Violent Injury Surveillance & Prevention - Part I
Over much of the past decade, Carmen Clavel Arcas, M.D., M.P.H., coordinated a women’s health center and emergency medicine program in Moskitia Costa in Nicaragua and volunteered for the Nicaraguan Women’s Network Against Violence - work that brought her face to face with victims of domestic violence. Although studies show that 30 to 70 percent of women in Nicaragua have been victims of domestic violence, Clavel Arcas refuses to accept these statistics as an inevitable part of life.
“Violence is not natural and it can be prevented,” she says. “But first it is necessary to know more about it - the populations, factors and types. Surveillance is the key. It can facilitate information for the decision makers and the communities so they can implement policies and interventions that will make a real difference.”
Halfway around the world in Africa, violent injury is also a major public health problem. “Violent injuries comprise nearly a quarter of emergency room cases in Africa. It is such a huge problem, health workers often feel they can’t do anything about it,” says Kidist Bartolomeos, M.P.H., a native of Ethiopia.
Although they are thousands of miles apart, Clavel Arcas and Bartolomeos are both CDC Foundation International Violent Injury Surveillance and Prevention Fellows who are working toward a common goal: gathering data that can be used to develop community strategies for violence prevention.
Bartolomeos, based at the World Health Organization in Geneva, is traveling to Mozambique, Uganda, Kenya and Ethiopia, providing technical support for those countries to establish violence and injury surveillance and data collection systems. “We are working to bring together the police, educators, traffic experts, ministries of health and hospital staffs,” she says. “Doctors cannot solve the problem of violent injuries alone.”
Clavel Arcas is working in Latin America and Caribbean countries. Currently, she is developing an injury surveillance system in emergency rooms in two hospitals in Nicaragua (in the cities of Managua, the capital, and Jinotepe). “We cannot understand violence without epidemiological information,” she says. With that data, she says they will be able to evaluate the extent and nature of violence in these countries and begin to do something to prevent it.
CDC Foundation Addresses the Global Threat of Violence - Part II
The World Health Assembly, the governing body of the World Health Organization (WHO), declared in l996 that violence is a global public health problem. By the l990s, it ranked 19th among the world’s leading causes of disability and death. Scientific indicators now project it will rise to 12th place by the year 2020.
Like a deadly plague, violence threatens the health and well being of people worldwide. Yet, like a disease caused by identifiable biologic pathogens, violence can be studied and subjected to public health measures to help prevent it.
“In many regions of the world, violence is being recognized as a public health problem, and countries need data to assess the magnitude of the problem to help guide programs and policies and to evaluate them,” says James Mercy, Ph.D., associate director for science in the Division of Violence Prevention at CDC. “Unfortunately, most communities lack sufficient information on violence-related injuries. So they are unable to undertake adequate efforts to prevent violence.”
What is needed, he adds, is a cadre of people with both public health and violence prevention expertise to offer these communities technical assistance in gathering and assessing data on violent injury. That is the model of the CDC Foundation International Violent Injury Surveillance and Prevention Program.
The program is a collaborative initiative coordinated by the CDC Foundation that brings together CDC and WHO, organizations with expertise in developing strategies for violence surveillance and prevention, and the John D. and Catherine T. MacArthur Foundation, a private, independent grant-making institution dedicated to helping groups and individuals foster lasting improvement in the human condition.
“The goal of the International Violent Injury Surveillance and Prevention Program is to create new models for prevention and control systems that will have real, measurable reduction of violent injuries throughout the world,” says Mercy, who supervises the program at CDC. “The two fellowships we have started with are a small beginning - but an important one.”
The fellows selected for the two year program, Carmen Clavel Arcas, M.D., M.P.H., and Kidist Bartolomeos, M.P.H., spent much of 2000 studying violent injury surveillance methods and traveling to work sites in their specific regions to establish surveillance activities and train public health workers. In 2001, the final year of their fellowship, they will continue to gather important data based on their surveillance work.
“We now have data from Mozambique that describes in a systematic way, for the first time, violent injuries seen in the emergency room. The local health workers are beginning to discuss what they can do about the problem and are working with us to plan other projects, including one describing the relationship between alcohol and injuries,” says Bartolomeos. “This can have an effect on violence prevention efforts throughout the whole country. This fellowship is a groundbreaking initiative, which can have far-reaching effects on violence prevention.”