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Finding a common vision for injury prevention
  1. Ms L A Sminkey
  1. Advocacy and Communications, WHO Department of Injuries and Violence Prevention, 20 Avenue Appia, 1211 Geneva 27, Switzerland; sminkeyl{at}who.int

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    Given the complex causality of violence and injuries, their prevention requires multisectoral and multidisciplinary efforts at national and local levels. For the prevention and control of child abuse, for example, collaboration is required across at least the sectors of health, social services, education, justice, and the police. Each sector has a specific role to play and contribution to make. However, to be coherent, each part of the response needs to be guided by a common vision, strategies, and objectives. These should be articulated in a national policy document designed to provide both overall direction and more specific objectives and activities of all involved in violence and injury prevention. Developing such a policy document—which, depending on the country and the focus could be a policy, a strategy, or a plan of action—serves not only to enhance synergies in approaches across sectors, but also to identify possible gaps, conflicts, and inconsistencies; facilitate the allocation of resources; and increase visibility at the political level.

    The World report on violence and health and the World report on road traffic injury prevention launched by WHO in 2002 and 2004, respectively, sought to bring violence and road traffic injuries to the attention of world leaders and provide recommendations for action. These reports were endorsed by the World Health Assembly—the annual gathering of ministers of health—in resolutions WHA 56.24 (Implementing the recommendations of the World report on violence and health) and WHA 57.10 (Road safety and health). Both the reports and resolutions, call upon governments to “develop and implement national—and by extension local—policy documents for violence and injury prevention”. In October 2005, the United Nations General Assembly adopted a historic resolution, A/RES/60/5 (Improving global road safety), which also invites Member States to develop a national plan to reduce road traffic injuries (United Nations General Assembly 2005).

    Despite the magnitude of the injury problem, surprisingly few countries have comprehensive policies in place. WHO conducted an informal review in 2005 of the websites of both governmental and non-governmental organizations in Dutch, English, French, Portuguese, and Spanish. The review identified 192 such policy documents (see http://www.who.int/violence_injury_prevention/policy/en/ for links to these documents). Despite obvious selection biases towards high income countries where the use of the Internet is common and countries where the above languages are spoken, the following general conclusions may be drawn from this review:

    • there seems to be an increase in the number of countries producing policy documents for violence and injury prevention

    • existing policy documents often focus only on a subtype of violence or injuries

    • only a small proportion of countries have policy documents that help them address violence and injuries in a comprehensive, structured, and organized way

    • most policy documents were produced by one sector, and therefore are less likely to facilitate multisectoral collaboration.

    To provide guidance to countries wishing to implement the above reports and resolutions by developing national policies for violence and injury prevention, WHO developed guidelines in collaboration with 29 experts from 22 countries. Developing policies to prevent injuries and violence: guidelines for policy-makers and planners was developed based on an initial consultation in 2003. The guidelines are primarily intended for government representatives of the ministries most concerned—in particular the ministries of health, transport, justice, interior, welfare, education, housing, labor, and consumer and family affairs—and cover the various steps in developing a policy up to its approval by governmental authorities. Recognizing the diversity of countries and their unique epidemiological, political, and resource situations, the guidelines are not prescriptive, but rather attempt to provide broad principles that could be applied in many different settings.

    The guidelines define the components of a policy document on injury and violence prevention and propose three phases for developing it.

    Phase 1 involves designing and leading the policy development process. Experience has shown that the process for developing a national or local policy document is as important as the document itself, in that the process of convening the stakeholders ensures the ownership that will be vital for the credibility and implementation of the policy.

    Phase 2 concerns the formulation of the policy document, a step which requires extensive discussion and review. Since all efforts should be made to ensure that the policy document will lead to action, the document should be as clear and concrete as possible. It should have a goal and objectives, guiding and operational principles, a series of proposed interventions, and a set time frame. A lead agency that will coordinate the implementation of the policy document should be identified, and responsibilities should be assigned to other agencies for achieving some of the objectives or subobjectives.

    Finally, approval and endorsement of the policy constitutes Phase 3. For relevant stakeholders and authorities to approve and endorse the policy, a shared commitment to the goals and objectives, principles, and proposed activities is required. If the process has been participatory at every step of the way, this approval and endorsement should follow easily. Throughout these guidelines, the experiences of developing policies in a number of countries are used to highlight some of the above issues.

    Although WHO and its partners recognize that policy documents alone are not enough to address the problem of violence and injuries, they can be an important step towards organized prevention efforts. They need, however, to be based on a real political commitment and made viable by appropriate levels of funding. Their implementation needs to be monitored and reviewed regularly and the plans adapted as needed.

    Developing policies to prevent injuries and violence: guidelines for policy-makers and planners was launched in April 2006 at the 8th World Conference on Injury Prevention and Safety Promotion and can be downloaded from WHO’s Department of Injuries and Violence Prevention website at http://www.who.int/violence_injury_prevention/en/ or ordered by contacting vip{at}who.int.

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