Implementation of the National Policy to Reduce Accidents and Violence
This Editorial focuses on recent efforts in Brazil to include violence and accidents on the public health agenda. The text continues the discussion conducted by Cadernos de Saúde Pública in May/June 2004. In that issue of the journal, I spoke mainly of the difficulties involved in incorporating the theme in a health sector whose thinking and acting is based primarily on biomedical logic. Today I wish to show that with institutional support, we can do everything possible to attempt the impossible. But there is a proviso to my optimistic tone, since this process has been dragging on for decades and has only gained real impetus in the last three years.
In order to implement the National Policy to Reduce Accidents and Violence (approved in 2001), in 2004 Brazil's Health Surveillance Secretariat (SVS) organized the National Network for the Prevention of Accidents and Violence, now consisting of 58 centers in areas with high morbidity and mortality rates from external causes. These centers or nuclei include Municipal, State, and academic institutions and NGOs. This incipient structure aims to foster studies and proposals for concrete action linked through policy guidelines.
The year 2005 witnessed the approval of the National Agenda for the Surveillance, Prevention, and Control of Accidents and Violence. Under the Ministry of Health, the National Health Surveillance Secretariat is implementing the Surveillance of Violence and Accidents by Sentinel Services, aimed at identifying and upgrading information on the magnitude and severity of traffic and work-related accidents, falls, drowning, poisoning, and violent outcomes in general. This program is distributed in 39 municipalities (counties) in the country's 26 States and Federal District. The system has already been evaluated after a year in operation.
In early 2007, in partnership with the SVS and the Health Care Secretariat (SAS), the Jorge Carelli Latin American Center for Studies on Violence and Health (CLAVES/ENSP/FIOCRUZ) will launch a distance training course entitled The Impact of Violence on Health, targeting health services professionals and administrators. This program, like the Children's Laboratory at the São Paulo University Hospital, will promote specialization focused on theoretical reflection and practical action in the prevention of violence against children and adolescents. There is an increase in the number of Master's and PhDs and short-term specialization courses at FIOCRUZ and various other teaching institutions.
Meanwhile, other programs are being implemented with a focus on care for specific groups like children and adolescents, women, the elderly, and people with disabilities. The importance of such initiatives is both real and symbolic, highlighting that it is possible to act against a phenomenon that afflicts Brazilian society, adopting the logic of prevention, promotion, and valorization of life.
Implementation of the National Policy to Reduce Accidents and Violence in the Unified National Health System (SUS) should definitely continue, as a long and painstaking task that requires ongoing dedication. An evaluation that we are now conducting at CLAVES has identified important bottlenecks in intra- and inter-sector linkage related to policy, management, and necessary human resources and the provision of pre-hospital, in-hospital, and rehabilitation services. There are also problems in the initiative to reduce violence and accidents. Even programs and services with person-power and basic material support are absolutely insufficient to meet the demands. Still, steps are being taken in the right direction, thereby giving the issue greater legitimacy on the agenda of the SUS.
Maria Cecília de Souza Minayo
Centro Latino-americano de Estudos de Violência e Saúde Jorge Carelli, Escola Nacional de Saúde
Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.