The USA's dangerous driving culture

The USA's dangerous driving culture

Editorial Mohamed Nureldin Abdallah/Reuters No peace of mind in South Sudan For Amnesty International’s report see https://www.amnesty. org/en/docu...

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Editorial

Mohamed Nureldin Abdallah/Reuters

No peace of mind in South Sudan

For Amnesty International’s report see https://www.amnesty. org/en/documents/ afr65/3203/2016/en/ For the Lancet 2014 letter see http://thelancet.com/journals/ lancet/article/PIIS01406736(14)60636-X/fulltext

As South Sudan this month marks its fifth anniversary as an independent nation, peace and stability remain elusive. Recent violence threatens the ceasefire agreement signed last year. Peace of mind is infinitely more fleeting. A report released by Amnesty International on July 6, Our hearts have gone dark, contains harrowing testimony of the mental health impacts of the mass killings, rape, torture, and abductions characterising South Sudan’s ongoing civil war. With fighting between rebel groups and violence toward civilians intensifying, particularly since December, 2013, virtually no one in South Sudan has escaped the horror of this war. More than 10 000 people have been killed. 2 million citizens are displaced due to armed conflict, says the report. It documents the accounts of survivors and witnesses of violence as well as of health and government officials, and says that depression and symptoms of posttraumatic stress disorder are widespread. Many people interviewed knew of others who had attempted or committed suicide. The deaths and physical destruction of war are readily apparent but the psychological trauma is less visible, emphasises the report, and must be addressed.

The mental health effects of war and torture produce long-term psychological scars. These will threaten South Sudan’s ability to recover and rebuild its communities. Despite mental health being critical to the country’s future, agencies including WHO and donor governments have not prioritised mental health services. Traditional family support networks and community non-governmental organisations cannot possibly meet the needs. Mentally ill people are said to be routinely held in prisons without access to health care or medicines. The South Sudan health system, already in tatters, is ill equipped to cope. Just two psychiatrists are present in the country of 11 million people, and they work in one centre, Juba Teaching Hospital, with 12 psychiatric beds. A letter in The Lancet in 2014 by two doctors who had trained 50 interns at Juba Hospital sounded an alarm for more attention to people with mental illnesses in South Sudan. The new report amplifies this appeal. International agencies and donors must support all efforts to end the war and its atrocities, but also must recognise and help repair the damage already inflicted on the hearts and minds of South Sudan’s population. „ The Lancet

Alan Schein Photography/ Getty

The USA’s dangerous driving culture

For the CDC report see http://www.cdc.gov/mmwr/ volumes/65/wr/pdfs/ mm6526e1.pdf

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July 4 is a time for celebration in the USA, but this day is also ranked the deadliest of the year for driving-related fatalities. On July 6, the US Centers for Disease Control and Prevention (CDC) released a report on motor vehicle deaths in the USA compared with 19 other high-income countries including the UK. They analysed data compiled by WHO and the Organisation for Economic Co-operation and Development on crash deaths in 2000 and 2013. On a positive note, the death rate from crashes in 2013 in the USA was 31% lower than the rate in 2000. However, the numbers are still unacceptably high: in 2013, 32 894 people died in vehicle crashes in the USA, equating to a death rate of 10·3 per 100 000 population. This was by far the highest rate of all 20 countries, and nearly twice as high as the comparison countries. Sadly, the most obvious factors are to blame: alcohol-impaired driving caused a third of the US crashes, and the USA has one of the lowest rankings for use of seat belts, with only 87% of car users using front-seat belts and 78% using rear-seat belts. Additionally, the USA defines

drunk driving as a blood alcohol concentration of 0·08%, whereas most of the other comparison countries use lower limits of 0·02–0·05%. The CDC’s National Center for Injury Prevention and Control noted that, per year in the USA, around 3000 lives could be saved by increasing seat-belt use to 100%, and up to 10 000 lives could be saved by eliminating alcohol-impaired driving. The researchers made recommendations for lowering the number of crashes and deaths, which include implementation of seat-belt laws that cover all occupants and require car seats and booster seats for passengers through at least 8 years of age, publicised sobriety checkpoints, and lower limits for blood alcohol. But these strategies cannot work unless the federal government, state governments, and the US health community are prepared to work together and invest in, advertise, enforce, and monitor them, and to help change public attitudes to unsafe driving through media campaigns. When traffic accidents are largely preventable in a country that has the means to address the problem, such a high loss of life on the road is not acceptable. „ The Lancet www.thelancet.com Vol 388 July 16, 2016