The logic of comparing international terrorism with other causes of injury

Our recent article in Injury Prevention comparing international terrorism mortality to road crash mortality¹ has stimulated questions around methodology and logic.²

To respond, firstly, we consider that there is a strong case for making comparisons between the burden of international terrorism and other causes of preventable mortality. Indeed, we and others have published such comparisons elsewhere in the peer reviewed literature (see studies cited in our previous papers¹,³,⁴). Such comparisons can inform the issues of societal risk perception, and guide more rational policy development processes, so as to optimize lives saved per level of government expenditure on prevention.

Regarding the sample frame and time period for our study, we strove to maximize methodologic rigour by using a standardized country grouping for which road crash mortality data are systematically collated and published (that is, OECD countries). Similarly, for the time period we used the latest 10 year period for which data were available at the time we undertook the analysis.

Furthermore, we studied “international terrorism” rather than “domestic terrorism”, because of the difficulty in obtaining data of adequate quality on the latter, partly because it overlaps more with criminal behavior and with various grades of civil war. As we have discussed elsewhere,⁵ the case of Israel highlights many definitional complexities around what is terrorism (relative to warfare) and how to classify terrorism within disputed areas of land (for example, those occupied by one state and claimed by another). We have suggested³ that such issues need to be resolved as best as possible by a well resourced global review of the epidemiology of international terrorism—ideally conducted by a respected international health agency such as the World Health Organization.

Finally, the respondents to our article² imply that resourcing is not important to reducing road crash injury (given revenue generation via speed cameras). Although we applaud such interventions as speed cameras, we note that no successful and sustainable road safety strategy relies on one intervention. Many other road crash prevention interventions do require substantial resource inputs by governments, including roadside breath testing for alcohol, mass media campaigns around alcohol/sleepiness and driving, street lighting, speed calming measures, and especially major road modifications.

We hope that Injury Prevention continues to publish articles on the injury burden of terrorism, and continues to see this as an issue that can be informed by logic, data, and appropriate contextual commentary.