Anthony B. Zwi

The world report on violence and health

In 1996, the World Health Assembly declared violence a major public health issue. To follow up on this resolution, on Oct 3 this year, WHO released the first World Report on Violence and Health. The report analyses different types of violence including child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse, self-directed violence, and collective violence. For all these types of violence, the report explores the magnitude of the health and social effects, the risk and protective factors, and the types of prevention efforts that have been initiated. The launch of the report will be followed by a 1-year Global Campaign on Violence Prevention, focusing on implementation of the recommendations. This article summarises some of the main points of the world report.

Road traffic injuries in developing countries: a comprehensive review of epidemiological studies

Summary Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three‐quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. This review summarizes studies on the epidemiology of motor vehicle accidents in developing countries and examines the evidence for association with alcohol.

Pathways to "evidence-informed" policy and practice: a framework for action.

Bowen and Zwi propose a new framework that can help researchers and policy makers to navigate the use of evidence.

Violence against women: a neglected public health issue in less developed countries.

Violence against women is a significant public health issue in countries of both the industrialized and less developed world. This paper describes the magnitude and health consequences of domestic violence and rape, with an emphasis on developing countries; it recognizes, however, that there is a dearth of documentation regarding the wide range of activity opposing violence against women which is taking place in less developed countries. It briefly explores the factors that perpetuate violence against women and the strategies that have evolved to respond to the problem. It analyses the constellation of factors that may assist violence to emerge as a legitimate public health concern, and explores opportunities and obstacles to further progress in this field. Particular attention is devoted to the role of research in the policy-making process; research areas which may assist those opposing violence against women in all its forms are tentatively suggested.

Increasing the use of evidence in health policy: practice and views of policy makers and researchers

BackgroundBetter communication is often suggested as fundamental to increasing the use of research evidence in policy, but little is known about how researchers and policy makers work together or about barriers to exchange. This study explored the views and practice of policy makers and researchers regarding the use of evidence in policy, including: (i) current use of research to inform policy; (ii) dissemination of and access to research findings for policy; (iii) communication and exchange between researchers and policy makers; and (iv) incentives for increasing the use of research in policy.MethodsSeparate but similar interview schedules were developed for policy makers and researchers. Senior policy makers from NSW Health and senior researchers from public health and health service research groups in NSW were invited to participate. Consenting participants were interviewed by an independent research company.ResultsThirty eight policy makers (79% response rate) and 41 researchers (82% response rate) completed interviews. Policy makers reported rarely using research to inform policy agendas or to evaluate the impact of policy; research was used more commonly to inform policy content. Most researchers reported that their research had informed local policy, mainly by increasing awareness of an issue. Policy makers reported difficulty in accessing useful research syntheses, and only a third of researchers reported developing targeted strategies to inform policy makers of their findings. Both policy makers and researchers wanted more exchange and saw this as important for increasing the use of research evidence in policy; however, both groups reported a high level of involvement by policy makers in research.ConclusionPolicy makers and researchers recognise the potential of research to contribute to policy and are making significant attempts to integrate research into the policy process. These findings suggest four strategies to assist in increasing the use of research in policy: making research findings more accessible to policy makers; increasing opportunities for interaction between policy makers and researchers; addressing structural barriers such as research receptivity in policy agencies and a lack of incentives for academics to link with policy; and increasing the relevance of research to policy.

Conflict and health. Public health and humanitarian interventions: developing the evidence base.

This is the first of four articles Worldwide, millions of people are annually affected by conflict and over

Towards an epidemiology of political violence in the third world

2bn was spent on non-food emergency aid each year between 1991 and 1997.1 Recently, 30 million people were estimated to be internally displaced and 23 million to be refugees (seeking refuge across international borders), the vast majority of whom were fleeing conflict zones.2 More agencies than ever are working in relief activities; over 200 humanitarian agencies responded to the Rwandan genocide and population displacement.3 Populations affected by armed conflict experience severe public health consequences as a result of food insecurity, population displacement, the effects of weapons, and the collapse of basic health services. 4 5 Though most conflicts after the second world war took place in Africa, the Middle East, Asia, and Latin America, since the end of the Cold War and break up of the Soviet Union we have also witnessed conflicts in Europe and the former Soviet Union, notably in Tajikistan, Chechnya, former Yugoslavia, and Nagorno-Karabakh.6 Increasingly, with relatively few exceptions, conflicts are internal rather than waged between states. This article argues that the evidence base for humanitarian health interventions should be actively developed and explores mechanisms for its promotion. #### Summary points Humanitarian interventions are increasingly complex and are difficult and costly to resource Research to identify effective and efficient approaches to the delivery of aid warrants additional investment Data on the public health effects of war and on delivery of public health in settings affected by conflict are increasingly being assembled, but the effectiveness of many humanitarian initiatives has not been adequately evaluated Evaluation of the effectiveness of intervention in conflict settings needs to make explicit the humanitarian principles on which interventions are based Generating knowledge and promoting an evidence based culture will require collaborative initiatives between …

Brain Gains: a literature review of medical missions to low and middle-income countries.

Political violence is distressingly widespread in many parts of the world. This paper reviews the forms and effects of political violence and devotes particular attention to experiences from Central America and Southern Africa. The forms of violence vary from those which are extensive such as civil unrest and war, to those which are intensive, such as assassinations, disappearances and torture. The effects of violence on health may be direct, such as deaths, disabilities, psychological stress and the destruction of health services, or indirect such as the erosion of innovative health policies in favour of increased military expenditure. Health workers have a role to play in opposing political violence, providing care for those affected by violence, and documenting and analysing its impact on health. Research needs include documenting the impact of different forms of violence on health, and analysing the social and political factors which promote and support political violence. It is hoped that increasing recognition of political violence and man-made violence as being of major public health concern will play a part in promoting a more peaceful world.

Private health care in developing countries.

BackgroundHealthcare professionals’ participation in short-term medical missions to low and middle income countries (LMIC) to provide healthcare has become common over the past 50 years yet little is known about the quantity and quality of these missions. The aim of this study was to review medical mission publications over 25 years to better understand missions and their potential impact on health systems in LMICs.MethodsA literature review was conducted by searching Medline for articles published from 1985–2009 about medical missions to LMICs, revealing 2512 publications. Exclusion criteria such as receiving country and mission length were applied, leaving 230 relevant articles. A data extraction sheet was used to collect information, including sending/receiving countries and funding source.ResultsThe majority of articles were descriptive and lacked contextual or theoretical analysis. Most missions were short-term (1 day – 1 month). The most common sending countries were the U.S. and Canada. The top destination country was Honduras, while regionally Africa received the highest number of missions. Health care professionals typically responded to presenting health needs, ranging from primary care to surgical relief. Cleft lip/palate surgeries were the next most common type of care provided.ConclusionsBased on the articles reviewed, there is significant scope for improvement in mission planning, monitoring and evaluation as well as global and/or national policies regarding foreign medical missions. To promote optimum performance by mission staff, training in such areas as cross-cultural communication and contextual realities of mission sites should be provided. With the large number of missions conducted worldwide, efforts to ensure efficacy, harmonisation with existing government programming and transparency are needed.

Violence: a priority for public health? (part 2)

Private healthcare provision is growing in low and middle income countries. 1 2 The poor, as well as the rich, often seek health care from private providers, including for conditions of public health importance such as malaria, tuberculosis, and sexually transmitted infections. 3 4 5 The reasons cited by users include better and more flexible access, shorter waiting, greater confidentiality, and greater sensitivity to user needs. 1 6 International policymakers are currently recommending greater use of private providers 7 8 9 on the grounds that they offer consumers greater choice; increase competition in the healthcare market; and remove state responsibility for service provision, thereby encouraging its role as regulator and guarantor. We should, however, be concerned. When examined, the quality of care offered by many private providers is poor. 1 2 10 Furthermore, poor people spend a greater proportion of their income on health care (private or public) than do the rich, often using less qualified or totally untrained private providers. We have recommended three objectives in relation to the private provision of care for conditions of public health importance: widening access, improving quality, and ensuring non-exploitative prices.11 None of these will be simple to achieve; and multifaceted interventions, involving policymakers, providers, and …