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Rev. bras. epidemiol. vol.2 n.3 São Paulo Dec. 1999
Violent deaths: the epidemic of the third millenium?
José da Rocha Carvalheiro
This issue of Revista Brasileira de Epidemiologia (The Brazilian Journal of Epidemiology) sets two new trends. The first is the introduction of special issues, with topics that have been selected according to their epidemiological or methodological importance. The second is the process used for selecting these topics. This requires strictly following the basic principles that guide Abrasco publications: that the members of the community take part in selecting the topics to be included and the authors to be invited. The basic idea is to select topics that identify important issues in the field of epidemiology that can foster discussion and which are original contributions.
The choice of the topic and authors could not have been better. Violence is considered to be the main component, and one of concern in the epidemiological profile of every country in the Region. The authors chosen have vast experience in this field, particularly the main author, João Yunes, a full professor in the School of Public Health (Faculdade de Saúde Pública) of the University of São Paulo (USP) and who has an outstanding resume, both in the academic community and in the area of public health management in Brazil. He also represents Brazilian public health workers at the international level. He was a member of the management staff of the Ministry of Health in the 1970s, and Secretary of the São Paulo State Health Department during the first democratically elected government in São Paulo, in the early 1980s. As a member of the Ministry, he played an important role in reestablishing the tradition of periodically holding national health conferences, one of which was almost entirely dedicated to epidemiology and the control of schistosomiasis. During his term of office in the state government, he was able to give epidemiology its due importance in the organization of health actions by creating the Disease Surveillance Center (Centro de Vigilância Epidemiológica - CVE and Centro de Vigilância Sanitária - CVS) of the State Health Department. As a representative of the Pan-American Health Organization in Cuba and, later as a staff member of the Central Office in Washington, as Director of the Promotion of Health Division, and head of BIREME, the Latin American and Caribbean Center on Health Sciences Information, he has always been associated with relevant epidemiological issues in the regional offices of the WHO in the Americas. (AMRO/ WHO). He has made important scientific contributions in different areas, especially in the field of women and children's health and vital statistics. He is presently working on issues dealing with violent deaths. As we enter the twenty-first century, we see that violence is one of the most important topics, mainly in the region of the Americas. This alarming fact stands out in the health status reports produced by WHO and PAHO. Traffic accidents remain the main cause of deaths due to external causes, although the impressive increase in homicides, mainly among young men and adolescents, is one of the main characteristics of the epidemiological situation in the Americas. The main task that lies ahead of us as we enter the third millennium is to make this the main topic of discussion for health policies in the continent. Of course, studying this situation and proposing action is not a task that should fall solely to epidemiology and public health. It is basically a multidisciplinary issue that calls for theoretical and intersectoral thought in terms of the proposal for plans of action. The role to be played by health, and consequently epidemiology, is highly relevant although not exclusive. If for no other reason, this is important because the results of increasing violence have a great impact on the organization of services to assist victims and the incorporation of technology, as well as the need for improved organization for the timely rescue of victims.
Health, and its epidemiological tools, should be part of theoretical discussions. Here, the question of the social determination of phenomena takes on the utmost importance. The epidemiological tradition of surveillance, however, founded on the continuous recording of vital statistics, continues to be our main feature. In this sense, authors ably work with underrecording and its importance when seeking international comparisons. Bearing in mind the possibility of venturing into the issue of social determining factors, this will obviously be a matter for future in-depth consideration. Another issue that immediately arises from the text is related to the total lack of epidemiological studies of violent events that do not end in death, but in permanent disabling conditions, along with their economic consequences and especially consequences that affect the daily lives of thousands of young people in the Americas.
A last point to consider should be the question of what makes a continent, which is experiencing relatively few military conflicts at this time, become the main cause of concern for world health authorities with regard to the increase in mortality due to external causes, mainly the murder of adolescents and young adults. Why are we killing our young people?