Global Campaign for Violence Prevention Unveiled

For the first time, the series of Milestones in a Global Campaign for Violence Prevention Meetings is hosted in Africa by the World Health Organization (WHO). The fifth Milestones Meeting convenes leading public health experts from around the world in Cape Town, South Africa, to share the latest scientific knowledge on preventing violence-related death and disability.

Globally, violence takes the lives of more than 1.5 million people annually. The Western Cape Department of Health, on behalf of the Provincial Government of the Western Cape, initiated a Burden of Disease Reduction Project in 2007. This project was a collaborative effort amongst the Department, academic and research institutions in the province.

The aim of this project was to estimate the burden of disease in the province and to provide recommendations to government on priority interventions to be implemented to address all components of the burden of disease. The Western Cape was found to suffer from a quadruple burden of disease that includes infectious diseases, mainly HIV/AIDS and TB, other communicable diseases, non-communicable diseases, eg hypertension, diabetes, and injuries.

Premier Helen Zille opened the meeting and stated that there are numerous factors that have resulted in an excessive burden of violence and injury in the Western Cape. However, one of the main contributing factors is the high level of alcohol and substance abuse in the province. That is why the Western Cape Government launched a comprehensive plan last year to reduce drug- and alcohol-related harms and also passed the Western Cape Liquor Act, which aims to decrease alcohol consumption by regulating the provincial liquor supply.

The Premier also said that it is essential that the reduction of violence in communities, including curbing alcohol and substance abuse, becomes a joint effort from all three spheres of government, together with the private sector and civil society. There are a number of policy options related to reducing the harmful use of alcohol that need to be debated at a national level. In this regard, the Premier welcomed yesterday's launch of Sobriety Week by the National Department of Trade and Industry.

"Violence prevention should be based on the best available scientific evidence. The Western Cape's Burden of Disease Project offers a best practice on using data to guide violence prevention efforts," said Dr Stella Anyangwe, WHO Representative for South Africa.

Western Cape Health Minister, Theuns Botha, says: "It is a privilege for the Western Cape to host this conference and that this very topical and serious subject will be discussed here. We welcome all delegates from around the world and hope that the discussions will prove to be significant and bring about change in the short- and long-term, not only in our country and continent but all over the globe."

With regards to injury, it was shown that the Western Cape experiences an excessive burden of injury and violence even compared with the rest of South Africa, which according to the estimated figures from 2000, had among the highest rates of violence and injury mortality in the world.

Homicide rates among women and men were five and eight times global averages respectively, whereas road traffic fatalities were roughly double. At this stage, a provincial-wide surveillance system did not exist and only sentinel mortuaries in the province were collecting the data from which the estimates for the province were made. This approach was used for the whole country through the National Injury Mortality Surveillance System coordinated by the Medical Research Council.

The province has since set up a Provincial Injury Mortality Surveillance System using data from all the mortuaries in the province. The first preliminary report for the province using data from 2008 shows that there have been significant decreases in homicide since the estimates of 2000. This report shows that there were 2 634 homicides in the province - 42% of the 6 277 injury deaths compared to the 3 400 estimated in 2000. Transport fatalities accounted for 29% of all injury deaths. Nearly 80% of these deaths occurred among males, particularly in the 20- to 34-year age group.

The decrease noted in homicide deaths is largely due to the substantial drop in firearm homicide. This therefore shows that tightening gun control is one example of a public health intervention that is likely to have a pronounced impact in broadly reducing fatal violence in the short-term.

Of the 6 277 people who were fatally injured, blood alcohol concentration levels were available in 4 051 - 64.5% - of the cases and of those 2 388 - 59% - were above the alcohol limit.

This data suggests that another "quick win" in addressing the high burden of injuries in the province could be on one hand stricter control of alcohol availability and on the other hand decreasing its harmful use. Global evidence has shown that a decrease in population level drinking in particular is likely to affect a population level decrease in violence - fatal and non-fatal.

Due to the complexity of this issue, these quick wins, however, need to be underpinned by a long-term approach that can drive an enhanced inter-sectoral response addressing root causes such as improved early childhood development, positive parenting and adult role models, community-based approaches, restorative justice, infrastructure, employment opportunities, etc.

To this end, the province has constituted the Injury Prevention Working Group, an inter-sectoral working group that will (a.) coordinate data collection to identify high-risk groups and areas for violence reduction interventions, (b.) test and assess the effectiveness of these interventions and their suitability for scale up and (c.) inform provincial and national policies to reduce violence.

The initial work of this workgroup has focused on addressing the violence-alcohol nexus. This includes:

• Rapid assessments of trauma cases in high-risk areas in order to deliver targeted interventions.
• An assessment of existing programmes and interventions in these high-risk areas for further enhancement and support that will necessarily include aspects that extend beyond alcohol-related violence.
• The Booza TV documentary series to challenge norms and stereotypes around drinking.
• Piloting a motivational interview intervention among alcohol-positive trauma cases.