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World Health Organization
Geneva
Department of Injuries and
Violence Prevention
A N N U A L
R E P O R T
WHO / NMH / VIP/ 03.1
INJURIES constitute a major public health problem, killing more than five million
people worldwide each year and harming many millions more. Their occurrence
is creating mounting concern, with injury-related fatalities projected to rise to
8.4 million by 2020. Whether they are unintentional – resulting from incidents
such as road traffic collisions, drowning, and falls – or intentional – following an
assault, self-inflicted violence or war-related violence – injuries affect people of all
ages and economic groups.
The WHO DEPARTMENT OF INJURIES AND VIOLENCE PREVENTION acts
as a facilitating authority for international science-based efforts to promote safety
and prevent violence and unintentional injuries and mitigate their consequences
as major threats to public health and human development. 2002
COPY
RIGH
T 200
2. SI
PA PR
ESS,
MAR
IE DO
RIGN
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COPYRIGHT 2002. DUKAS/SIGMA, STEPHAN VERDER
prevention
VIP AR02_coverB.id2 4/4/03, 3:45 AM1
Department of Injuries and
Violence Prevention
e WHO Department of Injuries and Violence Prevention acknowledges with thanks the contributions of Laura Sminkey and other staff from the Department for the preparation of this document and Tony Kahane for editing the final text.
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prevention
cknowledgements:
Department of Injuries and
Violence Prevention
A N N U A L
R E P O R T
2002
prevention
A N N U A L R E P O R T 2 0 0 2 v
Table of Contents
I FOREWORD 1
II INTRODUCTION 3
A. Background 3
B. The history of WHO’s Department of Injuries and Violence Prevention 4
C. Challenges 6
D. Structure of the annual report 6
III PREVENTION OF VIOLENCE 7
A. Background 7
B. The response of WHO 8
C. World report on violence and health 8
D. Global Campaign for Violence Prevention 10
E. Implementing the recommendations of the World report on violence and health 11
F. Partnerships 14
G. Technical cooperation with countries 15
H. Next steps in violence prevention 16
IV PREVENTION OF ROAD TRAFFIC INJURIES 17
A. Background 17
B. The response of WHO 17
C. The Five-year WHO strategy for road traffic injury prevention 18
D. Implementing the Five-year WHO strategy for road traffic injury prevention 18
E. Partnerships 19
F. Technical cooperation with countries 19
G. Next steps in road traffic injury prevention 20
V SURVEILLANCE 21
A. Background 21
B. Methodology 21
C. Dissemination of data 22
D. Next steps in surveillance 22
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VI EMERGENCY SERVICES FOR VICTIMS OF INJURIES AND VIOLENCE 25
A. Background 25
B. Guidelines for essential trauma care services 26
C. Guidelines for prehospital trauma care systems 26
D. Next steps in emergency services 26
VII CAPACITY BUILDING 27
A. Background 27
B. Training, educating, and advancing collaboration in health on violence and injury prevention (TEACH-VIP) 27
C. Next steps in capacity building 28
VIII PARTNERSHIPS 29
A. WHO Headquarters, and Regional and Country Offices 29
B. WHO Collaborating Centres 29
C. The 6th World Conference on Injury Prevention and Control 30
D. Safe Communities around the World 30
IX RESOURCES 31
A. VIP’s world wide web site 31
B. Selected WHO publications on injuries and violence prevention: 1996–2002 32
C. The roles and responsibilities of staff in the Department of Injuries and Violence Prevention 32
D. Next steps 32
X FUTURE DIRECTIONS 33
I N J U R I E S A N D V I O L E N C E P R E V E N T I O Nv i A N N U A L R E P O R T 2 0 0 2 1
ForewordI
I am pleased to share with you the f irst
annual repor t of WHO’s Depar tment of
Injuries and Violence Prevention (VIP). This
summarizes the many activities we under-
took during 2002 – not an easy task, since the
year was such a full and dynamic one for our
recently-established department.
The World report on violence and health,
released in October 2002 after three years of
preparation, has undoubtedly been the depart-
ment’s most visible product. Hundreds of press
articles have been published and dozens of pol-
icy meetings have already taken place around
the world to discuss its implications. As a result,
many Member States have started to develop
national reports, plans of action, networks and
other activities stemming from the Report and
designed to prevent violence. In the coming
years, we will actively continue to follow up
the campaign around the World report on vio-
lence and health. The context for doing so will
be a favourable one, given the WHO Executive
Board’s endorsement in January 2003 of a pro-
posed resolution on implementing the Report’s
recommendations.
Th e Fi ve - ye a r W H O s t ra te g y f o r ro a d
traffic injury prevention guides our work in this
area. During 2002, we started implementing
it by developing several technical documents
with guidance on training and on best prac-
tices in traffic injury prevention. The bulk of
our work, however, went towards providing
technical assistance to several countries. This
will continue in 2003, while at the same time
we prepare the joint WHO–World Bank World
report on road traffic injury prevention, to be
released on World Health Day 2004, which will
be dedicated to “Road Safety”.
The year 2002 was also an opportunity to
strengthen our partnerships with relevant WHO
Collaborating Centres, sister United Nations
agencies, and key nongovernmental organ-
izations. A meeting to discuss collaboration
on preventing interpersonal violence brought
together ten UN agencies. This work resulted
in the publication in January 2003 of the Guide
to United Nations resources and activities for the
prevention of interpersonal violence.
All these documents and activities are just
the beginning of increased scientific efforts
towards the prevention of what is a major
cause of ill-health worldwide. Injuries and vio-
lence are among the leading causes of death
for all age groups. The attention devoted to
injuries and violence and the efforts to pre-
vent them still remain minimal compared to
the magnitude of the problem. The Depart-
ment will provide Member States and partners
with tools to pursue injury and violence preven-
tion and control, so as to prevent and mitigate
the suffering they cause to tens of millions of
people around the world each year.
Dr Etienne Krug, Director
Department of Injuries and Violence Prevention
Geneva, 31 January 2003
I N J U R I E S A N D V I O L E N C E P R E V E N T I O Nv i A N N U A L R E P O R T 2 0 0 2 1
A N N U A L R E P O R T 2 0 0 2 3
A. BACKGROUND
Injuries constitute a major public health problem, killing more than five million people
worldwide each year and harming many millions more (see table 1 entitled “Lead-
ing causes of death, both sexes, world, 2000”). Their occurrence is creating mounting
concern, with injury-related fatalities projected to rise to 8.4 million by 2020. Whether
IntroductionII
Rank − years − years − years − years - years + years All ages
1Lower respiratory
infections2 134 248
Childhood cluster diseases200 139
HIV/AIDS855 406
HIV/AIDS1 249 048
Ischaemic heart disease931 267
Ischaemic heart disease5 694 495
Ischaemic heart disease6 894 057
2 Diarrhoeal diseases1 315 412
Road traffic injuries118 212
Road traffic injuries354 692
Tuberculosis368 501
Cerebrovascular disease573 065
Cerebrovascular disease4 312 376
Cerebrovascular disease5 101 446
3Childhood-cluster
diseases1 108 666
Drowning113 614
Tuberculosis238 021
Road traffic injuries302 922
Tuberculosis413 851
Chronic obstructive pulmonary diseases
2 285 834
Lower respiratoryinfections3 866 321
4Low birth weight
1 025 488Lower respiratory
infections112 739
Self-inflicted injuries216 661
Ischaemic heart disease224 986
HIV/AIDS332 996
Lower respiratoryinfections1 225 643
HIV/AIDS2 942 901
5Malaria905 838
Diarrhoeal diseases88 430
Interpersonal violence188 451
Self-inflicted injuries215 263
Trachea, bronchus, lung cancers
275 895
Trachea, bronchus, lung cancers
886 787
Chronic obstructive pulmonary diseases
2 522 983
6Birth asphyxia and
birth trauma787 179
Malaria76 257
War injuries95 015
Interpersonal violence146 751
Cirrhosis of the liver226 975
Hypertensive heart disease754 495
Diarrhoeal diseases2 124 032
7HIV/AIDS419 480
HIV/AIDS46 022
Drowning78 639
Cerebrovascular disease145 965
Lower respiratoryinfections226 105
Diabetes mellitus612 725
Tuberculosis1 660 411
8Congenital heart
anomalies281 751
War injuries43 671
Lower respiratoryinfections
65 153
Cirrhosis of the liver135 072
Road traffic injuries212 040
Tuberculosis536 303
Childhood-clusterdiseases
1 385 455
9Protein-energy
malnutrition172 530
Tuberculosis36 362
Poisonings61 865
Lower respiratoryinfections102 431
Diarrhoeal diseases210 994
Stomach cancer529 461
Road traffic injuries1 259 838
10STDs excluding HIV
142 176Tropical cluster diseases
31 845Fires
61 341Liver cancer
84 279Chronic obstructive pulmonary diseases
181 458
Colon and rectum cancers441 961
Trachea, bronchus, lung cancers
1 212 625
11 Drowning115 922
Fires30 599
Maternal haemorrhage59 456
Poisonings78 060
Liver cancer180 263
Diarrhoeal diseases400 705
Malaria1 079 877
12 Anencephaly85 247
Interpersonal violence24 668
Rheumatic heart disease48 062
War injuries72 314
Self-inflicted injuries165 412
Cirrhosis of the liver385 886
Low birth weight1 025 584
13 Meningitis76 870
Leukaemia23 808
Leukaemia44 740
Nephritis and nephrosis71 654
Stomach cancer160 140
Nephritis and nephrosis357 074
Hypertensive heart disease940 818
14 Road traffic injuries75 710
Poisonings23 293
Nephritis and nephrosis41 300
Diarrhoeal diseases68 098
Breast cancer145 200
Liver cancer341 157
Self-inflicted injuries814 778
15 Tuberculosis67 372
Self-inflicted injuries21 967
Diarrhoeal diseases40 392
Breast cancer61 480
Hypertensive heart disease135 894
Oesophagus cancer284 252
Diabetes mellitus809 685
able 1. Leading causes of death, both sexes, world, 2000. (Gray boxes indicate injury-related causes of death.)
A N N U A L R E P O R T 2 0 0 2 3
they are unintentional – resulting
from incidents such as road traffic
collisions, drowning, and falls – or
intentional – following an assault,
self-inflicted violence or war-
related violence – injuries affect
people of all ages and economic
groups. Death rates due to injuries,
however, tend to be higher among
poorer people, particularly those
of the most economically-produc-
tive age group. Efforts to prevent
injuries, which have thus far been
concentrated in developed coun-
tries, need to be focused more on
developing countries, and need
to be implemented in an appro-
priate, cost-efficient and effective
manner.
B. THE HISTORY OF WHO’S DEPARTMENT OF INJURIES AND VIOLENCE PREVENTION
WHO’s Department of Injuries and Violence Prevention (VIP) was established within the
Cluster of Noncommunicable Diseases and Mental Health in March 2000. For the 17
years prior to this, injuries and violence prevention had been housed as a unit within
three consecutive departments: the Department of Health Protection and Promotion; the
Department of Emergency and Humanitarian Action; and the Department of Disabilities,
Injuries Prevention and Rehabilitation. Historically, injuries had been neglected compared
to other serious public health concerns, largely because they were viewed as accidents or
random events over which people had little control. This misconception, together with a
lack of health professionals trained to deal with injuries and violence and limited fund-
ing for initiatives in these areas led to the neglect of injuries and violence within global
public health agendas. However, their elevation to departmental level within WHO has
clearly demonstrated the Organization’s increasing commitment to addressing injuries
and violence, and is an appropriate reflection of the requests of several World Health
Assemblies, calling on WHO to tackle these issues. The following resolutions related to
injuries and violence have been passed by various World Health Assemblies:
• WHA51.8, in 1998, calling for concerted public health action on anti-personnel mines
• WHA50.19, in 1997, endorsing WHO’s integrated plan of action for a science-based
public health approach to violence prevention
• WHA49.25, in 1996, declaring violence a leading global public health problem
• WHA27.59, in 1974, calling for the growing problem of road traffic injuries to be
addressed.
E M U S T M U L T I P L Y O U R E F F O R T S to prevent people from falling victim
to road traffic collisions, interpersonal violence, the savagery of war and conflict, or harm they may inflict upon themselves. Over the past few years, national and world leaders have become aware of what health professionals long have argued: that stable and prosperous societies cannot be achieved without investing in health. As such, investments in injury and violence prevention are ultimately investments in health and development.
– Dr Gro Harlem Brundtland, WHO Director-General: Sixth World Conference on Injury Prevention and Control, Montreal, Canada, May
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e WHO Department of Injuries and Violence Prevention acts as a facilitating authority for international science-based efforts to promote safety and prevent violence and unintentional injuries and mitigate their consequences as major threats to public health and human development, by pursuing the following goals:
• raising awareness about violence and uninten-tional injuries as major public health problems, and advocating for increased human and finan-cial resources for their prevention and control
• collating, analysing and disseminating global data on violence and unintentional injuries
• promoting and facilitating improved collection of data on violence and unintentional injuries
• promoting and facilitating international research on violence and unintentional injuries prevention and control
• promoting and facilitating implementation of violence and unintentional injuries prevention and control at country level
• promoting and facilitating provision of services for victims of violence and unintentional injuries
• promoting and facilitating best practices for violence and unintentional injuries prevention and control
• promoting and facilitating teaching and training for violence and unintentional injuries prevention and control
• fostering multi-disciplinary collaboration among relevant global, regional and national stakeholders.
• the Governments of Australia, Belgium, Brazil, Canada, Finland, Italy, Japan,
the Netherlands, Norway, Sweden, and the United Kingdom;
• the United States Centers for Disease Control and Prevention;
• the California Wellness Foundation;
• the Fédération Internationale de l’Automobile Foundation;
• the Geneva International Academic Network;
• the Global Forum for Health Research;
• the Rockefeller Foundation; and
• the Small Arms Survey.
VIP thanks the
following donors
for their generous
support:
i n a n c i a l C o n t r i b u t o r s t o V I P
I P Mi s s i o n S t a te m e n t
I N J U R I E S A N D V I O L E N C E P R E V E N T I O N4 A N N U A L R E P O R T 2 0 0 2 5
C. CHALLENGES
Despite the progress made in the past three years, the Department faces a number
of challenges. These are generally associated with the still limited – albeit growing
– awareness of injuries and violence as major threats to public health. Given the signif-
icant contribution of injuries and violence to the global burden of disease, the human
and financial resources being used to prevent them are inadequate. Even when this
is recognized, there are few readily-identifiable focal points within governments and
professional circles that can assume responsibility for prevention efforts. This hinders
the creation of the partnerships across sectors that are necessary to address these
problems comprehensively. Without such partnerships, prevention remains elusive.
Yet much has been learned about prevention during the past two decades, and this
knowledge and experience can be adapted and applied to ongoing prevention efforts
in all countries.
D. STRUCTURE OF THE ANNUAL REPORT
The information in this report is presented along the lines of the current structure of
VIP. As the Department’s programme activities are grouped into two thematic areas –
prevention of violence and prevention of road traffic injuries – the report contains a
section on each of these topics. Descriptions of the activities within the three cross-
cutting areas then follow – namely, surveillance; emergency services for victims of
injuries and violence; and capacity building. To conclude, there are sections on part-
nerships and on resources.
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A. BACKGROUND
Violence is a leading cause of deaths and non-fatal injuries worldwide and a pressing
public health issue for every country. According to the World report on violence and
health, every day more than 4000 people around the world die a violent death, nearly
half of them by suicide, almost one third from homicide, and one fifth due to violence
related to armed conflict. Many more people survive acts of violence, often remain-
ing disabled or psychologically traumatized. Violence, however, can be prevented, and
much can be done to reduce the harm caused by violence when it does occur. Given
the complexity of the problem, a multifaceted response is required targeting individ-
uals, their family environments, the communities in which they live, and the broader
cultural, social and economic spheres in which they operate. Examples of proven
or promising interventions include social development programmes; incentives to
complete secondary schooling; home visitation; parent training; reducing alcohol avail-
ability; improving access to trauma care and health services; improving institutional
policies in schools, workplaces, hospitals and residential institutions; public informa-
tion campaigns; reducing access to means such as firearms; reducing inequalities; and
strengthening the police and judicial systems.
Prevention of violenceIII
No data
15.4–27.3
8.2–15.3
2.9–6.1
1.0–2.8
Mortality rate(per 100 000 population)
igure 1. Global interpersonal violence mortality, 2000
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N M Y V I E W , the WHO World report on violence and health is an excellent starting point on both national and international levels from which to work toward
ending violence. Since there is no simple response to this problem, varied approaches must be taken, particularly those which target groups most at risk of violence. …e goal is not to regret violence once it has occurred, but to the contrary to be aware of its many causes and consequences, and to arm oneself more effectively to confront violence.
– His Excellency King Albert II of Belgium: Speech to the Authorities of the Country, Brussels, Belgium, January
B. THE RESPONSE OF WHO
In 1996, the World Health Assembly’s resolution WHA49.25 declared violence a lead-
ing global public health problem. The following year, the Assembly passed resolution
WHA50.19 endorsing WHO’s integrated plan of action for a science-based public health
approach to violence prevention. VIP’s work to prevent violence is a direct response to
these resolutions which proposed tasks in the areas of surveillance, research, preven-
tion, treating and caring for victims, and advocacy for the prevention of violence.
C. WORLD REPORT ON VIOLENCE AND HEALTH
In October 2002, after three years of preparation and the contributions of more than
160 violence prevention experts from around the world, WHO launched the World
report on violence and health, the first global publication of its kind to explore vio-
lence as a major public health issue. The Report includes chapters on youth violence,
child abuse and neglect by parents and other caregivers, violence by intimate part-
ners, abuse of the elderly, sexual violence, self-directed violence and collective violence.
The document is the most comprehensive assessment to date of the magnitude and
impact of violence throughout the world; the major risk factors for violence; and the
types of interventions that have been tried and what is known about their effective-
ness. It concludes with a set of nine recommendations for mobilizing action in
response to violence at all levels of society (see “recommendations for action”
in the box entitled “World report on violence and health”).
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e multifaceted nature of violence requires the engagement of governments and stakeholders at all levels of decision-making – local, national and international. e following recommendations reflect this need for collaborative approaches cutting across sectors.
• Create, implement and monitor a national action plan for violence prevention.
• Enhance capacity for collecting data on violence. • Define priorities for, and support research on,
the causes, consequences, costs and prevention of violence.
• Promote primary prevention responses. • Strengthen responses for victims of violence. • Integrate violence prevention into social and
educational policies, and thereby promote gender and social equality.
• Increase collaboration and exchange of information on violence prevention.
• Promote and monitor adherence to international treaties, laws and other mechanisms to protect human rights.
• Seek practical, internationally agreed responses to the global drugs trade and the global arms trade.
Despite major gaps in knowledge and a pressing need for more research, experience has provided some important lessons about preventing violence and mitigating its consequences.
• Violence is often predictable and preventable.
• Investing in prevention – especially primary prevention activities that operate “upstream” of problems – may be more cost-effective and have significant and long-lasting benefits.
• Understanding the context of violence is vital in designing interventions.
• Different types of violence are linked in many important ways and often share common risk factors.
• Resources should be focused on the most vulnerable groups.
• Complacency is a barrier to tackling violence.
• Political commitment to tackling violence is vital to the public health effort.
• Violence is not inevitable.
R e c o m m e n d a t i o n s f o r a c t i o n :
L e s so n s o f e x p e r i e n c e :
Wo rl d re p o r t o n v i o l e n c e a n d h e a l th
I N J U R I E S A N D V I O L E N C E P R E V E N T I O N8 A N N U A L R E P O R T 2 0 0 2 9
In the three months following publica-
tion of the Report, some 18 000 copies of the
document were disseminated – to Ministries
of Health, United Nations agencies, non-
governmental organizations (NGOs), WHO
Collaborating Centres, libraries, academic
journals and commercial book distributors
throughout the world. In addition, extensive
media coverage was important in spreading
the Report’s messages and findings. More
than five hundred press articles on the Report
were published during this period in over fifty
countries. The Report also stimulated discus-
sion in the scientific press on violence as a
public health issue, and some twenty edito-
rials, articles or reviews appeared in leading
journals such as the American Journal of Public
Health, the Australian and New Zealand Journal
of Public Health, the British Medical Journal, the
Indian Journal of Medical Research, Injury Pre-
vention, The Lancet and the South Africa Medical
Journal. Several schools of public health have
indicated that the Report will be required read-
ing for some of their courses in public health. By the end of December 2002, a summary
of the Report was available in the six official languages of the United Nations: Arabic,
Chinese, English, French, Russian and Spanish as well as Portuguese, and the full docu-
ment was available in Chinese, English, French and Portuguese. The full document will
also be available in Arabic, Russian and Spanish in the early months of 2003.
D. GLOBAL CAMPAIGN FOR VIOLENCE PREVENTION
At the same time as releasing the World report on violence and health, the WHO Director-
General launched the Global Campaign for Violence Prevention. This campaign aims to
promote the implementation of the Report’s recommendations, and to raise awareness
generally about violence as a major public health problem. It also calls for increased
human and financial resources to be made available for violence prevention at all lev-
els of society. As part of the campaign, WHO is working with governments and NGOs
worldwide to support high-profile national or regional-level launches of the World
report on violence and health. Events of this type provide an ideal opportunity to bring
together those with a part to play in violence prevention: government officials from
a range of sectors, researchers, practitioners and advocates. In 2002, presentations
took place in Armenia, Australia, Azerbaijan, the Bahamas, Belgium (global launch),
Brazil, Colombia, Costa Rica, Georgia, India, Madagascar, Mozambique, Nicaragua,
OR THOSE OF US
involved in the
prevention of violence
against women, the
World report on violence
and health is a huge
achievement, the end point
of a ten-year campaign
to highlight the issue of
violence against women.
– Ms Lori Heise, Senior Associate, Program of Appropriate Technology in Health: Global launch of the World report on violence and health, Brussels, Belgium, October
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Papua New Guinea, Peru, Philippines, Sri Lanka and South Africa. The Report was also
presented to the European Parliament.
As a result, governments have committed themselves to pursuing various important
initiatives. Examples are the adoption of a resolution calling for the development of a
regional multisectoral plan of action for violence prevention in Central America; the
signing of the “Bogotá Declaration” by Vice-Ministers of Health from Colombia, Peru
and Venezuela, committing their governments to address violence as a public health
problem; the creation of a national network for violence prevention in Brazil; and the
development of national reports on violence and health in Belgium, Jordan, the Russian
Federation and South Africa. In addition, European parliamentarians have called for a
European year dedicated to violence prevention. In the months ahead, a further twenty
launches of the Report are being planned as part of the campaign, from which WHO is
anticipating concrete outcomes. In collaboration with partners from Harvard Univer-
sity, USA and the University of New South Wales, Australia, a critical evaluation of the
impact of the World report on violence and health and the Global Campaign for Vio-
lence Prevention will be undertaken in 2004 and 2005.
E. IMPLEMENTING THE RECOMMENDATIONS OF THE WORLD REPORT ON
VIOLENCE AND HEALTH
1. Prevention
a) Tools for implementing the recommendations of the World report on violence and health
This work begins where the World report on violence and health ends, by providing
Member States with tools to implement the Report’s recommendations. For this pur-
pose, VIP and the Belgian Ministry of Health hosted a consultative meeting in Brussels
in March 2002, where policy makers and practitioners from around the world shared
experiences on how to mobilize the political will necessary to establish and entrench
violence prevention policies and programmes. Their message was clear. Investment
in violence prevention will occur once violence is proved to be a major and costly
societal problem, and once policy and decision makers are convinced that violence
is preventable through a series of clear and concrete steps. Commenting upon VIP’s
draft framework document, provisionally entitled Safer lives: a shared agenda for the
prevention of interpersonal violence, participants discussed what elements the docu-
ment should contain so as to galvanize prevention efforts. The intersectoral nature
of the deliberations was especially valuable, with representatives from the sectors of
health, justice, human security, policing, welfare, human rights and academia not only
agreeing that interpersonal violence can and should be prevented, but also on the
approaches for doing so. Safer lives: a shared agenda for the prevention of interpersonal
violence will be completed by mid-2003, based on the input from the consultative
meeting and ongoing dialogues on the topic with partner agencies.
M É D E C I N S S A N S F R O N T I È R E S
salutes the initiative of WHO which publishes today its World report on violence and health.
“is report, the first of its kind, highlights the links between violence and health, stating that violence caused the death of . million people in the world in ”, comments Jean-Hervé Bradol, President of Médecins sans Frontières. As the report emphasizes, the incidence of violence which results in fatality is only the tip of the iceberg, as violence has numerous other consequences on the health of individuals.
– Médecins sans Frontières, France: Press release on the global launch of the World report on violence and health, Brussels, Belgium, October
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b) Compiling promising and proven practicesEasily-accessible descriptions of promising and proven practices are essential to the
growth of vigorous violence prevention programmes. Such descriptions can serve as
examples for governments, municipalities and community-based organizations that are
beginning to work on prevention. They can also provide suggestions for those managing
established programmes to strengthen their work, and can give policy makers and deci-
sion makers concrete ideas about the types of interventions they might be supporting.
To begin the process of developing a database of best and promising practices to
complement the existing catalogue of scientifically-evaluated interventions contained
in the World report on violence and health, VIP has begun work on a Handbook for the
documentation of promising and proven practices in violence prevention. This handbook
identifies the core features of violence prevention programmes, defines quantitative
and qualitative indicators for them, and provides a structured questionnaire for sys-
tematically documenting such programmes. The book will be finalized following a
consultative review in February 2003, after which VIP will contract agencies to collect
standardized descriptions of violence prevention programmes at country-level.
c) Reducing armed violence where human security is threatenedThe Programme of Action of the United Nations Conference on the Illicit Trade in Small
Arms and Light Weapons, July 2001, defined a role for the health sector in the reduc-
tion of small arms violence. It was acknowledged that the problem was complex and
involved both health and development dimensions, and there was a call for “action-
oriented research” so that the problems associated with small arms could be better
understood. Within this context, VIP and the Small Arms Survey undertook a project to
reduce armed violence in settings where these weapons are widely available and often
used. In March 2002, VIP hosted a consultation of international experts that reached
two main conclusions. First, countries required evidence before deciding to allocate
resources for the prevention of armed violence. Second, in order to achieve reduc-
tions in armed violence and make communities safer, efforts on small arms needed to
expand beyond “supply side” approaches, such as programmes to collect and destroy
weapons, and address some of the “demand side” issues. To this end, the project tries
to provide a more developed understanding of the causes and consequences of armed
violence in settings of high violence and to evaluate the effectiveness of existing pro-
grammes to reduce armed violence in these settings.
Later in 2002, VIP staff visited Brazil and Mozambique, both designated for the pilot
phase of the project. The visits found that the use of small arms in these countries
was primarily a problem afflicting marginalized communities within urban areas. In
both countries, a number of community-based violence prevention programmes were
identified, several of them modelled on promising violence prevention approaches.
The organizations involved expressed the desire to collaborate with VIP in rigorously
evaluating their programmes. Assessing the effectiveness of these programmes will
provide an opportunity to reach a better understanding of armed violence in highly
insecure settings, and to give guidance to the international community on the extent
to which different strategies may prevent armed violence and enhance human secu-
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rity. Pending funding, the project may be expanded to El Salvador, Honduras, Nicaragua,
the Philippines and South Africa.
d) Preventing child abuse and neglectAlthough reliable data are extremely scarce, the World report on violence and health
estimates that there were 57 000 homicides among children under fifteen years of
age worldwide in the year 2000. Hundreds of thousands of others suffer from non-
fatal abuse and neglect every year. The abuse and neglect of children have grave and
often long-lasting consequences on health, including a substantially increased risk for
substance abuse, depression and both interpersonal and self-directed violence later in
life. Early developmental initiatives to prevent child abuse and neglect are among the
most effective of all violence prevention measures identified to date.
Since its involvement in the September 2001 United Nations Committee on the
Rights of the Child Day of General Discussion on Violence against Children, VIP has
scaled up its activities in this area. In collaboration with the International Society for
the Prevention of Child Abuse and Neglect, VIP is preparing Guidelines for the prevention
of child abuse and neglect by parents and caregivers. The guidelines will offer recommen-
dations for identifying cases of child abuse and neglect, collecting data on such cases,
and preventing and responding to known or suspected instances of child abuse and
neglect. In May 2002, VIP hosted a consultative meeting at which the four core draft
modules of the guidelines, including an overview and sections on the health, social
and legal aspects, were reviewed by prevention experts from around the world. The
guidelines will be finalized following a final peer review scheduled for mid-2003.
VIP, together with the WHO Department of Child and Adolescent Health and Devel-
opment, also represents WHO as part of the United Nations secretariat coordinating
the United Nations Study of Violence against Children. Alongside the United
Nations Office of the High Commissioner for Human Rights (OHCHR) and the
United Nations Children’s Fund (UNICEF), WHO is a partner of the working
group providing technical support for this major global study, expected to
be completed in 2005. It is anticipated that the study will reinforce the mes-
sages of the World report on violence and health, and address those areas of
violence against children which may not have received sufficient attention
in previous reports.
2. Services for victims of sexual violence
Although millions of women worldwide experience sexual violence at the
hands of intimate partners, acquaintances and strangers, the health and legal
services for victims of such violence are often poorly developed. Based on
appeals by Human Rights Watch and the 15th World Congress of Gynaeco-
logy and Obstetrics in 1997, and following an international consultation on
health responses to sexual violence convened in 2001 by VIP and WHO’s
Department of Gender and Women’s Health, VIP is now finalizing Guidelines
for medico-legal care of victims of sexual violence. These guidelines provide Copyright 2002. Sipa press, Marie Dorigny.
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T H E R O O T S of violence are
deep and complex, and its prevention requires collaboration across all sectors of society and the engagement of many parts of the United Nations family.
– Mr Kofi Annan, United Nations Secretary-General: Message to the Guide to UN resources and activities for the prevention of interpersonal violence
health care professionals with the knowledge and skills required to provide quality
health services to victims of sexual violence, conduct accurate and ethical documen-
tation of their cases, and collect forensic evidence. They are designed in such a way as
to be appropriate and adaptable in settings where there may be severe constraints on
the ability to provide comprehensive health services. The final draft of the guidelines
has already been peer-reviewed, and is currently being prepared for publication. Dur-
ing 2003, the guidelines will be pilot-tested in Honduras, Nicaragua, Mozambique and
the Philippines. VIP is complementing these guidelines – which deal mainly with clin-
ical and forensic issues – with a set of guiding principles for health policy and health
systems with regard to sexual violence.
F. PARTNERSHIPS
1. Collaboration on violence prevention with United Nations agencies
In November 2001, WHO hosted the Meeting on UN Collaboration for the Prevention of
Interpersonal Violence, involving representatives of ten UN agencies. In planning the
meeting, it was decided to focus on interpersonal violence – violence in the home,
schools, workplaces and communities – which, unlike war and conflict-related violence,
receives little sustained media attention. In the meeting, participants spoke of the great
impact that interpersonal violence has on health, development, human rights, human
security, and peace. They also drew attention to the major role that most UN agencies
can play in preventing interpersonal violence, and they committed
themselves to collaborating on joint projects in research, preven-
tion and advocacy. As a follow-up to the meeting, in January 2003,
VIP published the Guide to UN resources and activities for the preven-
tion of interpersonal violence. This Guide, describing the work of
fifteen UN agencies in preventing interpersonal violence, contains
brief descriptions of each agency’s activities, relevant publica-
tions, contact information, web addresses and databases. As a
next step there will be focused collaborations on data collection
and research, prevention and advocacy, and country-level proj-
ects on specific topics within these areas.
2. Collaboration on violence prevention with nongovernmental organizations
In recent years, VIP has made a concerted effort to increase collaboration with the NGO
community in preventing violence. Input is systematically sought from NGO represent-
atives on the development of guidelines such as those currently being finalized on the
medico-legal care of victims of sexual violence. The various launches of the World report
on violence and health have benefited from NGO representation, particularly at national
level. Together with VIP, NGOs such as the Global Forum for Health Research, the Inter-
national Federation of Medical Students’ Associations (IFMSA), and the International
Physicians for the Prevention of Nuclear War (IPPNW) – all in an official relationship with
WHO – have helped campaign for violence prevention among their members and at
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meetings of the WHO leadership. The Global Forum for Health Research has collaborated
with VIP to support international research on child abuse and neglect and on sexual vio-
lence. With IFMSA, VIP has collaborated on a survey of the curricula of medical schools
covering injuries and violence prevention, and IPPNW and VIP have worked together on
ways to prevent violence by addressing the availability and use of small arms.
G. TECHNICAL COOPERATION WITH COUNTRIES
Among the nine general recommendations for violence prevention in the World report
on violence and health, six concern country-level activities. These are recommendations
on: national action plans for violence prevention; data collection; research; primary
prevention; services to victims of violence; and the integration of violence preven-
tion into social and educational policies. Through the various national launches of
the World report on violence and health, support has been rallied for implementing
these recommendations. These recent advocacy-oriented efforts build upon VIP’s
work within countries to pilot-test guidelines and hold policy discussions on violence-
related topics. VIP’s current work on violence prevention in Mozambique will provide
useful lessons on the type of country-level activities that the Department should sup-
port in the future (see box below).
In , VIP responded to requests from the gov-ernment of Mozambique to collaborate in the challenging task of improving the safety and secu-rity of the nation’s nearly twenty million inhabitants, who until recently lived with chronic civil war. e core of the Mozambique Project is a national action plan for violence prevention, based on which the country will develop a national policy on violence prevention – expected to be in place by the end of . e policy will be shaped by the information and experience obtained from several projects. One of these is a detailed country-wide analysis of injuries using mortuary, hospital and clinic-based registries of injuries, supplemented by the inclusion of questions on injuries in a nationwide demographic and health survey. Another project is the creation of a network
of violence prevention practitioners. rough train-ing workshops and seminars, this project aims to raise awareness about violence prevention and iden-tify prevention partners and opportunities around which they might collaborate at community, munic-ipal, and national levels. A third initiative addresses the issue of small arms, an important factor related to violent injury in post-conflict settings. VIP’s small arms project complements the many efforts aimed at controlling the supply of small arms with violence prevention interventions that reduce the demand for such weapons. Evaluation is a core component of this work and, together with the findings from other set-tings, will provide important new information on how human security can be enhanced and sustained in some of the world’s most violent settings.
h e oz a m b i q u e r o j e c t
T H E N E E D F O R complex partnerships,
with involvement of local, national and international bodies, is crucial in promoting a clear vision of peace and tolerance, which was the overall aim of the World report on violence and health.
– Dr Derek Yach, Executive Director, Noncommunicable Diseases and Mental Health, in response to discussion at the WHO Executive Board on the resolution “Implementing the recommendations of the World report on violence and health”, January
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H. NEXT STEPS IN VIOLENCE PREVENTION
1. Technical support for the development of national action plans for
violence prevention
In 2003, VIP will initiate a new project aimed at providing guidance to Member States
about implementing Recommendation No. 1 of the World report on violence and health:
the development of a national action plan for violence prevention. The national action
plan is the blueprint that provides the different sectors of society with a set of common
objectives and strategies, a shared time-frame, and an evaluation mechanism through
which their activities can be coordinated. Key to the development of such a plan is the
production of a national report on violence and health. Such reports are already being
prepared in countries including Belgium, Jordan, the Russian Federation and South
Africa. To produce a national action plan involves reviewing existing national plans
and the lessons learnt from them, drafting detailed guidelines for the development of
such plans, and training on how to implement these guidelines. Such training will take
place during the 7th World Conference on Injury Prevention and Safety Promotion in
Vienna, Austria in June 2004.
2. Assessing the economic dimensions of violence
An important document to be released by VIP in 2003 is a comprehensive literature
review of the research on the economic aspects of interpersonal violence and its pre-
vention. The review includes research on not only the costs of violence for individuals
and the broader society, but also the ways in which violence affects economic proc-
esses within societies. The review, currently being prepared in collaboration with
Johns Hopkins University, USA, seeks to provide sound information which policy mak-
ers and decision makers can use for setting priorities and deciding on the allocation of
resources for interpersonal violence prevention.
3. WHO’s Executive Board/World Health Assembly
At its meeting in January 2003, WHO’s Executive Board will discuss a proposed res-
olution on implementing the recommendations of the World report on violence and
health. The resolution calls on the 56th World Health Assembly to recognize that the
prevention of violence is a prerequisite of human security and that urgent action by
governments is needed to prevent all forms of violence and reduce their consequences
for health and socioeconomic development. Specifically, the resolution asks the World
Health Assembly to endorse the nine recommendations of the Report. It also requests
Member States to hold national launches or discussions on the Report, to appoint a focal
point for the prevention of violence within their health ministry, and to prepare within
a year a report on violence and violence prevention in the country. If approved, the res-
olution will be presented for adoption to the 56th World Health Assembly in May.
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Prevention of road traffic injuries
A. BACKGROUND
Road traffic injuries are a leading cause of death by injury, killing nearly 1.2 million peo-
ple annually. Approximately 90% of these deaths occur in developing countries, mostly
among people who will never be able to afford a car – pedestrians, cyclists and users of
public transportation. Those injured in this way in developing countries are at higher
risk of death or long-term disability than their counterparts in developed countries. Esti-
mates suggest that the economic costs of road traffic injuries amount to $100 billion,
twice the annual development assistance to developing countries. Road traffic inju-
ries can, however, be prevented.
A number of strategies and
policies have contributed to
dramatic decreases in road
crashes in developed coun-
tries. These have focused on
such things as safety devices –
including seat belts, car seats,
and helmets; laws relating to
alcohol consumption and the
enforcement of these laws;
speeding; and road design. The
challenge is to adapt and apply
these strategies – or else create
new strategies – for develop-
ing countries, particularly those
where road traffic fatalities are
increasing at alarming rates.
B. THE RESPONSE OF WHO
In recent years, indications that road traffic injuries are rising sharply, particularly in
developing countries, have given WHO a new impetus to address this major public
health concern. The WHO Director-General has recently announced that the annual
World Health Day in 2004 will be dedicated to “Road Safety”. This will provide an ideal
venue for the global launch of the World report on road traffic injury prevention that WHO
IV
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igure 2. Road fatality trends
(1987-1995)
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is currently preparing with the World Bank. Although efforts on road traffic injuries have
been rather sporadic since the World Health Assembly called on WHO to act on the prob-
lem in 1974, there is no doubt of WHO’s renewed determination to address the issue.
C. THE FIVE-YEAR WHO STRATEGY FOR ROAD TRAFFIC INJURY PREVENTION
The first tangible outcome of this renewed commitment was the production of the
Five-year WHO strategy for road traffic injury prevention. Developed in 2001 in collabo-
ration with experts from health, transport and policing, as well as from NGOs and the
private sector, the document covers the areas of epidemiology, prevention and advo-
cacy. It outlines a strategy for building capacity at local and national levels to monitor
the burden of road traffic injuries; for incorporating road traffic injury prevention and
control into national public health agendas; and for promoting action-oriented poli-
cies and programmes so as to prevent road traffic injuries.
D. IMPLEMENTING THE FIVE-YEAR WHO STRATEGY FOR ROAD TRAFFIC
INJURY PREVENTION
1. Documenting good practice in road traffic injury prevention
In order to identify effective and cost-effective strategies for preventing road traffic
injuries, VIP has commissioned the Cochrane Injuries Group to conduct a systematic
review of existing good practice in this area. The Cochrane Injuries Group, based at the
London School of Hygiene and Tropical Medicine, is an international network whose
task is to prepare, maintain and promote high-quality, peer-reviewed systematic
reviews. The Manual of good practice in road traffic injury prevention will identify inter-
ventions in this field which have been proved to be effective, as well as those which
are promising but warrant further evaluation. The manual, to be available in late 2003,
will serve as a resource for policy makers and practitioners involved in the prevention
of road traffic accidents.
“ h i s m u s t n e v e r h a p p e n aga i n .”
Coroner: London, UK, at the inquest of the world’s first road fatality, Mrs Bridget Driscoll, a -year-old mother of two, and a pedestrian killed on the grounds of the Crystal Palace in London, August
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2. Building capacity in road traffic injury
prevention
VIP and one of its Collaborating Centres, the Transpor-
tation Research and Injury Prevention Programme in
New Delhi, India, are developing the Training manual
for road traffic injury prevention. This is a tool to help
professionals from developing countries design and
implement prevention policies and programmes. The
end product will also serve as the basis for one of the
modules of the TEACH-VIP training project described
below. The manual will include chapters on the follow-
ing aspects of road traffic injury prevention: concepts
and terminology; the magnitude, burden, and deter-
minants of road traffic injuries; the evidence base;
planning and implementing interventions; first aid, pre-
hospital and hospital care; institutions, networks and
partnerships; and prevention policies and programmes.
After being peer-reviewed and revised, the manual will
be made available for distribution in late 2003.
E. PARTNERSHIPS
VIP is involved with a host of partners in its work on preventing road traffic injuries. The
production of the World report on road traffic injury prevention is a joint WHO/World
Bank initiative. Other major partners in this effort include the Fédération Internation-
ale de l’Automobile Foundation; the Centers for Disease Control and Prevention, USA;
the Global Road Safety Partnership; the National Highway Traffic Safety Administra-
tion, USA; and the International Federation of the Red Cross and Red Crescent Societies.
To help implement the Five-year WHO strategy for road traffic injury prevention, VIP is
receiving support from the Centers for Disease Control and Prevention, USA, the Global
Forum for Health Research, and victims’ organizations, including the European Feder-
ation of Road Traffic Victims. VIP represents WHO as a member of the United Nations
Economic Commission for Europe’s Traffic Safety Committee, which will hold its Euro-
pean Road Safety Week to coincide with World Health Day 2004, as described below.
F. TECHNICAL COOPERATION WITH COUNTRIES
Apart from the partner organizations mentioned above, VIP is collaborating with a
number of countries to help implement the Five-year WHO strategy for road traffic injury
prevention. Such efforts are currently under way in five countries: Cambodia, Ethiopia,
Mexico, Poland and Viet Nam. From each of these countries, VIP has received project
proposals from their Ministries of Health, requesting support for collaboration on data
WHO / P. VIROT
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collection, developing national policies and programmes, strengthening institutions
and building human resource capacities in the area of road traffic injury prevention.
These projects will be operational in early 2003.
G. NEXT STEPS IN ROAD TRAFFIC INJURY PREVENTION
The year 2004 will be the year for road traffic injury prevention. WHO is planning two
major initiatives related to its work in this area – World Health Day 2004 on “Road
Safety” and the World report on road traffic injury prevention. World Health Day is held
every year on 7 April to mark the date of the establishment of WHO. Through World
Health Day, WHO leads a general public debate on a health issue that is known, but
often neglected. “Road Safety” aims to draw global attention to the growing but pre-
ventable burden of road traffic injuries; to campaign for visible and sustained action
in research, policy, programmes, and funding; to place road traffic injury prevention
high on the agendas of governments and their development partners; and to build
partnerships for road traffic injury prevention. World Health Day 2004 on “Road Safety”
will also be the date of the launch of the WHO–World Bank World report on road traffic
injury prevention. This report was begun in 2002. It will be the first global multisectoral
scientific assessment of road traffic injuries, their magnitude and consequences, and
the strategies for preventing them. The report will be an invaluable tool for policy and
decision makers in ministries of health, transport, national planning and local govern-
ment and their partners at country level.
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Surveillance
A. BACKGROUND
Most developed countries have sophisticated health information systems that include
injury surveillance. However, this is not the case in most developing countries. The
scant data available on injuries and violence in these settings show that these are
serious public health problems. All the same, these indications are based largely on
estimates, and although sufficient for advocacy purposes, such estimates do not sat-
isfy the requirement for concrete data to set priorities. VIP’s own priorities with regard
to surveillance are to assist countries to obtain more accurate data and compile and
analyze this data to form global estimates.
B. METHODOLOGY
1. Providing guidance on injury surveillance
In an attempt to promote the use of international standards and provide criteria for
the collection of information on patients presenting to a health facility as a result
of injury, VIP and the Centers for Disease Control and Prevention, USA jointly issued
the Injury surveillance guidelines. The guidelines, based on the International Classi-
fication of External Causes of Injury, suggest how to design an injury surveillance
system to help data collection, based on the appropriate standards to allow for
international comparison. Nearly 2000 copies of the existing guidelines have
been distributed worldwide. During 2002, VIP started an evaluation of the use
of the guidelines in seven countries: Colombia, El Salvador, Ethiopia, Honduras,
Mozambique, Nicaragua and Sri Lanka, and the results of these ongoing evalua-
tions are expected to be completed in mid-2003. Based on these evaluations and
other comments received, the guidelines will be revised.
2. Providing guidance on conducting injury surveys
Since injury surveillance systems are not yet sustainable in many countries, community-
based injury surveys conducted on a regular basis serve as useful alternatives. Such
surveys are also of value because hospital-based injury surveillance systems do not
capture information on injured people who fail to reach hospitals. Community-based
injury surveys offer comprehensive baseline information on injuries, and can be an
important supplement to hospital surveillance, particularly in situations where basic
demographic data about the population are not available.
V
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However, conducting community-based surveys requires methodological exper-
tise which may not be widely accessible. For this purpose, the Injury survey guidelines
will provide a standardized methodology for conducting community-based surveys
on injuries. This methodology can be adapted and used in different settings depend-
ing upon local needs and resources. The guidelines are currently being developed
in partnership with several of WHO’s Collaborating Centres and other experts from
the Centers for Disease Control and Prevention, USA; Johns Hopkins University, USA;
the London School of Hygiene and Tropical Medicine, UK; Moi University, Kenya; and
Ramathibodi Hospital, Thailand. They will be published in late 2003.
C. DISSEMINATION OF DATA
In 2002, based on data from the WHO Mortality
and Morbidity Database, VIP prepared The injury
chartbook: a graphical overview of the global bur-
den of injuries. The booklet provides a global
overview of the nature and extent of death and
illness as a result of injury, in the form of user-
friendly tables and charts. Some striking findings
are revealed. In 2000, injuries accounted for 9%
of the world’s deaths and 12% of the world’s bur-
den of disease; road traffic injuries are the leading cause of injury-related
deaths worldwide; young people between the ages of 15 and 44 years account for
almost 50% of the world’s injury-related mortality; and children under five years of age
account for approximately 25% of drowning deaths and a little over 15% of fire-related
deaths worldwide. It is hoped that the visual representation of the main patterns of
the burden of disease due to injury will raise awareness of the importance of injuries
as a public health issue and lead to sound prevention policies and programmes being
introduced. The document will be released in early 2003.
D. NEXT STEPS IN SURVEILLANCE
During 2002, VIP began preparing a second version of the document enti-
tled Injury – a leading cause of the global burden of disease, due for release in
early 2003. This will provide the most recent estimates of the magnitude of
injuries in the world and will compare the burden of injuries to other lead-
ing public health concerns. The document will be valuable for policy and
decision makers in informing them about injuries and providing sound
facts for allocation of resources. The original version of this document,
published in 1998, was broadly disseminated and generated widespread
interest in the topic.
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Data on landmine-related injuries and disability are difficult to collect because the regions most affected by landmines are generally among the poorest and most inaccessible, and are sometimes still at war. In , the World Health Assembly endorsed a plan of action for a concerted public health response to anti-personnel mines. e first priority of this plan was for better documentation of the incidence of fatal and non-fatal landmine-related injuries, and the circumstances in which these injuries occurred. In this plan, WHO calls for an integrated public health approach to dealing with victims. In , with support from the relevant ministries of health and WHO Country Offices, VIP conducted prehospital care training for health professionals in Angola, Cambodia, Ethiopia and Mozambique. is training was aimed at providing more timely and appropriate emergency medical care for victims of landmines while being evacuated from where they were injured to the nearest health facility. With a view to developing health information systems to document the health impact of landmine-related injuries, pilot projects were set up in Ethiopia, Mozambique and Sri Lanka. In Ethiopia, WHO co-organized a meeting which brought together ministries of health and national and international NGOs working on landmine issues to discuss how to coordinate and integrate data collection on landmine-related and other injuries.
u r ve i l l a n c e o f l a n d m i n e - r e l a te d i n j u r i e s a n d e m e r g e n c y s e r v i c e s f o r v i c t i m s
UN/D
PI P
HOTO
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A N N U A L R E P O R T 2 0 0 2 2 5
Emergency services for victims
of injuries and violence
A. BACKGROUND
A large proportion of people die in the hours or days following the occurrence of an
injury resulting from a car collision, burn, or landmine or bullet wound. Others remain
permanently disabled. The figures vary, but the death rate of injured people may be
as high as 55% in some places. These people die often before receiving any form of
medical assistance. However, many lives could be saved with adequate prehospital and
hospital care services. Countries need the tools to identify, treat and prevent needless
deaths and disability due to such traumas. Low-cost efforts can help to strengthen
current trauma treatment systems worldwide and, in so doing, help to lower the over-
all burden from injury.
VI
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B. GUIDELINES FOR ESSENTIAL TRAUMA CARE SERVICES
In June 2002, VIP, in collaboration with the International Association for Trauma and
Surgical Intensive Care, organized a consultative meeting of experts from around the
world to make recommendations for the production of Guidelines for essential trauma
care services. These guidelines aim to set achievable standards for making available
essential trauma care services in all settings, and to identify the resources, both human
and material, necessary for such services. Thus, VIP hopes to strengthen such services
worldwide. A first draft of these guidelines was sent for review in December 2002. After
pilot-testing, they will be revised for publication in 2004.
C. GUIDELINES FOR PREHOSPITAL TRAUMA CARE SYSTEMS
In 2002, VIP and its partners made progress toward finalizing the Guidelines for prehos-
pital trauma care systems. Through the development of these guidelines, VIP hopes to
increase capacities at country level to provide immediate, life-saving care to patients
with life-threatening injuries. VIP receives support for this project from the Center for
Injury Control at Emory University, USA, a WHO Collaborating Centre; the International
Federation of the Red Cross and Red Crescent Societies; and St Stephen’s Hospital in
New Delhi, India. These guidelines, expected to be published in 2003, focus on simple,
yet proven interventions, and are applicable across the socioeconomic spectrum.
D. NEXT STEPS IN EMERGENCY SERVICES
Once these guidelines are released, VIP will work with Member States to ensure that
they are appropriately implemented at the country level. As the Department continues
to develop guidelines on services for victims of injuries and violence, it will ensure their
consistency with other sets of guidelines being released by WHO, cross-referencing
sections of the guidelines that appear in other documents.
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W E , T H E F U T U R E P H Y S I C I A N S of many countries, are faced with
violence in our private lives and in our future careers in the medical profession. Yet we are ill-prepared to deal with violence and other types of injuries, as these issues are not adequately covered in medical schools. As such we support the recommendations of the World report on violence and health.
– Ms Kristina Øgaard, President, International Federation of Medical Students’ Associations: Statement of support to the WHO Executive Board on the resolution “Implementing the recommendations of the World report on violence and health”, January
Capacity building
A. BACKGROUND
In several regions of the world, responses to reduce high rates of mortality from inju-
ries and violence are lacking in the public health sector. Although 90% of deaths due
to injuries and violence occur in developing countries, most of the prevention efforts
that currently exist are concentrated in developed countries. Even if injuries and vio-
lence were widely accepted as major but preventable public health problems, though,
and even if governments and their partners were willing to respond, the lack of trained
professionals in their countries would thwart attempts at prevention.
B. TRAINING, EDUCATING, AND ADVANCING COLLABORATION IN HEALTH
ON VIOLENCE AND INJURY PREVENTION (TEACH-VIP)
In response to numerous requests from Member States and professional groups for
tools to help build capacities for preventing injuries and violence, VIP is devising a com-
prehensive curriculum for training in schools of public health worldwide. In April 2002,
VIP organized a consultation of experts to draft
a strategy for developing the curriculum. The
group set out key concepts and the competen-
cies required in the field of injuries and violence,
and worked out a curriculum for a twenty-hour
core course and additional elective topics. The
core course will be divided into two sections:
foundations and fundamentals of injury pre-
vention, and specialized topics in the field. After
studying the basic principles and methodolog-
ical approaches to injury prevention, students
will be taught to apply these approaches to
specific types of injuries, both intentional and
unintentional. In designing the curriculum, much
attention is being paid to ensuring that there is
flexibility in terms of delivering the course, and
that it can be adapted to various settings. The
curriculum will be available for pilot testing by
the end of 2003.
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C. NEXT STEPS IN CAPACITY BUILDING
VIP is also working with the International Federation of Medical Students’ Associations
to design and conduct a survey investigating which components of the curriculum
are currently being taught in medical schools around the world. The data collection
phase has been completed, and the final analysis, currently in progress, will yield val-
uable information on education on injury prevention in medical schools at the global
level. The findings of the survey will be published in 2003.
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Partnerships
Injuries – both intentional and unintentional – are a major public health problem
demanding a concerted and multidisciplinary response at all levels of society. One of
VIP’s objectives is to foster the partnerships and networks required to develop such
a response.
A. WHO HEADQUARTERS, AND REGIONAL AND COUNTRY OFFICES
VIP collaborates closely with various departments within WHO Headquarters.
These include, in particular, the Departments of Child and Adolescent Health and
Development, Emergency and Humanitarian Action, Gender and Women’s Health,
Noncommunicable Disease Prevention and Health Promotion, Mental Health and
Substance Dependence, and Sustainable Development and Healthy Environments.
VIP also supports the Cross Cluster Surveillance initiative within its cluster. Since it
was set up as a department, VIP has aimed to have a close liaison with staff in Regional
Offices dealing with injury prevention and control issues. Recent efforts to strengthen
these relationships have been very successful, and VIP staff and Regional Advisors are
now collaborating on a range of initiatives. In this connection, VIP hosted a second
Regional Advisors’ meeting on injury and violence in November 2002. Through the
WHO Regional Offices, VIP liaises with the Country Offices on a number of activities
described in this report.
B. WHO COLLABORATING CENTRES
VIP is supported in its work by a network of WHO Collaborating Centres – national
institutions designated by the WHO Director-General to form part of an international
network undertaking activities in support of WHO’s programme priorities. Seventeen
such bodies have been designated WHO Collaborating Centres on Injury Preven-
tion and Control. Discussions to create an additional six – five of them in developing
countries – are in progress. In November 2002, VIP hosted the 12th Meeting of WHO
Collaborating Centres on Injury Prevention and Control. With the participation of VIP
staff and Regional Advisors and representatives of the Collaborating Centres, the meet-
ing was also an opportunity to update participants on the current work of WHO and
the Collaborating Centres and to discuss the production of a strategy document laying
out, for the years ahead, the common goals of WHO and the Collaborating Centres.
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C. THE 6TH WORLD CONFERENCE ON INJURY PREVENTION AND CONTROL
The 6th World Conference on Injury Prevention and Control took place in Montreal,
Canada in May 2002. The conference was organized by WHO’s Collaborating Centre for
Safety Promotion and Injury Prevention in Quebec, Canada and co-sponsored by WHO.
After an opening address by Dr Gro Harlem Brundtland, the WHO Director-General,
the 1400 delegates from more than one hundred countries discussed research find-
ings and prevention programmes in the areas of safety – at work, at home, on the road
and during sports activities – as well as violence prevention and post-trauma care.
One hundred and eight scholarships were distributed to participants from develop-
ing countries, to enable them to attend the conference. VIP organized fifteen business
meetings and workshops to discuss global projects, while other workshops were
organized by WHO Regional Advisors for injuries and violence prevention in Africa,
Latin America and South East Asia, on increasing activities and developing networks
of experts in these regions. The much higher number of delegates and scholarships
at this conference reflects a growing international interest in injury prevention. The
next – and 7th – World Conference will take place in Vienna, Austria in June 2004
(www.safety2004.info).
D. SAFE COMMUNITIES AROUND THE WORLD
The network of “Safe Communities around the World” is being developed under the
auspices of the Karolinska Institutet, Sweden, a WHO Collaborating Centre on Commu-
nity Safety Promotion. Since 1989, seventy-one demonstration programmes have been
developed in eleven countries: Australia, Austria, Canada, Denmark, the Netherlands,
Norway, New Zealand, South Africa, the Republic of Korea, Sweden, and the United
States of America. These programmes promote safety through partnerships involv-
ing communities, their leaders, academic institutions and private sector bodies. Nine
of the programmes were added to the network during 2002. On behalf of the network,
the Suwon Safe Community Council in Suwon, South Korea, organized the First Asian
Regional Safe Communities Conference in February 2002.
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Resources
A. VIP’S WORLD WIDE WEB SITE
In 2001, a major shift in WHO’s internet communications strategy led to the develop-
ment of a new VIP web site (www5.who.int/violence_injury_prevention/). Since then,
the VIP web site has been dramatically transformed from a small, static site providing
limited information – mainly descriptions of VIP’s activities – to an expanded, more
comprehensive one with details of injury and violence prevention globally. Apart from
describing its own work, the VIP web site lists conferences, training courses and other
forthcoming events. It also contains a regularly-updated news section on topical issues,
and has free links to injury and violence-related
publications produced by WHO. Additionally, the
VIP web site provides an extensive list of external
links to organizations around the world involved
in injury and violence research, prevention and
advocacy. These are listed by geographic region
and country, by type of injury and violence, and by
other topics. Increasingly, this site is being used to
communicate to partners about activities related
to events within the Department and about ways
in which they might consider becoming involved
in campaigns, such as the Global Campaign for
Violence Prevention and World Health Day 2004
on “Road Safety”.
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B. SELECTED WHO PUBLICATIONS ON
INJURIES AND VIOLENCE PREVENTION: 1996–2002
In 2002, VIP released a compilation of WHO publications on CD-ROM, Selected WHO
publications on injuries and violence prevention: 1996–2002. This includes documents
prepared by VIP, as well as those from other departments at WHO Headquarters and
Regional Offices. It is envisaged that an updated version of the CD-ROM will be created
in late 2003. VIP publications, including documents, meeting proceedings, fact sheets
and press releases, are also available on VIP’s world wide web site (www5.who.int/
violence_injury_prevention/)
C. THE ROLES AND RESPONSIBILITIES OF STAFF IN THE
DEPARTMENT OF INJURIES AND VIOLENCE PREVENTION
In November 2002, VIP updated its publication, Who is who in the department of inju-
ries and violence prevention: a guide to the roles and responsibilities of VIP staff. In order
to assist partners identify and locate focal points on specific topics, this document pro-
vides information about VIP staff, their backgrounds and experiences, and current areas
of work. The guide is expected to be revised again in 2003 to include information on
focal points in WHO Regional and Country Offices.
D. NEXT STEPS
In 2003, VIP will start work on a new project for assessing national capacities in injury
and violence prevention and control – in the areas of surveillance, research, pol-
icy, prevention and advocacy. The project will compile an inventory of activities and
resources for injury and violence prevention and control in Member States, document-
ing country-level activities that relate specifically to interpersonal violence and road
traffic injuries. The National response to injuries and violence: a capacity assessment is a
step in the development of an information system to support global injury and vio-
lence prevention and control efforts. The information gathered will help identify gaps
where little or no such efforts currently exist, and will serve as the basis for planning
resources to fill the gaps.
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Future directions
The coming two years will be an eventful period for VIP. The Department expects to
complete many of the initiatives related to follow-up of the release of the World report
on violence and health, while at the same time raising the profile of WHO’s work on
road traffic injury prevention. Through the Global Campaign for Violence Prevention,
an additional twenty launches of the World report on violence and health are planned
for 2003. Many of these will address not only the applicability to the countries of the
Report’s recommendations, but also ways in which the countries might assist in glo-
bal efforts to prevent violence.
The Department will devote much of its efforts and energy towards finalizing the
World report on road traffic injury prevention, and establishing a network of partners
worldwide to ensure the success of World Health Day 2004 on “Road Safety”. At the
request of Member States, VIP will also be providing guidance and technical support
to policy makers and practitioners to help them design and implement policies and
programmes at country level related to the prevention of injuries and violence.
In all facets of its work, VIP will continue to maintain and indeed expand its active
network of partners – within WHO, including WHO Regional and Country Offices,
Collaborating Centres, other UN agencies, and NGOs – so as to fulfil its mission to
prevent injuries and violence and to mitigate their consequences as major threats to
public health and human development.
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World Health Organization
Geneva
Department of Injuries and
Violence Prevention
A N N U A L
R E P O R T
WHO / NMH / VIP/ 03.1
INJURIES constitute a major public health problem, killing more than five million
people worldwide each year and harming many millions more. Their occurrence
is creating mounting concern, with injury-related fatalities projected to rise to
8.4 million by 2020. Whether they are unintentional – resulting from incidents
such as road traffic collisions, drowning, and falls – or intentional – following an
assault, self-inflicted violence or war-related violence – injuries affect people of all
ages and economic groups.
The WHO DEPARTMENT OF INJURIES AND VIOLENCE PREVENTION acts
as a facilitating authority for international science-based efforts to promote safety
and prevent violence and unintentional injuries and mitigate their consequences
as major threats to public health and human development. 2002CO
PYRI
GHT 2
002.
SIPA
PRES
S, M
ARIE
DORI
GNY
COPYRIGHT 2002. DUKAS/SIGMA, STEPHAN VERDER
prevention
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