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.03 g/dl ≤ 0.03 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 5/10 7/10 8/10 9/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. CZECHIA contd Behavioural risk-factor legislation and enforcement for road safety in Czechia, 2017 57 Denmark European Region Rank Cause of death YLL % % All causes 920 102 1 Malignant neoplasms 333 467 36.2 25.3 2 Cardiovascular diseases 184 400 20.0 34.9 3 Respiratory diseases 74 100 8.1 3.8 4 Neurological conditions 67 875 7.4 4.3 5 Digestive diseases 48 425 5.3 5.2 6 Mental and substance-use disorders 32 129 3.5 2.2 7 Intentional injuries 27 292 3.0 3.9 8 Respiratory infectious 26 059 2.8 2.7 9 Diabetes mellitus 25 935 2.8 1.7 10 Unintentional injuries 24 594 2.7 5.8 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.4 : 1 2.4 : 1 1.3 : 1 0.9 : 1 1.8 : 1 4.8 : 1 2.1 : 1 1.3 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 2 37 2 9 1 18 27 3 1 Commonwealth of Independent States European Union DenmarkEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 48% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Denmark, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Denmark, 2016 (%) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 114 Brain and nervous system cancers 6 Self-harm 59 Self-harm 194 Trachea, bronchus, lung cancers 359 Trachea, bronchus, lung cancers 1 041 Ischaemic heart disease 4 453 Ischaemic heart disease 5 439 2 Other congenital anomalies 24 Other neurological conditions 5 Road injury 37 Drug use disorders 102 Ischaemic heart disease 276 Ischaemic heart disease 620 Alzheimer disease and other dementias 3 991 Alzheimer disease and other dementias 4 100 3 Birth asphyxia and birth trauma 21 Road injury 5 Drug use disorders 34 Alcohol use disorders 90 Alcohol use disorders 215 COPD a 512 COPD a 3 413 COPD a 4 085 4 Congenital heart anomalies 21 Self-harm 2 Other neurological conditions 13 Ischaemic heart disease 87 Cirrhosis of the liver 197 Colon and rectum cancers 400 Stroke 2 962 Trachea, bronchus, lung cancers 3 951 5 Other neonatal conditions 16 Other malignant neoplasms 2 Other malignant neoplasms 12 Cirrhosis of the liver 77 COPD a 142 Stroke 300 Trachea, bronchus, lung cancers 2 484 Stroke 3 447 6 Other chromosomal anomalies 12 Other endocrine, blood and immune disorders 2 Brain and nervous system cancers 11 Breast cancer 73 Colon and rectum cancers 137 Cirrhosis of the liver 269 Other circulatory diseases 2 313 Other circulatory diseases 2 692 7 Neonatal sepsis and infections 11 Other congenital anomalies 2 Other circulatory diseases 8 Trachea, bronchus, lung cancers 66 Self-harm 135 Breast cancer 265 Lower respiratory infections 1 929 Colon and rectum cancers 2 154 8 Other endocrine, blood and immune disorders 5 Leukaemia 2 Epilepsy 8 Brain and nervous system cancers 55 Stroke 134 Pancreas cancer 251 Colon and rectum cancers 1 563 Lower respiratory infections 2 118 9 Lower respiratory infections 4 Stroke 1 Interpersonal violence 8 Colon and rectum cancers 51 Breast cancer 128 Other circulatory diseases 239 Prostate cancer 1 216 Diabetes mellitus 1 485 10 Down syndrome 3 Interpersonal violence 1 Other endocrine, blood and immune disorders 6 Stroke 48 Diabetes mellitus 100 Diabetes mellitus 227 Diabetes mellitus 1 120 Prostate cancer 1 403 11 Brain and nervous system cancers 3 Other circulatory diseases 1 Leukaemia 6 Other circulatory diseases 41 Other circulatory diseases 89 Alcohol use disorders 194 Breast cancer 847 Breast cancer 1 315 12 Other neurological conditions 2 Cardiomyopathy, myocarditis, endocarditis 1 Other unintentional injuries b 5 Road injury 38 Pancreas cancer 88 Prostate cancer 161 Pancreas cancer 666 Pancreas cancer 1 026 13 Meningitis 2 Congenital heart anomalies 1 Congenital heart anomalies 5 Diabetes mellitus 34 Brain and nervous system cancers 74 Oesophagus cancer 137 Other digestive diseases 574 Other digestive diseases 738 14 Other malignant neoplasms 2 Other neoplasms 1 Other congenital anomalies 4 Other neurological conditions 33 Mouth and oropharynx cancers 74 Brain and nervous system cancers 136 Kidney diseases 525 Cirrhosis of the liver 733 15 Other infectious diseases 2 Liver cancer 1 Cardiomyopathy, myocarditis, endocarditis 4 Other malignant neoplasms 32 Oesophagus cancer 53 Mouth and oropharynx cancers 134 Lymphomas, multiple myeloma 520 Self-harm 729 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 2.9 (8) 24.2 (10) 42.8 (122) 19.1 (293) 7.0 (230) 3.2 (241) 2.7 (1 045) 3.8 (1 947) Leading causes of death in Denmark, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Trends in violence and injury deaths (0–64 years) in Denmark Male-to-female mortality ratios in Denmark, 2016 Violence and injury proportion by years of life lost (YLL) in Denmark, 2016 DENMARK Income group (2016) High (2) Population (2016) 5 711 870 (1) Gross national income per capita (2016) US$ 56 730 (2) 58 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Denmark, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Denmark Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 33.7 34.6 Unintentional injuries, 2014a 33.6 31.8 Intentional injuries, 2014a 35.2 39.6 Road injuries, 2016b 34.6 37.7 Behavioural risk-factor legislation and enforcement for road safety in Denmark, 2017 ND: no data. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa ND ND ND ND ND DENMARK contd Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. 59 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.5 : 1 2.3 : 1 3.8 : 1 3.1 : 1 2.5 : 1 3.9 : 1 4.6 : 1 3.2 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 3 34 711 1 11 18 8 7 61% Commonwealth of Independent States European Union EstoniaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Estonia, 2016 (%) Trends in violence and injury deaths (0–64 years) in Estonia Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Estonia, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Estonia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 6 Drowning 3 Self-harm 35 Cirrhosis of the liver 81 Ischaemic heart disease 254 Ischaemic heart disease 599 Ischaemic heart disease 4 816 Ischaemic heart disease 5 749 2 Birth asphyxia and birth trauma 6 Self-harm 2 Drug use disorders 28 Ischaemic heart disease 77 Cirrhosis of the liver 83 Trachea, bronchus, lung cancers 215 Stroke 795 Stroke 991 3 Congenital heart anomalies 4 Road injury 2 Road injury 17 Self-harm 64 Trachea, bronchus, lung cancers 78 Stroke 120 Trachea, bronchus, lung cancers 402 Trachea, bronchus, lung cancers 709 4 Other congenital anomalies 3 Brain and nervous system cancers 2 Falls 6 Alcohol use disorders 63 Alcohol use disorders 67 Colon and rectum cancers 92 Colon and rectum cancers 375 Colon and rectum cancers 514 5 Other unintentional injuries a 3 Other neurological conditions 1 Drowning 6 Drug use disorders 49 Stroke 48 Cirrhosis of the liver 79 Other circulatory diseases 360 Other circulatory diseases 470 6 Brain and nervous system cancers 2 Other congenital anomalies 1 HIV/AIDS 6 HIV/AIDS 37 Cardiomyopathy, myocarditis, endocarditis 46 Stomach cancer 78 Hypertensive heart disease 342 Hypertensive heart disease 399 7 Other chromosomal anomalies 2 Exposure to mechanical forces 1 Alcohol use disorders 5 Cardiomyopathy, myocarditis, endocarditis 33 Self-harm 44 Other circulatory diseases 69 Kidney diseases 288 Kidney diseases 341 8 Lower respiratory infections 2 Other unintentional injuries a 1 Interpersonal violence 4 Stroke 24 Breast cancer 37 Pancreas cancer 58 Prostate cancer 243 Stomach cancer 322 9 Sudden infant death syndrome 1 Lower respiratory infections 1 Other malignant neoplasms 4 Interpersonal violence 22 Colon and rectum cancers 36 Cardiomyopathy, myocarditis, endocarditis 57 COPD 206 Prostate cancer 304 10 Other neurological conditions 1 Falls 1 Ischaemic heart disease 4 Lower respiratory infections 22 Stomach cancer 34 Breast cancer 51 Stomach cancer 192 Cirrhosis of the liver 281 11 Drowning 1 Fire, heat and hot substances 1 Other neurological conditions 4 Road injury 20 Lower respiratory infections 30 Prostate cancer 50 Lower respiratory infections 177 Lower respiratory infections 280 12 Other malignant neoplasms 1 Leukaemia 0 Stroke 3 Other unintentional injuries a 19 Other circulatory diseases 28 Alcohol use disorders 48 Pancreas cancer 170 COPD 271 13 Fire, heat and hot substances 1 Epilepsy 0 Other unintentional injuries a 3 Breast cancer 18 Pancreas cancer 26 Lower respiratory infections 48 Breast cancer 152 Pancreas cancer 263 14 Other endocrine, blood and immune disorders 1 Other digestive diseases 0 Cirrhosis of the liver 3 Falls 17 Mouth and oropharynx cancers 23 COPD 47 Other digestive diseases 131 Breast cancer 258 15 Leukaemia 1 Other circulatory diseases 0 Epilepsy 3 Stomach cancer 16 Falls 23 Lymphomas, multiple myeloma 44 Lymphomas, multiple myeloma 126 Self-harm 234 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 16.1 (7) 53.7 (12) 45.0 (73) 21.2 (174) 10.6 (133) 4.8 (114) 1.6 (168) 4.5 (680) Leading causes of death in Estonia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Estonia European Region Rank Cause of death YLL % % All causes 301 532 1 Cardiovascular diseases 121 122 40.2 34.9 2 Malignant neoplasms 83 435 27.7 25.3 3 Digestive diseases 17 342 5.8 5.2 4 Unintentional injuries 14 591 4.8 5.8 5 Mental and substance-use disorders 12 961 4.3 2.2 6 Intentional injuries 11 537 3.8 3.9 7 Neurological conditions 7 963 2.6 4.3 8 Respiratory diseases 6 157 2.0 3.8 9 Respiratory infectious 5 958 2.0 2.7 10 Genitourinary diseases 5 695 1.9 1.6 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Estonia, 2016 ESTONIA Income group (2016) High (2) Population (2016) 1 312 442 (1) Gross national income per capita (2016) US$ 17 750 (2) 60 Behavioural risk-factor legislation and enforcement for road safety in Estonia, 2017 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Estonia, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES — Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: The Incredible Years (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Estonia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 42.6 34.6 Unintentional injuries, 2014a 41.1 31.8 Intentional injuries, 2014a 44.9 39.6 Road injuries, 2016b 49.0 37.7 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes 0.02 g/dl 0.02 g/dl Yes Yes Yes Yes Yes No No Unrestricted Member States' reported enforcement effectivenessa 7/10 8/10 7/10 9/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. ESTONIA contd 61 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.9 : 1 2.5 : 1 1.8 : 1 1.2 : 1 2.6 : 1 3.6 : 1 3.0 : 1 1.9 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 30 2 8 1 11 41 4 2 32% Commonwealth of Independent States European Union FinlandEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Finland, 2016 (%) Trends in violence and injury deaths (0–64 years) in Finland Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Finland, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Finland, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 26 Brain and nervous system cancers 6 Self-harm 167 Self-harm 262 Cirrhosis of the liver 362 Ischaemic heart disease 1 334 Alzheimer disease and other dementias 9 400 Ischaemic heart disease 10 865 2 Other congenital anomalies 18 Road injury 6 Drug use disorders 71 Cirrhosis of the liver 161 Ischaemic heart disease 359 Trachea, bronchus, lung cancers 724 Ischaemic heart disease 9 074 Alzheimer disease and other dementias 9 634 3 Congenital heart anomalies 16 Other neurological conditions 5 Road injury 48 Drug use disorders 123 Alcohol use disorders 178 Cirrhosis of the liver 452 Stroke 3 698 Stroke 4 308 4 Other chromosomal anomalies 12 Other endocrine, blood and immune disorders 5 Other unintentional injuries a 15 Alcohol use disorders 121 Trachea, bronchus, lung cancers 174 Stroke 430 Other circulatory diseases 1 946 Other circulatory diseases 2 424 5 Birth asphyxia and birth trauma 11 Self-harm 3 Interpersonal violence 14 Ischaemic heart disease 96 Self-harm 166 Other circulatory diseases 300 Trachea, bronchus, lung cancers 1 350 Trachea, bronchus, lung cancers 2 276 6 Sudden infant death syndrome 8 Other malignant neoplasms 3 Alcohol use disorders 12 Other circulatory diseases 67 Stroke 121 Pancreas cancer 292 COPD b 1 013 COPD b 1 322 7 Other neonatal conditions 8 Leukaemia 2 Diabetes mellitus 11 Breast cancer 57 Colon and rectum cancers 106 Colon and rectum cancers 275 Falls 944 Colon and rectum cancers 1 319 8 Neonatal sepsis and infections 4 Cardiomyopathy, myocarditis, endocarditis 2 Brain and nervous system cancers 9 Stroke 54 Breast cancer 103 COPD b 260 Colon and rectum cancers 899 Falls 1 196 9 Lower respiratory infections 3 Other unintentional injuries a 2 Drowning 9 Cardiomyopathy, myocarditis, endocarditis 48 Other circulatory diseases 102 Breast cancer 221 Prostate cancer 800 Cirrhosis of the liver 1 183 10 Other endocrine, blood and immune disorders 3 Interpersonal violence 2 Other circulatory diseases 9 Brain and nervous system cancers 47 Pancreas cancer 91 Alzheimer disease and other dementias 201 Hypertensive heart disease 770 Pancreas cancer 1 110 11 Other unintentional injuries a 2 Drowning 2 Other malignant neoplasms 9 Road injury 45 Cardiomyopathy, myocarditis, endocarditis 74 Lymphomas, multiple myeloma 179 Pancreas cancer 707 Prostate cancer 963 12 Road injury 2 Other congenital anomalies 1 Cardiomyopathy, myocarditis, endocarditis 8 Colon and rectum cancers 39 Falls 67 Alcohol use disorders 178 Parkinson disease 700 Breast cancer 900 13 Other neurological conditions 2 Other chromosomal anomalies 1 Other neurological conditions 7 Other unintentional injuries a 37 Brain and nervous system cancers 55 Falls 146 Lymphomas, multiple myeloma 644 Lymphomas, multiple myeloma 891 14 Other malignant neoplasms 2 Exposure to mechanical forces 1 Falls 6 Falls 32 Drug use disorders 54 Prostate cancer 144 Breast cancer 519 Hypertensive heart disease 889 15 Drowning 2 Congenital heart anomalies 1 Epilepsy 6 Other malignant neoplasms 30 Diabetes mellitus 47 Cardiomyopathy, myocarditis, endocarditis 143 Other digestive diseases 438 Self-harm 874 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.5 (10) 32.9 (16) 56.8 (267) 25.8 (440) 12.0 (359) 6.0 (463) 3.5 (1 393) 5.5 (2 948) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Finland, 2016 Finland European Region Rank Cause of death YLL % % All causes 923 436 1 Cardiovascular diseases 278 285 30.1 34.9 2 Malignant neoplasms 249 466 27.0 25.3 3 Neurological conditions 125 245 13.6 4.3 4 Digestive diseases 59 739 6.5 5.2 5 Unintentional injuries 45 813 5.0 5.8 6 Intentional injuries 40 688 4.4 3.9 7 Mental and substance-use disorders 38 458 4.2 2.2 8 Respiratory diseases 29 057 3.1 3.8 9 Diabetes mellitus 10 723 1.2 1.7 10 Congenital anomalies 9 289 1.0 1.5 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Finland, 2016 FINLAND Income group (2016) High (2) Population (2016) 5 503 132 (1) Gross national income per capita (2016) US$ 44 730 (2) 62 Behavioural risk-factor legislation and enforcement for road safety in Finland, 2017 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Finland, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES — Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: The Incredible Years (parenting education); KiVa (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Finland Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 32.1 34.6 Unintentional injuries, 2014a 30.8 31.8 Intentional injuries, 2014a 33.6 39.6 Road injuries, 2016b 36.0 37.7 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes Yes No No Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 9/10 8/10 9/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. FINLAND contd 63 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.4 : 1 2.7 : 1 0.6 : 1 0.9 : 1 1.5 : 1 2.1 : 1 2.0 : 1 1.5 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 32 8 1 1 2 18 2 35 36% Commonwealth of Independent States European Union FranceEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in France, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in France, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 639 Brain and nervous system cancers 81 Road injury 763 Self-harm 2 963 Trachea, bronchus, lung cancers 5 879 Trachea, bronchus, lung cancers 10 502 Ischaemic heart disease 52 665 Ischaemic heart disease 61 854 2 Other neonatal conditions 431 Road injury 61 Self-harm 750 Trachea, bronchus, lung cancers 1 583 Ischaemic heart disease 2 689 Ischaemic heart disease 5 239 Alzheimer disease and other dementias 48 309 Alzheimer disease and other dementias 49 553 3 Other congenital anomalies 316 Other neurological conditions 52 Other unintentional injuries a 222 Ischaemic heart disease 1 217 Self-harm 1 959 Colon and rectum cancers 3 595 Other circulatory diseases 31 113 Other circulatory diseases 35 064 4 Birth asphyxia and birth trauma 305 Other endocrine, blood and immune disorders 48 Other malignant neoplasms 175 Breast cancer 1 105 Cirrhosis of the liver 1 893 Breast cancer 2 841 Stroke 29 758 Trachea, bronchus, lung cancers 34 013 5 Congenital heart anomalies 299 Leukaemia 46 Other neurological conditions 168 Cirrhosis of the liver 849 Breast cancer 1 836 Other malignant neoplasms 2 632 COPD b 17 660 Stroke 33 843 6 Neonatal sepsis and infections 141 Other malignant neoplasms 37 Drug use disorders 161 Alcohol use disorders 768 Other malignant neoplasms 1 588 Pancreas cancer 2 608 Lower respiratory infections 16 366 Colon and rectum cancers 20 706 7 Sudden infant death syndrome 124 Self-harm 31 Leukaemia 112 Road injury 722 Colon and rectum cancers 1 463 Cirrhosis of the liver 2 500 Trachea, bronchus, lung cancers 16 035 COPD b 20 365 8 Other chromosomal anomalies 96 Other unintentional injuries a 31 Other endocrine, blood and immune disorders 103 Stroke 609 Mouth and oropharynx cancers 1 132 Liver cancer 2 416 Colon and rectum cancers 15 090 Lower respiratory infections 17 851 9 Other endocrine, blood and immune disorders 66 Other neoplasms 29 Other circulatory diseases 101 Other malignant neoplasms 598 Alcohol use disorders 1 113 Stroke 2 335 Diabetes mellitus 10 111 Breast cancer 14 434 10 Other unintentional injuries a 58 Other congenital anomalies 26 Brain and nervous system cancers 100 Other unintentional injuries a 574 Stroke 1 064 Other circulatory diseases 2 264 Other unintentional injuries a 9 705 Diabetes mellitus 12 375 11 Other neurological conditions 43 Drowning 22 Interpersonal violence 96 Other circulatory diseases 571 Pancreas cancer 1 056 COPD b 1 903 Prostate cancer 9 056 Other unintentional injuries a 12 239 12 Drowning 34 Interpersonal violence 20 Epilepsy 74 Other neurological conditions 548 Other circulatory diseases 1 005 Self-harm 1 577 Breast cancer 8 639 Other malignant neoplasms 12 083 13 Lower respiratory infections 32 Epilepsy 17 Lymphomas, multiple myeloma 65 Colon and rectum cancers 530 Liver cancer 957 Lymphomas, multiple myeloma 1 498 Other respiratory diseases 8 179 Self-harm 11 455 14 Other infectious diseases 32 Congenital heart anomalies 17 Drowning 64 Brain and nervous system cancers 488 Other neurological conditions 782 Mouth and oropharynx cancers 1 454 Other digestive diseases 7 724 Pancreas cancer 11 281 15 Other neoplasms 30 Stroke 13 Cardiomyopathy, myocarditis, endocarditis 60 Drug use disorders 403 Oesophagus cancer 734 Diabetes mellitus 1 443 Kidney diseases 7 543 Prostate cancer 10 384 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.9 (175) 29.5 (197) 50.8 (2 010) 24.2 (4 910) 9.6 (3 564) 5.4 (3 764) 4.9 (20 833) 6.4 (35 453) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in France, 2016 France European Region Rank Cause of death YLL % % All causes 9 515 312 1 Malignant neoplasms 3 574 999 37.6 25.3 2 Cardiovascular diseases 1 892 536 19.9 34.9 3 Neurological conditions 772 704 8.1 4.3 4 Unintentional injuries 476 649 5.0 5.8 5 Digestive diseases 470 359 4.9 5.2 6 Respiratory diseases 422 549 4.4 3.8 7 Intentional injuries 402 848 4.2 3.9 8 Respiratory infectious 207 728 2.2 2.7 9 Mental and substance-use disorders 188 810 2.0 2.2 10 Diabetes mellitus 185 202 1.9 1.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Trends in violence and injury deaths (0–64 years) in France Male-to-female mortality ratios in France, 2016 Violence and injury proportion by years of life lost (YLL) in France, 2016 FRANCE Income group (2016) High (2) Population (2016) 64 720 688 (1) Gross national income per capita (2016) US$ 38 950 (2) 64 Behavioural risk-factor legislation and enforcement for road safety in France, 2017 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in France, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings NO — Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➂ ➍ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Step Towards Effective Enjoyable Parenting (home visiting); Triple P (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in France Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 36.2 34.6 Unintentional injuries, 2014a 33.3 31.8 Intentional injuries, 2014a 40.6 39.6 Road injuries, 2016b 42.8 37.7 a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl 0.02 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 7/10 8/10 9/10 9/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. FRANCE contd 65 Georgia European Region Rank Cause of death YLL % % All causes 1 197 672 1 Cardiovascular diseases 629 698 52.6 34.9 2 Malignant neoplasms 188 855 15.8 25.3 3 Unintentional injuries 65 349 5.5 5.8 4 Digestive diseases 61 142 5.1 5.2 5 Respiratory diseases 41 464 3.5 3.8 6 Neurological conditions 33 657 2.8 4.3 7 Diabetes mellitus 30 821 2.6 1.7 8 Infectious and parasitic diseases 29 128 2.4 3.2 9 Neonatal conditions 25 185 2.1 2.2 10 Intentional injnuries 21 623 1.8 3.9 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.5 : 1 4.4 : 1 2.6 : 1 1.5 : 1 2.4 : 1 5.7 : 1 5.2 : 1 5.2 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 716 23 16 12 10 6 91 35% Commonwealth of Independent States European Union GeorgiaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Georgia, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Georgia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 162 Lower respiratory infections 15 Road injury 99 Ischaemic heart disease 540 Ischaemic heart disease 1 400 Ischaemic heart disease 2 518 Ischaemic heart disease 16 115 Ischaemic heart disease 20 603 2 Congenital heart anomalies 80 Other unintentional injuries a 13 Self-harm 44 Cirrhosis of the liver 293 Stroke 730 Stroke 1 508 Stroke 8 587 Stroke 11 096 3 Other congenital anomalies 63 Road injury 12 Interpersonal violence 38 Stroke 247 Other malignant neoplasms 449 Other malignant neoplasms 494 Hypertensive heart disease 2 249 Hypertensive heart disease 2 642 4 Birth asphyxia and birth trauma 50 Drowning 11 Other unintentional injuries a 38 HIV/AIDS 187 Cirrhosis of the liver 397 Diabetes mellitus 360 Alzheimer disease and other dementias 2 143 Alzheimer disease and other dementias 2 225 5 Lower respiratory infections 39 Congenital heart anomalies 7 Drowning 30 Road injury 159 Trachea, bronchus, lung cancers 221 Cirrhosis of the liver 321 COPD b 1 358 Other malignant neoplasms 2 018 6 Other neonatal conditions 35 Rheumatic heart disease 7 Other malignant neoplasms 29 Other malignant neoplasms 144 Diabetes mellitus 176 Trachea, bronchus, lung cancers 288 Other malignant neoplasms 893 COPD b 1 808 7 Neonatal sepsis and infections 28 Exposure to mechanical forces 6 Ischaemic heart disease 29 Self-harm 89 COPD b 132 COPD b 253 Other circulatory diseases 796 Cirrhosis of the liver 1 520 8 Other unintentional injuries a 15 Fire, heat and hot substances 5 HIV/AIDS 25 Trachea, bronchus, lung cancers 81 Breast cancer 123 Hypertensive heart disease 253 Diabetes mellitus 738 Diabetes mellitus 1 329 9 Neural tube defects 9 Falls 5 Stroke 22 Other unintentional injuries a 79 Kidney diseases 110 Kidney diseases 154 Kidney diseases 528 Other circulatory diseases 1 098 10 Fire, heat and hot substances 9 Kidney diseases 4 Exposure to mechanical forces 18 Breast cancer 76 Hypertensive heart disease 106 Other circulatory diseases 137 Cirrhosis of the liver 494 Trachea, bronchus, lung cancers 958 11 Other malignant neoplasms 7 Meningitis 3 Fire, heat and hot substances 16 Interpersonal violence 73 Other circulatory diseases 104 Stomach cancer 136 Rheumatic heart disease 371 Kidney diseases 868 12 HIV/AIDS 6 Epilepsy 3 Lower respiratory infections 15 Tuberculosis 66 Road injury 84 Liver cancer 102 Trachea, bronchus, lung cancers 364 Lower respiratory infections 554 13 Kidney cancer 6 Brain and nervous system cancers 3 Tuberculosis 14 Kidney diseases 61 Liver cancer 76 Breast cancer 100 Lower respiratory infections 310 Stomach cancer 532 14 Falls 6 Encephalitis 2 Cirrhosis of the liver 14 COPD b 52 Stomach cancer 70 Colon and rectum cancers 93 Stomach cancer 279 Rheumatic heart disease 528 15 Other chromosomal anomalies 5 Interpersonal violence 2 Falls 12 Cardiomyopathy, myocarditis, endocarditis 52 Self-harm 68 Lower respiratory infections 81 Parkinson disease 272 Breast cancer 491 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.5 (44) 43.4 (59) 48.0 (301) 18.4 (571) 6.6 (365) 3.2 (261) 1.2 (472) 3.6 (20 733) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Georgia, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Georgia, 2016 Trends in violence and injury deaths (0–64 years) in Georgia Male-to-female mortality ratios in Georgia, 2016 Income group (2016) Lower-middle (2) Population (2016) 3 925 405 (1) Gross national income per capita (2016) US$ 3810 (2) GEORGIA66 Behavioural risk-factor legislation and enforcement for road safety in Georgia, 2017 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Georgia, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings NOb ➀ ➁ ➂ ➍ Parenting education NO — Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➋ ➂ ➃ Against female genital mutilation YES ➀ ➋ ➂ ➃ School-based antibullying NO — Reporting of suspected child maltreatment YES ➀ ➋ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children NO Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers NO Response to violence against children Mental health services for victims NO Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims NO Child protection services for victims YES ➀ ➋ ➂ Medicolegal services for victims NO Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: Nurse-Family Partnership (home visiting); Stay Safe (primary school-based empowering children). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Georgia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 33.7 34.6 Unintentional injuries, 2014a 32.3 31.8 Intentional injuries, 2014a 39.4 39.6 Road injuries, 2016b 30.5 37.7 NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr No ≤ 0.03 g/dl ≤ 0.03 g/dl Yes No Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 6/10 7/10 8/10 7/10 NA Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. GEORGIA contd 67 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.4 : 1 2.2 : 1 0.6 : 1 0.9 : 1 1.5 : 1 2.6 : 1 2.6 : 1 0.8 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 30 9 19 37 1 1 1 2 19% Commonwealth of Independent States European Union GermanyEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Germany, 2016 (%) Trends in violence and injury deaths (0–64 years) in Germany Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Germany, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Germany, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 758 Brain and nervous system cancers 72 Self-harm 913 Self-harm 2 571 Ischaemic heart disease 7 556 Ischaemic heart disease 14 760 Ischaemic heart disease 167 309 Ischaemic heart disease 191 913 2 Other congenital anomalies 308 Road injury 45 Road injury 688 Ischaemic heart disease 2 218 Trachea, bronchus, lung cancers 6 803 Trachea, bronchus, lung cancers 12 529 Stroke 51 894 Other circulatory diseases 59 006 3 Other neonatal conditions 282 Other neurological conditions 39 Drug use disorders 307 Cirrhosis of the liver 1 564 Cirrhosis of the liver 3 803 COPD a 6 078 Other circulatory diseases 51 662 Stroke 58 306 4 Congenital heart anomalies 270 Other malignant neoplasms 38 Other neurological conditions 168 Breast cancer 1 195 Breast cancer 2 545 Colon and rectum cancers 4 622 Alzheimer disease and other dementias 47 598 Alzheimer disease and other dementias 48 770 5 Other chromosomal anomalies 205 Leukaemia 36 Other unintentional injuries b 160 Trachea, bronchus, lung cancers 1 194 Colon and rectum cancers 2 288 Other circulatory diseases 4 193 COPD a 39 836 COPD a 48 209 6 Birth asphyxia and birth trauma 198 Other congenital anomalies 31 Other malignant neoplasms 125 Alcohol use disorders 1 048 Self-harm 2 275 Cirrhosis of the liver 4 173 Trachea, bronchus, lung cancers 26 585 Trachea, bronchus, lung cancers 47 131 7 Sudden infant death syndrome 106 Epilepsy 29 Other circulatory diseases 116 Other circulatory diseases 909 Other circulatory diseases 2 110 Stroke 3 882 Kidney diseases 21 664 Colon and rectum cancers 28 809 8 Neonatal sepsis and infections 54 Other endocrine, blood and immune disorders 26 Brain and nervous system cancers 115 Drug use disorders 823 Alcohol use disorders 2 071 Breast cancer 3 534 Colon and rectum cancers 21 216 Diabetes mellitus 24 764 9 Down syndrome 50 Self-harm 23 Epilepsy 107 Stroke 679 COPD a 1 982 Pancreas cancer 3 455 Diabetes mellitus 20 960 Kidney diseases 23 316 10 Lower respiratory infections 46 Other unintentional injuries b 22 Leukaemia 100 Brain and nervous system cancers 663 Stroke 1 777 Diabetes mellitus 2 334 Hypertensive heart disease 20 468 Lower respiratory infections 23 122 11 Other endocrine, blood and immune disorders 43 Congenital heart anomalies 21 Other endocrine, blood and immune disorders 93 Road injury 657 Pancreas cancer 1 671 Other malignant neoplasms 2 001 Lower respiratory infections 20 464 Hypertensive heart disease 21 803 12 Other unintentional injuries b 41 Drowning 16 Interpersonal violence 89 Colon and rectum cancers 651 Mouth and oropharynx cancers 1 481 Mouth and oropharynx cancers 1 868 Prostate cancer 13 346 Breast cancer 20 072 13 Other neurological conditions 39 Other chromosomal anomalies 15 Cardiomyopathy, myocarditis, endocarditis 83 Other neurological conditions 498 Brain and nervous system cancers 1 140 Stomach cancer 1 829 Breast cancer 12 778 Pancreas cancer 17 536 14 Other infectious diseases 22 Interpersonal violence 14 Ischaemic heart disease 68 Other malignant neoplasms 481 Stomach cancer 1 080 Lymphomas, multiple myeloma 1 828 Pancreas cancer 12 010 Prostate cancer 15 583 15 Other malignant neoplasms 21 Lower respiratory infections 13 Falls 62 Other endocrine, blood and immune disorders 454 Other malignant neoplasms 1 076 Prostate cancer 1 803 Falls 11 838 Cirrhosis of the liver 14 901 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.6 (125) 24.7 (139) 47.7 (2 025) 17.6 (4 244) 6.9 (4 032) 3.6 (3 744) 3.1 (22 398) 4.0 (36 707) Leading causes of death in Germany, 2016 Germany European Region Rank Cause of death YLL % % All causes 15 452 480 1 Malignant neoplasms 4 810 191 31.1 25.3 2 Cardiovascular diseases 4 717 742 30.5 34.9 3 Neurological conditions 954 593 6.2 4.3 4 Respiratory diseases 918 318 5.9 3.8 5 Digestive diseases 831 926 5.4 5.2 6 Unintentional injuries 495 428 3.2 5.8 7 Intentional injuries 405 054 2.6 3.9 8 Diabetes mellitus 368 716 2.4 1.7 9 Genitourinary diseases 367 094 2.4 1.6 10 Respiratory infectious 323 445 2.1 2.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Germany, 2016 Income group (2016) High (2) Population (2016) 81 914 672 (1) Gross national income per capita (2016) US$ 43 660 (2) GERMANY68 Behavioural risk-factor legislation and enforcement for road safety in Germany, 2017 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). Prevention of, and response to, violence against children in Germany, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying — — Reporting of suspected child maltreatment NO — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children NO Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers NO Response to violence against children Mental health services for victims NO Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims NO Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims NO Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership, Step Towards Effective Enjoyable Parenting (home visiting); Triple P (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Germany Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 44.4 34.6 Unintentional injuries, 2014a 42.4 31.8 Intentional injuries, 2014a 47.2 39.6 Road injuries, 2016b 40.8 37.7 ND: no data. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl 0.00 g/dl Yes Yes No No No Yes Yes Restricted Member States' reported enforcement effectivenessa ND ND ND ND ND Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. GERMANY contd 69 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1116 27 21 15 4 1 2 3 18% Commonwealth of Independent States European Union GreeceEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Greece, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Greece, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.4 : 1 3.8 : 1 2.2 : 1 1.5 : 1 1.1 : 1 2.4 : 1 4.1 : 1 2.4 : 1 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 122 Other unintentional injuries a 26 Road injury 203 Ischaemic heart disease 668 Ischaemic heart disease 1 367 Ischaemic heart disease 2 280 Ischaemic heart disease 18 747 Ischaemic heart disease 23 082 2 Other congenital anomalies 60 Road injury 11 Drug use disorders 71 Road injury 259 Trachea, bronchus, lung cancers 901 Trachea, bronchus, lung cancers 2 218 Stroke 14 189 Stroke 15 530 3 Congenital heart anomalies 50 Leukaemia 11 Self-harm 54 Breast cancer 186 Stroke 330 Stroke 826 COPD b 6 124 Trachea, bronchus, lung cancers 7 526 4 Birth asphyxia and birth trauma 18 Brain and nervous system cancers 9 Other unintentional injuries a 40 Trachea, bronchus, lung cancers 186 Breast cancer 278 Colon and rectum cancers 492 Lower respiratory infections 6 066 COPD b 6 645 5 Lower respiratory infections 16 Other congenital anomalies 7 Other neurological conditions 30 Self-harm 182 Colon and rectum cancers 202 Breast cancer 413 Other circulatory diseases 4 274 Lower respiratory infections 6 478 6 Down syndrome 11 Other malignant neoplasms 6 Ischaemic heart disease 20 Stroke 174 Pancreas cancer 189 Pancreas cancer 409 Trachea, bronchus, lung cancers 4 218 Other circulatory diseases 4 945 7 Other neonatal conditions 7 Other neurological conditions 6 Brain and nervous system cancers 19 Drug use disorders 144 Brain and nervous system cancers 178 COPD b 396 Other respiratory diseases 3 509 Other respiratory diseases 3 825 8 Other chromosomal anomalies 7 Congenital heart anomalies 5 Drowning 18 Brain and nervous system cancers 122 Cirrhosis of the liver 174 Other circulatory diseases 393 Kidney diseases 3 062 Kidney diseases 3 338 9 Other neurological conditions 6 Drowning 5 Interpersonal violence 17 Other circulatory diseases 98 Other circulatory diseases 172 Liver cancer 304 Colon and rectum cancers 2 465 Colon and rectum cancers 3 245 10 Other unintentional injuries a 6 Lymphomas, multiple myeloma 3 Cardiomyopathy, myocarditis, endocarditis 17 Other unintentional injuries a 94 Stomach cancer 144 Brain and nervous system cancers 299 Alzheimer disease and other dementias 1 946 Breast cancer 2 466 11 Brain and nervous system cancers 6 Other endocrine, blood and immune disorders 3 Other malignant neoplasms 17 Cirrhosis of the liver 89 Road injury 125 Stomach cancer 281 Hepatitis 1 861 Alzheimer disease and other dementias 2 085 12 Sudden infant death syndrome 5 Exposure to mechanical forces 3 Leukaemia 14 Colon and rectum cancers 84 Other malignant neoplasms 119 Diabetes mellitus 275 Prostate cancer 1 842 Prostate cancer 2 048 13 Other endocrine, blood and immune disorders 5 Lower respiratory infections 2 Lymphomas, multiple myeloma 14 Cardiomyopathy, myocarditis, endocarditis 82 Self-harm 119 Bladder cancer 251 Hypertensive heart disease 1 760 Hypertensive heart disease 1 939 14 Other malignant neoplasms 5 Epilepsy 2 Stroke 9 Other malignant neoplasms 80 Liver cancer 118 Lymphomas, multiple myeloma 233 Upper respiratory infections 1 728 Hepatitis 1 923 15 Neural tube defects 4 Cardiomyopathy, myocarditis, endocarditis 2 Exposure to mechanical forces 9 Other neurological conditions 77 Diabetes mellitus 102 Other malignant neoplasms 228 Breast cancer 1 588 Pancreas cancer 1 900 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.5 (16) 42.5 (49) 52.3 (350) 18.6 (697) 7.0 (449) 3.7 (481) 1.5 (1 437) 2.9 (3 479) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Greece, 2016 Greece European Region Rank Cause of death YLL % % All causes 1 963 448 1 Cardiovascular diseases 651 044 33.2 34.9 2 Malignant neoplasms 626 700 31.9 25.3 3 Respiratory diseases 127 344 6.5 3.8 4 Respiratory infectious 95 778 4.9 2.7 5 Unintentional injuries 88 357 4.5 5.8 6 Neurological conditions 73 015 3.7 4.3 7 Digestive diseases 65 584 3.3 5.2 8 Infectious and parasitic diseases 55 188 2.8 3.2 9 Genitourinary diseases 51 917 2.6 1.6 10 Diabetes mellitus 30 699 1.6 1.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Greece, 2016 Trends in violence and injury deaths (0–64 years) in Greece Male-to-female mortality ratios in Greece, 2016 Income group (2016) High (2) Population (2016) 11 183 716 (1) Gross national income per capita (2016) US$ 18 980 (2) GREECE70 Behavioural risk-factor legislation and enforcement for road safety in Greece, 2017 Prevention of, and response to, violence against children in Greece, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting NO — Ban on corporal punishment in all settings YES ➀ ➁ ➌ ➃ Parenting education YES ➀ ➋ ➂ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation NO — School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➋ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers — — Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims — Child protection services for victims YES ➀ ➋ ➂ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➋ ➂ a Sources: vital registration data; National Statistical Authority (ELSTAT); the 2010 BECAN (Balkan Epidemiological Study on Child Abuse and Neglect) study; WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Greece Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 38.4 34.6 Unintentional injuries, 2014a 37.8 31.8 Intentional injuries, 2014a 41.6 39.6 Road injuries, 2016b 35.9 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.02 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 3/10 4/10 4/10 4/10 2/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. GREECE contd 71 Hungary European Region Rank Cause of death YLL % % All causes 2 565 962 1 Cardiovascular diseases 1 014 202 39.5 34.9 2 Malignant neoplasms 787 129 30.7 25.3 3 Digestive diseases 162 189 6.3 5.2 4 Respiratory diseases 131 121 5.1 3.8 5 Unintentional injuries 98 068 3.8 5.8 6 Neurological conditions 73 883 2.9 4.3 7 Intentional injuries 71 530 2.8 3.9 8 Diabetes mellitus 52 974 2.1 1.7 9 Genitourinary diseases 28 223 1.1 1.6 10 Mental and substance-use disorders 24 533 1.0 2.2 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.1 : 1 3.3 : 1 2.8 : 1 1.2 : 1 1.5 : 1 3.9 : 1 3.1 : 1 1.6 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 22 33 13 14 31 2 1 2 46% Commonwealth of Independent States European Union HungaryEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Hungary, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Hungary, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 175 Leukaemia 11 Self-harm 135 Ischaemic heart disease 645 Ischaemic heart disease 2 096 Ischaemic heart disease 5 692 Ischaemic heart disease 32 609 Ischaemic heart disease 41 054 2 Congenital heart anomalies 49 Other congenital anomalies 9 Road injury 107 Self-harm 510 Trachea, bronchus, lung cancers 1 542 Trachea, bronchus, lung cancers 3 571 Stroke 8 317 Stroke 10 717 3 Other congenital anomalies 42 Road injury 8 Other unintentional injuries a 31 Cirrhosis of the liver 384 Cirrhosis of the liver 821 Stroke 1 569 COPD b 3 778 Trachea, bronchus, lung cancers 8 889 4 Birth asphyxia and birth trauma 28 Other neurological conditions 8 Leukaemia 27 Trachea, bronchus, lung cancers 238 Stroke 588 COPD b 1 455 Trachea, bronchus, lung cancers 3 537 COPD b 5 920 5 Lower respiratory infections 22 Idiopathic intellectual disability 7 Other neurological conditions 27 Stroke 224 COPD b 553 Colon and rectum cancers 1 402 Hypertensive heart disease 3 325 Colon and rectum cancers 5 229 6 Other neonatal conditions 18 Drowning 6 Brain and nervous system cancers 22 Road injury 197 Colon and rectum cancers 538 Cirrhosis of the liver 1 215 Alzheimer disease and other dementias 3 293 Hypertensive heart disease 4 003 7 Sudden infant death syndrome 12 Congenital heart anomalies 6 Idiopathic intellectual disability 21 Cardiomyopathy, myocarditis, endocarditis 188 Mouth and oropharynx cancers 452 Other circulatory diseases 734 Colon and rectum cancers 3 119 Other circulatory diseases 3 763 8 Down syndrome 11 Other endocrine, blood and immune disorders 5 Other congenital anomalies 17 Colon and rectum cancers 166 Self-harm 369 Pancreas cancer 658 Other circulatory diseases 2 568 Alzheimer disease and other dementias 3 609 9 Other chromosomal anomalies 10 Brain and nervous system cancers 5 Drowning 16 Breast cancer 158 Cardiomyopathy, myocarditis, endocarditis 310 Breast cancer 578 Diabetes mellitus 1 952 Cirrhosis of the liver 3 102 10 Neonatal sepsis and infections 10 Stroke 4 Stroke 15 Other circulatory diseases 147 Breast cancer 302 Mouth and oropharynx cancers 569 Breast cancer 1 273 Diabetes mellitus 2 789 11 Other unintentional injuries a 10 Epilepsy 4 Cardiomyopathy, myocarditis, endocarditis 14 COPD b 130 Other circulatory diseases 300 Diabetes mellitus 561 Falls 1 268 Breast cancer 2 314 12 Other endocrine, blood and immune disorders 9 Other malignant neoplasms 4 Drug use disorders 14 Other unintentional injuries a 125 Pancreas cancer 262 Cardiomyopathy, myocarditis, endocarditis 501 Pancreas cancer 1 156 Pancreas cancer 2 180 13 Meningitis 8 Other unintentional injuries a 4 Other endocrine, blood and immune disorders 13 Pancreas cancer 102 Diabetes mellitus 213 Hypertensive heart disease 464 Kidney diseases 1 041 Self-harm 1 866 14 Other malignant neoplasms 5 Exposure to mechanical forces 2 Other malignant neoplasms 13 Brain and nervous system cancers 96 Stomach cancer 179 Stomach cancer 430 Prostate cancer 1 037 Falls 1 741 15 Other neurological conditions 5 Cardiomyopathy, myocarditis, endocarditis 2 Other circulatory diseases 12 Mouth and oropharynx cancers 95 Hypertensive heart disease 155 Self-harm 364 Stomach cancer 939 Cardiomyopathy, myocarditis, endocarditis 1 664 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.5 (21) 22.7 (23) 47.5 (322) 19.9 (1 026) 7.4 (858) 4.0 (1 038) 2.8 (2 309) 4.4 (5 597) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Hungary, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Hungary, 2016 Trends in violence and injury deaths (0–64 years) in Hungary Male-to-female mortality ratios in Hungary, 2016 Income group (2016) High (2) Population (2016) 9 753 281 (1) Gross national income per capita (2016) US$ 12 570 (2) HUNGARY72 Behavioural risk-factor legislation and enforcement for road safety in Hungary, 2017 Prevention of, and response to, violence against children in Hungary, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➋ ➂ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➋ ➂ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: KiVa (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Hungary Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 36.8 34.6 Unintentional injuries, 2014a 34.5 31.8 Intentional injuries, 2014a 39.7 39.6 Road injuries, 2016b 39.4 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes 0.00 g/dl 0.00 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 6/10 5/10 7/10 8/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. HUNGARY contd 73 2.0 : 1 2.7 : 1 2.0 : 1 1.4 : 1 1.5 : 1 56.5 : 1 4.0 : 1 1.5 : 1 0 1 2 3 4 5 60 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 3 1 35 10 33 3 15 1 5% Commonwealth of Independent States European Union IcelandEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Iceland, 2016 (%) Trends in violence and injury deaths (0–64 years) in Iceland Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Iceland, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Iceland, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 2 Epilepsy 1 Self-harm 12 Self-harm 18 Ischaemic heart disease 18 Ischaemic heart disease 37 Ischaemic heart disease 390 Ischaemic heart disease 452 2 Other congenital anomalies 1 Other neurological conditions 0 Drug use disorders 3 Ischaemic heart disease 6 Trachea, bronchus, lung cancers 13 Trachea, bronchus, lung cancers 35 Alzheimer disease and other dementias 225 Alzheimer disease and other dementias 231 3 Sudden infant death syndrome 1 Road injury 0 Other unintentional injuries a 3 Brain and nervous system cancers 5 Breast cancer 9 Colon and rectum cancers 17 Stroke 128 Stroke 143 4 Congenital heart anomalies 1 Leukaemia 0 Road injury 2 Drug use disorders 5 Colon and rectum cancers 7 COPD b 16 COPD b 107 Trachea, bronchus, lung cancers 139 5 Birth asphyxia and birth trauma 1 Other congenital anomalies 0 Brain and nervous system cancers 1 Colon and rectum cancers 4 Brain and nervous system cancers 6 Breast cancer 13 Trachea, bronchus, lung cancers 88 COPD b 126 6 Other unintentional injuries a 0 Interpersonal violence 0 Other endocrine, blood and immune disorders 1 Other malignant neoplasms 3 Cirrhosis of the liver 6 Stroke 9 Other circulatory diseases 77 Other circulatory diseases 86 7 Other neurological conditions 0 Other chromosomal anomalies 0 Interpersonal violence 1 Road injury 3 Self-harm 6 Self-harm 8 Lower respiratory infections 63 Colon and rectum cancers 77 8 Brain and nervous system cancers 0 Poisonings 0 Epilepsy 1 Breast cancer 3 Other circulatory diseases 4 Pancreas cancer 8 Prostate cancer 55 Lower respiratory infections 68 9 Drowning 0 Eating disorders 0 Down syndrome 1 Pancreas cancer 3 Kidney cancer 3 Oesophagus cancer 7 Colon and rectum cancers 48 Prostate cancer 62 10 Other chromosomal anomalies 0 – Cardiomyopathy, myocarditis, endocarditis 1 Trachea, bronchus, lung cancers 3 Pancreas cancer 3 Other neurological conditions 6 Pancreas cancer 39 Breast cancer 57 11 Down syndrome 0 – Other digestive diseases 1 Alcohol use disorders 3 Other neurological conditions 3 Alzheimer disease and other dementias 6 Breast cancer 32 Pancreas cancer 52 12 Interpersonal violence 0 – Colon and rectum cancers 1 Other unintentional injuries a 2 Stroke 3 Kidney cancer 6 Other unintentional injuries a 32 Self-harm 47 13 Other malignant neoplasms 0 – Other malignant neoplasms 1 Stroke 2 Other unintentional injuries a 3 Lymphomas, multiple myeloma 5 Parkinson disease 32 Other unintentional injuries a 43 14 Road injury 0 – Idiopathic intellectual disability 0 Other circulatory diseases 2 Alcohol use disorders 3 Prostate cancer 5 Other digestive diseases 30 Other digestive diseases 35 15 Leukaemia 0 – Alcohol use disorders 0 Falls 2 COPD b 3 Leukaemia 5 Kidney diseases 24 Parkinson disease 33 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 16.1 (1) 19.2 (1) 61.8 (18) 32.7 (27) 10.2 (14) 5.8 (15) 3.2 (56) 5.8 (131) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Iceland, 2016 Iceland European Region Rank Cause of death YLL % % All causes 389 954 1 Malignant neoplasms 134 307 34.4 25.3 2 Cardiovascula diseases 95 755 24.6 34.9 3 Neurological conditions 38 271 9.8 4.3 4 Intentional injuries 24 763 6.4 3.9 5 Respiratory diseases 22 061 5.7 3.8 6 Unintentional injuries 19 360 5.0 5.8 7 Digestive diseases 11 484 2.9 5.2 8 Mental and substance-use disorders 9 839 2.5 2.2 9 Respiratory infectious 7 108 1.8 2.7 10 Congenital anomalies 4 747 1.2 1.5 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Iceland, 2016 Income group (2016) High (2) Population (2016) 332 474 (1) Gross national income per capita (2016) US$ 56 990 (2) ICELAND74 Behavioural risk-factor legislation and enforcement for road safety in Iceland, 2017 Prevention of, and response to, violence against children in Iceland, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: Oleweus (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Iceland Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 35.6 34.6 Unintentional injuries, 2014a 33.8 31.8 Intentional injuries, 2014a 37.6 39.6 Road injuries, 2016b 33.4 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes Yes No No Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 7/10 9/10 9/10 9/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. ICELAND contd 75 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.4 : 12.3 : 1 2.4 : 1 1.2 : 1 1.5 : 1 4.8 : 1 4.1 : 1 2.7 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 4 2 41 11 15 3 3 20 1 24% Commonwealth of Independent States European Union IrelandEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Ireland, 2016 (%) Trends in violence and injury deaths (0–64 years) in Ireland Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Ireland, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Ireland, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 56 Brain and nervous system cancers 7 Self-harm 106 Self-harm 226 Ischaemic heart disease 301 Ischaemic heart disease 595 Ischaemic heart disease 4 046 Ischaemic heart disease 5 070 2 Other congenital anomalies 34 Other endocrine, blood and immune disorders 4 Drug use disorders 46 Ischaemic heart disease 124 Trachea, bronchus, lung cancers 200 Trachea, bronchus, lung cancers 527 Alzheimer disease and other dementias 2 428 Alzheimer disease and other dementias 2 506 3 Congenital heart anomalies 28 Other malignant neoplasms 4 Road injury 41 Breast cancer 100 Breast cancer 124 Colon and rectum cancers 221 COPD a 1 767 COPD a 2 029 4 Other chromosomal anomalies 27 Other neurological conditions 4 Other neurological conditions 11 Drug use disorders 98 Self-harm 111 COPD a 213 Stroke 1 595 Trachea, bronchus, lung cancers 1 930 5 Other neonatal conditions 19 Other congenital anomalies 4 Other unintentional injuries b 10 Cirrhosis of the liver 80 Colon and rectum cancers 106 Breast cancer 166 Trachea, bronchus, lung cancers 1 161 Stroke 1 845 6 Birth asphyxia and birth trauma 14 Leukaemia 4 Interpersonal violence 10 Brain and nervous system cancers 47 Cirrhosis of the liver 87 Other circulatory diseases 146 Other circulatory diseases 1 103 Other circulatory diseases 1 364 7 Sudden infant death syndrome 12 Road injury 3 Other malignant neoplasms 9 Other circulatory diseases 47 Stroke 69 Stroke 137 Lower respiratory infections 1 084 Lower respiratory infections 1 176 8 Neural tube defects 9 Self-harm 3 Drowning 9 Road injury 42 Other circulatory diseases 58 Pancreas cancer 113 Colon and rectum cancers 751 Colon and rectum cancers 1 113 9 Down syndrome 7 Congenital heart anomalies 3 Brain and nervous system cancers 8 Trachea, bronchus, lung cancers 41 Pancreas cancer 53 Lymphomas, multiple myeloma 102 Other respiratory diseases 565 Breast cancer 806 10 Neonatal sepsis and infections 6 Other unintentional injuries b 3 Other circulatory diseases 8 Stroke 40 Oesophagus cancer 50 Oesophagus cancer 98 Diabetes mellitus 492 Other respiratory diseases 654 11 Lower respiratory infections 5 Drowning 2 Other endocrine, blood and immune disorders 7 Colon and rectum cancers 34 Ovary cancer 49 Brain and nervous system cancers 80 Prostate cancer 490 Prostate cancer 579 12 Other endocrine, blood and immune disorders 4 Kidney cancer 2 Epilepsy 6 Alcohol use disorders 32 Brain and nervous system cancers 48 Cirrhosis of the liver 79 Kidney diseases 458 Diabetes mellitus 572 13 Other neurological conditions 4 Exposure to mechanical forces 2 Leukaemia 5 Cardiomyopathy, myocarditis, endocarditis 25 COPD a 41 Prostate cancer 72 Breast cancer 414 Self-harm 543 14 Brain and nervous system cancers 2 Asthma 1 Congenital heart anomalies 4 Other neurological conditions 23 Lymphomas, multiple myeloma 40 Ovary cancer 69 Parkinson disease 412 Lymphomas, multiple myeloma 525 15 Meningitis 2 Epilepsy 1 Cardiomyopathy, myocarditis, endocarditis 4 Stomach cancer 23 Other malignant neoplasms 38 Other neurological conditions 66 Other digestive diseases 377 Pancreas cancer 517 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 2.5 (6) 23.5 (15) 53.8 (188) 24.4 (361) 9.6 (199) 3.9 (156) 1.7 (393) 4.3 (1 316) Leading causes of death in Ireland, 2016 Ireland European Region Rank Cause of death YLL % % All causes 579 040 1 Malignant neoplasms 196 406 33.9 25.3 2 Cardiovascula diseases 135 671 23.4 34.9 3 Neurological conditions 43 937 7.6 4.3 4 Respiratory diseases 39 238 6.8 3.8 5 Intentional injuries 27 652 4.8 3.9 6 Digestive diseases 25 158 4.3 5.2 7 Unintentional injuries 22 410 3.9 5.8 8 Respiratory infectious 14 319 2.5 2.7 9 Congenital anomalies 13 136 2.3 1.5 10 Mental and substance-use disorders 12 976 2.2 2.2 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Ireland, 2016 Income group (2016) High (2) Population (2016) 4 726 078 (1) Gross national income per capita (2016) US$ 52 560 (2) IRELAND76 Behavioural risk-factor legislation and enforcement for road safety in Ireland, 2017 Standardized mortality from alcohol-attributable disease and injury categories in Ireland Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 41.9 34.6 Unintentional injuries, 2014a 38.9 31.8 Intentional injuries, 2014a 45.8 39.6 Road injuries, 2016b 44.2 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl 0.02 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 10/10 10/10 10/10 10/10 10/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. IRELAND contd Prevention of, and response to, violence against children in Ireland, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting — ➀ ➁ ➂ ➃ Ban on corporal punishment in all settings — ➀ ➁ ➂ ➃ Parenting education — ➀ ➁ ➂ ➃ Against statutory rape — ➀ ➁ ➂ ➃ Hospital-based parental training (abusive head trauma) — ➀ ➁ ➂ ➃ Against child marriage — ➀ ➁ ➂ ➃ Primary school-based empowering children — ➀ ➁ ➂ ➃ Against female genital mutilation — ➀ ➁ ➂ ➃ School-based antibullying — ➀ ➁ ➂ ➃ Reporting of suspected child maltreatment — ➀ ➁ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — ➀ ➁ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — ➀ ➁ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers — ➀ ➁ ➂ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims — ➀ ➁ ➂ Child protection services for victims — Child protection services for victims — ➀ ➁ ➂ Medicolegal services for victims — Medicolegal services for victims — ➀ ➁ ➂ Source: WHO Regional Office for Europe (6). Data not available Data not available Data not available Data not available 77 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 31 8 224 13 41 8 1 42% Commonwealth of Independent States European Union IsraelEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Israel, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Israel, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.9 : 1 3.9 : 1 1.7 : 1 1.5 : 1 1.7 : 1 4.5 : 1 3.0 : 1 2.7 : 1 Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 114 Brain and nervous system cancers 19 Road injury 93 Breast cancer 146 Trachea, bronchus, lung cancers 293 Trachea, bronchus, lung cancers 617 Ischaemic heart disease 4 328 Ischaemic heart disease 5 185 2 Other congenital anomalies 94 Other neurological conditions 18 Self-harm 81 Self-harm 143 Ischaemic heart disease 232 Ischaemic heart disease 524 Alzheimer disease and other dementias 2 172 Diabetes mellitus 2 676 3 Congenital heart anomalies 67 Other unintentional injuries a 14 Other neurological conditions 44 Ischaemic heart disease 97 Breast cancer 169 Diabetes mellitus 363 Stroke 2 155 Stroke 2 525 4 Other neonatal conditions 58 Other malignant neoplasms 11 Interpersonal violence 44 Trachea, bronchus, lung cancers 86 Diabetes mellitus 145 Colon and rectum cancers 283 Diabetes mellitus 2 119 Lower respiratory infections 2 437 5 Other chromosomal anomalies 38 Road injury 9 Other unintentional injuries a 33 Colon and rectum cancers 71 Colon and rectum cancers 129 Pancreas cancer 253 Lower respiratory infections 2 109 Alzheimer disease and other dementias 2 269 6 Birth asphyxia and birth trauma 35 Other endocrine, blood and immune disorders 7 Other malignant neoplasms 26 Brain and nervous system cancers 67 Pancreas cancer 109 Breast cancer 251 Other circulatory diseases 1 666 Trachea, bronchus, lung cancers 2 136 7 Sudden infant death syndrome 19 Self-harm 7 Leukaemia 22 Other neurological conditions 61 Stroke 91 Stroke 231 Kidney diseases 1 563 Other circulatory diseases 1 934 8 Other endocrine, blood and immune disorders 18 Interpersonal violence 6 Brain and nervous system cancers 17 Road injury 60 Brain and nervous system cancers 80 COPD b 216 COPD b 1 519 COPD b 1 829 9 Other unintentional injuries a 16 Congenital heart anomalies 5 Epilepsy 13 Other unintentional injuries a 57 Lymphomas, multiple myeloma 79 Lower respiratory infections 201 Trachea, bronchus, lung cancers 1 138 Kidney diseases 1 829 10 Down syndrome 13 Other congenital anomalies 5 Other circulatory diseases 12 Stomach cancer 53 Self-harm 71 Lymphomas, multiple myeloma 181 Colon and rectum cancers 1 049 Colon and rectum cancers 1 536 11 Neonatal sepsis and infections 12 Cardiomyopathy, myocarditis, endocarditis 5 Drowning 11 Diabetes mellitus 47 COPD b 70 Kidney diseases 179 Other respiratory diseases 691 Breast cancer 1 194 12 Lower respiratory infections 9 Leukaemia 4 Lymphomas, multiple myeloma 11 Interpersonal violence 47 Other neurological conditions 69 Other circulatory diseases 155 Other infectious diseases 654 Pancreas cancer 1 011 13 Other neurological conditions 9 Drowning 4 Drug use disorders 11 Other malignant neoplasms 47 Stomach cancer 68 Brain and nervous system cancers 124 Other digestive diseases 643 Other endocrine, blood and immune disorders 865 14 Neural tube defects 8 Lower respiratory infections 4 Other endocrine, blood and immune disorders 11 Other endocrine, blood and immune disorders 45 Lower respiratory infections 67 Stomach cancer 110 Other endocrine, blood and immune disorders 635 Lymphomas, multiple myeloma 864 15 Diarrhoeal diseases 6 Alzheimer disease and other dementias 3 Cardiomyopathy, myocarditis, endocarditis 10 Lymphomas, multiple myeloma 43 Other circulatory diseases 65 Other digestive diseases 108 Breast cancer 625 Other digestive diseases 827 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.2 (43) 27.9 (44) 47.9 (279) 18.9 (335) 6.5 (179) 3.1 (182) 2.4 (785) 4.1 (1 847) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Israel, 2016 Israel European Region Rank Cause of death YLL % % All causes 834 641 1 Malignant neoplasms 265 041 31.8 25.3 2 Cardiovascula diseases 152 930 18.3 34.9 3 Neurological conditions 48 944 5.9 4.3 4 Diabetes mellitus 42 800 5.1 1.7 5 Respiratory diseases 42 046 5.0 3.8 6 Unintentional injuries 37 871 4.5 5.8 7 Respiratory infectious 34 495 4.1 2.7 8 Genitourinary diseases 33 208 4.0 1.6 9 Digestive diseases 30 140 3.6 5.2 10 Intentional injuries 27 072 3.2 3.9 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Israel, 2016 Trends in violence and injury deaths (0–64 years) in Israel Male-to-female mortality ratios in Israel, 2016 Income group (2016) High (2) Population (2016) 8 191 828 (1) Gross national income per capita (2016) US$ 36 190 (2) ISRAEL78 Behavioural risk-factor legislation and enforcement for road safety in Israel, 2017 Prevention of, and response to, violence against children in Israel, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings YES — Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➋ ➂ ➃ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES — School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➌ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➋ ➂ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Subnational. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Israel Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 17.3 34.6 Unintentional injuries, 2014a 14.9 31.8 Intentional injuries, 2014a 21.9 39.6 Road injuries, 2016b 28.3 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl 0.01 g/dl Yes Yes Yes Yes Yes Up to 8 years Yes Restricted Member States' reported enforcement effectivenessa 5/10 7/10 7/10 9/10 6/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. ISRAEL contd 79 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.3 : 1 2.7 : 1 0.6 : 1 1.2 : 1 1.7 : 1 3.3 : 1 2.7 : 1 2.1 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 22 16 1 1 20 13 42 2 1 35% Commonwealth of Independent States European Union ItalyEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Italy, 2016 (%) Trends in violence and injury deaths (0–64 years) in Italy Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Italy, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Italy, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 406 Leukaemia 52 Road injury 502 Ischaemic heart disease 1 527 Ischaemic heart disease 3 384 Trachea, bronchus, lung cancers 7 648 Ischaemic heart disease 100 050 Ischaemic heart disease 112 229 2 Other neonatal conditions 224 Natural disasters 49 Self-harm 364 Self-harm 1 210 Trachea, bronchus, lung cancers 3 104 Ischaemic heart disease 7 212 Stroke 57 904 Stroke 62 229 3 Congenital heart anomalies 164 Brain and nervous system cancers 44 Drowning 129 Breast cancer 1 095 Breast cancer 1 722 Colon and rectum cancers 3 242 Alzheimer disease and other dementias 34 486 Alzheimer disease and other dementias 35 443 4 Other congenital anomalies 161 Other neurological conditions 42 Drug use disorders 115 Trachea, bronchus, lung cancers 780 Colon and rectum cancers 1 457 Stroke 2 646 COPD a 28 952 Trachea, bronchus, lung cancers 34 188 5 Birth asphyxia and birth trauma 121 Other malignant neoplasms 40 Other malignant neoplasms 113 Road injury 678 Stroke 1 064 Breast cancer 2 435 Other circulatory diseases 26 935 COPD a 31 191 6 Other chromosomal anomalies 71 Road injury 31 Leukaemia 107 Cirrhosis of the liver 581 Cirrhosis of the liver 1 059 Pancreas cancer 2 183 Trachea, bronchus, lung cancers 22 643 Other circulatory diseases 29 829 7 Neonatal sepsis and infections 68 Congenital heart anomalies 23 Other neurological conditions 105 Colon and rectum cancers 577 Pancreas cancer 962 Diabetes mellitus 1 999 Diabetes mellitus 19 242 Diabetes mellitus 22 112 8 Other malignant neoplasms 44 Other endocrine, blood and immune disorders 20 Other unintentional injuries b 89 Stroke 558 Liver cancer 912 Liver cancer 1 800 Hypertensive heart disease 16 707 Colon and rectum cancers 21 326 9 Other neurological conditions 36 Other congenital anomalies 17 Lymphomas, multiple myeloma 78 Other circulatory diseases 470 Self-harm 850 Other circulatory diseases 1 671 Colon and rectum cancers 16 034 Hypertensive heart disease 17 660 10 Other endocrine, blood and immune disorders 36 Other neoplasms 13 Interpersonal violence 76 Brain and nervous system cancers 457 Stomach cancer 815 Stomach cancer 1 659 Kidney diseases 13 922 Kidney diseases 14 940 11 Down syndrome 30 Drowning 13 Brain and nervous system cancers 75 Stomach cancer 370 Diabetes mellitus 688 COPD a 1 617 Lower respiratory infections 13 254 Lower respiratory infections 14 149 12 Brain and nervous system cancers 28 Self-harm 12 Other circulatory diseases 63 Other neurological conditions 350 Brain and nervous system cancers 687 Lymphomas, multiple myeloma 1 522 Other unintentional injuries b 9 140 Breast cancer 13 828 13 Leukaemia 28 Stroke 10 Other endocrine, blood and immune disorders 54 Other malignant neoplasms 348 Other circulatory diseases 677 Cirrhosis of the liver 1 475 Other respiratory diseases 8 593 Pancreas cancer 11 554 14 Natural disasters 24 Cardiomyopathy, myocarditis, endocarditis 9 Ischaemic heart disease 53 Lymphomas, multiple myeloma 346 Lymphomas, multiple myeloma 631 Other malignant neoplasms 1 325 Breast cancer 8 568 Stomach cancer 10 775 15 Other neoplasms 24 Epilepsy 9 Natural disasters 52 Other endocrine, blood and immune disorders 302 Other malignant neoplasms 625 Brain and nervous system cancers 1 118 Pancreas cancer 8 119 Other unintentional injuries b 10 202 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.0 (84) 26.1 (131) 48.0 (1 299) 17.7 (2 779) 6.6 (1 893) 3.3 (1 987) 3.0 (15 867) 3.8 (24 039) Leading causes of death in Italy, 2016 Italy European Region Rank Cause of death YLL % % All causes 9 773 837 1 Malignant neoplasms 3 351 361 34.3 25.3 2 Cardiovascula diseases 2 854 966 29.2 34.9 3 Neurological conditions 603 536 6.2 4.3 4 Respiratory diseases 513 345 5.3 3.8 5 Digestive diseases 434 558 4.4 5.2 6 Unintentional injuries 363 063 3.7 5.8 7 Diabetes mellitus 307 179 3.1 1.7 8 Infectious and parasitic diseases 217 645 2.2 3.2 9 Genitourinary diseases 204 344 2.1 1.6 10 Intentional injuries 184 269 1.9 3.9 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Italy, 2016 Income group (2016) High (2) Population (2016) 59 429 936 (1) Gross national income per capita (2016) US$ 31 590 (2) ITALY80 Behavioural risk-factor legislation and enforcement for road safety in Italy, 2017 Prevention of, and response to, violence against children in Italy, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings NOa — Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims — Child protection services for victims YES ➀ ➋ ➂ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Does not cover: home. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Italy Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 32.1 34.6 Unintentional injuries, 2014a 31.3 31.8 Intentional injuries, 2014a 34.3 39.6 Road injuries, 2016b 30.0 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl 0.00 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 7/10 7/10 9/10 6/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. ITALY contd 81 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.5 : 1 2.7 : 1 2.5 : 1 3.0 : 1 2.6 : 1 4.8 : 1 5.0 : 1 4.0 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 6 2 5 3 10 3 29 32 10 Commonwealth of Independent States European Union KazakhstanEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ).42% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Kazakhstan, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Kazakhstan, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 749 Road injury 261 Road injury 1 085 Ischaemic heart disease 2 488 Ischaemic heart disease 4 816 Ischaemic heart disease 8 191 Ischaemic heart disease 32 049 Ischaemic heart disease 47 651 2 Lower respiratory infections 572 Drowning 103 Self-harm 858 Self-harm 1 849 Stroke 2 294 Stroke 3 974 Stroke 11 644 Stroke 19 074 3 Birth asphyxia and birth trauma 571 Leukaemia 53 Interpersonal violence 328 Cirrhosis of the liver 1 840 Cirrhosis of the liver 1 802 Cirrhosis of the liver 1 852 COPD a 3 449 Cirrhosis of the liver 7 816 4 Other congenital anomalies 393 Self-harm 51 Drowning 168 Road injury 1 780 Trachea, bronchus, lung cancers 957 Trachea, bronchus, lung cancers 1 384 Alzheimer disease and other dementias 2 996 COPD a 5 789 5 Congenital heart anomalies 388 Other unintentional injuries b 46 Other unintentional injuries b 146 Stroke 1 081 Road injury 673 COPD a 1 313 Cirrhosis of the liver 2 174 Road injury 4 502 6 Neonatal sepsis and infections 274 Lower respiratory infections 41 Cirrhosis of the liver 134 Interpersonal violence 715 Self-harm 666 Stomach cancer 762 Trachea, bronchus, lung cancers 1 552 Trachea, bronchus, lung cancers 4 164 7 Diarrhoeal diseases 235 Brain and nervous system cancers 33 Drug use disorders 111 Cardiomyopathy, myocarditis, endocarditis 695 COPD a 641 Other malignant neoplasms 667 Colon and rectum cancers 1 435 Self-harm 4 048 8 Other neonatal conditions 203 Congenital heart anomalies 33 Ischaemic heart disease 106 Lower respiratory infections 581 Other malignant neoplasms 546 Colon and rectum cancers 550 Stomach cancer 1 310 Alzheimer disease and other dementias 3 194 9 Other unintentional injuries b 153 Other malignant neoplasms 28 Other malignant neoplasms 99 Other unintentional injuries b 484 Stomach cancer 541 Lower respiratory infections 493 Other malignant neoplasms 1 294 Lower respiratory infections 3 082 10 Sudden infant death syndrome 88 Other congenital anomalies 25 Cardiomyopathy, myocarditis, endocarditis 92 Drug use disorders 405 Lower respiratory infections 523 Oesophagus cancer 459 Hypertensive heart disease 1 220 Other malignant neoplasms 3 003 11 Other neoplasms 74 Encephalitis 25 Lower respiratory infections 89 Alcohol use disorders 351 Cardiomyopathy, myocarditis, endocarditis 494 Hypertensive heart disease 453 Other circulatory diseases 986 Stomach cancer 2 912 12 Leukaemia 68 Falls 23 Falls 77 COPD a 344 Breast cancer 478 Breast cancer 440 Oesophagus cancer 887 Colon and rectum cancers 2 539 13 Road injury 66 Lymphomas, multiple myeloma 21 Epilepsy 70 HIV/AIDS 333 Colon and rectum cancers 384 Other circulatory diseases 417 Lower respiratory infections 783 Cardiomyopathy, myocarditis, endocarditis 2 360 14 Other malignant neoplasms 52 Interpersonal violence 20 Leukaemia 67 Breast cancer 324 Other circulatory diseases 333 Diabetes mellitus 405 Breast cancer 754 Hypertensive heart disease 2 115 15 Other infectious diseases 40 Epilepsy 20 Stroke 66 Drowning 321 Hypertensive heart disease 297 Kidney diseases 392 Kidney diseases 742 Other circulatory diseases 2 031 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 8.1 (351) 57.7 (551) 63.5 (2 807) 31.0 (5 783) 10.9 (2 252) 4.7 (1 268) 1.5 (1 061) 9.5 (14 072) Leading causes of death in Kazakhstan, 2016 Kazakhstan European Region Rank Cause of death YLL % % All causes 4 250 881 1 Cardiovascula diseases 1 578 050 37.1 34.9 2 Malginant neoplasms 729 168 17.2 25.3 3 Unintentional injuries 435 041 10.2 5.8 4 Digestive diseases 323 746 7.6 5.2 5 Intentional injuries 276 036 6.5 3.9 6 Neonatal conditions 165 100 3.9 2.2 7 Respiratory diseases 150 158 3.5 3.8 8 Respiratory infectious 136 100 3.2 2.7 9 Infectious and parasitic diseases 91 813 2.2 3.2 10 Congenital anomalies 88 800 2.1 1.5 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Kazakhstan, 2016 Trends in violence and injury deaths (0–64 years) in Kazakhstan Male-to-female mortality ratios in Kazakhstan, 2016 Income group (2016) Upper-middle (2) Population (2016) 17 987 736 (1) Gross national income per capita (2016) US$ 8710 (2) KAZAKHSTAN82 Behavioural risk-factor legislation and enforcement for road safety in Kazakhstan, 2017 Prevention of, and response to, violence against children in Kazakhstan, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings NOb ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➂ ➍ Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying NO — Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Kazakhstan Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 33.2 34.6 Unintentional injuries, 2014a 30.4 31.8 Intentional injuries, 2014a 36.5 39.6 Road injuries, 2016b 32.8 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr No ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes No Yes No No Yes Restricted Member States' reported enforcement effectivenessa 7/10 7/10 7/10 7/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. KAZAKHSTAN contd 83 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.2 : 1 3.0 : 1 2.0 : 1 3.9 : 1 1.8 : 1 3.0 : 1 3.8 : 1 3.8 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 8 24 3 15 1 18 37 12 32% Commonwealth of Independent States European Union KyrgyzstanEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Kyrgyzstan, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Kyrgyzstan, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 837 Other neurological conditions 37 Road injury 263 Cirrhosis of the liver 660 Ischaemic heart disease 1 102 Ischaemic heart disease 2 026 Ischaemic heart disease 9 263 Ischaemic heart disease 12 961 2 Lower respiratory infections 651 Road injury 29 Self-harm 158 Ischaemic heart disease 535 Stroke 787 Stroke 1 108 Stroke 2 807 Stroke 5 069 3 Birth asphyxia and birth trauma 442 Lower respiratory infections 29 Interpersonal violence 97 Road injury 428 Cirrhosis of the liver 578 Cirrhosis of the liver 420 COPD a 989 Cirrhosis of the liver 2 035 4 Congenital heart anomalies 258 Other unintentional injuries b 27 Cirrhosis of the liver 69 Stroke 339 Road injury 169 COPD a 218 Cirrhosis of the liver 303 COPD a 1 391 5 Other congenital anomalies 217 Drowning 21 Other unintentional injuries b 67 Self-harm 205 Stomach cancer 166 Stomach cancer 204 Stomach cancer 249 Road injury 1 043 6 Neonatal sepsis and infections 134 Self-harm 20 Kidney diseases 61 Tuberculosis 194 Trachea, bronchus, lung cancers 125 Trachea, bronchus, lung cancers 191 Hypertensive heart disease 192 Lower respiratory infections 964 7 Diarrhoeal diseases 121 Leukaemia 15 Tuberculosis 57 Cardiomyopathy, myocarditis, endocarditis 188 COPD a 116 Diabetes mellitus 154 Trachea, bronchus, lung cancers 151 Preterm birth complications 837 8 Other unintentional injuries b 87 Epilepsy 12 Epilepsy 56 Interpersonal violence 164 Kidney diseases 115 Liver cancer 98 Kidney diseases 132 Stomach cancer 726 9 Other neonatal conditions 52 Brain and nervous system cancers 10 Maternal conditions 53 Kidney diseases 161 Cardiomyopathy, myocarditis, endocarditis 111 Kidney diseases 87 Other circulatory diseases 111 Kidney diseases 569 10 Drowning 50 Congenital heart anomalies 10 Other neurological conditions 43 Alcohol use disorders 147 Alcohol use disorders 109 Road injury 79 Diabetes mellitus 110 Trachea, bronchus, lung cancers 515 11 Road injury 31 Encephalitis 7 Drowning 37 Other unintentional injuries b 121 Diabetes mellitus 108 Hypertensive heart disease 73 Liver cancer 110 Self-harm 494 12 Neural tube defects 29 Other malignant neoplasms 7 Ischaemic heart disease 35 HIV/AIDS 107 Tuberculosis 93 Cardiomyopathy, myocarditis, endocarditis 71 Colon and rectum cancers 102 Birth asphyxia and birth trauma 442 13 Encephalitis 24 Kidney diseases 6 Lower respiratory infections 28 Stomach cancer 102 Breast cancer 77 Colon and rectum cancers 68 Lower respiratory infections 89 Diabetes mellitus 428 14 Fire, heat and hot substances 23 Exposure to mechanical forces 5 Leukaemia 27 Drug use disorders 86 Cervix uteri cancer 75 Other circulatory diseases 65 Oesophagus cancer 81 Tuberculosis 427 15 Meningitis 21 Interpersonal violence 5 Stroke 26 Lower respiratory infections 80 Liver cancer 74 Breast cancer 60 Breast cancer 69 Cardiomyopathy, myocarditis, endocarditis 416 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.2 (228) 38.0 (115) 46.6 (663) 21.8 (1 060) 8.0 (403) 3.4 (202) 0.8 (118) 7.7 (2 789) Leading causes of death in Kyrgyzstan, 2016 Kyrgyzstan European Region Rank Cause of death YLL % % All causes 1 221 484 1 Cardiovascula diseases 400 491 32.8 34.9 2 Neonatal conditions 134 639 11.0 2.2 3 Malignant neoplasms 125 484 10.3 25.3 4 Unintentional injuries 108 920 8.9 5.8 5 Digestive diseases 95 529 7.8 5.2 6 Respiratory infectious 72 336 5.9 2.7 7 Infectious and parasitic diseases 54 470 4.5 3.2 8 Congenital anomalies 51 006 4.2 1.5 9 Intentional injuries 45 723 3.7 3.9 10 Respiratory diseases 30 391 2.5 3.8 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Kyrgyzstan, 2016 Trends in violence and injury deaths (0–64 years) in Kyrgyzstan Male-to-female mortality ratios in Kyrgyzstan, 2016 Income group (2016) Lower-middle (2) Population (2016) 5 955 734 (1) Gross national income per capita (2016) US$ 1110 (2) KYRGYZSTAN84 Behavioural risk-factor legislation and enforcement for road safety in Kyrgyzstan, 2017 Prevention of, and response to, violence against children in Kyrgyzstan, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings NOb ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) — — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership, Step Towards Effective Enjoyable Parenting (home visiting); Triple P, Adults and Children Against Violence (ACT), Safe Environment for Every Kid (parenting education); Kidpower (primary school-based empowering children); Olweus (school- based antibullying) b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Kyrgyzstan Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 19.7 34.6 Unintentional injuries, 2014a 18.6 31.8 Intentional injuries, 2014a 21.8 39.6 Road injuries, 2016b 22.4 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr No No No No No Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 5/10 5/10 7/10 5/10 NA Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. KYRGYZSTAN contd 85 Latvia European Region Rank Cause of death YLL % % All causes 570 432 1 Cardiovascula diseases 263 681 46.2 34.9 2 Malignant neoplasms 134 542 23.6 25.3 3 Unintentional injuries 35 457 6.2 5.8 4 Digestive diseases 29 716 5.2 5.2 5 Intentional injuries 22 186 3.9 3.9 6 Infectious and parasitic diseases 11 283 2.0 3.2 7 Respiratory infectious 11 119 1.9 2.7 8 Neurological conditions 11 007 1.9 4.3 9 Mental and substance-use disorders 10 576 1.9 2.2 10 Diabetes mellitus 9 456 1.7 1.7 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.3 : 13.3 : 1 5.6 : 1 2.3 : 1 2.3 : 1 5.6 : 1 5.1 : 1 2.6 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 11 3 8 8 15 28 12 14 1 Commonwealth of Independent States European Union LatviaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 51% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Latvia, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Latvia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Birth asphyxia and birth trauma 15 Road injury 5 Self-harm 55 Cardiomyopathy, myocarditis, endocarditis 212 Ischaemic heart disease 517 Ischaemic heart disease 1 084 Ischaemic heart disease 7 224 Ischaemic heart disease 8 984 2 Preterm birth complications 15 Brain and nervous system cancers 5 Road injury 36 Ischaemic heart disease 154 Stroke 186 Stroke 470 Stroke 4 208 Stroke 4 938 3 Other congenital anomalies 10 Drowning 5 Cardiomyopathy, myocarditis, endocarditis 20 Self-harm 141 Cardiomyopathy, myocarditis, endocarditis 177 Trachea, bronchus, lung cancers 294 Colon and rectum cancers 514 Trachea, bronchus, lung cancers 944 4 Congenital heart anomalies 9 Other neurological conditions 3 Drowning 18 Cirrhosis of the liver 118 Trachea, bronchus, lung cancers 131 Cardiomyopathy, myocarditis, endocarditis 168 Trachea, bronchus, lung cancers 491 Cardiomyopathy, myocarditis, endocarditis 816 5 Sudden infant death syndrome 6 Other congenital anomalies 2 Other unintentional injuries a 14 HIV/AIDS 74 Cirrhosis of the liver 126 Colon and rectum cancers 144 Hypertensive heart disease 459 Colon and rectum cancers 733 6 Lower respiratory infections 6 Other malignant neoplasms 2 Interpersonal violence 12 Stroke 70 Self-harm 88 Stomach cancer 114 Other circulatory diseases 409 Hypertensive heart disease 568 7 Other neonatal conditions 4 Encephalitis 1 Other neurological conditions 8 Alcohol use disorders 67 Alcohol use disorders 72 Breast cancer 99 Diabetes mellitus 355 Other circulatory diseases 551 8 Other unintentional injuries a 3 Leukaemia 1 HIV/AIDS 8 Lower respiratory infections 60 Lower respiratory infections 68 Cirrhosis of the liver 95 Prostate cancer 324 Stomach cancer 498 9 Fire, heat and hot substances 2 Stroke 1 Lower respiratory infections 5 Other unintentional injuries a 57 Breast cancer 67 Pancreas cancer 85 Stomach cancer 291 Diabetes mellitus 494 10 Drowning 2 Epilepsy 1 Falls 5 Road injury 56 Stomach cancer 65 Diabetes mellitus 80 Kidney diseases 271 Breast cancer 460 11 Other infectious diseases 2 Lymphomas, multiple myeloma 1 Other malignant neoplasms 5 Drowning 50 Colon and rectum cancers 61 Prostate cancer 78 Breast cancer 258 Prostate cancer 418 12 Down syndrome 2 Kidney cancer 1 Alcohol use disorders 5 Interpersonal violence 45 Mouth and oropharynx cancers 58 Other circulatory diseases 73 Alzheimer disease and other dementias 241 Self-harm 418 13 Other chromosomal anomalies 2 Other unintentional injuries 1 Brain and nervous system cancers 5 Pancreatitis 35 Pancreas cancer 48 Lower respiratory infections 70 Cardiomyopathy, myocarditis, endocarditis 237 Lower respiratory infections 410 14 Neonatal sepsis and infections 2 Cardiomyopathy, myocarditis, endocarditis 1 Epilepsy 5 Breast cancer 35 Other circulatory diseases 46 Mouth and oropharynx cancers 70 Other digestive diseases 233 Cirrhosis of the liver 410 15 Hepatitis 2 Fire, heat and hot substances 1 Ischaemic heart disease 5 Falls 35 Drowning 40 Hypertensive heart disease 67 Chronic obstructive pulmonary disease 224 Pancreas cancer 367 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 11.8 (11) 36.9 (14) 56.4 (149) 25.1 (434) 11.7 (306) 5.4 (230) 1.9 (364) 5.4 (1 507) Leading causes of death in Latvia, 2016 Trends in violence and injury deaths (0–64 years) in Latvia Male-to-female mortality ratios in Latvia, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Latvia, 2016 Income group (2016) High (2) Population (2016) 1 970 530 (1) Gross national income per capita (2016) US$ 14 630 (2) LATVIA86 Behavioural risk-factor legislation and enforcement for road safety in Latvia, 2017 Prevention of, and response to, violence against children in Latvia, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting NO — Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education NO — Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children NO — Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children NO — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence NO — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers NO Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims NO — Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Latvia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 35.2 34.6 Unintentional injuries, 2014a 34.0 31.8 Intentional injuries, 2014a 37.3 39.6 Road injuries, 2016b 51.4 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl ≤ 0.02 g/dl Yes Yes Yes Yes No Yes No Restricted Member States' reported enforcement effectivenessa 7/10 7/10 7/10 7/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. LATVIA contd 87 Lithuania European Region Rank Cause of death YLL % % All causes 836 519 1 Cardiovascula diseases 364 862 43.6 34.9 2 Malignant neoplasms 188 822 22.6 25.3 3 Digestive diseases 60 098 7.2 5.2 4 Unintentional injuries 54 066 6.5 5.8 5 Intentional injuries 45 815 5.5 3.9 6 Mental and substance-use disorders 22 185 2.7 2.2 7 Infectious and parasitic diseases 20 903 2.5 3.2 8 Respiratory infectious 16 186 1.9 2.7 9 Neurological conditions 15 847 1.9 4.3 10 Respiratory diseases 13 143 1.6 3.8 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.6 : 13.5 : 1 3.8 : 1 1.9 : 1 2.1 : 1 5.3 : 1 6.1 : 1 3.0 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 8 1 6 1 1 22 35 9 16 1 Commonwealth of Independent States European Union LithuaniaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 38% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Lithuania, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Lithuania, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Other congenital anomalies 28 Drowning 8 Self-harm 129 Self-harm 298 Ischaemic heart disease 741 Ischaemic heart disease 1 586 Ischaemic heart disease 12 989 Ischaemic heart disease 15 569 2 Congenital heart anomalies 26 Brain and nervous system cancers 8 Road injury 55 Cirrhosis of the liver 244 Cirrhosis of the liver 247 Stroke 591 Stroke 4 738 Stroke 5 640 3 Birth asphyxia and birth trauma 15 Other neurological conditions 6 Drowning 26 Ischaemic heart disease 241 Stroke 209 Trachea, bronchus, lung cancers 405 Colon and rectum cancers 670 Trachea, bronchus, lung cancers 1 287 4 Preterm birth complications 15 Other congenital anomalies 5 Interpersonal violence 25 Alcohol use disorders 119 Self-harm 204 Colon and rectum cancers 193 Other circulatory diseases 651 Other circulatory diseases 1 018 5 Neonatal sepsis and infections 9 Road injury 4 Drug use disorders 25 Cardiomyopathy, myocarditis, endocarditis 118 Trachea, bronchus, lung cancers 198 Cirrhosis of the liver 188 Trachea, bronchus, lung cancers 651 Colon and rectum cancers 985 6 Other chromosomal anomalies 8 Self-harm 3 Other unintentional injuries a 24 Other unintentional injuries a 109 Other unintentional injuries a 140 Other circulatory diseases 173 Prostate cancer 441 Self-harm 927 7 Lower respiratory infections 6 Epilepsy 1 Other neurological conditions 23 Stroke 89 Cardiomyopathy, myocarditis, endocarditis 128 Stomach cancer 154 COPD b 429 Cirrhosis of the liver 780 8 Other neonatal conditions 6 Lymphomas, multiple myeloma 1 Cirrhosis of the liver 13 Other circulatory diseases 82 Alcohol use disorders 105 Prostate cancer 132 Other digestive diseases 421 Stomach cancer 702 9 Other unintentional injuries a 6 Stroke 1 Stroke 13 Drug use disorders 80 Other circulatory diseases 103 Self-harm 129 Stomach cancer 405 Lower respiratory infections 668 10 Sudden infant death syndrome 5 Other unintentional injuries a 1 Ischaemic heart disease 12 Lower respiratory infections 76 Stomach cancer 100 Cardiomyopathy, myocarditis, endocarditis 125 Lower respiratory infections 367 Other digestive diseases 657 11 Meningitis 4 Meningitis 1 Cardiomyopathy, myocarditis, endocarditis 11 Interpersonal violence 67 Breast cancer 95 Lower respiratory infections 121 Alzheimer disease and other dementias 320 Prostate cancer 602 12 Other malignant neoplasms 3 Leukaemia 1 Falls 11 Breast cancer 63 Lower respiratory infections 94 Other unintentional injuries a 119 Pancreas cancer 294 Other unintentional injuries a 578 13 Leukaemia 3 Interpersonal violence 1 Alcohol use disorders 10 Road injury 61 Colon and rectum cancers 93 Breast cancer 117 Kidney diseases 274 COPD b 574 14 Brain and nervous system cancers 2 Other endocrine, blood and immune disorders 1 Epilepsy 9 Falls 60 Other digestive diseases 74 Mouth and oropharynx cancers 116 Hypertensive heart disease 270 Breast cancer 543 15 Encephalitis 2 Other chromosomal anomalies 1 Other circulatory diseases 8 Tuberculosis 56 Pancreas cancer 68 COPD b 112 Breast cancer 267 Pancreas cancer 491 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 9.1 (15) 36.7 (18) 57.5 (279) 26.6 (673) 14.8 (583) 7.1 (434) 2.5 (675) 6.6 (2 677) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Lithuania, 2016 Male-to-female mortality ratios in Lithuania, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Lithuania, 2016 Trends in violence and injury deaths (0–64 years) in Lithuania Income group (2016) High (2) Population (2016) 2 908 249 (1) Gross national income per capita (2016) US$ 14 770 (2) LITHUANIA88 Behavioural risk-factor legislation and enforcement for road safety in Lithuania, 2017 Prevention of, and response to, violence against children in Lithuania, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➌ ➃ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Olweus (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Lithuania Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 48.1 34.6 Unintentional injuries, 2014a 47.1 31.8 Intentional injuries, 2014a 49.6 39.6 Road injuries, 2016b 53.3 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.04 g/dl 0.00 g/dl Yes Yes Yes Yes No Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 8/10 7/10 9/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. LITHUANIA contd 89 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.5 : 1 3.4 : 1 0.9 : 1 1.1 : 1 0.3 : 1 1.4 : 1 2.2 : 1 0.9 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 1 1 33 30 12 22 28% Commonwealth of Independent States European Union LuxembourgEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Luxembourg, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Luxembourg, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 4 Self-harm 1 Self-harm 8 Self-harm 21 Ischaemic heart disease 37 Trachea, bronchus, lung cancers 64 Ischaemic heart disease 492 Ischaemic heart disease 599 2 Other congenital anomalies 2 Leukaemia 1 Road injury 8 Ischaemic heart disease 16 Trachea, bronchus, lung cancers 33 Ischaemic heart disease 54 Alzheimer disease and other dementias 241 Stroke 251 3 Other neonatal conditions 2 Other neurological conditions 1 Drug use disorders 1 Breast cancer 11 Cirrhosis of the liver 20 Colon and rectum cancers 26 Stroke 223 Other circulatory diseases 248 4 Congenital heart anomalies 1 Other endocrine, blood and immune disorders 1 Other unintentional injuries a 1 Cirrhosis of the liver 10 Self-harm 15 COPD b 25 Other circulatory diseases 214 Trachea, bronchus, lung cancers 247 5 Birth asphyxia and birth trauma 1 Other unintentional injuries a 0 Liver cancer 1 Road injury 10 Breast cancer 12 Other circulatory diseases 21 COPD b 184 Alzheimer disease and other dementias 246 6 Other chromosomal anomalies 1 Thalassaemias 0 Other circulatory diseases 1 Trachea, bronchus, lung cancers 9 Colon and rectum cancers 12 Pancreas cancer 21 Trachea, bronchus, lung cancers 140 COPD b 220 7 Sudden infant death syndrome 1 Interpersonal violence 0 Brain and nervous system cancers 1 Other circulatory diseases 6 Stroke 11 Cirrhosis of the liver 19 Lower respiratory infections 103 Colon and rectum cancers 134 8 Other unintentional injuries a 0 Poisonings 0 Other neurological conditions 1 Other unintentional injuries a 5 Stomach cancer 9 Breast cancer 19 Colon and rectum cancers 93 Lower respiratory infections 114 9 Road injury 0 Other haemo- globinopathies and haemolytic anaemias 0 Exposure to mechanical forces 0 Brain and nervous system cancers 4 Brain and nervous system cancers 9 Liver cancer 15 Diabetes mellitus 73 Breast cancer 103 10 Leukaemia 0 Sickle cell disorders and trait 0 Stroke 0 Colon and rectum cancers 3 COPD b 9 Stroke 14 Other unintentional injuries a 65 Diabetes mellitus 89 11 Brain and nervous system cancers 0 Eating disorders 0 Lymphomas, multiple myeloma 0 Epilepsy 3 Other circulatory diseases 7 Self-harm 11 Breast cancer 60 Other unintentional injuries a 86 12 Other malignant neoplasms 0 Corpus uteri cancer 0 Ovary cancer 3 Pancreas cancer 7 Other unintentional injuries a 11 Kidney diseases 59 Pancreas cancer 83 13 Neonatal sepsis and infections 0 Diabetes mellitus 0 Other malignant neoplasms 3 Mouth and oropharynx cancers 6 Diabetes mellitus 11 Pancreas cancer 54 Self-harm 78 14 Other endocrine, blood and immune disorders 0 Drowning 0 Alcohol use disorders 3 Road injury 6 Other malignant neoplasms 10 Prostate cancer 51 Cirrhosis of the liver 72 15 Neural tube defects 0 Falls 0 Diabetes mellitus 3 Alcohol use disorders 6 Lymphomas, multiple myeloma 9 Other digestive diseases 48 Kidney diseases 66 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 8.2 (1) 35.8 (1) 71.4 (18) 25.5 (40) 10.3 (30) 6.9 (34) 4.7 (139) 6.7 (263) a Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Luxembourg, 2016 Luxembourg European Region Rank Cause of death YLL % % All causes 69 539 1 Malignant neoplasms 23 831 34.3 25.3 2 Cardiovascular diseases 17 159 24.7 34.9 3 Neurological conditions 4 515 6.5 4.3 4 Unintentional injuries 4 293 6.2 5.8 5 Respiratory diseases 3 940 5.7 3.8 6 Digestive diseases 3 747 5.4 5.2 7 Intentional injuries 2 968 4.3 3.9 8 Respiratory infectious 1 418 2.0 2.7 9 Diabetes mellitus 1 402 2.0 1.7 10 Genitourinary diseases 1 039 1.5 1.6 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Luxembourg, 2016 Trends in violence and injury deaths (0–64 years) in Luxembourg Male-to-female mortality ratios in Luxembourg, 2016 Income group (2016) High (2) Population (2016) 575 747 (1) Gross national income per capita (2016) US$ 76 660 (2) LUXEMBOURG90 Behavioural risk-factor legislation and enforcement for road safety in Luxembourg, 2017 Prevention of, and response to, violence against children in Luxembourg, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Kidpower (primary school-based empowering children); KiVa (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Luxembourg Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a Data not available 34.6 Unintentional injuries, 2014a Data not available 31.8 Intentional injuries, 2014a Data not available 39.6 Road injuries, 2016b 47.8 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes <0.05 g/dl <0.02 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 6/10 7/10 10/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. LUXEMBOURG contd 91 Malta European Region Rank Cause of death YLL % % All causes 63 619 1 Cardiovascular diseases 20 543 32.3 34.9 2 Malignant neoplasms 20 505 32.2 25.3 3 Neurological conditions 3 308 5.2 4.3 4 Respiratory diseases 2 901 4.6 3.8 5 Diabetes mellitus 2 534 4.0 1.7 6 Respiratory infectious 2 319 3.6 2.7 7 Digestive diseases 2 033 3.2 5.2 8 Unintentional injuries 1 909 3.0 5.8 9 Intentional injuries 1 602 2.5 3.9 10 Neonatal conditions 1 188 1.9 2.2 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.1 : 1 1.7 : 1 2.0 : 1 1.3 : 1 1.7 : 1 2.3 : 1 4.2 : 1 1.8 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 32 411 29 12 38 1 23% Commonwealth of Independent States European Union MaltaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Malta, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Malta, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 10 Self-harm 1 Self-harm 5 Ischaemic heart disease 12 Ischaemic heart disease 36 Ischaemic heart disease 114 Ischaemic heart disease 738 Ischaemic heart disease 901 2 Other congenital anomalies 4 Kidney cancer 0 Road injury 3 Self-harm 12 Trachea, bronchus, lung cancers 20 Trachea, bronchus, lung cancers 53 Stroke 253 Stroke 288 3 Other chromosomal anomalies 2 Other neurological conditions 0 Other circulatory diseases 2 Breast cancer 7 Colon and rectum cancers 12 Colon and rectum cancers 29 Lower respiratory infections 166 Trachea, bronchus, lung cancers 183 4 Congenital heart anomalies 2 Meningitis 0 Other neurological conditions 1 Road injury 4 Pancreas cancer 11 Pancreas cancer 29 Alzheimer disease and other dementias 135 Lower respiratory infections 180 5 Birth asphyxia and birth trauma 2 Cardiomyopathy, myocarditis, endocarditis 0 Drug use disorders 1 Other neurological conditions 4 Stroke 9 Diabetes mellitus 26 COPDa 118 Diabetes mellitus 145 6 Other neurological conditions 1 Other congenital anomalies 0 Cardiomyopathy, myocarditis, endocarditis 1 Drug use disorders 4 Breast cancer 9 Stroke 24 Diabetes melitus 109 Alzheimer disease and other dementias 144 7 Lower respiratory infections 1 Ovary cancer 0 Other unintentional injuries b 1 Other circulatory diseases 3 Diabetes mellitus 8 Breast cancer 21 Trachea, bronchus, lung cancers 108 COPDa 138 8 Other endocrine, blood and immune disorders 1 Road injury 0 Lymphomas, multiple myeloma 1 Cirrhosis of the liver 3 Self-harm 8 COPDa 18 Colon and rectum cancers 84 Colon and rectum cancers 128 9 Neural tube defects 1 Exposure to mechanical forces 0 Other malignant neoplasms 1 Trachea, bronchus, lung cancers 3 Brain and nervous system cancers 6 Other circulatory diseases 15 Other circulatory diseases 79 Other circulatory diseases 103 10 Down syndrome 1 Drowning 0 Interpersonal violence 1 Lymphomas, multiple myeloma 3 Other circulatory diseases 5 Lymphomas, multiple myeloma 12 Breast cancer 53 Breast cancer 89 11 Other malignant neoplasms 0 Other chromosomal anomalies 0 Falls 1 Colon and rectum cancers 3 Kidney cancer 4 Prostate cancer 10 Other respiratory diseases 44 Pancreas cancer 85 12 Other neonatal conditions 0 Brain and nervous system cancers 0 Lower respiratory infections 1 Other malignant neoplasms 2 Other malignant neoplasms 4 Brain and nervous system cancers 10 Pancreas cancer 43 Other respiratory diseases 51 13 Leukaemia 0 Interpersonal violence 0 Epilepsy 1 Lower respiratory infections 2 Cirrhosis of the liver 4 Stomach cancer 9 Parkinson disease 43 Lymphomas, multiple myeloma 50 14 Neonatal sepsis and infections 0 Poisonings 0 Other endocrine, blood and immune disorders 1 Stroke 2 Mouth and oropharynx cancers 4 Kidney cancer 9 Kidney diseases 39 Other digestive diseases 47 15 Brain and nervous system cancers 0 Eating disorders 0 Exposure to mechanical forces 0 Pancreas cancer 2 Ovary cancer 4 Lower respiratory infections 9 Other digestive diseases 38 Parkinson disease 46 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 1.7 (0) 40.4 (2) 41.9 (11) 22.0 (23) 7.2 (14) 1.9 (10) 2.0 (51) 3.2 (110) b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ) Leading causes of death in Malta, 2016 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Malta, 2016 Trends in violence and injury deaths (0–64 years) in Malta Male-to-female mortality ratios in Malta, 2016 Income group (2016) High (2) Population (2016) 429 362 (1) Gross national income per capita (2016) US$ 24 140 (2) MALTA92 Behavioural risk-factor legislation and enforcement for road safety in Malta, 2017 Prevention of, and response to, violence against children in Malta, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Triple P, The Incredible Years (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Malta Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 36.6 34.6 Unintentional injuries, 2014a 34.7 31.8 Intentional injuries, 2014a 40.6 39.6 Road injuries, 2016b 33.8 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl ≤ 0.02 g/dl Yes Yes Yes No No Up to 3 years Yes Restricted Member States' reported enforcement effectivenessa 4/10 4/10 6/10 9/10 3/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. MALTA contd 93 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.9 : 12.9 : 1 1.6 : 1 3.4 : 1 1.0 : 1 3.0 : 1 2.9 : 1 2.5 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 62 11 3 17 28 25 7 1 20% Commonwealth of Independent States European Union MontenegroEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Montenegro, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Montenegro, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Birth asphyxia and birth trauma 10 Road injury 2 Road injury 12 Trachea, bronchus, lung cancers 35 Trachea, bronchus, lung cancers 100 Ischaemic heart disease 254 Stroke 1 377 Ischaemic heart disease 1 672 2 Preterm birth complications 8 Other unintentional injuries a 1 Self-harm 7 Ischaemic heart disease 27 Ischaemic heart disease 84 Stroke 191 Ischaemic heart disease 1 307 Stroke 1 644 3 Lower respiratory infections 1 Other malignant neoplasms 1 Other unintentional injuries a 4 Stroke 18 Stroke 55 Trachea, bronchus, lung cancers 125 Alzheimer disease and other dementias 277 Trachea, bronchus, lung cancers 342 4 Sudden infant death syndrome 1 Leukaemia 1 Drug use disorders 3 Self-harm 15 Colon and rectum cancers 28 Colon and rectum cancers 56 Other circulatory diseases 182 Alzheimer disease and other dementias 288 5 Other malignant neoplasms 1 Brain and nervous system cancers 1 Interpersonal violence 2 Road injury 13 Breast cancer 24 Diabetes mellitus 34 Cardiomyopathy, myocarditis, endocarditis 162 Other circulatory diseases 226 6 Congenital heart anomalies 1 Exposure to mechanical forces 1 Other malignant neoplasms 2 Breast cancer 12 Other malignant neoplasms 20 Other malignant neoplasms 30 COPD b 139 Cardiomyopathy, myocarditis, endocarditis 204 7 Other congenital anomalies 1 Drowning 0 Exposure to mechanical forces 2 Colon and rectum cancers 12 Pancreas cancer 18 Other circulatory diseases 30 Diabetes mellitus 113 Colon and rectum cancers 170 8 Neonatal sepsis and infections 1 Lower respiratory infections 0 Leukaemia 2 Other malignant neoplasms 9 Stomach cancer 14 Breast cancer 27 Kidney diseases 85 COPD b 168 9 Leukaemia 0 Self-harm 0 Brain and nervous system cancers 2 Other unintentional injuries a 8 Liver cancer 12 Stomach cancer 27 Trachea, bronchus, lung cancers 82 Diabetes melltus 160 10 Tuberculosis 0 Interpersonal violence 0 HIV/AIDS 2 Stomach cancer 8 Brain and nervous system cancers 12 Liver cancer 26 Colon and rectum cancers 74 Kidney diseases 119 11 Brain and nervous system cancers 0 Lymphomas, multiple myeloma 0 Stroke 2 Brain and nervous system cancers 6 Cardiomyopathy, myocarditis, endocarditis 11 Pancreas cancer 26 Prostate cancer 49 Other malignant neoplasms 107 12 Other neonatal conditions 0 Stroke 0 Lymphomas, multiple myeloma 1 Cardiomyopathy, myocarditis, endocarditis 6 Self-harm 11 Prostate cancer 24 Other malignant neoplasms 43 Breast cancer 100 13 Down syndrome 0 Epilepsy 0 Ischaemic heart disease 1 Pancreas cancer 6 Diabetes mellitus 10 Cardiomyopathy, myocarditis, endocarditis 24 Parkinson disease 41 Prostate cancer 79 14 Other unintentional injuries a 0 Congenital heart anomalies 0 Trachea, bronchus, lung cancers 1 Cervix uteri cancer 5 Other circulatory diseases 10 COPD b 23 Lower respiratory infections 41 Pancreas cancer 76 15 Paralytic ileus and intestinal obstruction 0 Cardiomyopathy, myocarditis, endocarditis 0 Cardiomyopathy, myocarditis, endocarditis 1 Interpersonal violence 5 Road injury 9 Kidney diseases 22 Breast cancer 36 Stomach cancer 76 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 2.0 (1) 47.0 (5) 54.7 (30) 18.0 (48) 6.2 (35) 3.5 (41) 1.6 (72) 3.5 (231) Leading causes of death in Montenegro, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Montenegro European Region Rank Cause of death YLL % % All causes 130 035 1 Cardiovascular diseases 60 873 46.8 34.9 2 Malignant neoplasms 39 709 30.5 25.3 3 Unintentional injuries 5 462 4.2 5.8 4 Neurological conditions 4 395 3.4 4.3 5 Diabetes mellitus 3 082 2.4 1.7 6 Intentional injuries 3 030 2.3 3.9 7 Respiratory diseases 2 995 2.3 3.8 8 Digestive diseases 2 951 2.3 5.2 9 Genitourinary diseases 2 370 1.8 1.6 10 Neonatal conditions 1 732 1.3 2.2 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Trends in violence and injury deaths (0–64 years) in Montenegro Male-to-female mortality ratios in Montenegro, 2016 Violence and injury proportion by years of life lost (YLL) in Montenegro, 2016 Income group (2016) Upper-middle (2) Population (2016) 628 615 (1) Gross national income per capita (2016) US$ 6970 (2) MONTENEGRO94 Behavioural risk-factor legislation and enforcement for road safety in Montenegro, 2017 Prevention of, and response to, violence against children in Montenegro, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership, Step Towards Effective Enjoyable Parenting (home visiting); Triple P, Adults and Children Against Violence (ACT), Safe Environment for Every Kid (parenting education); Kidpower (primary school-based empowering children); Olweus (school- based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Montenegro Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 25.4 34.6 Unintentional injuries, 2014a 23.9 31.8 Intentional injuries, 2014a 26.9 39.6 Road injuries, 2016b 32.4 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.03 g/dl 0.00 g/dl Yes Yes Yes Yes Yes Up to 5 years No Restricted Member States' reported enforcement effectivenessa 7/10 7/10 6/10 6/10 4/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. MONTENEGRO contd 95 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.1 : 1 2.3 : 1 0.8 : 1 0.7 : 1 1.8 : 1 3.1 : 1 1.8 : 1 1.6 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 7 1 1 28 18 43 1 2 3% Commonwealth of Independent States European Union NetherlandsEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in the Netherlands, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in the Netherlands, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 171 Other malignant neoplasms 16 Self-harm 217 Self-harm 605 Trachea, bronchus, lung cancers 1 295 Trachea, bronchus, lung cancers 3 226 Alzheimer disease and other dementias 15 787 Ischaemic heart disease 18 253 2 Other congenital anomalies 83 Brain and nervous system cancers 14 Road injury 109 Trachea, bronchus, lung cancers 297 Ischaemic heart disease 852 Ischaemic heart disease 1 927 Ischaemic heart disease 15 180 Alzheimer disease and other dementias 16 246 3 Birth asphyxia and birth trauma 71 Other endocrine, blood and immune disorders 11 Other circulatory diseases 37 Breast cancer 290 Breast cancer 598 Colon and rectum cancers 1 248 Stroke 8 675 Trachea, bronchus, lung cancers 11 150 4 Congenital heart anomalies 55 Road injury 10 Drug use disorders 31 Ischaemic heart disease 287 Colon and rectum cancers 560 COPD a 1 190 COPD a 7 532 Stroke 9 954 5 Other neonatal conditions 54 Other neurological conditions 10 Other malignant neoplasms 31 Colon and rectum cancers 195 Self-harm 475 Stroke 835 Other circulatory diseases 6 514 COPD a 9 145 6 Neonatal sepsis and infections 49 Self-harm 9 Other neurological conditions 29 Brain and nervous system cancers 153 COPD a 370 Breast cancer 777 Trachea, bronchus, lung cancers 6 331 Other circulatory diseases 7 568 7 Other chromosomal anomalies 37 Lower respiratory infections 7 Other endocrine, blood and immune disorders 28 Other circulatory diseases 141 Pancreas cancer 318 Pancreas cancer 772 Lower respiratory infections 4 126 Colon and rectum cancers 5 886 8 Other neurological conditions 17 Other unintentional injuries b 7 Brain and nervous system cancers 24 Stroke 126 Stroke 305 Oesophagus cancer 657 Colon and rectum cancers 3 875 Lower respiratory infections 4 706 9 Other endocrine, blood and immune disorders 15 Epilepsy 6 Interpersonal violence 24 Other malignant neoplasms 113 Other malignant neoplasms 255 Other circulatory diseases 633 Falls 2 983 Breast cancer 3 580 10 Down syndrome 11 Drowning 6 Epilepsy 23 Other neurological conditions 112 Oesophagus cancer 253 Other malignant neoplasms 595 Prostate cancer 2 570 Falls 3 309 11 Lower respiratory infections 10 Idiopathic intellectual disability 4 Lower respiratory infections 19 Road injury 92 Other circulatory diseases 241 Lymphomas, multiple myeloma 472 Diabetes mellitus 2 416 Prostate cancer 3 099 12 Brain and nervous system cancers 9 Leukaemia 4 Cardiomyopathy, myocarditis, endocarditis 19 Melanoma and other skin cancers 84 Cirrhosis of the liver 216 Prostate cancer 446 Other malignant neoplasms 2 056 Other malignant neoplasms 3 070 13 Sudden infant death syndrome 9 Interpersonal violence 3 Lymphomas, multiple myeloma 17 Cirrhosis of the liver 79 Brain and nervous system cancers 206 Alzheimer disease and other dementias 384 Other digestive diseases 1 911 Diabetes mellitus 3 030 14 Leukaemia 9 Cardiomyopathy, myocarditis, endocarditis 3 Exposure to mechanical forces 14 Lymphomas, multiple myeloma 73 Other neurological conditions 187 Diabetes mellitus 382 Breast cancer 1 909 Pancreas cancer 2 953 15 Neural tube defects 9 Other congenital anomalies 3 Leukaemia 13 Drug use disorders 71 Lymphomas, multiple myeloma 175 Other neurological conditions 376 Kidney diseases 1 876 Lymphomas, multiple myeloma 2 515 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.0 (27) 27.1 (36) 46.0 (397) 20.1 (854) 7.7 (709) 3.7 (750) 4.4 (4 980) 5.2 (7 753) Leading causes of death in the Netherlands, 2016 Netherlands European Region Rank Cause of death YLL % % All causes 2 264 048 1 Malingnant neoplasms 994 077 43.9 25.3 2 Cardiovascular diseases 546 482 24.1 34.9 3 Neurological conditions 249 451 11.0 4.3 4 Respiratory diseases 167 852 7.4 3.8 5 Unintentional injuries 90 300 4.0 5.8 6 Intentional injuries 86 739 3.8 3.9 7 Digestive diseases 85 774 3.8 5.2 8 Respiratory infectious 63 433 2.8 2.7 9 Diabetes mellitus 47 928 2.1 1.7 10 Genitourinary diseases 43 241 1.9 1.6 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in the Netherlands, 2016 Trends in violence and injury deaths (0–64 years) in the Netherlands Male-to-female mortality ratios in the Netherlands, 2016 Income group (2016) High (2) Population (2016) 16 987 330 (1) Gross national income per capita (2016) US$ 46 310 (2) NETHERLANDS96 Behavioural risk-factor legislation and enforcement for road safety in the Netherlands, 2017 Prevention of, and response to, violence against children in the Netherlands, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment N0 — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Triple P, The Incredible Years (parenting education); Kidpower (primary school-based empowering children); Olweus (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in the Netherlands Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 33.2 34.6 Unintentional injuries, 2014a 30.9 31.8 Intentional injuries, 2014a 36.5 39.6 Road injuries, 2016b 31.8 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.02 g/dl Yes Yes No Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 6/10 6/10 6/10 5/10 6/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. NETHERLANDS contd 97 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.7 : 1 1.7 : 1 1.0 : 1 1.8 : 1 2.3 : 1 3.0 : 1 2.6 : 1 2.6 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 23 10 2 26 29 21 6 1 34% Commonwealth of Independent States European Union North Macedonia European Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in North Macedonia, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in North Macedonia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 154 Road injury 3 Road injury 21 Ischaemic heart disease 171 Ischaemic heart disease 382 Ischaemic heart disease 637 Stroke 3 224 Stroke 4 102 2 Congenital heart anomalies 19 Stroke 3 Other unintentional injuries a 18 Stroke 86 Stroke 212 Stroke 566 Cardiomyopathy, myocarditis, endocarditis 2 821 Ischaemic heart disease 3 697 3 Lower respiratory infections 19 Other unintentional injuries a 3 Self-harm 17 Trachea, bronchus, lung cancers 50 Trachea, bronchus, lung cancers 202 Trachea, bronchus, lung cancers 337 Ischaemic heart disease 2 496 Cardiomyopathy, myocarditis, endocarditis 3 272 4 Birth asphyxia and birth trauma 17 Brain and nervous system cancers 3 Cardiomyopathy, myocarditis, endocarditis 12 Cardiomyopathy, myocarditis, endocarditis 47 Cardiomyopathy, myocarditis, endocarditis 97 Cardiomyopathy, myocarditis, endocarditis 288 Diabetes mellitus 641 Diabetes mellitus 927 5 Other congenital anomalies 13 Leukaemia 3 Ischaemic heart disease 10 Self-harm 44 Colon and rectum cancers 65 Diabetes mellitus 201 Other circulatory diseases 507 Trachea, bronchus, lung cancers 876 6 Neonatal sepsis and infections 9 Cardiomyopathy, myocarditis, endocarditis 2 Stroke 10 Breast cancer 38 Diabetes mellitus 61 Colon and rectum cancers 132 COPD b 492 COPD b 686 7 Other neonatal conditions 6 Other neurological conditions 2 Other neurological conditions 7 Road injury 32 Breast cancer 60 COPD b 130 Hypertensive heart disease 431 Other circulatory diseases 618 8 Sudden infant death syndrome 5 Other malignant neoplasms 1 Brain and nervous system cancers 6 Other unintentional injuries a 28 Stomach cancer 48 Stomach cancer 111 Trachea, bronchus, lung cancers 285 Hypertensive heart disease 535 9 Cardiomyopathy, myocarditis, endocarditis 4 Congenital heart anomalies 1 Lower respiratory infections 6 Stomach cancer 27 Cirrhosis of the liver 47 Breast cancer 87 Kidney diseases 277 Colon and rectum cancers 453 10 Diarrhoeal diseases 3 Epilepsy 1 Interpersonal violence 6 Colon and rectum cancers 26 COPD b 43 Kidney diseases 82 Colon and rectum cancers 229 Kidney diseases 416 11 Down syndrome 3 Lower respiratory infections 1 Other malignant neoplasms 5 Brain and nervous system cancers 26 Self-harm 35 Pancreas cancer 70 Stomach cancer 183 Stomach cancer 370 12 Brain and nervous system cancers 2 Drowning 1 Other circulatory diseases 5 Cirrhosis of the liver 23 Kidney diseases 35 Brain and nervous system cancers 67 Prostate cancer 154 Breast cancer 312 13 Leukaemia 2 Self-harm 1 Leukaemia 5 Diabetes mellitus 22 Brain and nervous system cancers 34 Liver cancer 67 Breast cancer 127 Liver cancer 214 14 Meningitis 2 Chronic obstructive pulmonary disease 1 Congenital heart anomalies 4 Kidney diseases 18 Liver cancer 33 Hypertensive heart disease 63 Other respiratory diseases 125 Pancreas cancer 213 15 Other endocrine, blood and immune disorders 2 Encephalitis 0 Kidney diseases 3 COPD b 16 Other malignant neoplasms 32 Other malignant neoplasms 62 Liver cancer 102 Other malignant neoplasms 210 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 2.0 (6) 33.7 (10) 40.7 (70) 14.4 (132) 5.4 (97) 2.2 (80) 1.3 (171) 2.8 (566) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in North Macedonia, 2016 Trends in violence and injury deaths (0–64 years) in North Macedonia Male-to-female mortality ratios in North Macedonia 2016 North Macedonia European Region Rank Cause of death YLL % % All causes 436 395 1 Cardiovascular diseases 217 590 49.9 34.9 2 Malignant neoplasms 105 315 24.1 25.3 3 Diabetes mellitus 18 578 4.3 1.7 4 Respiratory diseases 17 607 4.0 3.8 5 Neonatal conditions 17 141 3.9 2.2 6 Unintentional injuries 13 638 3.1 5.8 7 Digestive diseases 10 605 2.4 5.2 8 Genitourinary diseases 8 959 2.1 1.6 9 Intentional injuries 7 717 1.8 3.9 10 Neurological conditions 5 681 1.3 4.3 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in North Macedonia, 2016 Income group (2016) Upper-middle (2) Population (2016) 2 081 206 (1) Gross national income per capita (2016) US$ 4980 (2) NORTH MACEDONIA98 Behavioural risk-factor legislation and enforcement for road safety in North Macedonia, 2017 Prevention of, and response to, violence against children in North Macedonia, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➋ ➂ ➃ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➌ ➃ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation NO — School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in North Macedonia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 15.1 34.6 Unintentional injuries, 2014a 14.6 31.8 Intentional injuries, 2014a 16.0 39.6 Road injuries, 2016b 33.2 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl <0.01 g/dl Yes Yes Yes No No Up to 5 years No Restricted Member States' reported enforcement effectivenessa 6/10 5/10 5/10 7/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. NORTH MACEDONIA contd 99 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.2 : 1 2.7 : 1 1.7 : 1 1.0 : 1 1.4 : 1 4.0 : 1 1.9 : 1 1.4 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 7 0 13 28 30 28 21 17% Commonwealth of Independent States European Union NorwayEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Norway, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Norway, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 25 Brain and nervous system cancers 6 Self-harm 103 Self-harm 205 Ischaemic heart disease 265 Trachea, bronchus, lung cancers 660 Ischaemic heart disease 5 051 Ischaemic heart disease 5 969 2 Other neonatal conditions 25 Leukaemia 5 Drug use disorders 78 Drug use disorders 180 Trachea, bronchus, lung cancers 205 Ischaemic heart disease 557 Alzheimer disease and other dementias 3 564 Alzheimer disease and other dementias 3 659 3 Other congenital anomalies 19 Other neurological conditions 4 Road injury 38 Ischaemic heart disease 93 Self-harm 118 COPD a 359 Stroke 2 434 Stroke 2 742 4 Birth asphyxia and birth trauma 18 Road injury 3 Other neurological conditions 12 Breast cancer 62 Colon and rectum cancers 114 Colon and rectum cancers 318 COPD a 2 206 COPD a 2 633 5 Congenital heart anomalies 16 Self-harm 3 Other malignant neoplasms 12 Colon and rectum cancers 57 Breast cancer 103 Stroke 196 Other circulatory diseases 2 089 Other circulatory diseases 2 331 6 Other chromosomal anomalies 12 Other endocrine, blood and immune disorders 2 Other unintentional injuries b 12 Brain and nervous system cancers 50 Alcohol use disorders 79 Pancreas cancer 187 Lower respiratory infections 1 795 Trachea, bronchus, lung cancers 2 293 7 Sudden infant death syndrome 7 Other congenital anomalies 2 Epilepsy 11 Alcohol use disorders 40 Stroke 77 Other circulatory diseases 153 Trachea, bronchus, lung cancers 1 387 Lower respiratory infections 1 910 8 Neonatal sepsis and infections 4 Other malignant neoplasms 2 Brain and nervous system cancers 9 Trachea, bronchus, lung cancers 39 Pancreas cancer 74 Breast cancer 124 Colon and rectum cancers 1 264 Colon and rectum cancers 1 757 9 Other endocrine, blood and immune disorders 3 Epilepsy 2 Diabetes mellitus 9 Melanoma and other skin cancers 36 Cirrhosis of the liver 64 Prostate cancer 123 Prostate cancer 1 040 Prostate cancer 1 176 10 Other neurological conditions 3 Exposure to mechanical forces 1 Other circulatory diseases 7 Road injury 35 COPD a 62 Lymphomas, multiple myeloma 117 Other unintentional injuries b 598 Pancreas cancer 767 11 Brain and nervous system cancers 3 Lymphomas, multiple myeloma 1 Interpersonal violence 7 Stroke 33 Brain and nervous system cancers 57 Brain and nervous system cancers 98 Falls 563 Breast cancer 705 12 Lower respiratory infections 3 Falls 1 Leukaemia 7 Other malignant neoplasms 30 Drug use disorders 57 Self-harm 94 Diabetes mellitus 530 Other unintentional injuries b 688 13 Other infectious diseases 3 Fire, heat and hot substances 1 Cardiomyopathy, myocarditis, endocarditis 6 Other circulatory diseases 27 Other circulatory diseases 54 Melanoma and other skin cancers 87 Other infectious diseases 494 Diabetes mellitus 681 14 Down syndrome 2 Interpersonal violence 1 Other endocrine, blood and immune disorders 6 Other neurological conditions 26 Other neurological conditions 47 Alzheimer disease and other dementias 83 Lymphomas, multiple myeloma 488 Lymphomas, multiple myeloma 655 15 Other unintentional injuries b 2 Other chromosomal anomalies 1 Drowning 5 Other unintentional injuries b 25 Ovary cancer 44 Ovary cancer 81 Pancreas cancer 485 Falls 641 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.1 (7) 28.5 (11) 47.2 (180) 24.1 (321) 9.4 (203) 4.5 (218) 4.3 (1 362) 5.6 (2 303) Leading causes of death in Norway, 2016 Norway European Region Rank Cause of death YLL % % All causes 684 291 1 Malingnant neoplasms 227 232 33.2 25.3 2 Cardiovascular diseases 156 166 22.8 34.9 3 Neurological conditions 59 091 8.6 4.3 4 Respiratory diseases 46 996 6.9 3.8 5 Unintentional injuries 30 388 4.4 5.8 6 Intentional injuries 27 942 4.1 3.9 7 Mental and substance-use disorders 26 477 3.9 2.2 8 Digestive diseases 22 578 3.3 5.2 9 Respiratory infectious 21 044 3.1 3.8 10 Diabetes mellitus 11 424 1.7 1.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Norway, 2016 Trends in violence and injury deaths (0–64 years) in Norway Male-to-female mortality ratios in Norway, 2016 Income group (2016) High (2) Population (2016) 5 254 694 (1) Gross national income per capita (2016) US$ 82 330 (2) NORWAY100 Behavioural risk-factor legislation and enforcement for road safety in Norway, 2017 Prevention of, and response to, violence against children in Norway, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➋ ➂ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Olweus (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Norway Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 27.6 34.6 Unintentional injuries, 2014a 26.5 31.8 Intentional injuries, 2014a 29.2 39.6 Road injuries, 2016b 36.3 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.02 g/dl ≤ 0.02 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 10/10 10/10 10/10 10/10 10/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. NORWAY contd 101 3.0 : 1 3.4 : 1 2.2 : 1 1.3 : 1 3.0 : 1 5.2 : 1 6.8 : 1 3.1 : 1 0 1 2 3 4 5 7 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 11 14 33 19 26 32 1 34% Commonwealth of Independent States European Union PolandEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Poland, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Poland, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 609 Road injury 66 Self-harm 995 Ischaemic heart disease 2 445 Ischaemic heart disease 7 512 Ischaemic heart disease 17 201 Ischaemic heart disease 94 686 Ischaemic heart disease 121 935 2 Congenital heart anomalies 275 Brain and nervous system cancers 50 Road injury 778 Self-harm 2 045 Trachea, bronchus, lung cancers 3 974 Trachea, bronchus, lung cancers 10 325 Stroke 25 390 Stroke 33 739 3 Other congenital anomalies 243 Lower respiratory infections 38 Other unintentional injuries a 174 Cirrhosis of the liver 1 475 Stroke 2 063 Stroke 5 262 Other circulatory diseases 13 794 Trachea, bronchus, lung cancers 25 494 4 Other chromosomal anomalies 104 Congenital heart anomalies 31 Drowning 133 Alcohol use disorders 1 329 Cirrhosis of the liver 1 954 Colon and rectum cancers 3 651 Lower respiratory infections 12 646 Other circulatory diseases 18 668 5 Lower respiratory infections 83 Other neurological conditions 30 Lower respiratory infections 132 Stroke 947 Self-harm 1 437 Other circulatory diseases 2 801 COPD b 11 897 Lower respiratory infections 16 529 6 Birth asphyxia and birth trauma 71 Self-harm 20 Falls 108 Road injury 946 Colon and rectum cancers 1 361 COPD b 2 800 Trachea, bronchus, lung cancers 10 646 COPD b 15 710 7 Other neonatal conditions 41 Leukaemia 20 Drug use disorders 95 Other circulatory diseases 732 Other circulatory diseases 1 257 Lower respiratory infections 2 074 Colon and rectum cancers 8 381 Colon and rectum cancers 13 804 8 Sudden infant death syndrome 28 Drowning 20 Cardiomyopathy, myocarditis, endocarditis 91 Cardiomyopathy, myocarditis, endocarditis 683 Alcohol use disorders 1 141 Cirrhosis of the liver 2 065 Diabetes mellitus 6 154 Diabetes mellitus 8 721 9 Other unintentional injuries a 28 Other congenital anomalies 19 Alcohol use disorders 90 Lower respiratory infections 589 Breast cancer 1 133 Breast cancer 1 990 Prostate cancer 4 104 Breast cancer 7 094 10 Neonatal sepsis and infections 27 Other malignant neoplasms 17 Ischaemic heart disease 90 Breast cancer 559 Lower respiratory infections 967 Stomach cancer 1 769 Other neoplasms 3 992 Cirrhosis of the liver 6 514 11 Neural tube defects 19 Other endocrine, blood and immune disorders 16 Other malignant neoplasms 86 Trachea, bronchus, lung cancers 542 COPD b 807 Pancreas cancer 1 726 Breast cancer 3 404 Stomach cancer 6 203 12 Road injury 17 Other unintentional injuries a 15 Other neurological conditions 86 Falls 414 Mouth and oropharynx cancers 789 Diabetes mellitus 1 623 Stomach cancer 3 356 Self-harm 6 174 13 Other endocrine, blood and immune disorders 15 Epilepsy 14 Brain and nervous system cancers 83 Brain and nervous system cancers 411 Stomach cancer 759 Other neoplasms 1 245 Falls 3 160 Other neoplasms 5 798 14 Brain and nervous system cancers 14 Falls 8 Other circulatory diseases 80 Colon and rectum cancers 397 Pancreas cancer 729 Mouth and oropharynx cancers 1 153 Pancreas cancer 2 718 Prostate cancer 5 464 15 Leukaemia 11 Stroke 6 Leukaemia 77 Other unintentional injuries a 391 Diabetes mellitus 638 Bladder cancer 1 151 Bladder cancer 2 695 Pancreas cancer 5 383 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.5 (76) 31.9 (143) 57.7 (2 286) 21.9 (4 356) 8.7 (3 288) 3.9 (3 036) 2.1 (5 300) 4.7 (18 485) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Poland, 2016 Poland European Region Rank Cause of death YLL % % All causes 8 114 208 1 Cardiovascular diseases 3 016 654 37.2 34.9 2 Malignant neoplasms 2 494 063 30.7 25.3 3 Digestive diseases 442 349 5.5 5.2 4 Unintentional injuries 391 256 4.8 5.8 5 Respiratory diseases 312 863 3.9 3.8 6 Respiratory infectious 286 672 3.5 2.7 7 Intentional injuries 285 022 3.5 3.9 8 Mental and substance-use disorders 169 307 2.1 2.2 9 Diabetes mellitus 161 815 2.0 1.7 10 Neurological conditions 130 622 1.6 4.3 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Trends in violence and injury deaths (0–64 years) in Poland Male-to-female mortality ratios in Poland, 2016 Violence and injury proportion by years of life lost (YLL) in Poland, 2016 Income group (2016) High (2) Population (2016) 38 224 408 (1) Gross national income per capita (2016) US$ 12 680 (2) POLAND102 Behavioural risk-factor legislation and enforcement for road safety in Poland, 2017 Prevention of, and response to, violence against children in Poland, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➂ ➍ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Triple P (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Poland Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 40.3 34.6 Unintentional injuries, 2014a 38.8 31.8 Intentional injuries, 2014a 42.8 39.6 Road injuries, 2016b 42.0 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.02 g/dl ≤ 0.02 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 10/10 8/10 7/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. POLAND contd 103 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.1 : 1 3.3 : 1 1.9 : 1 1.4 : 1 1.4 : 1 3.2 : 1 3.4 : 1 1.8 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 25 1 2 32 17 17 3 2 24% Commonwealth of Independent States European Union PortugalEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Portugal, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Portugal, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 61 Brain and nervous system cancers 15 Road injury 107 Self-harm 339 Trachea, bronchus, lung cancers 729 Trachea, bronchus, lung cancers 1 145 Stroke 11 116 Stroke 12 549 2 Other neonatal conditions 35 Other neurological conditions 15 Self-harm 64 HIV/AIDS 294 Ischaemic heart disease 563 Ischaemic heart disease 1 009 Ischaemic heart disease 10 300 Ischaemic heart disease 12 129 3 Congenital heart anomalies 29 Road injury 13 Other neurological conditions 49 Cirrhosis of the liver 255 Stroke 395 Stroke 848 Lower respiratory infections 7 545 Lower respiratory infections 8 158 4 Other congenital anomalies 27 Leukaemia 9 Brain and nervous system cancers 28 Ischaemic heart disease 249 Cirrhosis of the liver 389 Colon and rectum cancers 781 Alzheimer disease and other dementias 6 188 Alzheimer disease and other dementias 6 330 5 Birth asphyxia and birth trauma 24 Other malignant neoplasms 8 Other malignant neoplasms 27 Breast cancer 200 Colon and rectum cancers 385 Stomach cancer 510 COPD a 4 306 COPD a 4 750 6 Lower respiratory infections 15 Other endocrine, blood and immune disorders 6 Leukaemia 25 Trachea, bronchus, lung cancers 196 Stomach cancer 306 Diabetes mellitus 453 Diabetes mellitus 4 075 Diabetes mellitus 4 715 7 Neonatal sepsis and infections 14 Other unintentional injuries b 4 Other unintentional injuries b 21 Road injury 182 Breast cancer 249 Breast cancer 371 Other circulatory diseases 3 579 Colon and rectum cancers 4 411 8 Other chromosomal anomalies 11 Other congenital anomalies 3 Interpersonal violence 16 Stroke 178 Self-harm 246 Cirrhosis of the liver 350 Colon and rectum cancers 3 096 Other circulatory diseases 4 176 9 Other malignant neoplasms 8 Interpersonal violence 3 Other endocrine, blood and immune disorders 15 Colon and rectum cancers 145 Mouth and oropharynx cancers 238 Lower respiratory infections 345 Trachea, bronchus, lung cancers 2 098 Trachea, bronchus, lung cancers 4 171 10 Other endocrine, blood and immune disorders 7 Congenital heart anomalies 2 HIV/AIDS 15 Stomach cancer 140 Liver cancer 180 COPD a 307 Other respiratory diseases 1 993 Stomach cancer 2 652 11 Down syndrome 7 Drowning 2 Lymphomas, multiple myeloma 13 Other circulatory diseases 108 Other circulatory diseases 170 Other circulatory diseases 307 Prostate cancer 1 841 Other respiratory diseases 2 229 12 Other neurological conditions 6 Epilepsy 2 Other circulatory diseases 12 Other unintentional injuries b 95 Pancreas cancer 160 Pancreas cancer 303 Kidney diseases 1 752 Other digestive diseases 2 176 13 Leukaemia 4 Lymphomas, multiple myeloma 2 Stroke 11 Brain and nervous system cancers 95 Lower respiratory infections 156 Lymphomas, multiple myeloma 294 Other digestive diseases 1 712 Prostate cancer 2 087 14 Brain and nervous system cancers 4 Other chromosomal anomalies 2 Drowning 11 Mouth and oropharynx cancers 94 Oesophagus cancer 153 Liver cancer 243 Stomach cancer 1 694 Breast cancer 1 932 15 Other unintentional injuries b 4 Encephalitis 2 Congenital heart anomalies 9 Lower respiratory infections 87 Brain and nervous system cancers 141 Other digestive diseases 241 Hypertensive heart disease 1 287 Kidney diseases 1 900 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 3.4 (10) 23.5 (25) 40.7 (236) 18.2 (735) 8.0 (543) 4.9 (565) 2.8 (2 353) 4.2 (4 467) Leading causes of death in Portugal, 2016 Portugal European Region Rank Cause of death YLL % % All causes 1 803 201 1 Malignant neoplasms 595 902 33.0 25.3 2 Cardiovascular diseases 434 649 24.1 34.9 3 Neurological conditions 110 792 6.1 4.3 4 Digestive diseases 101 901 5.7 5.2 5 Respiratory infectious 97 603 5.4 2.7 6 Respiratory diseases 93 025 5.2 3.8 7 Unintentional injuries 70 922 3.9 5.8 8 Diabetes mellitus 67 913 3.8 1.7 9 Infectious and parasitic diseases 52 573 2.9 3.2 10 Intentional injuries 50 609 2.8 3.9 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Portugal, 2016 Trends in violence and injury deaths (0–64 years) in Portugal Male-to-female mortality ratios in Portugal, 2016 Income group (2016) High (2) Population (2016) 10 371 627 (1) Gross national income per capita (2016) US$ 19 850 (2) PORTUGAL104 Behavioural risk-factor legislation and enforcement for road safety in Portugal, 2017 Prevention of, and response to, violence against children in Portugal, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) — — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership, Early Head-Start (home visiting). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Portugal Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 26.4 34.6 Unintentional injuries, 2014a 24.9 31.8 Intentional injuries, 2014a 29.0 39.6 Road injuries, 2016b 36.6 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No <0.05 g/dl <0.02 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 7/10 8/10 9/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. PORTUGAL contd 105 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.8 : 1 3.3 : 1 2.5 : 1 4.5 : 1 1.5 : 1 4.3 : 1 5.9 : 1 2.3 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 8 1 7 3 33 24 14 8 2 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 29% Commonwealth of Independent States European Union Republic of Moldova European Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Republic of Moldova, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Republic of Moldova, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Lower respiratory infections 118 Drowning 13 Self-harm 105 Cirrhosis of the liver 520 Ischaemic heart disease 1 133 Ischaemic heart disease 2 850 Ischaemic heart disease 13 591 Ischaemic heart disease 18 043 2 Other congenital anomalies 111 Road injury 11 Road injury 89 Ischaemic heart disease 434 Cirrhosis of the liver 978 Stroke 1 358 Stroke 5 034 Stroke 7 047 3 Preterm birth complications 107 Self-harm 10 Other unintentional injuries a 38 Lower respiratory infections 234 Stroke 494 Cirrhosis of the liver 987 Hypertensive heart disease 1 143 Cirrhosis of the liver 3 224 4 Neonatal sepsis and infections 95 Lower respiratory infections 8 Ischaemic heart disease 34 Other unintentional injuries a 225 Lower respiratory infections 284 Trachea, bronchus, lung cancers 473 Cirrhosis of the liver 716 Hypertensive heart disease 1 356 5 Congenital heart anomalies 75 Other neurological conditions 8 Interpersonal violence 31 Self-harm 214 Trachea, bronchus, lung cancers 273 Colon and rectum cancers 372 COPD b 661 Trachea, bronchus, lung cancers 1 142 6 Birth asphyxia and birth trauma 57 Other unintentional injuries a 7 Lower respiratory infections 30 Stroke 151 Other unintentional injuries a 263 Lower respiratory infections 224 Colon and rectum cancers 468 Lower respiratory infections 1 081 7 Other neonatal conditions 16 Brain and nervous system cancers 6 Drowning 25 Alcohol use disorders 127 Self-harm 159 Breast cancer 223 Kidney diseases 358 Colon and rectum cancers 1 053 8 Other unintentional injuries a 16 Kidney cancer 3 Cirrhosis of the liver 23 HIV/AIDS 125 Colon and rectum cancers 159 Other unintentional injuries a 213 Trachea, bronchus, lung cancers 333 COPD b 889 9 Other neoplasms 7 Other malignant neoplasms 2 HIV/AIDS 18 Tuberculosis 122 Cardiomyopathy, myocarditis, endocarditis 145 Liver cancer 196 Other digestive diseases 232 Other unintentional injuries a 866 10 Drowning 7 Leukaemia 2 Lymphomas, multiple myeloma 18 Cardiomyopathy, myocarditis, endocarditis 103 Alcohol use disorders 144 Stomach cancer 185 Breast cancer 213 Self-harm 644 11 Sudden infant death syndrome 6 Upper respiratory infections 2 Brain and nervous system cancers 14 Road injury 103 Mouth and oropharynx cancers 128 Hypertensive heart disease 185 Diabetes mellitus 212 Breast cancer 627 12 Fire, heat and hot substances 5 Poisonings 2 Drug use disorders 13 Interpersonal violence 85 Liver cancer 121 Diabetes mellitus 172 Liver cancer 211 Liver cancer 561 13 Road injury 5 Congenital heart anomalies 1 Other neurological conditions 12 Pancreatitis 80 Breast cancer 120 COPD b 149 Stomach cancer 204 Stomach cancer 536 14 Other chromosomal anomalies 5 Meningitis 1 Tuberculosis 11 Drowning 74 Stomach cancer 100 Cardiomyopathy, myocarditis, endocarditis 143 Lower respiratory infections 183 Kidney diseases 535 15 Meningitis 4 Epilepsy 1 Alcohol use disorders 11 Breast cancer 69 Tuberculosis 88 Mouth and oropharynx cancers 133 Pancreas cancer 177 Cardiomyopathy, myocarditis, endocarditis 496 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 6.3 (43) 50.2 (45) 49.6 (299) 21.0 (772) 10.8 (655) 5.4 (541) 1.2 (305) 5.7 (2 660) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Republic of Moldova, 2016 Republic of Moldova European Region Rank Cause of death YLL % % All causes 1 150 128 1 Cardiovascular diseases 500 802 43.5 34.9 2 Malignant neoplasms 200 028 17.4 25.3 3 Digestive diseases 132 345 11.5 5.2 4 Unintentional injuries 74 226 6.5 5.8 5 Respiratory infectious 45 372 3.9 2.7 6 Intentional injuries 38 497 3.3 3.9 7 Infectious and parasitic diseases 26 005 2.3 3.2 8 Neonatal conditions 25 271 2.2 2.2 9 Mental and substance-use disorders 23 221 2.0 2.2 10 Respiratory diseases 19 714 1.7 3.8 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Republic of Moldova, 2016 Trends in violence and injury deaths (0–64 years) in Republic of Moldova Male-to-female mortality ratios in Republic of Moldova, 2016 Income group (2016) Lower-middle (2) Population (2016) 4 059 608 (1) Gross national income per capita (2016) US$ 2120 (2) REPUBLIC OF MOLDOVA106 Behavioural risk-factor legislation and enforcement for road safety in Republic of Moldova, 2017 Prevention of, and response to, violence against children in Republic of Moldova, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➌ ➃ Parenting education YES ➀ ➋ ➂ ➃ Against statutory rape YES ➀ ➁ ➌ ➃ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➌ ➃ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➌ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Stay Safe (primary school-based empowering children). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Republic of Moldova Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 50.8 34.6 Unintentional injuries, 2014a 43.9 31.8 Intentional injuries, 2014a 63.8 39.6 Road injuries, 2016b 50.8 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.03 g/dl ≤ 0.03 g/dl Yes Yes Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 8/10 8/10 8/10 8/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. REPUBLIC OF MOLDOVA contd 107 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 3.5 : 1 3.2 : 1 1.6 : 1 3.3 : 1 1.6 : 1 3.7 : 1 5.4 : 1 2.4 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 24 27 23 20 16 3 4 Commonwealth of Independent States European Union RomaniaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). 32% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Romania, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Romania, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Lower respiratory infections 491 Road injury 53 Road injury 337 Ischaemic heart disease 1 827 Ischaemic heart disease 4 200 Ischaemic heart disease 10 322 Ischaemic heart disease 64 944 Ischaemic heart disease 81 349 2 Preterm birth complications 398 Lower respiratory infections 53 Self-harm 186 Cirrhosis of the liver 1 189 Trachea, bronchus, lung cancers 1 954 Stroke 5 262 Stroke 35 481 Stroke 43 149 3 Congenital heart anomalies 190 Drowning 39 Other unintentional injuries a 143 Stroke 745 Cirrhosis of the liver 1 953 Trachea, bronchus, lung cancers 3 892 Hypertensive heart disease 7 575 Trachea, bronchus, lung cancers 10 357 4 Other congenital anomalies 181 Brain and nervous system cancers 27 Lower respiratory infections 135 Self-harm 661 Stroke 1 622 Cirrhosis of the liver 2 929 COPD b 5 252 Hypertensive heart disease 8 936 5 Other unintentional injuries a 62 Other unintentional injuries a 25 HIV/AIDS 78 Lower respiratory infections 638 Colon and rectum cancers 749 Colon and rectum cancers 1 738 Kidney diseases 4 871 Cirrhosis of the liver 8 763 6 Other neonatal conditions 55 Other neurological conditions 22 Drowning 76 Trachea, bronchus, lung cancers 617 Lower respiratory infections 683 Other circulatory diseases 1 386 Other circulatory diseases 4 824 COPD b 7 313 7 Birth asphyxia and birth trauma 49 Epilepsy 21 Drug use disorders 57 Road injury 493 Mouth and oropharynx cancers 665 COPD b 1 241 Colon and rectum cancers 4 025 Other circulatory diseases 7 301 8 Leukaemia 23 Other malignant neoplasms 17 Ischaemic heart disease 56 Other unintentional injuries a 486 Other circulatory diseases 620 Lower respiratory infections 1 238 Trachea, bronchus, lung cancers 3 882 Lower respiratory infections 6 868 9 Drowning 19 Self-harm 16 Epilepsy 47 Breast cancer 433 COPD b 583 Breast cancer 1 059 Lower respiratory infections 3 631 Colon and rectum cancers 6 847 10 Other malignant neoplasms 19 Leukaemia 15 Brain and nervous system cancers 44 Other circulatory diseases 431 Breast cancer 541 Kidney diseases 1 013 Cirrhosis of the liver 2 647 Kidney diseases 6 379 11 Brain and nervous system cancers 16 Other respiratory diseases 14 Tuberculosis 43 Cardiomyopathy, myocarditis, endocarditis 346 Other digestive diseases 495 Liver cancer 985 Cardiomyopathy, myocarditis, endocarditis 2 497 Cardiomyopathy, myocarditis, endocarditis 4 167 12 Road injury 16 Congenital heart anomalies 12 Cardiomyopathy, myocarditis, endocarditis 43 Other digestive diseases 325 Cardiomyopathy, myocarditis, endocarditis 473 Hypertensive heart disease 982 Alzheimer disease and other dementias 2 031 Breast cancer 3 771 13 Fire, heat and hot substances 15 Cardiomyopathy, myocarditis, endocarditis 10 Cirrhosis of the liver 42 Colon and rectum cancers 323 Liver cancer 438 Stomach cancer 934 Stomach cancer 1 990 Stomach cancer 3 589 14 Neonatal sepsis and infections 14 Falls 9 Other neurological conditions 38 Tuberculosis 318 Stomach cancer 422 Other digestive diseases 906 Prostate cancer 1 973 Other digestive diseases 3 572 15 Falls 12 Other congenital anomalies 9 Lymphomas, multiple myeloma 36 Cervix uteri cancer 315 Other unintentional injuries a 422 Pancreas cancer 889 Other digestive diseases 1 814 Liver cancer 3 151 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 8.1 (139) 37.2 (157) 44.0 (848) 16.8 (2 361) 7.3 (1 642) 3.8 (1 779) 1.3 (2 213) 3.6 (9 139) Leading causes of death in Romania, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Romania European Region Rank Cause of death YLL % % All causes 5 325 658 1 Cardiovascular diseases 2 375 511 44.6 34.9 2 Malignant neoplasms 1 313 818 24.7 25.3 3 Digestive diseases 407 400 7.6 5.2 4 Unintentional injuries 253 397 4.8 5.8 5 Respiratory infectious 198 612 3.7 2.7 6 Respiratory diseases 182 155 3.4 3.8 7 Genitourinary diaseases 114 199 2.1 1.6 8 Infectious and parasitic diseases 99 153 1.9 3.2 9 Intentional injuries 93 491 1.8 3.9 10 Neurological conditions 71 964 1.4 4.3 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Romania, 2016 Trends in violence and injury deaths (0–64 years) in Romania Male-to-female mortality ratios in Romania, 2016 Income group (2016) Upper-middle (2) Population (2016) 19 778 084 (1) Gross national income per capita (2016) US$ 9470 (2) ROMANIA108 Behavioural risk-factor legislation and enforcement for road safety in Romania, 2017 Prevention of, and response to, violence against children in Romania, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➋ ➂ ➃ Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Triple P (parenting education); Kidpower (primary school-based empowering children); Olweus (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Romania Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 40.6 34.6 Unintentional injuries, 2014a 38.7 31.8 Intentional injuries, 2014a 45.3 39.6 Road injuries, 2016b 41.4 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.08 g/dl ≤ 0.08 g/dl Yes Yes Yes No No Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 8/10 7/10 7/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. ROMANIA contd 109 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 4.0 : 1 3.1 : 1 3.3 : 1 3.0 : 1 2.6 : 1 6.3 : 1 5.9 : 1 3.3 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 2 17 36 31 17 8 11 5 0 80 40 120 160 200 240 45% Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union Russian Federation European Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Russian Federation, 2016 (%) Trends in violence and injury deaths (0–64 years) in Russian Federation Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Russian Federation, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 2 866 Road injury 600 Self-harm 7 640 HIV/AIDS 23 771 Ischaemic heart disease 48 405 Ischaemic heart disease 93 947 Ischaemic heart disease 438 279 Ischaemic heart disease 599 001 2 Congenital heart anomalies 1 942 Drowning 505 Road injury 6 051 Self-harm 18 569 Stroke 19 879 Stroke 45 358 Stroke 235 193 Stroke 308 347 3 Other congenital anomalies 1 839 Other unintentional injuries a 238 Drug use disorders 3 194 Ischaemic heart disease 17 517 Trachea, bronchus, lung cancers 14 462 Trachea, bronchus, lung cancers 24 044 Alzheimer disease and other dementias 49 116 Trachea, bronchus, lung cancers 62 445 4 Lower respiratory infections 951 Leukaemia 199 HIV/AIDS 2 962 Cardiomyopathy, myocarditis, endocarditis 15 905 Cardiomyopathy, myocarditis, endocarditis 13 715 Colon and rectum cancers 14 051 Colon and rectum cancers 26 165 Cardiomyopathy, myocarditis, endocarditis 56 740 5 Birth asphyxia and birth trauma 882 Self-harm 178 Interpersonal violence 2 676 Cirrhosis of the liver 12 528 Cirrhosis of the liver 11 099 Stomach cancer 12 506 Other circulatory diseases 23 819 Alzheimer disease and other dementias 51 341 6 Sudden infant death syndrome 725 Lower respiratory infections 161 Other unintentional injuries a 1 966 Alcohol use disorders 11 143 Alcohol use disorders 8 039 Cirrhosis of the liver 9 997 Trachea, bronchus, lung cancers 20 812 Colon and rectum cancers 49 040 7 Other neonatal conditions 562 Brain and nervous system cancers 153 Cardiomyopathy, myocarditis, endocarditis 1 699 Road injury 9 400 Self-harm 7 999 Cardiomyopathy, myocarditis, endocarditis 9 924 COPD b 19 788 Self-harm 44 673 8 Other unintentional injuries a 544 Other congenital anomalies 138 Drowning 1 408 Other unintentional injuries a 8 187 Lower respiratory infections Breast cancer 8 525 Stomach cancer 18 593 Cirrhosis of the liver 41 091 9 Neonatal sepsis and infections 394 Congenital heart anomalies 127 Alcohol use disorders 1 377 Drug use disorders 8 173 Stomach cancer 6 897 Other malignant neoplasms 8 278 Cardiomyopathy, myocarditis, endocarditis 15 366 Stomach cancer 40 824 10 Other neoplasms 287 Interpersonal violence 124 Cirrhosis of the liver 1 160 Lower respiratory infections 8 123 Breast cancer 6 859 COPD b 6 676 Hypertensive heart disease 13 832 HIV/AIDS 36 193 11 Leukaemia 229 Exposure to mechanical forces 117 Lower respiratory infections 1 139 Interpersonal violence 7 585 HIV/AIDS 6 812 Pancreas cancer 6 324 Other malignant neoplasms 12 484 Other circulatory diseases 35 135 12 Other chromosomal anomalies 207 Fire, heat and hot substances 113 Falls 929 Stroke 7 365 Colon and rectum cancers 6 688 Lower respiratory infections 6 112 Breast cancer 10 476 Lower respiratory infections 32 041 13 Exposure to mechanical forces 204 Poisonings 108 Tuberculosis 897 Tuberculosis 4 986 Other unintentional injuries a 6 619 Other circulatory diseases 6 058 Prostate cancer 9 388 COPD b 29 877 14 Other infectious diseases 194 Other malignant neoplasms 106 Ischaemic heart disease 851 Drowning 3 480 Other malignant neoplasms 4 126 Self-harm 4 993 Lower respiratory infections 8 566 Breast cancer 29 175 15 Road injury 157 Falls 92 Exposure to mechanical forces 568 Breast cancer 3 239 Road injury 3 792 Other unintentional injuries a 4 897 Pancreas cancer 8 416 Other malignant neoplasms 26 817 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 9.9 (1 404) 58.1 (2 083) 52.8 (22 038) 27.2 (54 816) 11.8 (27 932) 5.6 (19 324) 1.8 (18 041) 7.8 (145 637) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Russian Federation, 2016 Male-to-female mortality ratios in Russian Federation, 2016 Russian Federation European Region Rank Cause of death YLL % % All causes 46 541 441 1 Cardiovascular diseases 19 280 948 41.4 34.9 2 Malignant neoplasms 9 297 485 20.0 25.3 3 Unintentional injuries 3 729 522 8.0 5.8 4 Intentional injuries 2 837 416 6.1 3.9 5 Digestive diseases 2 481 636 5.3 5.2 6 Infectious and parasitic diseases 2 443 525 5.3 3.2 7 Mental and substance-use disorders 1 983 772 4.3 2.2 8 Respiratory infectious 1 150 580 2.5 2.7 9 Neurological conditions 841 427 1.8 4.3 10 Respiratory diseases 691 717 1.5 3.8 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Russian Federation, 2016 Income group (2016) Upper-middle (2) Population (2016) 143 964 512 (1) Gross national income per capita (2016) US$ 9720 (2) RUSSIAN FEDERATION110 Behavioural risk-factor legislation and enforcement for road safety in Russian Federation, 2017 Prevention of, and response to, violence against children in Russian Federation, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting — — Ban on corporal punishment in all settings NOb — Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) — — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation NO — School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence NO ➊ ➁ ➂ Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Triple P (parenting education). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Russian Federation Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 51.9 34.6 Unintentional injuries, 2014a 45.0 31.8 Intentional injuries, 2014a 61.0 39.6 Road injuries, 2016b 46.1 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr Yes ≤ 0.03 g/dl ≤ 0.03 g/dl Yes Yes Yes Yes Yes Up to 7 years Yes Restricted Member States' reported enforcement effectivenessa 8/10 6/10 5/10 4/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. RUSSIAN FEDERATION contd 111 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.7 : 1 3.1 : 1 1.7 : 1 1.9 : 1 2.0 : 1 3.1 : 1 2.9 : 1 2.2 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 18 23 43 14 13 2 4 26% Commonwealth of Independent States European Union SerbiaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Serbia, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Serbia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 240 Other neurological conditions 10 Road injury 103 Ischaemic heart disease 498 Ischaemic heart disease 1 395 Ischaemic heart disease 3 197 Ischaemic heart disease 15 947 Ischaemic heart disease 21 058 2 Congenital heart anomalies 61 Road injury 10 Self-harm 81 Self-harm 307 Trachea, bronchus, lung cancers 1 144 Trachea, bronchus, lung cancers 2 315 Cardiomyopathy, myocarditis, endocarditis 13 603 Cardiomyopathy, myocarditis, endocarditis 15 221 3 Birth asphyxia and birth trauma 60 Brain and nervous system cancers 10 Other unintentional injuries a 24 Trachea, bronchus, lung cancers 218 Stroke 552 Stroke 1 658 Stroke 11 187 Stroke 13 618 4 Other congenital anomalies 38 Other malignant neoplasms 6 Other neurological conditions 21 Stroke 206 Colon and rectum cancers 338 Cardiomyopathy, myocarditis, endocarditis 1 147 Other circulatory diseases 3 572 Trachea, bronchus, lung cancers 5 752 5 Lower respiratory infections 20 Drowning 4 Ischaemic heart disease 20 Breast cancer 151 Cardiomyopathy, myocarditis, endocarditis 329 Colon and rectum cancers 858 COPD b 2 939 Other circulatory diseases 4 495 6 Other neonatal conditions 17 Congenital heart anomalies 4 Interpersonal violence 18 Road injury 143 Breast cancer 319 COPD b 733 Hypertensive heart disease 2 520 COPD b 3 961 7 Brain and nervous system cancers 11 Other unintentional injuries a 4 Leukaemia 17 Cardiomyopathy, myocarditis, endocarditis 121 Self-harm 250 Diabetes mellitus 624 Diabetes mellitus 2 210 Colon and rectum cancers 3 141 8 Other unintentional injuries a 8 Leukaemia 3 Cardiomyopathy, myocarditis, endocarditis 16 Colon and rectum cancers 113 Other circulatory diseases 236 Other circulatory diseases 562 Kidney diseases 2 186 Diabetes mellitus 3 063 9 Neonatal sepsis and infections 7 Epilepsy 3 Other malignant neoplasms 15 Other circulatory diseases 109 COPD b 226 Breast cancer 529 Trachea, bronchus, lung cancers 2 071 Hypertensive heart disease 3 000 10 Other chromosomal anomalies 7 Cardiomyopathy, myocarditis, endocarditis 3 Lymphomas, multiple myeloma 14 Cirrhosis of the liver 89 Cirrhosis of the liver 201 Kidney diseases 460 Alzheimer disease and other dementias 2 014 Kidney diseases 2 856 11 Leukaemia 6 Lymphomas, multiple myeloma 2 Other circulatory diseases 13 Brain and nervous system cancers 80 Diabetes mellitus 171 Pancreas cancer 365 Colon and rectum cancers 1 828 Alzheimer disease and other dementias 2 147 12 Sudden infant death syndrome 6 Other endocrine, blood and immune disorders 2 Brain and nervous system cancers 12 Other unintentional injuries a 76 Mouth and oropharynx cancers 155 Hypertensive heart disease 324 Lower respiratory infections 1 004 Breast cancer 2 000 13 Other malignant neoplasms 6 Lower respiratory infections 2 Lower respiratory infections 12 Other malignant neoplasms 70 Pancreas cancer 146 Stomach cancer 317 Breast cancer 998 Lower respiratory infections 1 390 14 Down syndrome 5 Exposure to mechanical forces 2 Drowning 12 Cervix uteri cancer 67 Kidney diseases 145 Cirrhosis of the liver 272 Prostate cancer 975 Self-harm 1 380 15 Road injury 5 Other respiratory diseases 2 Drug use disorders 12 Lower respiratory infections 59 Brain and nervous system cancers 140 Other malignant neoplasms 268 Other digestive diseases 901 Other digestive diseases 1 266 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.1 (22) 27.7 (25) 46.3 (249) 17.9 (652) 6.3 (514) 3.2 (591) 1.6 (1 176) 3.0 (3 231) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Serbia, 2016 Serbia European Region Rank Cause of death YLL % % All causes 2 087 714 1 Cardiovascular diseases 919 429 44.0 34.9 2 Malignant neoplasms 578 102 27.7 25.3 3 Respiratory diseases 101 996 4.9 3.8 4 Digestive diseases 80 176 3.8 5.2 5 Diabetes mellitus 58 124 2.8 1.7 6 Neurological conditions 57 228 2.7 4.3 7 Unintentional injuries 56 625 2.7 5.8 8 Genitourinary diseases 53 064 2.5 1.6 9 Intentional injuries 50 824 2.4 3.9 10 Neonatal conditions 29 870 1.4 2.2 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Serbia, 2016 Trends in violence and injury deaths (0–64 years) in Serbia Male-to-female mortality ratios in Serbia, 2016 Income group (2016) Upper-middle (2) Population (2016) 8 820 083 (1) Gross national income per capita (2016) US$ 5280 (2) SERBIA112 Behavioural risk-factor legislation and enforcement for road safety in Serbia, 2017 Prevention of, and response to, violence against children in Serbia, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings NOa ➀ ➁ ➌ ➃ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➌ ➃ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➁ ➌ a Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Serbia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 15.7 34.6 Unintentional injuries, 2014a 14.5 31.8 Intentional injuries, 2014a 17.2 39.6 Road injuries, 2016b 37.8 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.03 g/dl 0.00 g/dl Yes Yes Yes Yes No Up to 3 years Yes Restricted Member States' reported enforcement effectivenessa 6/10 5/10 6/10 8/10 3/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. SERBIA contd 113 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 2.8 : 1 1.9 : 1 1.4 : 1 2.7 : 1 3.7 : 1 6.5 : 1 2.4 : 1 2.4 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 13 5 3 23 12 40 21 12% Commonwealth of Independent States European Union SlovakiaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Slovakia, 2016 (%) Trends in violence and injury deaths (0–64 years) in Slovakia Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Slovakia, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Slovakia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 99 Other neurological conditions 14 Road injury 85 Cirrhosis of the liver 328 Ischaemic heart disease 788 Ischaemic heart disease 1 848 Ischaemic heart disease 10 570 Ischaemic heart disease 13 485 2 Other congenital anomalies 48 Road injury 8 Self-harm 83 Ischaemic heart disease 271 Cirrhosis of the liver 440 Trachea, bronchus, lung cancers 908 Stroke 3 471 Stroke 4 600 3 Congenital heart anomalies 47 Lower respiratory infections 7 Other unintentional injuries a 35 Self-harm 234 Trachea, bronchus, lung cancers 370 Stroke 719 Alzheimer disease and other dementias 2 290 Trachea, bronchus, lung cancers 2 431 4 Lower respiratory infections 34 Brain and nervous system cancers 6 Other neurological conditions 30 Stroke 123 Stroke 277 Colon and rectum cancers 613 Colon and rectum cancers 1 418 Alzheimer disease and other dementias 2 425 5 Birth asphyxia and birth trauma 16 Other unintentional injuries a 5 Drowning 22 Falls 111 Colon and rectum cancers 233 Cirrhosis of the liver 516 Lower respiratory infections 1 406 Colon and rectum cancers 2 357 6 Other chromosomal anomalies 13 Drowning 4 Falls 17 Road injury 105 Mouth and oropharynx cancers 218 Mouth and oropharynx cancers 283 Trachea, bronchus, lung cancers 1 081 Lower respiratory infections 1 925 7 Sudden infant death syndrome 12 Other congenital anomalies 3 Lower respiratory infections 17 Other circulatory diseases 95 Self-harm 163 Breast cancer 274 COPD b 768 Cirrhosis of the liver 1 525 8 Other neonatal conditions 11 Exposure to mechanical forces 3 Other malignant neoplasms 14 Other unintentional injuries a 91 Breast cancer 148 Pancreas cancer 260 Falls 753 Falls 1 218 9 Other unintentional injuries a 5 Congenital heart anomalies 3 Brain and nervous system cancers 14 Colon and rectum cancers 89 Falls 147 Lower respiratory infections 259 Other circulatory diseases 726 Other circulatory diseases 1 214 10 Down syndrome 4 Leukaemia 3 Drug use disorders 12 Lower respiratory infections 79 Other circulatory diseases 131 Other circulatory diseases 252 Prostate cancer 629 COPD b 1 130 11 Brain and nervous system cancers 4 Other endocrine, blood and immune disorders 2 Cirrhosis of the liver 11 Breast cancer 75 Lower respiratory infections 123 COPD b 236 Diabetes mellitus 603 Breast cancer 1 049 12 Other neurological conditions 3 Other malignant neoplasms 2 Leukaemia 11 Cardiomyopathy, myocarditis, endocarditis 71 Pancreas cancer 118 Diabetes mellitus 228 Hypertensive heart disease 572 Diabetes mellitus 944 13 Other endocrine, blood and immune disorders 3 Falls 2 Congenital heart anomalies 11 Trachea, bronchus, lung cancers 70 Cardiomyopathy, myocarditis, endocarditis 96 Stomach cancer 203 Kidney diseases 556 Pancreas cancer 842 14 Meningitis 3 Epilepsy 1 Cardiomyopathy, myocarditis, endocarditis 10 Mouth and oropharynx cancers 65 COPD b 95 Falls 187 Breast cancer 550 Prostate cancer 814 15 Neonatal sepsis and infections 3 Lymphomas, multiple myeloma 1 Interpersonal violence 10 Alcohol use disorders 58 Stomach cancer 81 Lymphomas, multiple myeloma 184 Other digestive diseases 448 Stomach cancer 778 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 3.5 (12) 32.0 (25) 50.9 (265) 23.0 (651) 10.4 (519) 4.9 (486) 3.4 (1 084) 6.0 (3 043) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Slovakia, 2016 Slovakia European Region Rank Cause of death YLL % % All causes 1 094 088 1 Cardiovascular diseases 355 942 32.5 34.9 2 Malignant neoplasms 345 140 31.5 25.3 3 Digestive diseases 86 423 7.9 5.2 4 Unintentional injuries 70 006 6.4 5.8 5 Neurological conditions 46 368 4.2 4.3 6 Respiratory infectious 37 862 3.5 2.7 7 Intentional injuries 31 827 2.9 3.9 8 Respiratory diseases 27 151 2.5 3.8 9 Diabetes mellitus 19 798 1.8 1.7 10 Genitourinary diseases 16 410 1.5 1.6 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Slovakia, 2016 Income group (2016) High (2) Population (2016) 5 447 662 (1) Gross national income per capita (2016) US$ 16 810 (2) SLOVAKIA114 Behavioural risk-factor legislation and enforcement for road safety in Slovakia, 2017 Prevention of, and response to, violence against children in Slovakia, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting — — Ban on corporal punishment in all settings NOa ➀ ➁ ➂ ➍ Parenting education YES ➀ ➋ ➂ ➃ Against statutory rape YES ➀ ➁ ➌ ➃ Hospital-based parental training (abusive head trauma) — — Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Does not cover: home. Covers: alternative care settings, day care, schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Slovakia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 38.7 34.6 Unintentional injuries, 2014a 37.2 31.8 Intentional injuries, 2014a 41.5 39.6 Road injuries, 2016b 42.1 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No 0.00 g/dl 0.00 g/dl Yes Yes Yes Yes No Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 8/10 8/10 8/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. SLOVAKIA contd 115 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.7 : 1 2.9 : 1 1.9 : 1 0.8 : 1 3.3 : 1 2.7 : 1 4.4 : 1 1.3 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 15 22 29 9 41 11 35% Commonwealth of Independent States European Union SloveniaEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Slovenia, 2016 (%) Trends in violence and injury deaths (0–64 years) in Slovenia Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Slovenia, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Slovenia, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 16 Other neurological conditions 3 Self-harm 33 Self-harm 101 Trachea, bronchus, lung cancers 196 Trachea, bronchus, lung cancers 407 Ischaemic heart disease 3 456 Ischaemic heart disease 4 043 2 Other congenital anomalies 5 Other endocrine, blood and immune disorders 2 Road injury 22 Cirrhosis of the liver 61 Ischaemic heart disease 151 Ischaemic heart disease 378 Stroke 1 773 Stroke 2 031 3 Congenital heart anomalies 5 Road injury 2 Other neurological conditions 9 Ischaemic heart disease 56 Cirrhosis of the liver 127 Stroke 184 Other circulatory diseases 909 Trachea, bronchus, lung cancers 1 195 4 Neonatal sepsis and infections 3 Brain and nervous system cancers 1 Drug use disorders 6 Breast cancer 36 Self-harm 80 Cirrhosis of the liver 173 Lower respiratory infections 776 Other circulatory diseases 1 047 5 Other chromosomal anomalies 3 Leukaemia 1 Other unintentional injuries a 4 Road injury 32 Colon and rectum cancers 73 Colon and rectum cancers 171 Colon and rectum cancers 560 Colon and rectum cancers 837 6 Birth asphyxia and birth trauma 2 Other congenital anomalies 1 Congenital heart anomalies 3 Colon and rectum cancers 32 Stroke 50 Pancreas cancer 96 Trachea, bronchus, lung cancers 560 Lower respiratory infections 811 7 Other neonatal conditions 2 Self-harm 1 Other malignant neoplasms 3 Trachea, bronchus, lung cancers 30 Breast cancer 49 Other circulatory diseases 96 COPD b 499 COPD b 574 8 Other endocrine, blood and immune disorders 2 Other chromosomal anomalies 1 Other endocrine, blood and immune disorders 3 Alcohol use disorders 25 Stomach cancer 43 Breast cancer 87 Falls 465 Falls 538 9 Other neurological conditions 1 Other malignant neoplasms 1 Stroke 3 Stroke 21 Mouth and oropharynx cancers 41 Liver cancer 75 Hypertensive heart disease 421 Cirrhosis of the liver 526 10 Brain and nervous system cancers 1 Lymphomas, multiple myeloma 1 Exposure to mechanical forces 3 Brain and nervous system cancers 19 Pancreas cancer 41 Self-harm 70 Prostate cancer 366 Hypertensive heart disease 438 11 Other unintentional injuries a 1 Other unintentional injuries a 1 Epilepsy 2 Other unintentional injuries a 17 Alcohol use disorders 35 Lymphomas, multiple myeloma 64 Diabetes mellitus 275 Breast cancer 436 12 Down syndrome 1 Congenital heart anomalies 1 Falls 2 Stomach cancer 16 Lymphomas, multiple myeloma 29 Stomach cancer 63 Breast cancer 264 Prostate cancer 429 13 Sudden infant death syndrome 1 Alzheimer disease and other dementias 0 Brain and nervous system cancers 2 Falls 16 Brain and nervous system cancers 29 COPD b 59 Cardiomyopathy, myocarditis, endocarditis 262 Self-harm 386 14 Leukaemia 1 Neural tube defects 0 Leukaemia 2 Mouth and oropharynx cancers 16 Other circulatory diseases 29 Mouth and oropharynx cancers 55 Kidney diseases 262 Stomach cancer 379 15 Other malignant neoplasms 1 Epilepsy 0 Ischaemic heart disease 2 Melanoma and other skin cancers 15 Liver cancer 26 Prostate cancer 52 Lymphomas, multiple myeloma 261 Pancreas cancer 379 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.7 (2) 23.1 (4) 56.6 (69) 27.0 (190) 11.2 (156) 5.9 (172) 4.9 (722) 6.6 (1 315) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Slovenia, 2016 Slovenia European Region Rank Cause of death YLL % % All causes 357 070 1 Malignant neoplasms 133 739 37.5 25.3 2 Cardiovascular diseases 109 463 30.7 34.9 3 Digestive diseases 22 680 6.4 5.2 4 Unintentional injuries 19 879 5.6 5.8 5 Intentional injuries 14 657 4.1 3.9 6 Respiratory diseases 10 476 2.9 3.8 7 Respiratory infectious 9 155 2.6 2.7 8 Neurological conditions 8 466 2.4 4.3 9 Mental and substance-use disorders 5 707 1.6 2.2 10 Diabetes mellitus 5 608 1.6 1.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Slovenia, 2016 Income group (2016) High (2) Population (2016) 2 077 862 (1) Gross national income per capita (2016) US$ 21 660 (2) SLOVENIA116 Behavioural risk-factor legislation and enforcement for road safety in Slovenia, 2017 Prevention of, and response to, violence against children in Slovenia, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➋ ➂ ➃ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➌ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children NO — Prenatal risk assessment of violence against children NO Prenatal risk assessment of intimate-partner violence YES ➀ ➋ ➂ Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims NO Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims NO Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims NO Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: The Incredible Years (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Slovenia Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 35.3 34.6 Unintentional injuries, 2014a 32.8 31.8 Intentional injuries, 2014a 38.9 39.6 Road injuries, 2016b 42.0 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No ≤ 0.05 g/dl 0.00 g/dl Yes Yes Yes Yes Yes Yes No Restricted Member States' reported enforcement effectivenessa 7/10 7/10 9/10 8/10 9/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. SLOVENIA contd 117 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.6 : 1 3.0 : 1 1.0 : 1 1.1 : 1 1.6 : 1 3.6 : 1 2.9 : 1 1.6 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 33 13 28 11 20 21 38% Commonwealth of Independent States European Union SpainEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Spain, 2016 (%) Trends in violence and injury deaths (0–64 years) in Spain Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Spain, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Spain, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 298 Leukaemia 46 Self-harm 295 Self-harm 1263 Trachea, bronchus, lung cancers 3 478 Trachea, bronchus, lung cancers 6 107 Ischaemic heart disease 46 494 Ischaemic heart disease 54 784 2 Other neonatal conditions 167 Other neurological conditions 46 Road injury 234 Ischaemic heart disease 1 177 Ischaemic heart disease 2 627 Ischaemic heart disease 4 447 Alzheimer disease and other dementias 38 284 Alzheimer disease and other dementias 39 048 3 Congenital heart anomalies 127 Brain and nervous system cancers 43 Other neurological conditions 94 Trachea, bronchus, lung cancers 836 Colon and rectum cancers 1 446 Colon and rectum cancers 2 872 Stroke 25 783 Stroke 28 785 4 Other congenital anomalies 125 Other malignant neoplasms 37 Other malignant neoplasms 93 Breast cancer 772 Cirrhosis of the liver 1 173 COPD a 1 777 COPD a 24 200 COPD a 26 763 5 Birth asphyxia and birth trauma 120 Other endocrine, blood and immune disorders 27 Drug use disorders 77 Cirrhosis of the liver 515 Breast cancer 1 072 Stroke 1 701 Other circulatory diseases 18 432 Trachea, bronchus, lung cancers 22 049 6 Neonatal sepsis and infections 80 Road injury 25 Other unintentional injuries b 68 Colon and rectum cancers 442 Stroke 833 Pancreas cancer 1 409 Other respiratory diseases 13 372 Other circulatory diseases 20 792 7 Other chromosomal anomalies 67 Congenital heart anomalies 18 Leukaemia 62 Road injury 441 Self-harm 803 Other circulatory diseases 1 312 Colon and rectum cancers 12 372 Colon and rectum cancers 17 151 8 Down syndrome 35 Other neoplasms 15 Brain and nervous system cancers 50 Stroke 426 Pancreas cancer 681 Cirrhosis of the liver 1 263 Lower respiratory infections 11 736 Other respiratory diseases 14 715 9 Other endocrine, blood and immune disorders 33 Drowning 14 Drowning 44 Other circulatory diseases 375 Liver cancer 647 Breast cancer 1 201 Trachea, bronchus, lung cancers 11 620 Lower respiratory infections 12 794 10 Sudden infant death syndrome 32 Other unintentional injuries b 10 Falls 43 Brain and nervous system cancers 362 Other circulatory diseases 620 Stomach cancer 1 079 Diabetes mellitus 9 026 Diabetes mellitus 10 074 11 Lower respiratory infections 29 Other congenital anomalies 10 Lymphomas, multiple myeloma 43 Drug use disorders 343 Stomach cancer 619 Liver cancer 1 074 Kidney diseases 8 242 Other digestive diseases 9 255 12 Other unintentional injuries b 24 Self-harm 9 Other circulatory diseases 42 HIV/AIDS 331 COPD a 578 Lymphomas, multiple myeloma 854 Other digestive diseases 7 663 Kidney diseases 8 790 13 Other neoplasms 23 Epilepsy 9 Other endocrine, blood and immune disorders 39 Other neurological conditions 317 Mouth and oropharynx cancers 536 Other digestive diseases 834 Hypertensive heart disease 6 908 Hypertensive heart disease 7 244 14 Other neurological conditions 22 Falls 8 Interpersonal violence 39 Stomach cancer 284 Brain and nervous system cancers 517 Brain and nervous system cancers 819 Prostate cancer 5 686 Breast cancer 7 107 15 Leukaemia 16 Other infectious diseases 7 Ischaemic heart disease 35 Other malignant neoplasms 279 Other digestive diseases 499 Bladder cancer 778 Other urinary diseases 4 578 Prostate cancer 6 425 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.0 (68) 19.1 (80) 42.9 (741) 18.3 (2 378) 6.6 (1 592) 3.4 (1 424) 2.5 (8 256) 3.5 (14 540) Leading causes of death in Spain, 2016 Spain European Region Rank Cause of death YLL % % All causes 6 675 870 1 Malignant neoplasms 2 260 058 33.9 25.3 2 Cardiovascular diseases 1 598 788 23.9 34.9 3 Neurological conditions 559 907 8.4 4.3 4 Respiratory diseases 544 463 8.2 3.8 5 Digestive diseases 367 443 5.5 5.2 6 Unintentional injuries 218 061 3.3 5.8 7 Intentional injuries 158 461 2.4 3.9 8 Genitourinary diseases 157 516 2.4 1.6 9 Respiratory infectious 155 333 2.3 2.7 10 Diabetes mellitus 129 958 1.9 1.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Spain, 2016 Income group (2016) High (2) Population (2016) 46 347 576 (1) Gross national income per capita (2016) US$ 27 520 (2) SPAIN118 Behavioural risk-factor legislation and enforcement for road safety in Spain, 2017 Prevention of, and response to, violence against children in Spain, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Triple P (parenting education); KiVa (school-based antibullying). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Spain Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 36.6 34.6 Unintentional injuries, 2014a 35.1 31.8 Intentional injuries, 2014a 40.0 39.6 Road injuries, 2016b 33.9 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.03 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 7/10 8/10 8/10 8/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. SPAIN contd 119 01 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence 1.5 : 1 2.8 : 1 1.9 : 1 1.1 : 1 1.4 : 1 4.6 : 1 1.8 : 1 2.7 : 1 Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 1 29 13 33 6 24 2 1 1% Commonwealth of Independent States European Union SwedenEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Sweden, 2016 (%) Trends in violence and injury deaths (0–64 years) in Sweden Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Sweden, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Sweden, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 59 Other congenital anomalies 9 Self-harm 216 Self-harm 405 Ischaemic heart disease 522 Ischaemic heart disease 1 522 Ischaemic heart disease 14 369 Ischaemic heart disease 16 582 2 Other neonatal conditions 46 Other malignant neoplasms 8 Drug use disorders 111 Ischaemic heart disease 163 Self-harm 248 Trachea, bronchus, lung cancers 921 Alzheimer disease and other dementias 9 269 Alzheimer disease and other dementias 9 496 3 Other congenital anomalies 44 Epilepsy 7 Road injury 60 Drug use disorders 146 Trachea, bronchus, lung cancers 234 Colon and rectum cancers 541 Other circulatory diseases 5 832 Other circulatory diseases 6 472 4 Birth asphyxia and birth trauma 38 Brain and nervous system cancers 7 Interpersonal violence 35 Breast cancer 120 Colon and rectum cancers 175 COPD a 415 Stroke 5 718 Stroke 6 340 5 Congenital heart anomalies 26 Other endocrine, blood and immune disorders 6 Other malignant neoplasms 20 Colon and rectum cancers 98 Breast cancer 172 Stroke 413 COPD a 3 695 COPD a 4 178 6 Sudden infant death syndrome 20 Road injury 5 Brain and nervous system cancers 18 Other circulatory diseases 90 Stroke 156 Other circulatory diseases 397 Trachea, bronchus, lung cancers 2 590 Trachea, bronchus, lung cancers 3 801 7 Other chromosomal anomalies 20 Other neurological conditions 5 Other endocrine, blood and immune disorders 17 Brain and nervous system cancers 70 Cirrhosis of the liver 154 Pancreas cancer 382 Lower respiratory infections 2 418 Colon and rectum cancers 3 122 8 Neonatal sepsis and infections 11 Self-harm 5 Drowning 17 Alcohol use disorders 61 Other circulatory diseases 144 Cirrhosis of the liver 293 Colon and rectum cancers 2 302 Lower respiratory infections 2 701 9 Lower respiratory infections 11 Lower respiratory infections 4 Other neurological conditions 16 Road injury 58 Pancreas cancer 110 Breast cancer 291 Prostate cancer 2 301 Prostate cancer 2 570 10 Leukaemia 6 Leukaemia 4 Other unintentional injuries b 15 Other malignant neoplasms 57 Brain and nervous system cancers 107 Prostate cancer 242 Diabetes mellitus 1 753 Diabetes mellitus 2 124 11 Brain and nervous system cancers 6 Congenital heart anomalies 2 Leukaemia 15 Melanoma and other skin cancers 56 Alcohol use disorders 94 Diabetes mellitus 226 Hypertensive heart disease 1 442 Pancreas cancer 1 798 12 Down syndrome 6 Other circulatory diseases 2 Falls 13 Trachea, bronchus, lung cancers 54 Diabetes mellitus 89 Lymphomas, multiple myeloma 205 Pancreas cancer 1 281 Breast cancer 1 608 13 Other neurological conditions 5 Other chromosomal anomalies 2 Cardiomyopathy, myocarditis, endocarditis 10 Stroke 53 Other malignant neoplasms 73 Alzheimer disease and other dementias 197 Other unintentional injuries b 1 105 Hypertensive heart disease 1 531 14 Other endocrine, blood and immune disorders 5 Liver cancer 2 Epilepsy 10 Diabetes mellitus 49 Ovary cancer 72 Self-harm 196 Lymphomas, multiple myeloma 1 099 Self-harm 1 455 15 Other unintentional injuries b 4 Other neoplasms 2 Other congenital anomalies 8 Cirrhosis of the liver 47 Other neurological conditions 65 Other neurological conditions 194 Kidney diseases 1 058 Lymphomas, multiple myeloma 1 387 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.6 (16) 18.6 (18) 52.6 (372) 26.5 (607) 10.9 (405) 5.0 (504) 3.5 (2 563) 4.9 (4 484) Leading causes of death in Sweden, 2016 Sweden European Region Rank Cause of death YLL % % All causes 1 460 005 1 Malignant neoplasms 445 557 30.5 25.3 2 Cardiovascular diseases 416 291 28.5 34.9 3 Neurological conditions 135 539 9.3 4.3 4 Respiratory diseases 74 661 5.1 3.8 5 Intentional injuries 61 465 4.2 3.9 6 Digestive diseases 56 565 3.9 5.2 7 Unintentional injuries 55 788 3.8 5.8 8 Respiratory infectious 34 801 2.4 2.7 9 Diabetes mellitus 32 932 2.3 1.7 10 Mental and substance-use disorders 31 771 2.2 2.2 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Sweden, 2016 Income group (2016) High (2) Population (2016) 8 401 739 (1) Gross national income per capita (2016) US$ 54 630 (2) SWEDEN120 Behavioural risk-factor legislation and enforcement for road safety in Sweden, 2017 Prevention of, and response to, violence against children in Sweden, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims — — a Programmes: Nurse-Family Partnership (home visiting); Triple P, The Incredible Years, Adults and Children Against Violence (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Sweden Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 35.6 34.6 Unintentional injuries, 2014a 33.7 31.8 Intentional injuries, 2014a 37.7 39.6 Road injuries, 2016b 35.5 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes < 0.02 g/dl < 0.02 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 6/10 6/10 8/10 6/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. SWEDEN contd 121 1.3 : 1 2.5 : 1 1.1 : 1 0.8 : 1 1.8 : 1 2.8 : 1 1.8 : 1 1.0 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 9 1 1 35 6 46 1 1 23% 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union SwitzerlandEuropean Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Switzerland, 2016 (%) Trends in violence and injury deaths (0–64 years) in Switzerland Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Switzerland, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Switzerland, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 104 Brain and nervous system cancers 9 Self-harm 127 Self-harm 301 Trachea, bronchus, lung cancers 437 Trachea, bronchus, lung cancers 929 Ischaemic heart disease 10 207 Ischaemic heart disease 11 591 2 Other congenital anomalies 41 Other malignant neoplasms 4 Road injury 47 Ischaemic heart disease 157 Ischaemic heart disease 402 Ischaemic heart disease 822 Alzheimer disease and other dementias 7 011 Alzheimer disease and other dementias 7 177 3 Other chromosomal anomalies 34 Road injury 4 Drug use disorders 38 Drug use disorders 103 Self-harm 268 Colon and rectum cancers 324 Stroke 3 371 Stroke 3 719 4 Birth asphyxia and birth trauma 32 Other endocrine, blood and immune disorders 4 Other unintentional injuries a 22 Breast cancer 100 Breast cancer 200 COPD b 319 Other circulatory diseases 2 741 Trachea, bronchus, lung cancers 3 435 5 Congenital heart anomalies 32 Self-harm 4 Other malignant neoplasms 17 Trachea, bronchus, lung cancers 90 Colon and rectum cancers 148 Pancreas cancer 286 COPD b 2 486 Other circulatory diseases 3 125 6 Other neoplasms 16 Other neurological conditions 3 Falls 16 Cirrhosis of the liver 70 Cirrhosis of the liver 145 Breast cancer 268 Trachea, bronchus, lung cancers 1 977 COPD b 2 901 7 Neonatal sepsis and infections 12 Leukaemia 3 Other neurological conditions 16 Brain and nervous system cancers 66 Pancreas cancer 127 Other circulatory diseases 223 Lower respiratory infections 1 713 Colon and rectum cancers 1 938 8 Down syndrome 8 Drowning 3 Brain and nervous system cancers 13 Colon and rectum cancers 59 Other circulatory diseases 97 Cirrhosis of the liver 212 Hypertensive heart disease 1 709 Falls 1 876 9 Sudden infant death syndrome 8 Other congenital anomalies 2 Drowning 10 Other circulatory diseases 54 Brain and nervous system cancers 93 Stroke 201 Falls 1 669 Lower respiratory infections 1 873 10 Other malignant neoplasms 7 Stroke 2 Other endocrine, blood and immune disorders 10 Other neurological conditions 53 Liver cancer 92 Self-harm 197 Colon and rectum cancers 1 403 Hypertensive heart disease 1 809 11 Other endocrine, blood and immune disorders 6 Falls 2 Leukaemia 9 Stroke 47 Stroke 92 Liver cancer 185 Prostate cancer 1 339 Breast cancer 1 539 12 Lower respiratory infections 5 Congenital heart anomalies 2 Other circulatory diseases 8 Road injury 45 Mouth and oropharynx cancers 84 Lymphomas, multiple myeloma 170 Diabetes mellitus 1 186 Prostate cancer 1 515 13 Other unintentional injuries a 5 Other chromosomal anomalies 2 Epilepsy 7 Other unintentional injuries a 42 COPD b 81 Other malignant neoplasms 148 Other digestive diseases 1 050 Self-harm 1 443 14 Brain and nervous system cancers 4 Epilepsy 2 Interpersonal violence 7 Other malignant neoplasms 40 Other neurological conditions 80 Oesophagus cancer 145 Kidney diseases 990 Diabetes mellitus 1 381 15 Other neurological conditions 4 Interpersonal violence 1 Stroke 6 Pancreas cancer 36 Other malignant neoplasms 74 Prostate cancer 145 Breast cancer 969 Pancreas cancer 1 322 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.1 (18) 28.0 (17) 54.0 (237) 24.1 (464) 11.7 (434) 5.5 (392) 4.7 (2 561) 6.1 (4 122) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Switzerland, 2016 Switzerland European Region Rank Cause of death YLL % % All causes 1 100 573 1 Malignant neoplasms 367 657 33.4 25.3 2 Cardiovascular diseases 271 583 24.7 34.9 3 Neurological conditions 105 932 9.6 4.3 4 Respiratory diseases 52 176 4.7 3.8 5 Unintentional injuries 49 237 4.5 5.8 6 Intentional injuries 48 541 4.4 3.9 7 Digestive diseases 46 325 4.2 5.2 8 Respiratory infectious 22 802 2.1 2.7 9 Mental and substance-use disorders 19 575 1.8 2.2 10 Diabetes mellitus 19 500 1.8 1.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Switzerland, 2016 Income group (2016) High (2) Population (2016) 8 401 739 (1) Gross national income per capita (2016) US$ 81 240 (2) SWITZERLAND122 Behavioural risk-factor legislation and enforcement for road safety in Switzerland, 2017 Prevention of, and response to, violence against children in Switzerland, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings NOb ➀ ➁ ➌ ➃ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation YES ➀ ➁ ➂ ➍ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment — — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers NO — Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims — Mental health services for victims NO — Child protection services for victims — Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims — Medicolegal services for victims — — a Programmes: Triple P (parenting education); Olweus (school-based antibullying). b Does not cover: home and alternative care settings. Covers: day care, schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Switzerland Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 27.3 34.6 Unintentional injuries, 2014a 26.3 31.8 Intentional injuries, 2014a 28.5 39.6 Road injuries, 2016b 38.3 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr No <0.05 g/dl < 0.01 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 7/10 6/10 8/10 9/10 7/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. SWITZERLAND contd 123 2.4 : 1 3.2 : 1 1.5 : 1 2.2 : 1 1.3 : 1 2.0 : 1 2.8 : 1 2.9 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 13 3 15 42 6 8 7 3 3 5% 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union TajikistanEuropean Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in Tajikistan, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Tajikistan, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Lower respiratory infections 1 909 Lower respiratory infections 157 Road injury 285 Road injury 520 Ischaemic heart disease 1 126 Ischaemic heart disease 2 520 Ischaemic heart disease 7 916 Ischaemic heart disease 12 012 2 Preterm birth complications 1 751 Road injury 140 Lower respiratory infections 89 Ischaemic heart disease 426 Stroke 590 Stroke 1 381 Stroke 3 660 Stroke 5 843 3 Birth asphyxia and birth trauma 1 422 Drowning 76 Drowning 78 HIV/AIDS 378 Cirrhosis of the liver 264 COPD a 328 COPD a 971 Lower respiratory infections 3 167 4 Neonatal sepsis and infections 731 Meningitis 31 Tuberculosis 77 Cirrhosis of the liver 206 Stomach cancer 208 Cirrhosis of the liver 323 Alzheimer disease and other dementias 803 Preterm birth complications 1 751 5 Diarrhoeal diseases 715 Diarrhoeal diseases 29 Epilepsy 58 Stroke 196 Road injury 205 Diabetes mellitus 298 Lower respiratory infections 501 COPD a 1 550 6 Congenital heart anomalies 573 Other unintentional injuries b 22 Self-harm 55 Tuberculosis 192 Diabetes mellitus 186 Lower respiratory infections 219 Hypertensive heart disease 401 Road injury 1 486 7 Other neonatal conditions 441 Epilepsy 20 HIV/AIDS 48 Lower respiratory infections 163 Oesophagus cancer 176 Stomach cancer 210 Cirrhosis of the liver 357 Birth asphyxia and birth trauma 1 422 8 Other congenital anomalies 423 Lymphomas, multiple myeloma 19 Lymphomas, multiple myeloma 46 Stomach cancer 110 COPD a 147 Oesophagus cancer 168 Stomach cancer 278 Cirrhosis of the liver 1 212 9 Other neoplasms 312 Leukaemia 15 Cirrhosis of the liver 46 Other malignant neoplasms 90 Lower respiratory infections 129 Hypertensive heart disease 151 Diabetes mellitus 236 Alzheimer disease and other dementias 871 10 Other infectious diseases 308 Congenital heart anomalies 14 Other malignant neoplasms 42 Drowning 88 HIV/AIDS 115 Road injury 131 Oesophagus cancer 178 Diarrhoeal diseases 860 11 Other unintentional injuries b 223 Fire, heat and hot substances 13 Other unintentional injuries b 37 Kidney diseases 85 Other malignant neoplasms 114 Other malignant neoplasms 98 Other circulatory diseases 175 Stomach cancer 836 12 Drowning 219 Falls 12 Kidney diseases 36 Self-harm 82 Trachea, bronchus, lung cancers 102 Kidney diseases 95 Kidney diseases 159 Diabetes mellitus 809 13 Meningitis 164 Brain and nervous system cancers 10 Interpersonal violence 36 COPD a 76 Tuberculosis 98 Liver cancer 83 Other malignant neoplasms 127 Neonatal sepsis and infections 731 14 Paralytic ileus and intestinal obstruction 138 Encephalitis 9 Maternal conditions 33 Breast cancer 74 Breast cancer 86 Trachea, bronchus, lung cancers 79 Road injury 110 Hypertensive heart disease 651 15 Protein-energy malnutrition 131 Other infectious diseases 9 Brain and nervous system cancers 28 Colon and rectum cancers 74 Kidney diseases 82 Tuberculosis 75 Parkinson disease 107 Congenital heart anomalies 603 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 8.0 (859) 40.4 (278) 39.0 (564) 22.3 (933) 8.4 (398) 3.7 (264) 1.4 (233) 7.6 (3 529) Leading causes of death in Tajikistan, 2016 Tajikistan European Region Rank Cause of death YLL % % All causes 1 955 412 1 Neonatal conditions 399 257 20.4 2.2 2 Cardiovascular diseases 390 442 20.0 34.9 3 Respiratory infectious 220 056 11.3 2.7 4 Infectious and parasitic diseases 200 300 10.2 3.2 5 Unintentional injuries 197 703 10.1 5.8 6 Malignant neoplasms 175 195 9.0 25.3 7 Congenital anomalies 101 584 5.2 1.5 8 Digestive diseases 66 461 3.4 5.2 9 Respiratory diseases 39 409 2.0 3.8 10 Neurological conditions 29 191 1.5 4.3 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Tajikistan, 2016 Trends in violence and injury deaths (0–64 years) in Tajikistan Male-to-female mortality ratios in Tajikistan, 2016 Income group (2016) Lower-middle (2) Population (2016) 8 734 951 (1) Gross national income per capita (2016) US$ 1110 (2) TAJIKISTAN124 Behavioural risk-factor legislation and enforcement for road safety in Tajikistan, 2017 Prevention of, and response to, violence against children in Tajikistan, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting — — Ban on corporal punishment in all settings NOb ➀ ➋ ➂ ➃ Parenting education YES ➀ ➋ ➂ ➃ Against statutory rape — — Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children — — Against female genital mutilation YES ➀ ➁ ➌ ➃ School-based antibullying — — Reporting of suspected child maltreatment — — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children NO — Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence NO — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➋ ➂ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims — Child protection services for victims YES ➀ ➋ ➂ Medicolegal services for victims — Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: Adults and Children Against Violence (parenting education). b Does not cover: home, alternative care settings, day care, penal institutions. Covers: schools.. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Tajikistan Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 5.6 34.6 Unintentional injuries, 2014a 5.3 31.8 Intentional injuries, 2014a 6.9 39.6 Road injuries, 2016b 14.9 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr No No No Yes No Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 9/10 9/10 3/10 6/10 NA Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. TAJIKISTAN contd 125 3.1 : 1 4.1 : 1 1.8 : 1 1.5 : 1 2.0 : 1 6.7 : 1 3.5 : 1 4.6 : 1 0 1 2 3 4 5 7 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 8 9 23 21 2 4 19 1 11 2 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union TurkeyEuropean Region Linear trendline 50% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Turkey, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Turkey, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 3 959 Leukaemia 375 Self-harm 2 660 Ischaemic heart disease 7 663 Trachea, bronchus, lung cancers 6 634 Ischaemic heart disease 11 890 Ischaemic heart disease 67 795 Ischaemic heart disease 94 609 2 Congenital heart anomalies 2 559 Road injury 254 Road injury 2 406 Stroke 3 123 Ischaemic heart disease 6 421 Trachea, bronchus, lung cancers 7 520 Alzheimer disease and other dementias 40 908 Alzheimer disease and other dementias 43 505 3 Other congenital anomalies 1 955 Brain and nervous system cancers 194 Exposure to mechanical forces 1 108 Trachea, bronchus, lung cancers 3 102 Stroke 1 930 Stroke 3 698 Stroke 23 153 Stroke 32 918 4 Other neonatal conditions 1 371 Other malignant neoplasms 190 Other unintentional injuries a 934 Self-harm 2 404 Stomach cancer 1 731 Diabetes mellitus 3 484 COPD b 20 605 COPD b 26 410 5 Birth asphyxia and birth trauma 837 Lymphomas, multiple myeloma 145 Interpersonal violence 882 Road injury 2 293 Diabetes mellitus 1 617 COPD b 3 399 Diabetes mellitus 15 151 Trachea, bronchus, lung cancers 23 508 6 Lower respiratory infections 629 Congenital heart anomalies 130 Stroke 872 Breast cancer 1 799 Colon and rectum cancers 1 510 Stomach cancer 2 489 Kidney diseases 11 413 Diabetes mellitus 21 788 7 Neonatal sepsis and infections 551 Other infectious diseases 119 Ischaemic heart disease 829 Kidney diseases 1 600 Breast cancer 1 380 Kidney diseases 2 255 Hypertensive heart disease 10 282 Kidney diseases 17 164 8 Other endocrine, blood and immune disorders 453 Kidney cancer 115 Epilepsy 715 Other circulatory diseases 1 408 COPD b 1 193 Alzheimer disease and other dementias 2 171 Other circulatory diseases 9 061 Other circulatory diseases 13 332 9 Neural tube defects 328 Other unintentional injuries a 113 Kidney diseases 614 Diabetes mellitus 1 290 Lymphomas, multiple myeloma 1 165 Colon and rectum cancers 2 136 Prostate cancer 6 620 Hypertensive heart disease 12 034 10 Other chromosomal anomalies 302 Lower respiratory infections 106 Lower respiratory infections 570 Stomach cancer 1 231 Kidney diseases 1 153 Lymphomas, multiple myeloma 1 633 Trachea, bronchus, lung cancers 6 153 Stomach cancer 9 222 11 Leukaemia 252 Epilepsy 97 Drowning 538 Colon and rectum cancers 1 185 Other malignant neoplasms 909 Bladder cancer 1 523 Lower respiratory infections 4 567 Prostate cancer 8 249 12 Down syndrome 234 Other endocrine, blood and immune disorders 94 Falls 529 Cirrhosis of the liver 1 114 Bladder cancer 819 Prostate cancer 1 486 Stomach cancer 3 644 Colon and rectum cancers 8 203 13 Other unintentional injuries a 198 Drowning 91 Other circulatory diseases 518 Exposure to mechanical forces 1 089 Pancreas cancer 805 Other circulatory diseases 1 446 Colon and rectum cancers 3 214 Lower respiratory infections 7 931 14 Other neurological conditions 179 Exposure to mechanical forces 90 Other neurological conditions 446 Other unintentional injuries a 1 044 Other circulatory diseases 766 Breast cancer 1 232 Falls 3 161 Road injury 6 544 15 Road injury 175 Other congenital anomalies 65 Cardiomyopathy, myocarditis, endocarditis 393 COPD b 974 Brain and nervous system cancers 737 Other malignant neoplasms 1 200 Cirrhosis of the liver 2 904 Lymphomas, multiple myeloma 6 256 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 4.4 (727) 24.1 (748) 46.1 (9 588) 19.8 (933) 3.5 (1 388) 1.9 (1 222) 1.8 (4 861) 6.2 (28 054) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Turkey, 2016 Turkey European Region Rank Cause of death YLL % % All causes 12 442 810 1 Cardiovascular diseases 3 230 987 26.0 34.9 2 Malignant neoplasms 3 091 199 24.8 25.3 3 Unintentional injuries 958 520 7.7 5.8 4 Neurological conditions 833 130 6.7 4.3 5 Neonatal conditions 617 002 5.0 2.2 6 Congenital anomalies 582 988 4.7 1.5 7 Respiratory diseases 581 570 4.7 3.8 8 Intentional injuries 496 481 4.0 3.9 9 Diabetes mellitus 453 100 3.6 1.7 10 Genitourinary diseases 432 838 3.5 1.6 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Turkey, 2016 Trends in violence and injury deaths (0–64 years) in Turkey Male-to-female mortality ratios in Turkey, 2016 Income group (2016) Upper-middle (2) Population (2016) 79 512 424 (1) Gross national income per capita (2016) US$ 11 180 (2) TURKEY126 Behavioural risk-factor legislation and enforcement for road safety in Turkey, 2017 Prevention of, and response to, violence against children in Turkey, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings NOb ➀ ➁ ➂ ➍ Parenting education YES ➀ ➁ ➂ ➍ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➂ ➍ Against female genital mutilation NO — School-based antibullying YES ➀ ➁ ➂ ➍ Reporting of suspected child maltreatment YES ➀ ➁ ➂ ➍ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-family 0artnerships (home visiting). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Turkey Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 7.1 34.6 Unintentional injuries, 2014a 7.0 31.8 Intentional injuries, 2014a 7.7 39.6 Road injuries, 2016b 5.3 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 50 km/hr Yes ≤ 0.05 g/dl ≤ 0.05 g/dl Yes Yes Yes No Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 9/10 9/10 9/10 9/10 9/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. TURKEY contd 127 2.7 : 1 3.6 : 1 1.5 : 1 2.5 : 1 1.3 : 1 2.6 : 1 2.9 : 1 3.5 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 17 4 6 38 14 8 2 9 2 53% 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union TurkmenistanEuropean Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Turkmenistan, 2016 (%) Trends in violence and injury deaths (0–64 years) in Turkmenistan Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Turkmenistan, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Turkmenistan, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Lower respiratory infections 1 218 Road injury 59 Road injury 315 Ischaemic heart disease 801 Ischaemic heart disease 1 706 Ischaemic heart disease 2 565 Ischaemic heart disease 7 228 Ischaemic heart disease 12 401 2 Preterm birth complications 1 178 Lower respiratory infections 44 Cirrhosis of the liver 158 Cirrhosis of the liver 662 Stroke 888 Stroke 1 231 Stroke 1 935 Stroke 4 596 3 Birth asphyxia and birth trauma 955 Drowning 24 Self-harm 156 HIV/AIDS 570 Cirrhosis of the liver 570 Cirrhosis of the liver 440 Alzheimer disease and other dementias 552 Cirrhosis of the liver 2 198 4 Diarrhoeal diseases 580 Leukaemia 20 Ischaemic heart disease 83 Stroke 416 Oesophagus cancer 201 Diabetes mellitus 239 Cirrhosis of the liver 337 Lower respiratory infections 1 565 5 Neonatal sepsis and infections 445 Other unintentional injuries a 17 Interpersonal violence 81 Road injury 328 Diabetes mellitus 194 Oesophagus cancer 233 Kidney diseases 313 Preterm birth complications 1 178 6 Congenital heart anomalies 434 Brain and nervous system cancers 16 Tuberculosis 80 Tuberculosis 184 Trachea, bronchus, lung cancers 173 Stomach cancer 174 Hypertensive heart disease 249 Road injury 997 7 Other congenital anomalies 390 Cirrhosis of the liver 15 Kidney diseases 78 Kidney diseases 145 Stomach cancer 165 Kidney diseases 165 Oesophagus cancer 201 Birth asphyxia and birth trauma 955 8 Other neonatal conditions 271 Congenital heart anomalies 12 HIV/AIDS 72 Self-harm 137 HIV/AIDS 162 Hypertensive heart disease 145 COPD b 179 Kidney diseases 891 9 Other unintentional injuries a 223 Trachea, bronchus, lung cancers 11 Stroke 63 Trachea, bronchus, lung cancers 118 Kidney diseases 143 Trachea, bronchus, lung cancers 119 Stomach cancer 156 HIV/AIDS 880 10 Other infectious diseases 133 Kidney diseases 11 Lower respiratory infections 58 Interpersonal violence 98 Other malignant neoplasms 120 Other malignant neoplasms 95 Diabetes mellitus 152 Oesophagus cancer 730 11 Cardiomyopathy, myocarditis, endocarditis 129 Epilepsy 9 Other unintentional injuries a 46 Stomach cancer 96 Road injury 114 Liver cancer 84 Other circulatory diseases 137 Diabetes mellitus 691 12 Drowning 91 Lymphomas, multiple myeloma 9 Epilepsy 44 Other malignant neoplasms 90 Hypertensive heart disease 112 COPD b 84 Other malignant neoplasms 93 Stomach cancer 625 13 Road injury 79 Other malignant neoplasms 8 Cardiomyopathy, myocarditis, endocarditis 42 Cardiomyopathy, myocarditis, endocarditis 90 Tuberculosis 85 Colon and rectum cancers 67 Parkinson disease 81 Alzheimer disease and other dementias 598 14 Paralytic ileus and intestinal obstruction 77 Fire, heat and hot substances 7 Fire, heat and hot substances 39 Breast cancer 85 Liver cancer 79 Road injury 62 Cardiomyopathy, myocarditis, endocarditis 78 Diarrhoeal diseases 595 15 Other endocrine, blood and immune disorders 66 Cardiomyopathy, myocarditis, endocarditis 6 Other malignant neoplasms 37 Diabetes mellitus 75 Cardiomyopathy, myocarditis, endocarditis 72 Cardiomyopathy, myocarditis, endocarditis 55 Trachea, bronchus, lung cancers 75 Trachea, bronchus, lung cancers 569 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.2 (526) 33.6 (129) 38.2 (704) 14.4 (746) 4.7 (272) 2.2 (144) 0.9 (112) 6.7 (2 634) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Turkmenistan, 2016 Turkmenistan European Region Rank Cause of death YLL % % All causes 1 664 653 1 Cardiovascular diseases 463 711 27.9 34.9 2 Neonatal conditions 261 765 15.7 2.2 3 Malignant neoplasms 174 042 10.5 25.3 4 Infectious and parasitic diseases 152 535 9.2 3.2 5 Unintentional injuries 127 773 7.7 5.8 6 Respiratory infectious 127 016 7.6 2.7 7 Digestive diseases 105 118 6.3 5.2 8 Congenital anomalies 84 422 5.1 1.5 9 Genitourinary diseases 40 199 2.4 1.6 10 Intentional injuries 34 698 2.1 3.9 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Turkmenistan, 2016 Income group (2016) Upper-middle (2) Population (2016) 5 662 544 (1) Gross national income per capita (2016) US$ 6670 (2) TURKMENISTAN128 Behavioural risk-factor legislation and enforcement for road safety in Turkmenistan, 2017 Standardized mortality from alcohol-attributable disease and injury categories in Turkmenistan Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 21.5 34.6 Unintentional injuries, 2014a 19.8 31.8 Intentional injuries, 2014a 26.0 39.6 Road injuries, 2016b 26.9 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr Yes < 0.05 g/dl < 0.05 g/dl Yes Yes Yes No No No No Restricted Member States' reported enforcement effectivenessa 10/10 10/10 10/10 9/10 NA Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. TURKMENISTAN contd Prevention of, and response to, violence against children in Turkmenistan, 2016 Primary prevention programmes for violence against children Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting — ➀ ➁ ➂ ➃ Ban on corporal punishment in all settings — ➀ ➁ ➂ ➃ Parenting education — ➀ ➁ ➂ ➃ Against statutory rape — ➀ ➁ ➂ ➃ Hospital-based parental training (abusive head trauma) — ➀ ➁ ➂ ➃ Against child marriage — ➀ ➁ ➂ ➃ Primary school-based empowering children — ➀ ➁ ➂ ➃ Against female genital mutilation — ➀ ➁ ➂ ➃ School-based antibullying — ➀ ➁ ➂ ➃ Reporting of suspected child maltreatment — ➀ ➁ ➂ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children — ➀ ➁ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence — ➀ ➁ ➂ Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers — ➀ ➁ ➂ Identification of victims and referral for support by health-care providers — Response to violence against children Mental health services for victims — Mental health services for victims — ➀ ➁ ➂ Child protection services for victims — Child protection services for victims — ➀ ➁ ➂ Medicolegal services for victims — Medicolegal services for victims — ➀ ➁ ➂ Source: WHO Regional Office for Europe (6). Data not available Data not available Data not available Data not available 129 4.4 : 1 3.7 : 1 4.0 : 1 3.5 : 1 2.7 : 1 6.4 : 1 6.5 : 1 2.9 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 15 6 11 14 31 1 9 3 6 4 49% Commonwealth of Independent States European Union UkraineEuropean Region Linear trendline 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Ukraine, 2016 (%) Trends in violence and injury deaths (0–64 years) in Ukraine Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in Ukraine, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Ukraine, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 1 065 Drowning 135 Self-harm 1 465 HIV/AIDS 8 846 Ischaemic heart disease 15 957 Ischaemic heart disease 43 209 Ischaemic heart disease 237 826 Ischaemic heart disease 304 039 2 Congenital heart anomalies 622 Road injury 74 Road injury 933 Ischaemic heart disease 6 700 Stroke 5 260 Stroke 12 892 Stroke 58 727 Stroke 79 215 3 Other congenital anomalies 366 Congenital heart anomalies 49 HIV/AIDS 779 Cirrhosis of the liver 5 185 Cirrhosis of the liver 4 360 Trachea, bronchus, lung cancers 5 971 Alzheimer disease and other dementias 18 139 Alzheimer disease and other dementias 18 925 4 Lower respiratory infections 333 Leukaemia 43 Drug use disorders 740 Self-harm 3 787 Trachea, bronchus, lung cancers 3 906 Colon and rectum cancers 4 067 COPD b 7 833 Trachea, bronchus, lung cancers 16 608 5 Diarrhoeal diseases 303 Brain and nervous system cancers 42 Drowning 447 Drug use disorders 2 711 HIV/AIDS 2 314 Cirrhosis of the liver 3 466 Colon and rectum cancers 7 105 Cirrhosis of the liver 15 429 6 Birth asphyxia and birth trauma 301 Other unintentional injuries a 40 Cirrhosis of the liver 362 Alcohol use disorders 2 259 Breast cancer 2 277 Stomach cancer 3 014 Trachea, bronchus, lung cancers 5 715 Colon and rectum cancers 13 990 7 Other neonatal conditions 271 Other congenital anomalies 40 Ischaemic heart disease 347 Stroke 2 219 Colon and rectum cancers 2 147 Breast cancer 2 381 Hypertensive heart disease 4 917 HIV/AIDS 12 760 8 Neonatal sepsis and infections 109 HIV/AIDS 31 Other unintentional injuries a 346 Lower respiratory infections 1 638 Stomach cancer 2 012 Other malignant neoplasms 2 249 Other circulatory diseases 4 882 COPD b 11 492 9 Other unintentional injuries a 90 Self-harm 30 Interpersonal violence 304 Road injury 1 599 Self-harm 1 885 COPD b 2 232 Stomach cancer 4 049 Self-harm 9 952 10 Other infectious diseases 86 Lower respiratory infections 28 Falls 232 Other unintentional injuries a 1 466 Alcohol use disorders 1 579 Pancreas cancer 2 232 Other malignant neoplasms 3 400 Stomach cancer 9 888 11 Neural tube defects 85 Other malignant neoplasms 28 Tuberculosis 232 Tuberculosis 1 417 Mouth and oropharynx cancers 1 544 Mouth and oropharynx cancers 1 434 Breast cancer 3 203 Breast cancer 8 983 12 HIV/AIDS 85 Poisonings 26 Lower respiratory infections 226 Cardiomyopathy, myocarditis, endocarditis 1 316 Other malignant neoplasms 1 484 Self-harm 1 300 Prostate cancer 2 646 Other malignant neoplasms 7 517 13 Sudden infant death syndrome 68 Exposure to mechanical forces 22 Alcohol use disorders 219 Drowning 1 106 Tuberculosis 1 433 Hypertensive heart disease 1 256 Parkinson disease 2 601 Hypertensive heart disease 6 911 14 Other chromosomal anomalies 53 Falls 22 Cardiomyopathy, myocarditis, endocarditis 131 Breast cancer 1 092 Drug use disorders 1 309 Prostate cancer 1 227 Cirrhosis of the liver 2 045 Other circulatory diseases 6 392 15 Childhood-cluster diseases 38 Fire, heat and hot substances 19 Other malignant neoplasms 122 Trachea, bronchus, lung cancers 982 Other unintentional injuries a 1 120 Alcohol use disorders 1 054 Pancreas cancer 2 026 Drug use disorders 5 781 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 5.5 (241) 47.8 (390) 46.9 (4 112) 20.6 (11 157) 9.4 (6 238) 4.3 (4 620) 1.2 (4 830) 5.0 (31 588) a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Leading causes of death in Ukraine, 2016 Ukraine European Region Rank Cause of death YLL % % All causes 14 502 892 1 Cardiovascular diseases 7 071 293 48.8 34.9 2 Malignant neoplasms 2 603 524 18.0 25.3 3 Infectious and parasitic diseases 888 686 6.1 3.2 4 Unintentional injuries 810 303 5.6 5.8 5 Digestive diseases 785 878 5.4 5.2 6 Intentional injuries 543 529 3.7 3.9 7 Mental and substance-use disorders 493 159 3.4 2.2 8 Neurological conditions 327 746 2.3 4.3 9 Respiratory diseases 268 513 1.9 3.8 10 Respiratory infectious 208 765 1.4 2.7 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in Ukraine, 2016 Income group (2016) Lower-middle (2) Population (2016) 44 438 624 (1) Gross national income per capita (2016) US$ 2310 (2) UKRAINE130 Behavioural risk-factor legislation and enforcement for road safety in Ukraine, 2017 Prevention of, and response to, violence against children in Ukraine, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings YES ➊ ➁ ➂ ➃ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➋ ➂ ➃ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children YES ➀ ➋ ➂ ➃ Against female genital mutilation NO — School-based antibullying NO — Reporting of suspected child maltreatment YES ➀ ➁ ➌ ➃ Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➋ ➂ Prenatal risk assessment of violence against children — Prenatal risk assessment of intimate-partner violence NO — Prenatal risk assessment of intimate-partner violence — Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims — Child protection services for victims NO — Medicolegal services for victims — Medicolegal services for victims NO — a Programmes: Triple P (parenting education). Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Ukraine Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 52.4 34.6 Unintentional injuries, 2014a 46.5 31.8 Intentional injuries, 2014a 61.6 39.6 Road injuries, 2016b 44.1 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 60 km/hr Yes ≤ 0.02 g/dl ≤ 0.02 g/dl Yes Yes Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 3/10 5/10 3/10 3/10 2/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. UKRAINE contd Income group (2016) Lower-middle (2) 131 1.6 : 1 2.8 : 1 1.4 : 1 1.0 : 1 1.4 : 1 3.0 : 1 3.1 : 1 1.7 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 24 1 30 9 28 12 41 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union United Kingdom European Region Linear trendline 1% Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. a C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. b Pl ea se re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er un in te nt io na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Proportion of violence and injury deaths by cause in the United Kingdom, 2016 (%) Trends in violence and injury deaths (0–64 years) in the United Kingdom Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Male-to-female mortality ratios in the United Kingdom, 2016 Proportion of deaths from intentional and unintentional injuries and all other causes by age group in the United Kingdom, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 1 272 Brain and nervous system cancers 65 Self-harm 885 Self-harm 2 256 Ischaemic heart disease 4 605 Ischaemic heart disease 9 359 Alzheimer disease and other dementias 81 026 Alzheimer disease and other dementias 82 461 2 Other congenital anomalies 398 Other neurological conditions 60 Drug use disorders 528 Ischaemic heart disease 1 970 Trachea, bronchus, lung cancers 3 010 Trachea, bronchus, lung cancers 8 615 Ischaemic heart disease 60 369 Ischaemic heart disease 76 365 3 Congenital heart anomalies 360 Other malignant neoplasms 44 Road injury 463 Cirrhosis of the liver 1 917 Cirrhosis of the liver 2 196 COPD a 5 013 Lower respiratory infections 34 299 Stroke 38 649 4 Birth asphyxia and birth trauma 210 Other endocrine, blood and immune disorders 43 Interpersonal violence 170 Drug use disorders 1 395 Breast cancer 1 814 Colon and rectum cancers 3 217 Stroke 33 934 Lower respiratory infections 37 494 5 Lower respiratory infections 134 Road injury 40 Other neurological conditions 158 Breast cancer 1 183 Colon and rectum cancers 1 426 Stroke 2 633 COPD a 30 942 COPD a 37 384 6 Other neonatal conditions 124 Leukaemia 37 Epilepsy 131 Other circulatory diseases 806 Stroke 1 278 Other circulatory diseases 2 487 Trachea, bronchus, lung cancers 24 218 Trachea, bronchus, lung cancers 36 549 7 Other chromosomal anomalies 119 Other congenital anomalies 37 Other endocrine, blood and immune disorders 131 Stroke 724 Self-harm 1 176 Breast cancer 2 339 Other circulatory diseases 23 075 Other circulatory diseases 27 568 8 Sudden infant death syndrome 114 Interpersonal violence 27 Other malignant neoplasms 123 Trachea, bronchus, lung cancers 696 COPD a 1 138 Oesophagus cancer 2 103 Colon and rectum cancers 13 492 Colon and rectum cancers 18 798 9 Other endocrine, blood and immune disorders 70 Lower respiratory infections 26 Other unintentional injuries b 112 Colon and rectum cancers 631 Other circulatory diseases 1 088 Cirrhosis of the liver 2 003 Prostate cancer 11 219 Breast cancer 13 274 10 Other neurological conditions 56 Asthma 25 Brain and nervous system cancers 104 Brain and nervous system cancers 570 Oesophagus cancer 860 Pancreas cancer 1 962 Other respiratory diseases 9 635 Prostate cancer 12 987 11 Neural tube defects 50 Congenital heart anomalies 22 Other circulatory diseases 96 Lower respiratory infections 485 Pancreas cancer 820 Lower respiratory infections 1 730 Other digestive diseases 9 485 Other digestive diseases 11 996 12 Other infectious diseases 46 Epilepsy 22 Leukaemia 81 Road injury 458 Brain and nervous system cancers 752 Lymphomas, multiple myeloma 1 606 Breast cancer 7 916 Other respiratory diseases 11 166 13 Other unintentional injuries b 39 Exposure to mechanical forces 22 Cardiomyopathy, myocarditis, endocarditis 77 Other malignant neoplasms 439 Lower respiratory infections 750 Prostate cancer 1 485 Parkinson disease 7 005 Lymphomas, multiple myeloma 9 393 14 Meningitis 36 Other unintentional injuries b 17 Lower respiratory infections 71 Alcohol use disorders 433 Other malignant neoplasms 688 Other digestive diseases 1 400 Lymphomas, multiple myeloma 6 813 Pancreas cancer 8 984 15 Neonatal sepsis and infections 35 Cardiomyopathy, myocarditis, endocarditis 13 Exposure to mechanical forces 70 Other neurological conditions 409 Other digestive diseases 658 Other malignant neoplasms 1 351 Pancreas cancer 5 963 Oesophagus cancer 8 916 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 3.8 (130) 20.3 (135) 42.8 (1 854) 17.7 (3 923) 6.8 (2 264) 2.8 (1 958) 2.3 (10 651) 3.5 (20 916) Leading causes of death in the United Kingdom, 2016 United Kingdom European Region Rank Cause of death YLL % % All causes 10 331 936 1 Malignant neoplasms 3 324 505 32.2 25.3 2 Cardiovascular diseases 2 319 719 22.5 34.9 3 Neurological conditions 1 137 586 11.0 4.3 4 Respiratory diseases 774 944 7.5 3.8 5 Digestive diseases 606 783 5.9 5.2 6 Respiratory infectious 455 138 4.4 2.7 7 Unintentional injuries 319 902 3.1 5.8 8 Intentional injuries 291 336 2.8 3.9 9 Mental and substance-use disorders 173 394 1.7 2.2 10 Neonatal conditions 150 940 1.5 2.2 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Violence and injury proportion by years of life lost (YLL) in the United Kingdom, 2016 Income group (2016) High (2) Population (2016) 65 788 572 (1) Gross national income per capita (2016) US$ 42 390 (2) UNITED KINGDOM132 Income group (2016) High (2) Behavioural risk-factor legislation and enforcement for road safety in the United Kingdom, 2017 Prevention of, and response to, violence against children in the United Kingdom, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➂ ➍ Ban on corporal punishment in all settings NOb ➀ ➁ ➌ ➃ Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) YES ➀ ➁ ➌ ➃ Against child marriage YES ➀ ➁ ➂ ➍ Primary school-based empowering children YES ➀ ➁ ➌ ➃ Against female genital mutilation NO ➀ ➋ ➂ ➃ School-based antibullying YES ➀ ➁ ➌ ➃ Reporting of suspected child maltreatment NO — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children YES ➀ ➁ ➌ Prenatal risk assessment of violence against children YES Prenatal risk assessment of intimate-partner violence YES ➀ ➁ ➌ Prenatal risk assessment of intimate-partner violence YES Identification of victims and referral for support by health-care providers YES ➀ ➁ ➌ Identification of victims and referral for support by health-care providers YES Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➁ ➌ Child protection services for victims YES Child protection services for victims YES ➀ ➁ ➌ Medicolegal services for victims YES Medicolegal services for victims YES ➀ ➁ ➌ a Programmes: Nurse-Family Partnership (home visiting); Triple P, The Incredible Years (parenting education); KiVa (school-based antibullying). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in the United Kingdom Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 41.9 34.6 Unintentional injuries, 2014a 39.70 31.8 Intentional injuries, 2014a 45.8 39.6 Road injuries, 2016b 38.0 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 48 km/hr Yes ≤ 0.08 g/dl ≤ 0.08 g/dl Yes Yes Yes Yes Yes Yes Yes Restricted Member States' reported enforcement effectivenessa 8/10 8/10 10/10 9/10 10/10 Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. UNITED KINGDOM contd 133 2.8 : 1 3.9 : 1 2.9 : 1 3.2 : 1 1.2 : 1 2.5 : 1 2.1 : 1 3.2 : 1 0 1 2 3 4 5 6 Road injury All injuries Poisonings Falls Fire, heat and hot substances Drowning Self- harm Interpersonal violence Collective violence and legal intervention Drowning Exposure to mechanical forces Falls Fire, heat and hot substances Other unintentional injuries a Natural disasters Interpersonal violence Poisonings Road injury Self-harm 3 6 4 28 23 10 2 20 4 49% 0 40 20 60 80 140 160 120 100 180 Year St an da rd iz ed d ea th ra te p er 1 00 0 00 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 No te : t hr ee -y ea r m ov in g av er ag es . S ou rc e: W HO E ur op ea n M or ta lit y Da ta ba se (3 ). Commonwealth of Independent States European Union UzbekistanEuropean Region Linear trendline Sources: all data sources came from 2016 WHO Global Health Estimates unless otherwise stated. Proportion of violence and injury deaths by cause in Uzbekistan, 2016 (%) Intentional injuries ( European Region) Unintentional injuries ( European Region) Other causes of death ( European Region) 0 10 20 30 40 50 60 70 80 90 100 0–4 5–14 15–29 30–49 50–59 60–69 70+ All ages Proportion of deaths from intentional and unintentional injuries and all other causes by age group in Uzbekistan, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s (b y In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). Rank 0–4 years 5–14 years 15–29 years 30–49 years 50–59 years 60–69 years 70+ years All ages 1 Preterm birth complications 3 163 Lower respiratory infections 388 Self-harm 1 041 Ischaemic heart disease 3 760 Ischaemic heart disease 7 343 Ischaemic heart disease 12 080 Ischaemic heart disease 42 012 Ischaemic heart disease 65 680 2 Birth asphyxia and birth trauma 2 301 Road injury 187 Road injury 732 Cirrhosis of the liver 2 048 Stroke 2 442 Stroke 3 889 Stroke 9 600 Stroke 17 116 3 Lower respiratory infections 2 209 Drowning 181 Ischaemic heart disease 474 Stroke 1 075 Cirrhosis of the liver 1 657 Hypertensive heart disease 2 570 Hypertensive heart disease 6 401 Hypertensive heart disease 10 730 4 Congenital heart anomalies 1 492 Other neurological conditions 176 Cirrhosis of the liver 469 Road injury 1 029 Hypertensive heart disease 1 343 Diabetes mellitus 2 462 Other circulatory diseases 3 156 Cirrhosis of the liver 7 021 5 Neonatal sepsis and infections 1 158 Other unintentional injuries a 120 Other unintentional injuries a 451 Kidney diseases 854 Diabetes mellitus 1 228 Cirrhosis of the liver 1 599 Kidney diseases 1 962 Diabetes mellitus 5 714 6 Diarrhoeal diseases 753 Self-harm 106 Kidney diseases 443 Self-harm 798 Kidney diseases 790 Kidney diseases 1 006 Diabetes mellitus 1 510 Kidney diseases 5 147 7 Other congenital anomalies 714 Leukaemia 89 Lower respiratory infections 327 Tuberculosis 779 Stomach cancer 477 Stomach cancer 610 Cirrhosis of the liver 1 191 Lower respiratory infections 5 002 8 Other neonatal conditions 571 Encephalitis 88 Other neurological conditions 263 Other unintentional injuries a 595 Breast cancer 460 Other circulatory diseases 564 COPD b 1 033 Other circulatory diseases 4 366 9 Other infectious diseases 442 Kidney diseases 76 Tuberculosis 205 Lower respiratory infections 485 Road injury 437 Trachea, bronchus, lung cancers 533 Lower respiratory infections 808 Preterm birth complications 3 163 10 Neural tube defects 382 Epilepsy 69 Drowning 204 Breast cancer 421 Trachea, bronchus, lung cancers 404 Lower respiratory infections 420 Stomach cancer 543 Road injury 2 872 11 Other neoplasms 361 Brain and nervous system cancers 57 Epilepsy 198 Diabetes mellitus 398 Tuberculosis 384 COPD b 367 Asthma 437 Self-harm 2 316 12 Other unintentional injuries a 309 Cirrhosis of the liver 49 Interpersonal violence 183 Hypertensive heart disease 394 Lower respiratory infections 365 Breast cancer 330 Other respiratory diseases 390 Birth asphyxia and birth trauma 2 301 13 Drowning 278 Lymphomas, multiple myeloma 44 Maternal conditions 124 HIV/AIDS 394 Other circulatory diseases 315 Liver cancer 305 Trachea, bronchus, lung cancers 323 Other unintentional injuries a 2 020 14 Hepatitis 236 Congenital heart anomalies 35 Leukaemia 113 Other digestive diseases 390 Other digestive diseases 308 Tuberculosis 301 Other digestive diseases 315 Stomach cancer 1 998 15 Encephalitis 150 Falls 29 Stroke 108 Other neurological conditions 375 Other unintentional injuries a 280 Other digestive diseases 280 Liver cancer 270 Tuberculosis 1 879 Deaths attributed to injuries Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) Percentage (absolute number) 7.0 (1 104) 33.5 (687) 40.4 (2 887) 16.8 (3 228) 5.5 (1 236) 2.1 (650) 0.6 (417) 6.0 (10 208) Leading causes of death in Uzbekistan, 2016 a P le as e re fe r t o th e A nn ex fo r a fu ll de sc rip tio n of o th er u ni nt en tio na l i nj ur ie s ( by In te rn at io na l C la ss ifi ca tio n of D is ea se s, 1 0t h re vi si on (I CD 10 ) c od es ). b C O PD : c hr on ic o bs tr uc tiv e pu lm on ar y di se as e. Uzbekistan European Region Rank Cause of death YLL % % All causes 5 843 719 1 Cardiovascular diseases 2 162 425 37.0 34.9 2 Malignant neoplasms 497 906 8.5 25.3 3 Unintentional injuries 432 095 7.4 5.8 4 Digestive diseases 362 418 6.2 5.2 5 Respiratory infectious 319 861 5.5 2.7 6 Infectious and parasitic diseases 318 409 5.4 3.2 7 Congenital anomalies 250 358 4.3 1.5 8 Genitourinary diseases 172 573 3.0 1.6 9 Diabetes mellitus 169 139 2.9 1.7 10 Intentional injuies 167 688 2.9 3.9 No te : t op 1 0 of 2 3 se co nd -le ve l c at eg or ie s f or a na ly si s o f c au se s o f d ea th . Trends in violence and injury deaths (0–64 years) in Uzbekistan Male-to-female mortality ratios in Uzbekistan, 2016 Violence and injury proportion by years of life lost (YLL) in Uzbekistan, 2016 Income group (2016) Lower-middle (2) Population (2016) 31 446 796 (1) Gross national income per capita (2016) US$ 2220 (2) UZBEKISTAN134 Income group (2016) Lower-middle (2) Behavioural risk-factor legislation and enforcement for road safety in Uzbekistan, 2017 Prevention of, and response to, violence against children in Uzbekistan, 2016 Primary prevention programmes for violence against childrena Violence against children laws Key: No/don’t know ➊ One/few times ➋ Several times, multiple areas ➌ Larger scale ➍ Key: Not enforced/don’t know ➊ Limited ➋ Largely ➌ Full ➍ Implementation Enforcement Home visiting YES ➀ ➁ ➌ ➃ Ban on corporal punishment in all settings NOb — Parenting education YES ➀ ➁ ➌ ➃ Against statutory rape YES ➀ ➁ ➂ ➍ Hospital-based parental training (abusive head trauma) NO — Against child marriage YES ➀ ➁ ➌ ➃ Primary school-based empowering children NO — Against female genital mutilation NO — School-based antibullying YES ➀ ➋ ➂ ➃ Reporting of suspected child maltreatment NO — Health and social services Key: No/don’t know ➊ Once/few times ➋ Larger scale ➌ Detection of violence against children Implementation Capacity development Yes/No Prenatal risk assessment of violence against children NO — Prenatal risk assessment of violence against children NO Prenatal risk assessment of intimate-partner violence NO — Prenatal risk assessment of intimate-partner violence NO Identification of victims and referral for support by health-care providers NO — Identification of victims and referral for support by health-care providers NO Response to violence against children Mental health services for victims YES Mental health services for victims YES ➀ ➋ ➂ Child protection services for victims NO Child protection services for victims NO — Medicolegal services for victims NO Medicolegal services for victims YES ➀ ➋ ➂ a Programmes: Nurse-Family Partnership (home visiting); Triple P (parenting education). b Does not cover: home, alternative care settings, day care. Covers: schools, penal institutions. Source: WHO Regional Office for Europe (6). Standardized mortality from alcohol-attributable disease and injury categories in Uzbekistan Categories Country (%) European Region (%) Categories Country (%) European Region (%) Injury, 2014a 19.2 34.6 Unintentional injuries, 2014a 17.7 31.8 Intentional injuries, 2014a 23.8 39.6 Road injuries, 2016b 17.6 37.7 a Source: WHO Regional Office for Europe (7). b Source: WHO (8). NA: not available. a Respondents were asked to self-report enforcement effectiveness on a scale of 1 to 10, where 1 is no enforcement and 10 is full enforcement. The median score was calculated from all the respondents to reflect the enforcement effectiveness of the country. Source: WHO (5). Speed Alcohol Seat belts Motorcycle helmet Child restraints WHO legislative criteria Urban speed limit ≤ 50 km/hr Local authorities can reduce limits Blood alcohol concentration ≤ 0.05 g/dl general population Blood alcohol concentration ≤ 0.02 g/dl novice drivers Drivers and front-seat passengers Rear-seat passengers All drivers, passengers, all roads, all engine types Helmet must be fastened (Inter) national quality standard specified Children ≤ 10 years/ 135 cm (Inter) national quality standard specified Restrict children sitting in front seat Legislation coverage 70 km/hr No No No No No Yes Yes No No No Restricted Member States' reported enforcement effectivenessa 8/10 10/10 5/10 10/10 NA Legislation meeting WHO criteria Reported enforcement eectiveness Legislation coverage Legislation exists but does not meet WHO criteria No existing legislation Eective enforcement (a score of 8 and more) Moderately eective enforcement (a score between 5 and 7) Minimally eective enforcement (a score of 4 and less) References1 1. World population prospects: the 2017 revision, DVD edition. New York (NY): United Nations; 2018 (https://www.un.org/development/desa/publications/world-population-prospects-the-2017-revision.html). 2. World development indicators database [online database]. In: World Bank [website]. Washington (DC): World Bank; 2018 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country- and-lending-groups). 3. European mortality database (MDB) [online database]. Copenhagen: WHO Regional Office for Europe; 2019 (https://gateway.euro.who.int/en/datasets/european-mortality-database/). 4. Estimates for 2000–2016. Deaths by cause, age, sex, by country and by region, 2000–2016. In: Health statistics and information systems [website]. Geneva: World Health Organization; 2019 (http://www.who.int/ healthinfo/global_burden_disease/estimates/en/index1.html). 5. European regional status report on road safety 2019. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/en/health-topics/disease-prevention/violence-and-injuries/publications/2020/ european-regional-status-report-on-road-safety-2019). 6. European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe; 2018 (http://www.euro.who.int/en/publications/abstracts/european-status-report-on-preventing-child- maltreatment-2018). 7. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Copenhagen: WHO Regional Office for Europe; 2016 (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/publications/2016/public-health-successes-and-missed-opportunities.-trends-in-alcohol-consumption-and-attributable-mortality-in- the-who-european-region,-19902014-2016). 8. Mortality. In: Global Information System on Alcohol and Health (GISAH) [online database]. Geneva: World Health Organization; 2016 (http://apps.who.int/gho/data/node.gisah.A1109?lang=en&showonly=GISAH). 1 All weblinks accessed 1 March 2020. UZBEKISTAN contd 135

ANNEX. OTHER UNINTENTIONAL INJURIES 138 VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION The International Classification of Diseases, 10th revision (ICD10) codes (1) for “Other unintentional injuries” are: Other unintentional injuries: V05, V07-V08, V81-V86, V88, V90-V98, W39, W44, W53-W64, W77-W99, X20-X32, X50-X59, Y40-Y86, Y88, Y89. The description of the ICD10 codes for other unintentional injuries (2) are as follows. V01-V09: Pedestrian injured in transport accident V81: Occupant of railway train or railway vehicle injured in transport accident V82: Occupant of streetcar injured in transport accident V83: Occupant of special vehicle mainly used on industrial premises injured in transport accident V84: Occupant of special vehicle mainly used in agriculture injured in transport accident V85: Occupant of special construction vehicle injured in transport accident V86: Occupant of special all-terrain or other motor vehicle designed primarily for off-road use, injured in transport accident V88: Nontraffic accident of specified type but victim's mode of transport unknown V90-V94: Water transport accidents V95-V97: Air and space transport accidents V98: Other specified transport accidents W39: Discharge of firework W44: Foreign body entering into or through eye or natural orifice W50-W64: Exposure to animate mechanical forces W75-W84: Other accidental threats to breathing W85-W99: Exposure to electric current, radiation and extreme ambient air temperature and pressure X20-X29: Contact with venomous animals and plants X30: Exposure to excessive natural heat X31: Exposure to excessive natural cold X32: Exposure to sunlight X50-X57: Overexertion, travel and privation X58-X59: Accidental exposure to other and unspecified factors VIOLENCE AND INJURIES IN EUROPE: BURDEN, PREVENTION AND PRIORITIES FOR ACTION 139 OTHER UNINTENTIONAL INJURIES Y40-Y59: Drugs, medicaments and biological substances causing adverse effects in therapeutic use Y60-Y69: Misadventures to patients during surgical and medical care Y70-Y82: Medical devices associated with adverse incidents in diagnostic and therapeutic use Y83-Y84: Surgical and other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure Y85: Sequelae of transport accidents Y86: Sequelae of other accidents Y88: Sequelae with surgical and medical care as external cause Y89: Sequelae of other external causess References 1. WHO methods and data sources for country-level causes of death 2000–2016. Geneva: World Health Organization; 2018 (http://terrance.who.int/mediacentre/data/ghe/GlobalCOD_method_2000_2016. pdf?ua=1, accessed 1 March 2020). 2. International Standard Classification of Diseases and Related Health Problems, 10th revision. In: World Health Organization [website]. Geneva: World Health Organization; 2016 (https://icd.who.int/browse10/2015/en#/, accessed 1 March 2020). The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czechia Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands North Macedonia Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 33 70 00 Fax: +45 33 70 01 Email: eurocontact@who.int Website: www.euro.who.int Violence and injuries in Europe: burden, prevention and priorities for action An analysis of the 2016 WHO Global Health Estimates Violence and injuries in Europe: burden, prevention and priorities for action