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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

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COPYRIGHT 2002. DUKAS/SIGMA, STEPHAN VERDER

prevention

VIP AR02_coverB.id2 4/4/03, 3:45 AM1


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:


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

A N N U A L R E P O R T 2 0 0 2 v

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


Tuberculosis368 501

Cerebrovascular disease573 065

Cerebrovascular disease4 312 376

Cerebrovascular disease5 101 446

3Childhood-cluster

diseases1 108 666

Drowning113 614

Tuberculosis238 021


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


Trachea, bronchus, lung cancers

275 895


886 787

Chronic obstructive pulmonary diseases

2 522 983

6Birth asphyxia and

birth trauma787 179

Malaria76 257

War injuries95 015


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



Tuberculosis536 303

Childhood-clusterdiseases

1 385 455

9Protein-energy

malnutrition172 530

Tuberculosis36 362

Poisonings61 865

Lower respiratoryinfections102 431


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


1 212 625

11 Drowning115 922

Fires30 599

Maternal haemorrhage59 456

Poisonings78 060

Liver cancer180 263


Malaria1 079 877

12 Anencephaly85 247


Rheumatic heart disease48 062

War injuries72 314



Low birth weight1 025 584

13 Meningitis76 870

Leukaemia23 808

Leukaemia44 740

Nephritis and nephrosis71 654

Stomach cancer160 140



14 Road traffic injuries75 710

Poisonings23 293



Breast cancer145 200

Liver cancer341 157


15 Tuberculosis67 372



Breast cancer61 480


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

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

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


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.


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


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”).


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


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

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 N1 0 A N N U A L R E P O R T 2 0 0 2 1 1

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


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-


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.


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


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


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.


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

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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


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


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.


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


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.


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

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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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A N N U A L R E P O R T 2 0 0 2 2 5

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.


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.

VII


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.


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.

VIII


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.


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”.

IX


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.


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.

X


World Health Organization

Geneva


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

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