Building concrete, viable outputs and constructive proposals for injury prevention and safety promotion
We need to target the causes and risk factors for violence and traffic injuries
Merida, Yucatan, Mexico
March 15, 2008
Director's Speech, Dr. Mirta Roses Periago.
Ministers and Delegates,
Thank you Madam Ivonne Arancely Ortega Pacheco, Governor of Yucatán, for your hospitality, the wonderful supper at that venerable mansion, which gave us an opportunity to enjoy the cuisine and artistic culture of the Yucatan. We recognize your commitment to the sustainable development of your state and your deep interest in the topic that concerns us. Furthermore, we must mention your leadership and congratulate you as the first woman governor and the youngest person to hold this office, following the most participatory election with the highest turnout ever. We wish you a successful administration.
My special thanks to you, Dr. José Ángel Córdova Villalobos, for your decision to convene this meeting of Ministers of Health of the Americas. Not only have you been generous in inviting each and every one of your colleagues, but you have put all of your efforts into guaranteeing the preparations for this meeting. I am certain that your efforts will be reflected in concrete, viable outputs and constructive proposals, so that programs for the prevention of intentional and unintentional injuries will increase in our countries.
Thank you, Secretary of Health of Yucatán, Dr. Álvaro Augusto Quijano Vivas, for your constant dedication to the organization of this meeting, your concern, and your efforts.
I would like to thank each and every one of the Ministers or delegates present for their efforts to be here in this welcoming city of Mérida, so near to the ruins of the Mayan civilization, so rich in lessons of all types.
Our recognition and gratitude also to Dr. Etienne Krug and his colleagues at WHO, who have promoted this regional ministerial encounter and the 9th World Conference to be inaugurated morning, for this collective achievement in which the staff of the PAHO Representative Office in Mexico and our Headquarters in Washington, D.C. have worked together as one.
Challenge and opportunity to make progress toward the political decisions of the region
For the Pan American Health Organization and the World Health Organization, this first ministerial meeting that we are holding in our Hemisphere on the issue of violence and injury prevention is both a challenge and an opportunity to make progress toward the political decisions that must be made to prevent greater suffering, pain, and poverty, since the poorest people are the most affected, with a significant deterioration in their quality of life or the loss of their very lives; decisions that also must be taken to identify immediate measures to advance in the prevention of injuries.
Let me reiterate PAHO/WHO's commitment, made some time ago, to promote the prevention of injuries of every type. There is no need to describe in detail the different resolutions of the World Health Assembly of WHO or the Directing Council of PAHO, which for more than a decade have reiterated the need to target the causes and risk factors for violence and traffic injuries, just as we do for other types of health problems, but I do invite you to review the commitments we have made in them.
In those resolutions and in documents, guidelines, and educational materials published by WHO and PAHO and widely distributed, there is sufficient information on what we must do within the sector and with other sectors. Let me point out the World Report on Violence and Health (WHO, 2002) and the World Report on Road Traffic Injury Prevention (WHO and World Bank 2004), which we have used and turned into working tools with you and Ministers of other sectors: transport, police, safety, education, public works, as well as mayors, academics, nongovernmental organizations, communities, the media-- in short, all those who in one way or another must make a commitment to preventing injuries. There are many more documents, but I do not believe it necessary to mention them all. Besides, I know that Etienne is going to mention one of the recent ones, the Preventing Injuries and Violence: A Guide for Ministries of Health, so I will not linger here.
I would like to point out that in Resolution CD44/15 of 2003 Impact of Violence on the Health of the Populations in the Americas, the Directing Council of the Pan American Health Organization reinforced what it had declared in years previous about violence as a public health priority. This Resolution gave new mandates to PAHO and the member countries, ratifying the content of other, earlier resolutions.
Public health is joint action by the State and civil society
In all our documents we state that intentional and unintentional injuries are a public health problem, not only because of the high burden of injured people who must be treated in health facilities, but primarily, because the prevention of anything that jeopardizes the development, health, and well-being of individuals and the community is a public health responsibility. Public health is joint action by the State and civil society to protect and improve the health of people. It is an interdisciplinary social practice.
Violence, injuries, and insecurity are challenges, because like other social determinants, they also affect the health and well-being of the population. These problems, though not new, are understood as new challenges that individually and collectively affect the population.
Violence is the expression of a relationship in which the conflict that precedes it, either family, interpersonal, social, or political, has not been resolved, and the actors opt for aggression. It is of interest in this context to note that the specific area to which I am referring is Social Violence-that is, violence that destroys social harmony, the tolerance of differences, the right to enjoy public spaces, and that occurs in the family, society, the street, or public or private institutions.
Violence and insecurity threaten the people's development, diminish the quality of life, and erode the social fabric. The Region of the Americas is one of the regions that suffers the most from violence, with a major negative impact in the countries most affected, with an estimated 110,000 people murdered and over 55,000 suicides each year.
Women and children are the victims of domestic violence, young people are both victims and perpetrators in street violence; sexual violence impacts the physical and psychological health of those who experience it; in short, there is a broad and recognized spectrum of negative consequences that must be addressed and prevented.
In addition to the impact on the physical, psychological, or sexual health of the victims, social and interpersonal violence has a social impact and affects development.
Insecurity has a serious impact on health.
The inclusion of human safety in project planning and implementation has had a positive impact on interventions for violence prevention, road safety, and health promotion. It is necessary to enhance the protection of life, focus efforts on human safety as part of public policies to reduce violence and crime and improve road safety and human health.
In terms of economics, violence and injuries increase the costs of productive activities, reduce the possibilities of external investment, and decrease the social profitability of capital.
With regard to the social structure, violence produces and inflicts harm by promoting behaviors and attitudes that undermine the foundations and principles of harmony and conflict resolution and destroy social capital. Social ethics, the ethics of respect for the rights of others, or what Savater defines as the "search to improve the people in their relations with others" , are seriously undermined, especially in countries where the levels of violence are high and their expressions are multiple and daily. Domestic violence erodes the environment that has always been considered the safest in society, with members united by love, respect, and protection. Violence in the family and community causes aggressive behavior and is perpetuated in the next generation.
Violence continues to critically affect the populations of certain countries in the Region, despite the interest of their governments and society to diminish it. Homicides have increased in several countries, with men under 35 the most affected group; in Colombia, however, homicides fell 40% between 2001 and 2006. The percentage of women who at some time in their life are victims of violence perpetrated by their partner in all the countries ranges from 10% to 60%. Youth violence caused by gangs has spread throughout the Region, with El Salvador, Honduras, Guatemala, Jamaica, Brazil, Colombia, Mexico, and the United States particularly affected.
As to traffic injuries, nearly 130,000 deaths occur per year in the Americas, with more than 1,200,000 people injured and thousands disabled as a result of collisions, crashes, or pedestrian accidents. The principal risk factors are: driving under the influence of alcohol, speeding, and failure to respect traffic regulations, risks that fall under the concept of citizen culture. These are aggressive social behaviors that put public harmony, life, and safety in jeopardy. Other behaviors, such as low use of seat belts and helmets and poor or inadequate road and vehicle maintenance complete the scenario.
The persistence of poor road safety conditions results in risk to all forms of locomotion but above all, for pedestrians, cyclists and motorcyclists. New proposals and interventions are needed to make safer, more equitable traffic environments.
In many countries, the growing use of motorcycles, not only for private transportation but for transporting and distributing goods, is contributing to an increase in death and injury. Countries such as Brazil, Chile, Costa Rica, the United States, Canada, Colombia, and Cuba have adopted policies that have led to a reduction in mortality from traffic accidents.
The costs to society in general, families, and the health sector in particular are especially high. Nevertheless, even though there is widespread consensus that the majority of these situations are preventable; the lack of sustained and appropriately financed public policies with proposals backed by evidence of what works and what doesn't makes it more difficult to achieve a visible and permanent impact..
Public policies on injuries from external causes and safety
In order to design public policies on injuries from external causes and safety, we must recognize the magnitude of the problem, make it a matter of public concern, and turn it into a key item on government agendas. We have made progress in this regard. Joint projects with the CDC in several countries confirm this. I believe that El Salvador's model Information System on Injuries from External Causes (SILEX) is a demonstration of this. Furthermore, with the Inter-American Coalition for the Prevention of Violence, comprised of several international institutions and agencies, we have set up Observatories of Violence and Injuries from External Causes in several countries, a process that is expanding and which I wish to strengthen.
Reliable, timely, and representative information on the situation is needed in both the national and municipal area. It is hoped that every effort in that direction will consider the need to standardize the work of the different public and private sector entities as a guarantee of their representativeness and integrate all their systems that are still separate, for that is what hinders the analysis.
I know that we are not starting from scratch. I know that there is progress in your countries. In fact, at this meeting we will hear examples of successful activities that are under way in various latitudes of our Americas. This is very exciting.
There are many things that the Ministries of Health can and should do both in their own areas and in the intersectoral work that injury prevention demands. We have always said that the prevention of violence and injuries requires an intersectoral approach; it is eminently a collective work involving many sectors.
We might say that we are facing another epidemic that is not eliciting the same intense response as, justly, have others like avian flu or HIV/AIDS, or the yellow fever outbreak in some South American countries. I must stress that, okay, we must give our attention to those critical issues, but what concerns me is the lack of proportion between the investment and the magnitude of the problem. The potential years of life lost from intentional and unintentional injuries exceed those from other health problems, because they largely affect young people and adults in their most productive years.
Investing in injury prevention is profitable.
One of the most cost-effective ways of reducing violence is to reduce the supply, demand, and the risks caused by alcohol abuse in our Region.
We must continue and delve deeper into analyses by sex and age. We know that it is women who primarily suffer domestic or partners violence; young men who die the most from homicide or traffic accidents; and girls and adolescents who are the most exposed to abuse and sexual violence.
In addition, our work can and should concentrate on fighting for inclusion, on building a sense of community, on improving relations with others, on strengthening civic culture and solidarity with the victims of any type of injury, wherever they are.
The definition of priorities is based on:
- the particular forms of violence: social or interpersonal, gender, psychological and self-inflicted and injuries
- social groups that, because of inequity and the specific vulnerability in which they live and through gender analysis, are identified as being at greater risk, that is: children, women, the elderly, and youth, on which violence has a greater impact.
- transit trends: pedestrians, cyclists, and motorcyclists. Our cities are planned for cars. Trucks, buses, passenger vehicles, especially those with medium- and long-distance drives, should be taken into account.
PAHO contributes to injury reduction by promoting the adoption of strategies and lines of action designed by mutual consent with authorities and communities. Its role is to:
- promote the adoption and execution by national and municipal governments of specific plans or programs that address the magnitude and characteristics of the problem in each country or city; the Healthy Municipios Network is an important one
- promote research, situation analysis, and the evaluation and dissemination of programs and projects, good practices, and lessons learned that have shown to be more successful; there should be more research in areas such as anthropology, sociology. and behavior in order to develop greater tools for action;
- improve and develop information systems on the different expressions of interpersonal and social violence, expand the use of Geographic Information Systems; and link with Urban Health and Poverty Maps.
- improve the health sector response to patients who are victims of violence and with prevention programs developed at the grassroots level; this is a basic element of local development approaches.
- improve networking and the creation of strategic partnerships, and mobilize champions among artists, sportsmen, and political and social leaders.
- support the countries in addressing their training and institution-building needs in order to address the problem of violence, traffic injuries, and other injuries.
Declaration of Merida [Spanish] (389.42 kB)
The Declaration of Mérida has been drafted in consultation with all the countries, which have made valuable contributions and suggestions. Its signature will be a historic moment in the commitment of the Ministers of Health of the Americas and the beginning of a new stage of effort and energy to tackle this enormous problem that affects the health, well-being, and harmonious survival of society as a whole.