Strengthening Violence and Injury Surveillance: Challenges and Opportunities in the Eastern Caribbean Meeting of International Collaborative Effort on Injury Statistics Cuernavaca, Mexico, June 1-3, 2005 Presentation- Patricia Brandon

MAP OF THE CARIBBEAN

Defining the Caribbean:  A Matter of History, Geography, Political Economy:  Network of Island and Mainland Countries  Varying geophysical characteristics  Differing socio-economic political arrangements  Multilingual and multiethnic populations 4000 to 15, million population 4000 to 15, million population

Bahamas Barbados Belize Guyana Haiti Jamaica Suriname Trinidad Turks & Caicos Cayman Islands Bermuda Anguilla The BVI Antigua & Barbuda Dominica Grenada St Kitts Saint Lucia St Vincent Montserrat OECSCARICOM PAHO/CPC Martinique Guadeloupe French Guiana CARIBBEAN COMPLEXITIES

Injuries: A Growing Caribbean Concern  Increase in interpersonal violence  Decrease in social safety  Disruption and costs of hospital services  Financial drain on hospital services  Use and dissemination of findings of various studies by various interest groups,  Lifelong costs of injuries for rehabilitation, incarceration, social support  Mortality, morbidity and social sector data of varying quality.

Injury Surveillance: Infrastructural Challenges  Small infrastructure of public sector Ministries in small countries  Lack of specific policy and plan for national information system and coordinated sector components  Absence of an information system plan for the ‘health sector’: Articulated purpose and components Articulated purpose and components

Injury Surveillance: Infrastructural Challenges  Small epidemiological-information units: A unit of one ‘epidemiologist’ A unit of one ‘epidemiologist’ Staff with varying degrees of training Staff with varying degrees of training Responsible for coordinating production, analysis, dissemination of all national and international health sector commitments Responsible for coordinating production, analysis, dissemination of all national and international health sector commitments

Injury Surveillance: Infrastructural Challenges  Small epidemiological-information units: Roles and responsibilities at data collection at various levels of sector not clearly defined Roles and responsibilities at data collection at various levels of sector not clearly defined Communicable disease surveillanceCommunicable disease surveillance NCD, Behavioral SurveillanceNCD, Behavioral Surveillance Contact tracingContact tracing All emergent diseases: SARS, etcAll emergent diseases: SARS, etc Dedicated financial resources for information management: miniscule or lacking Dedicated financial resources for information management: miniscule or lacking

Injury Surveillance: Technical Challenges  Low perception by non health sectors of relevance of their information to health.  Non-standardization of definitions and categories used by various sectors to classify the data items: Definition of injury varied. Definition of injury varied. Latitude of interpretation within sectors (police) Latitude of interpretation within sectors (police)  Variation in categories between countries

Injury Surveillance: Technical Challenges  Variations in grouping of the ages by sector and departments or agencies within a sector.  Incomplete reporting and documentation Omissions of age and sex, road user Omissions of age and sex, road user Coding difficult due to incompletion Coding difficult due to incompletion Coding to nature of injury than external cause. Coding to nature of injury than external cause. Etc Etc

Injury Surveillance: Opportunities Identification of need to strengthen national health information systems in the PAHO/WHO Common Country for Identification of need to strengthen national health information systems in the PAHO/WHO Common Country for PAHO/CPC Proposal for Medium Term Plan for Strengthening National Health Information Systems PAHO/CPC Proposal for Medium Term Plan for Strengthening National Health Information Systems Caribbean Guidelines for Coordinated Injury Surveillance (adapted from the WHO Guidelines) Caribbean Guidelines for Coordinated Injury Surveillance (adapted from the WHO Guidelines)

Injury Surveillance: Opportunities The Region experience of Jamaica and the nascent work of Dominica: a learning opportunity. The Region experience of Jamaica and the nascent work of Dominica: a learning opportunity. Building capacity through virtual training. Building capacity through virtual training. ICE - Meeting an opportunity for partnerships: sharing information, mutual technical support. ICE - Meeting an opportunity for partnerships: sharing information, mutual technical support.

years 25 – 44 years Cause#RateCause#Rate HomicideHIV/AIDSMVIsSuicides HIV/AIDSHomicideMVIs Other heart disease DiabetesSuicides Cerebro-vascular Disease Leading causes of death for CAREC-member countries, 2000

Leading causes of death by potential years of life lost, 2000 Cause of death PYLL % of Total PYLL HIV/AIDS Respiratory disorders in the perinatal period Homicides Diabetes mellitus Ischaemic heart disease Cerebro-vascular disease Motor Vehicle Injuries Congenital malformations Other heart disease Intestinal infectious disease

Homicides  Rates vary from 6.1 (Grenada), and 6.9 (Antigua) to 21.9 (St. Vincent) and 23.9 (Saint Lucia)  Have increased, especially in the past e years - 36% increase in Antigua, 59% increase in Saint Lucia  Victims tend to be males aged years, although Saint Lucia victims now aged years