'Fatalism', accident causation and prevention: issues for health promotion from an exploratory study in a Yoruba town, Nigeria.

As countries experience the 'epidemiological transition' with a relative decline in infectious diseases, accident rates tend to increase, particularly road traffic accidents. The health promotion interventions intended to prevent or minimize the consequences of accidents have been developed in predominantly Western, industrialized countries. Although some of these solutions have been applied with success to less developed countries, there are also good reasons why such solutions are ineffective when tried in a different context. Health promotion as developed in the West has a particular ideological bias, being framed within a secular, individualist and rationalist culture. Different cosmologies exist outside this culture, often described as 'fatalist' by Western commentators and as obstructing change. Changing these cosmologies or worldviews may not fit with the ethic of paying due respect to the cultural traditions of the 'target group'. Health promotion is therefore faced with a dilemma. In addition to different worldviews, the different levels of development also mean that solutions formulated in richer countries do not suit poorer countries. This paper uses a small exploratory study in a Yoruba town in Nigeria to examine these points. Interviews with key informants were held in March 1994 in Igbo-Ora and data were extracted from hospital records. Levels of accidents from available records are noted and people's ideas about accident prevention are discussed. Recommendations as to the way forward are then proposed.