Disease prevention, treatment and health promotion are crucial livelihood undertakings that require considerable financial support. It is undoubtedly a heavy burden in the context of the global economic slowdown. Although the population provides both labour and purchasing power, which are essential for economic growth, the contributions of health promotion and maintenance to the economy are largely neglected. The conceptual shift from requiring funding to a prospering economy will provide new motivation for the practices of preventive medicine.

Benefiting from the demographic dividend and reform and opening up, China became the world’s second-largest economy and a vital engine for global economic growth. China’s average economic contribution to the world reached 38.6% from 2013 to 2021, which was higher than the total contribution of the Seven Group. However, China is simultaneously experiencing the pains of ageing, fewer children and industrial upgrading. Rapid changes lead to higher social dependency ratios, lower housing demand and weaker consumption. China has repeatedly tried to optimise its birth policy but has failed to stimulate constant population growth. The total fertility rate was less than 1.1 in 2022, only half of the replacement, presenting the first negative growth. From a global perspective, it is difficult to achieve long-term effects with most strategies and efforts to increase the population. Therefore, it is extremely urgent to protect the stock population.

The harm caused by chronic non-communicable disease (NCD) to human health in the 21st century is extensively recognised and has received much attention, whereas injuries caused by human activities are largely ignored. Injuries, including road traffic crashes, drowning, falls, suicides, violence, poisoning, etc, endanger all ages and demonstrate disparate patterns across different groups. Unlike NCDs, which primarily affect middle-aged and elderly individuals, injuries are the leading cause of death among those aged 1–4, 5–14 and 15–44 years in China. In general, injuries were released as the fifth leading cause of death by national death surveillance, resulting in approximately 640 000 deaths every year, which was 1.2 times the number of fewer births in 2023.1

Injuries, especially drowning and suicide, are severe challenges for youth protection. Drowning results in more than 300 000 victims annually worldwide, making it the third leading cause of unintentional injury death.2 In China, drowning causes 59 000 deaths per year, nearly one-fifth of the global total.3 Although mortality declined by 0.6 per 100 000 from 2011 to 2021, deaths remained above 45 000 when a large population was included.1 4 70% of deaths due to downing occur among those aged 1–14 years, making it the leading killer of minors. Unfortunately, laws, intervention strategies, school curricula and rescue systems such as Australia’s have not yet been well designed and implemented, apart from repeated warnings of drowning. Only 11.34% of drowning cases were rescued in the past 5 years.3 Suicide is another increasing problem that threatens the health of adolescents. An estimation of more than 116 000 deaths due to suicide in 2019 in China was reported by the WHO, which is higher than the 85 000 deaths reported by national surveillance.1 5 Deaths due to suicide have fallen by two-thirds in recent decades, whereas the mortality for both urban and rural children aged 5–14 years has sharply increased. The mortality of those aged 15–24 years exceeded 3 per 100 000, with an average annual increase of 20% from 2017 to 2021 after a 7-year decline.6 In addition, school and cyberbullying and falls from buildings are also growing public health concerns for adolescents. However, deaths are difficult to estimate accurately without reliable surveys and surveillance.

The injury affecting the working population most often is road traffic injury, which is the leading cause of unintentional injury deaths.7 There are an estimated 1.19 million road traffic deaths per year, with 92% occurring in low- and middle-income countries.8 As the largest developing country, China has more than 400 million motor vehicles and nearly 6 million road kilometres, of which the length of freeways open to traffic ranks first in the world. Over 240 000 Chinese die in road crashes each year, contributing to 20% of the global total road traffic deaths, according to WHO.9 Without regard to potential under-reporting, China’s death surveillance data announced 185 000 road victims in 2021.1 10 The deaths reported by WHO and China accounted for 34.3%–44.4% of the reduction in births in China in 2023. This figure strongly highlights the need for youth protections in the context of great demographic change, as road crashes are the leading cause of death for people aged 5–29 years.9

Falls are a rapidly growing threat worldwide, especially in ageing countries. An estimated 684 000 fatal falls occur each year, making it the second leading cause of unintentional injury and death after road traffic injuries.11 In China, falls killed 196 000 people in 2021, including a large proportion of the elderly population and nearly 5000 adolescents under 19 years of age.1 12 13 The number of deaths was almost double that of a decade ago.

Despite the discrepancies in statistics, there is no doubt that injuries are responsible for many young deaths. Given the potential reporting bias, the actual total number of injury deaths may be even greater than reported. As unacceptable as deaths are, injuries do not receive as much attention as the clinical treatment of diseases does. There are effective strategies and measures, such as the Hoddon model and 5E interventions for injury prevention, which ensure the expected health benefits.14 Vision Zero has made Sweden the safest country in terms of road traffic and has given birth to a well-known automotive safety industry. China’s urbanisation, pesticide control and women’s advancement have reduced the number of suicide cases by 60%–80%, and the revised Law on Road Traffic Safety, which includes a penalty for drunk driving, has prevented half of all road deaths over the past decades. These achievements have resulted in lower average costs than disease treatment does, benefiting the population at large and contributing to sustainable demographic and socioeconomic development. In recent years, injury prevention has been slow not only in China but also around the world. Target 3.6 of the Sustainable Development Goals to halve road traffic deaths by 2020 has not been met, and fewer deaths are only approximately 5%. In brief, injury prevention should be taken seriously for public health and socioeconomic development, especially in ageing countries such as China.