Action-Oriented Research on Small Arms Injuries: Needs and Challenges Keith Krause, Small Arms Survey, Geneva IPPNW-COST Workshop, Helsinki, 8 September 2006

The Context  Good news: international attention on armed violence is growing, and has never been higher  Bad news: the problem is serious, and few effective practical measures have been implemented  Complex issue – weapons possession and use is embedded in complex social networks  Multiple stakeholders with multiple agendas

Small Arms: Direct Effects  More than 300,000 fatal injuries in 2003  ,000 of these in conflict  ,000 from homicide, suicide and accident  Young males at risk

 Excess mortality in conflict contexts  Criminal violence  Costs to public health system  Delivery of basic services or humanitarian aid  Population Displacement  Economic opportunity costs Small Arms: Indirect Effects

Needs: Five Baskets   Systematic data collection   Comprehensive picture: direct/indirect consequences   Effective costing models   Information on weapons availability  Broader socio-economic data

Data Collection   Systematic collection of data on deaths and injuries, at least in representative sample of institutions   Better “catchment area” analysis – to allow extrapolation   Ongoing surveillance of armed violence  Creative techniques: eg: matching crime, public health and survey data (capture- recapture, etc.)

Measuring the Direct and Indirect Impacts of Armed Violence Direct Effects Mortality/Morbidity Direct deaths (fatal injury) Direct injury (non-fatal injuries) Excess deaths (above ‘natural’ death rate) Psycho/social trauma Indirect Effects Public Health Costs Treament, rehabilitation and care lost productivity (DALY, YPPL), pain and suffering (WHO guidelines) Criminality Rates of homicide, aggravated assault, armed robbery, insurance costs, private security Humanitarian Impacts Incidence of refugee/IDP expulsions/receptions, security of personnel, militarized refugee camps and costs of intervention Underdevelopment Access to/quality of social services, rates of investment in affected areas, social capital

Costing Models Total costs of violence amount to 12-20% of Latin America’s GDP Costs of gun violence to societies are higher than other types of violence Average medical costs per gunwound and stab, Brazil and Colombia (2003 PPP USD)

Weapons Availability and Use No simple relationship between availability and use Which guns, in whose hands, are associated with which types of armed violence What is the socio- culture context for guns and violence

Socio-economic context of armed violence   Demographic: Age, gender   Geographic: urban vs. peri-urban vs. rural armed violence   Socio-economic: income, education, employment   Temporal: time of day, day of week, time of year   Contagion, opportunity and neighbourhood effects

Policy/Advocacy Challenges   Acknowledge the relative importance of the issue, depending on the context   Emphasize the greater costs of armed violence relative to other kinds of violence   Determine the cost-effectiveness of interventions   Slow translation from evidence to action to prevent or reduce armed violence