WHO Report of the sixth annual European meeting of ......In spite of estimates from the Global Burden of Disease1 which suggest that injury deaths (both intentional and unintentional)

WHO Report of the sixth annual European meeting

of violence and injury prevention national focal persons

of the Ministries of Health

Report of a WHO meeting, hosted by the Norwegian Directorate of Health

Oslo, Norway 11-12 October 2011

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ABSTRACT

On 11-12 October 2011 the WHO Regional Office for Europe convened in Oslo the 6th network meeting of the violence and injury prevention national focal persons of the Ministries of Health. The meeting, hosted by the Norwegian Directorate of Health, was attended by 70 participants, with focal persons from 37 countries, as well as representatives from WHO, European Commission, and nongovernmental organizations. Key note presentations made on services for victims of violence and injury surveillance in Norway were much appreciated as were those on global and regional developments on the prevention of violence. Progress in the Region on violence and injury prevention was reviewed and ongoing activities discussed. These included lessons learnt from the launches of the European report on prevention of knife crime and violence among young people and the European report on preventing elder maltreatment, the on-going activities such as the survey for the second Global status report on road safety, the launches for the Decade of Action for Road Safety, the Road Safety in 10 countries project, and on promoting violence prevention, in particular through national surveys on adverse childhood experiences in several countries. The meeting agreed on the following priorities:

� Continuing to support Member States in advocating for road safety through activities such as the Decade of Action and the second Global status report on road safety;

� Give renewed attention to capacity building using the Training, Education, and Advancing Collaboration in Health on Violence and Injury Prevention (TEACH-VIP) curriculum with the train the trainer approach both at sub-regional level and national level;

� Support the drafting of a Regional action plan and resolution on child maltreatment prevention and other adverse childhood experiences.

� Seek opportunities to advocate for child injury prevention.

WHO wishes to thank the Norwegian Ministry of Health for kindly hosting 6th network meeting of the Ministry of Health Focal Persons for Violence and Injury Prevention. This report has been prepared by Francesco Mitis, Francesco Zambon, Dimitrinka Jordanova Pesevska and Dinesh Sethi.

Keywords

VIOLENCE - prevention and control WOUNDS AND INJURIES - prevention and control DECISION MAKING PUBLIC HEALTH - congresses EUROPE

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© World Health Organization 2011 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the views of the European Commission; nor is the Commission responsible for any use that may be made of the information contained herein.

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TABLE OF CONTENTS

INTRODUCTION ......................................................................................................................................................... 1

AIMS OF THE MEETING .............................................................................................................................................. 1

DAY ONE – 11 OCTOBER 2011 ................................................................................................................................ 2

Plenary session .................................................................................................................................................... 2

Workgroups ......................................................................................................................................................... 3

DAY TWO – 12 OCTOBER 2011 ............................................................................................................................... 5

Plenary session .................................................................................................................................................... 5

Workgroups ......................................................................................................................................................... 6

Final panel discussion ......................................................................................................................................... 8

Closing ................................................................................................................................................................. 9

ANNEX 1: LIST OF PARTICIPANTS ............................................................................................................................ 10

ANNEX 2. SCOPE AND PURPOSE ............................................................................................................................ 13

ANNEX 3: PROGRAMME .......................................................................................................................................... 15

ANNEX 4. EVALUATION QUESTIONNAIRE RESULTS ................................................................................................ 17

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INTRODUCTION

In spite of estimates from the Global Burden of Disease1 which suggest that injury deaths (both intentional and unintentional) have fallen in the WHO European Region from 790,000 in 2000, to 660,000 in 2008, they are still the leading cause of death in people aged 5- 44 years and their prevention remains a critical public health challenge in the Region. Regional Committee resolution EUR/RC55/R92 on the prevention of injuries in the WHO European Region and the European Council recommendation on the prevention of injury and the promotion of safety3 provide a public health framework for action to support Member States to address this problem more comprehensively. These have placed injury and violence prevention firmly on the public health agenda. The violence and injury prevention national focal persons of the Ministries of Health are critical partners in the implementation of European and national policy. Since 2005, there have been five annual meetings of European national focal persons for violence and injury prevention (VIP), hosted, in turn, by the Netherlands, Austria, Portugal, Finland and Germany. These meetings have been well attended by about 60 focal persons from most of the Member States in the WHO European Region, together with representatives of the European Commission (EC), the United Nations Children’s Fund and Non Governmental Organizations (NGO) (EuroSafe). These meetings have firmly established the network of European national VIP focal persons, and have promoted collaboration with WHO. Collaborative work has mainly focused on the implementation of the Regional Committee resolution EUR/RC55/R9 and the European Council recommendation on the prevention of injuries. Activities undertaken jointly have focused around key areas such as advocacy, national policy development, surveillance, capacity-building, and promoting violence prevention, road safety and child injury prevention.

AIMS OF THE MEETING

The main aim of the sixth network meeting which is being hosted by the Norwegian Directorate of Health is to review progress in implementing the WHO Regional Committee resolution and the European Council recommendation on the prevention of injuries and to discuss next steps in collaborative working. The specific objectives of the meeting were to:

• review progress achieved in the implementation of the joint activities undertaken by the network as defined in the WHO Regional Committee resolution and European Council recommendation;

• discuss how best to follow up on the implementation of World Health Assembly (WHA) resolution on child injury prevention (2011)4;

• deliberate on joint actions for the Decade of Road Safety 2011-20205 and learn about progress with the second survey of the Global status report on road safety;

1 http://apps.who.int/ghodata/?vid=10011, last accessed on 24 January 2012. 2 WHO Regional Committee for Europe resolution EUR/RC55/R9 on prevention of injuries in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2005. 3 European Council. Council recommendation of 31 May 2007 on the prevention of injury and promotion of safety. Official Journal of the European Union. 2007;200, C 164:1-2. 4 http://apps.who.int/gb/ebwha/pdf_files/EB128/B128_R15-en.pdf, last accessed on 24 January 2012.

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• seek opportunities for joint working in advocacy and violence prevention following reports by WHO in areas such as youth violence, intimate partner violence and elder maltreatment;

• stimulate discussion on a major theme related to the prevention of violence and injury through a key note lecture; and

• provide focal persons with an opportunity for networking and exchanging country experiences.

DAY ONE – 11 OCTOBER 2011

The sixth network meeting of the violence and injury prevention national focal persons of the Ministries of Health. was convened by the WHO Regional Office for Europe and hosted by the Norwegian directorate of Health in Oslo (Norway) and supported by the Norwegian Centre for Violence and Traumatic Stress Studies. It was attended by 70 participants, with focal persons from 37 countries, and staff from WHO Headquarters, the WHO Regional Office for Europe, the European Commission and NGOs.

Plenary session

Participants were welcomed by Dr Freja Karki, focal person from the Norwegian Directorate of Health. The meeting was opened by Dr Josè Martin Moreno, Director of Programme Management, from the WHO Regional Office for Europe, who thanked the Norwegian government for their generous support and emphasized the priority given by WHO in overcoming the public health threat of violence and injuries and how this is in line with initiatives such as Health2020, the Action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases (NCDs) 2012-2016 and the Alcohol Action Plan

The Minister of Health of Norway, Ms Strom-Erichsen, welcomed participants to the focal persons meeting in Oslo. The Minister emphasized the Norwegian government’s commitment to the subject of violence and injury prevention, and how this has enabled cross-sectoral collaboration between different ministries and implementation at a local level. The Minister acknowledged the relevance of the topic of violence in the world and in Norway, reminding the participants about the terrorist attack of 22nd July 2011 in Oslo. Ms Strom-Erichsen, also expressed appreciation for the WHO European report on elder maltreatment6, given that the Norwegian government is carrying out specific initiatives on this topic.

Ms Natacha Grenier, (Directorate General Health and Consumers, EC) welcomed participants and described ongoing support of projects by the EC, including an ongoing evaluation of the European Council recommendation. She invited focal persons to participate in the evaluation of the Council recommendation by filling out a survey questionnaire similar to that filled in 2009 at the request of WHO.

National violence prevention programmes with an emphasis on intimate relations.

Ms Randi Saur from the Norwegian Centre for Violence and Traumatic Stress Studies made a key note presentation on national programmes with an emphasis on violence in intimate relations. Ms Saur reported that 5% of the population is subjected to violence every year. This low level of violence was attributed to factors such as gender equality, access to education, equal

5 http://www.who.int/roadsafety/decade_of_action/en/, last accessed on 24 January 2012. 6 World Health Organization Regional Office for Europe. European report on preventing elder maltreatment. Copenhagen, 2011 (http://www.euro.who.int/__data/assets/pdf_file/0010/144676/e95110.pdf, last accessed on 24 January 2012).

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goods distribution etc. In Norway there are national action plans that address violence with legislation, dedicated budgets and incentives. During the past two decades, there has been increased attention from policy makers with more resources allocated to domestic violence, child maltreatment, adolescent sexual abuse, minority groups, female genital mutilation and forced marriages. A recent report7 compiled an overview of 63 ways of preventing violence, which indicated the organization, target group, programme description and evaluation. This was followed by discussion emphasizing the need for proper evaluation, for more evidence on programmes to prevent recidivism in perpetrators and on detecting child maltreatment which might present as unintentional injuries.

Progresses made since the last meeting

An update detailing the progresses made since the last meeting was presented by Dr Dinesh Sethi, WHO Regional Office for Europe. Dr Sethi stressed the important role of the network of the national focal persons for violence and injury prevention in addressing the difficult challenge of preventing injuries and violence. The main collaborative activities were summarized: the global focal person meeting held in London at SAFETY 2010 conference, the launch of the Decade for Road Safety 2011-20 (37 countries in Europe), the second survey for the Global

status report on road safety, the successful start of the Road Safety in 10 countries project, implemented in the European Region in Turkey and the Russian Federation, the publication of the European report on preventing violence and knife crime among young people

8, the European

report on preventing elder maltreatment and Methodological approaches to cost-effectiveness

and cost-utility analysis for injury prevention9. Country collaboration was described with

demands for advocacy, national policy development, training courses using TEACH-VIP and surveys of adverse childhood experiences. Forthcoming activities in 2012 were: subregional workshops on alcohol and violence prevention and injury surveillance for the Southern and Eastern European countries and for the Nordic and Baltic countries, a European report on preventing child maltreatment, the launch of the second Global status report on road safety, a survey for the Global status report on violence prevention, implementing the WHA resolution on child injury prevention, and the forthcoming SAFETY 2012 conference.

Workgroups

The programme of day 1 included four working group sessions dealing with the second Global

status report on road safety, adverse childhood experience (ACE) surveys, advocacy and the Decade of Action on Road Safety and intimate partner violence. Groups were asked to provide updates on the activities carried and to bring examples on barriers met and on how WHO could help. Group 1: second Global status report on road safety

This session discussed progress in implementing the survey for the second Global status report

on road safety. With the collaboration of the national data coordinators, good progress was being made. National data coordinators had been appointed in 51 countries, consensus meetings had been held with data collection in 42 countries, data were uploaded in 35 countries. Official

7 Norwegian Centre for Violence and Traumatic Stress Studies. Violence prevention in Norway. Activities and measures to prevent violence in close relationships. 2011 (http://www.nkvts.no/biblioteket/Publikasjoner/Violence-prevention-in-Norway-Activities-and-measures-to-prevent-violence-in-close-relationships.pdf, last accessed on 24 January 2012). 8 World Health Organization Regional Office for Europe. European report on preventing violence and knife crime among young people, Copenhagen, 2010 (http://www.euro.who.int/__data/assets/pdf_file/0012/121314/E94277.pdf, last accessed on 24 January 2012). 9 World Health Organization Regional Office for Europe, Erasmus MC and Consumer Safety Institute. Methodological approaches for cost–effectiveness and cost–utility analysis of injury prevention measures, 2011.

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approval was being obtained in 21 countries. Suggestions were made on how to improve methodology for the future. This included more attention to be paid to the layout for the French and Russian questionnaire, to pilot the questionnaire in several countries, to include items on hospital admission and emergency room data and more guidance on calculating the cost of injuries. Examples were received from participants and the focal person from Georgia described the national situation. The focal person from Turkey presented the country example and also described the implementation in Turkey of the Road Safety in 10 Countries.

Group 2: adverse childhood experience surveys

Focal persons from Lithuania, the former Yugoslav Republic of Macedonia and Latvia presented results of ACE surveys undertaken in their countries as part of biennial collaborative agreements. All surveys had been undertaken using sampling of university/high school students aged over 18 years with about 1200 respondents each. The results from Lithuania were analysed and showed strong associations between ACE and health risk behaviours; the other two (the former Yugoslav Republic of Macedonia and Latvia ) required further analysis. Focal persons from Albania, Montenegro and the Russian Federation where studies are being planned also took part in the debate. Group 3: advocacy and the Decade of Action on Road Safety

There was strong participation in the Region and 37 countries had held launches of the Decade of Action for Road Safety 2011-2020. The focal person from Serbia reported on the launch events: the Decade was celebrated with events of national importance in Belgrade and was supported by all relevant ministries and institutions, such as the Road traffic safety agency, the chief of Traffic Police, the president of Serbian Red Cross, Ministers of Education, Interior and Infrastructure and Assistant Minister of Health. The key message of the Decade aimed to make people understand that road safety is a shared responsibility for all citizens and was well conveyed with good media coverage. From Spain, the focal person reported that the Decade was launched with a press conference which was attended by more than 200 representatives from different sectors, NGOs, driving school associations, municipalities, radio, TV and newspapers. The Ministry of Health took a leading role in the launching event and in the preparation of a plan of action for the Decade. In the plan for the Decade, particular attention will be paid to vulnerable road users (specifically motorcyclists), urban crashes and intoxicated drivers. The focal person from Portugal described the launch prepared by the Ministry of Health with strong commitment of NGOs (“Strada Viva” a federation of 40 NGOs), with a speech by the Minister of Health and heads of national institutions responsible for road safety, mobility, safer vehicles and emergency, all expressing commitment to the Decade. The focus for health would be on safety and quality of care for children and young people. Brief reports about country-launches were also made by the Czech Republic, Italy and Croatia. It was acknowledged that the Decade represents a unique opportunity for advocacy. Some problems were also highlighted by some countries, such as the low involvement of the Ministry of Health, and the challenges of coordination and poor resources. Group 4: intimate partner violence

Presentations were received from focal persons from three countries to set the debate on finding solutions for the prevention of intimate partner violence in the European Region. The former Yugoslav Republic of Macedonia shared the experience from the United Nations Joint Programme on Strengthening National capacities to combat domestic violence. The focal person from Norway described the system for preventing and tackling intimate partner violence in her country. There is a strong emphasis on interministerial collaboration, primary prevention (focusing on intergenerational patterns) and research fertilizing policy decisions and actions. Examples were shared of good practice for perpetrator treatment, children’s homes, emergency

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units for sexual abuse and mental health in schools. The focal person from Denmark described the national action plans for preventing intimate partner violence, addressing primary, secondary and tertiary prevention. Goals and achievements of the action plans are monitored by means of the seven EU indicators on domestic violence proposed by the EU Member States. A national database on violence against women was set up in Denmark in 2004 and it is a powerful tool to monitor trends in intimate partner violence and other types of violence. Main recommendations for further action by the group included developing national plans, improving surveillance, building capacity, prioritizing research in primary prevention, promoting evidence based practices and sharing regional experiences. A feedback of the results obtained during these parallel sessions was shortly given to the plenary by the appointed rapporteurs at the end of day 1. The presentations are available on CD.

DAY TWO – 12 OCTOBER 2011

Plenary session

A short feedback was made from the presentation and discussions held during the first day.

Future global directions for violence prevention activities

Dr Alex Butchart (Violence and Injury Prevention and Disability, WHO Headquarters) emphasized the non-fatal outcomes of violence, the economic consequences (direct and indirect ones) and the intangible consequences on the quality of life: depression, anxiety, insomnia, mental health effects and unwanted pregnancies. Dr Butchart used the four phases of the public health approach (defining the problem, identification of risk and protective factors, interventions that work and their scaling up), to show that most progress had been made in high-income countries and less in low-income countries, who were often at the phase of defining the problem. While a lot has been done in the field of child maltreatment and youth violence, already at the phase of scaling up of the interventions, a lot has yet to be done for elder maltreatment, for which research on both risk factors and interventions was much needed. Violence prevention has not attained as much political attraction as other fields such as road safety. This was put down to multiple sectors using different approaches, the lack of a lead United Nations (UN) agency, the lack of passive prevention strategies, and success stories coming mainly from high-income countries and being difficult to scale up, and limited funds. This may suggest a new approach which focuses on some shared risk factors, or on proven prevention strategies and victim services or on a few targets that every country could reach. The forthcoming Global status report on violence prevention, which should follow the rationale of the Global status report on road

safety, was described. The questionnaire for this is report being piloted: the survey will commence in April 2012 and the report will be published in 2013.

Addressing children in crisis centers in women’s shelters

Ms Carolina Overlien, from the Norwegian Centre for Violence and Traumatic Stress Studies, spoke about children in crisis shelters for abused women. In Norway there are 51 such shelters providing a safe house for abused women and constitute a strong political lobby for the issue. There is a legal framework for such shelters which includes a funding source and protecting children as per the UN convention on the rights of the child10. The number of people who spent at least one night in a shelter in Norway in 2010 was 2038 women, 37 men and 1994 children. Most children are aged 5 years or younger. Mothers stay on average 29 days, and most have experienced violence for a long period (1/3 of the mothers seek help after more than 5 years of

10 http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&lang=en, last accessed on 24 January 2012.

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living with violence), live in socially, psychologically and economically disadvantaged situations with significant health risks, and may be immigrants who speak poor Norwegian. Mothers may move back to the abuser, putting the child at risk. Ms Overlien also presented the results of a pioneer study on children’s experiences of life at shelters for battered women, which focused on children as service users. Children felt safe in the shelters, felt positively about staff and other children in the shelter but felt the need for more information on the shelters. Longer term follow-up to measure health and social outcomes is needed.

Coping with the aftermath of the terror

Ms Grete Dyb, from the Norwegian Centre for Violence and Traumatic Stress Studies, described the events which happened in Utøya on 22 July 2011, when politically active youths became the victims of the worst terrorist attack in Norway in peacetime. For more than one and an half hours, they were shot at and chased by the perpetrator dressed as a policeman. The losses were huge: 69 died, 66 were injured, 650 were present at the attack, approximately 700 lost a close relative and 4500 were affected by the terror attack. The psychological consequences of mass killings are serious and the majority affected is young. To prevent and control these consequences, a plan has been developed by the Norwegian Centre for Violence and Traumatic Stress Studies, based on the experience of the 2004 Tsunami in South East Asia. The plan is to provide counselling and implement a close follow-up for all survivors and close relatives for one year. A follow up instrument has been provided for municipalities so that continuity is provided. The plan is to identify and treat post-traumatic stress disorders such as anxiety, depression, and feelings of horror, fear and helplessness. Injury surveillance with a focus on prevention of terror

Dr Knut Melhuss, from the Oslo University Hospital, described the injury surveillance systems used in Norway. The model is based on a two step registration system, which is practical and efficient for both continuous surveillance and identification of potential risk factors. The ideal data collection system would collect all information on the highest number of cases, but such a system is too costly. Instead, a two tier system is operated, which involves: 1) a minimum dataset which covers the maximum number of cases but collects only the basic variables and 2) an extended one, which collects detailed information on a limited number of cases. Dr Knut showed the injury register in detail and how it captures both unintentional injuries and violence. The advantages of the system are the provision of a general overview of injuries and related diagnosis, its credibility and speed and surveillance of new trends and activities. The disadvantages were high cost in terms of time, technology and human resources.

Workgroups

The programme of day 2 included four working group sessions dealing with injury surveillance, child injury prevention, alcohol and youth violence prevention and elder maltreatment. Groups were asked to discuss updates on activities and constraints and how WHO could help. Group 1: injury surveillance The focal person from Norway presented the two step injury surveillance system and a discussion was had on the trade off between data quality and quantity. The Joint Action on Monitoring Injuries in Europe (JAMIE) project11 was described by the participant from the European Association for Injury Prevention and Safety Promotion (EUROSAFE) who illustrated the quality manual for the project. It was hoped that injury surveillance using the Injury Database would be used by all EU countries. Progress on the implementation of the Injury Database was presented. There are plans to increase from 13 countries to 22 by 2014, with an additional 4

11 http://ec.europa.eu/eahc/projects/database.html?prjno=20102205, last accessed on 24 January 2012.

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countries committed to implementation thereafter. The challenge of variations in implementation of the Injury Database across countries would be overcome in the next few years. It was suggested that WHO should purpose the Injury Database to eastern European countries. Group 2: child injury prevention The WHA 64.7 resolution on child injury prevention urges all countries to implement effective actions as outlined in the World and European reports on child injury prevention and presented an opportunity to tackle the problem. The focal person from Finland reported on the positive progress which was made in addressing child injuries, particularly among road traffic injuries occurring to young boys. A national action plan is in force: it is based on solid data, presents a thorough situational assessment, is drawn on the basis of several stakeholder consultations and is coordinated by the National Institute of Health and Welfare. The plan proposes 200 actions and evidence-based practices. A web platform with publications for children who are considered stakeholders is also foreseen in the action plan. From the former Yugoslav Republic of Macedonia the focal person reported that the topic has been set as a government priority, particularly with regards to road traffic crashes which account for 25% of the children fatalities. Different strategies exist in the country: health strategy 2008-2020, national youth strategy, national adolescent health strategy, national road safety strategy, and the children environment and health action plan. These strategies are based on a situational assessment and analysis of gaps. They include the WHO recommendations on road safety and aim at achieving a 50% reduction by 2014 and a 0 fatality rate for child traffic injuries. The focal person from the Czech Republic reported on the national action plan on child injury prevention which was endorsed by the government in 2007. The strategy is reported as effective, and the government reports on results every two years. As a result of the action plan, the mortality rate for children aged 0-14 years decreased from 7.0 in 2005 to 4.3 in 2008 per 100,000 children. In the country a specific body is being established to coordinate all activities for intentional and unintentional injuries and for safety promotion: those activities which will be recognized as effective will be implemented throughout the country. Turkey reported that a conference on mother child health is being organized and that the event will serve as the ground for preparing a national action plan. In Portugal the child safety action plan is led by an NGO. Participants acknowledged that the WHA resolution could play a crucial role in boosting child injury prevention and should be widely publicized. Group 3: alcohol and youth violence prevention

The European report on preventing violence and knife crime among young people and data on alcohol consumption in Europe were used as a backdrop to the workshop. The focal person from the Russian Federation presented the situation on alcohol, adolescence and violence. The prevalence of alcohol use and misuse among adolescents and youth in the Russian Federation is still high. Trends are not improving and the age of alcohol use initiation moved down from 14 to 11 years. A social profile of the offenders shows that 65% had parental alcohol abuse, 45% came from single-parent families and 55% of minors were subjected to domestic violence. From the United Kingdom, the focal person described three approaches to tackle alcohol use and violence prevention: (i) reducing alcohol-related violence through licensing legislation and nightlife environments, (ii) reducing alcohol access and use through age verification and licensing legislation and (iii) reducing violence with a focus on gang and criminal justice and early interventions. Some examples of measures to improve safety in nightlife environments were safer drinking vessels, improved street lighting, late night transport, bar staff training, door supervisor training, banning violent people from the pubs and taxi marshals. To reduce access to alcohol, prices should be increased, but the proposal is still under consideration. Illegal sales to minors are punishable with very high fines. Particular attention was also dedicated to primary prevention (nurse family partnership, family centres and extended schools were provided as

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examples). A lively discussion followed. Some focal persons stated that youth violence in their country is not under the responsibility of health sector and so it is very difficult to raise awareness as this highlighted the need to work across sectors with a multidisciplinary approach.

Group 4: elder maltreatment

The focal person from Norway facilitated the discussion and presented the main public health concerns regarding elder maltreatment in the WHO European Region. A survey is underway to study the prevalence and risk factors of elder maltreatment in the former Yugoslav Republic of Macedonia using a stratified random sampling method. The target population for this research will be women and men, aged 65 years or older, who are living in private households, comprising 530 women and 430 men. The focal person from Croatia presented the situation of elder maltreatment in Croatia. The country has recently increased the legal framework for protecting citizens against violence. Research on violence (including elder maltreatment) is increasing as are the number of NGOs concerned with the area. In view of the demography of population ageing, elder maltreatment prevention should be prioritized. There was a general discussion that focused on: implementing national policies using a multisectoral approach and evidence-based primary prevention; strengthening responses for victims; building capacity and exchanging good practice; supporting research; raising awareness; focusing on protective factors, a life-course approach with intergenerational cohesion and improving the quality of services in the community and in institutions.

Final panel discussion

Several issues were discussed by the panelists during the final session. Key among these issues was how to meet the challenge of implementing national plans for injury and violence prevention within the resources allocated. To do so it was strategic and necessary to embed injury and violence prevention into other policy areas such as, child and adolescent health, healthy ageing, NCDs, physical activity promotion, climate change etc. For violence prevention it is important to place it on the NCDs agenda by drawing the links between exposure to violence, health risk behaviours (alcohol, tobacco, physical inactivity, obesity, etc.) and NCDs. Lessons were discussed from the success of getting road safety on the policy agenda. It was hoped that the Global status report on violence prevention which is in preparation may be used to highlight the issue globally and there was a discussion as to whether a UN resolution was needed with a Decade of Action for Violence Prevention. The WHA resolution on child injury prevention afforded an opportunity to advocate for child injury prevention. WHO should continue to develop the network of focal persons and increase its effectiveness and provide funding for activities in view of unmet needs. The importance of an intersectoral approach was stressed and one way of achieving this was through formal agreement at ministerial level. One of the challenges for the network is to stimulate action from other sectors. Advocacy as with the Decade of Action for Road Safety and using NGO networks were promoted as ways forward. The media can be used effectively for advocacy and WHO has undertaken media training for young journalists. Working with the media and using the social media were a priority for WHO and for Member States. Capacity building was a priority in the Region, with continued demand from countries. Translation of TEACH-VIP in different languages and mainstreaming it into national curricula was an important way forward. There is a collaborative project with the European Public Health Association to map schools of public health that have injury prevention in their curricula. On the policy front it was agreed that both the WHO Regional Committee resolution and the European Council recommendation had stimulated national action. These were a few years old

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now and it was necessary to put violence and injuries high on the political agenda. Participants agreed on the need for WHO Regional Committee resolution on child maltreatment

prevention as one way of achieving this. A discussion was had on better using reports for advocacy. In this respect the European report on preventing child maltreatment is being planned for 2012. The resolution and the report would be important tools to also generate support and resource mobilization. The area of measuring costs and cost-effectiveness was also highlighted as a priority.

Closing

The meeting agreed on the following priorities for WHO and the network:

� continuing to support Member States in advocating for road safety through activities such as the Decade of Action and the second Global status report on road safety;

� giving renewed attention to capacity building using TEACH-VIP with the train the trainer approach both at sub-regional level and national level;

� supporting the drafting of a Regional action plan and resolution on child maltreatment prevention and other adverse childhood experiences; and

� seeking opportunities to advocate for child injury prevention.

WHO thanked the hosts for their generosity, excellent support and warm hospitality. It was announced that the Violence and Injury Prevention team will move from WHO Rome Office to WHO Regional Office in Copenhagen from 1 November 2011. Warm appreciation was expressed for Manuela Gallitto, for her efficient and helpful support to the focal persons network over the last five years. The meeting was closed by the Norwegian Directorate of Health, who thanked the focal persons for their lively participation and contribution to the discussions.

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ANNEX 1: LIST OF PARTICIPANTS

Albania Maksim Bozo, Ministry of Health of Albania Gentiana Qirjako, University of Tirana Armenia Lilit Avetisyan, Inspectorate of Ministry of Health Austria Kuratorium für Verkehrssicherheit (KfV) Azerbaijan Rustam Talishinskiy, Scientific Research Institute of Traumatology and Orthopaedics Belarus Ivan Pikirenia, Ministry of Health of the Republic of Belarus Belgium Christiane Marie Vermeulen-Hauzeur, Directorate General for the organization of health care establishments, Federal Service of Health, Food Chain, Safety and Environment Bulgaria Maksim Gaydev, Ministry of Health Fanka Koycheva, University Hospital 'Ts. Ioanna-ISUL' Croatia Ivana Brkic Bilos, Croatian National Institute of Public Health Czech Republic Veronika Benesová, University Hospital Motol Iva Truellova, Ministry of Health of the Czech Republic Denmark Karin Helweg-Larsen, National Institute of Public Health Estonia Lis Roovali, Ministry of Health and Social Affairs Finland Merja Söderholm, Ministry of Social Affairs and Health Georgia Kakha Kheladze, Ministry of Labour, Health and Social Affairs Hungary Maria Benyi, National Center for Healthcare Audit and Inspection Italy M. Giuseppina Lecce, Ministry of Labour, Health and Social Affairs Kyrgyzstan

Bektur Anarkulov, Bishkek Scientific Research Centre of Trauma and Orthopaedics

Latvia Jana Feldmane, Ministry of Health Lithuania Robertas Povilaitis, Child Line

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Luxembourg Serge Kippler, Direction de la Santé Montenegro Svetlana Stojanovic, Ministry of Health Norway Freja Ulvestad Karki, Norwegian Directorate of Health Jakob Linhave, Norwegian Directorate of Health Portugal Gregoria Paixao von Amann, Ministry of Health Republic of Moldova Luminita Avornic, Ministry of Health Romania Daniel Verman, Ministry of Health Russian Federation Margarita Kachaeva, Centre for Social and Forensic Psychiatry Serbia Milena Paunovic, Institute of Public Health Slovakia Peter Jacko, Children´s Faculty Hospital and Policlinic Slovenia Barbara Mihevc, Institute of Public Health Spain María Villar Librada, Ministry of Health and Social Policy Sweden Ingalill Paulsson Lütz, National Board of Health and Welfare Tajikistan Abduvali Razzakov, Ministry of Health The former Yugoslav Republic of Macedonia Marija Raleva, University Clinic of Psychiatry Fimka Tozija, Institute of Public Health Turkey Tuba Atila, Ministry of Health Fazil Inan, Ministry of Health Turlmenistan Chemen Divankuliyeva, Science and Personnel Department Ukraine Liudmyla Kovalenko, Ministry of Health United Kingdom of Great Britain and Northern Ireland Mark Bellis, Liverpool John Moores University Uzbekistan Alisher Iskandarov, Tashkent Paediatric Medical Institute

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Representatives European Association for Injury Prevention and Safety Promotion (EuroSafe) Wim Rogmans European Commission (EC) Directorate-General for Health and Consumers (DG SANCO) Natacha Grenier

MEETING SECRETARIAT

Ministry of Heath and Care Services Anne-Grete Strøm-Erichsen, Minister of Health

Norwegian Directorate of Heath Hedda Bie, Senior Adivese (observer) Inga Fjelltveit Skagseth, Senior Adviser Mari Hagtvedt, Senior Adviser Bjørn-Inge Larsen, Director Johan Lund, Senior Advisor Norwegian Centre for Violence and Traumatic Stress Studies Arnfinn Jomar Andersen, Head of section Inger Elise Birkeland, Director Grete Dyb, Senior researcher/head of section Trond Heir, Researcher Carolina Øverlien, Researcher Randi Saur, Researcher Anne Lie Andreassen, Researcher

Oslo University hospital Knut Melhuss, Chief surgeon

World Health Organization Headquarters Alex Butchart, Department of Violence and Injury Prevention and Disability Regional Office for Europe (Copenhagen, Rome) Josè Martin Moreno, Director Programme Management, Copenhagen Dinesh Sethi, Technical Officer, Copenaghen Francesco Mitis, Technical Officer, Copenaghen Manuela Gallitto, Programme Assitant, European Centre for Environment and Health, Rome WHO Country office, Russian Federation Francesco Zambon, Technical Officer WHO Country office, The former Yugoslav Republic of Macedonia Dimitrinka Jordanova-Pesevska, National Professional Officer WHO Country office, Turkey Serap Sener, National Professional Officer

Interpreters Aleksei Repin Hanna Schönfeld

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ANNEX 2. SCOPE AND PURPOSE

Introduction

Unintentional injuries and violence are the third leading cause of death in the European Region, accounting for approximately 800 000 deaths in 2004. The burden is unequally distributed across the Region, being much higher in the low- and middle-income countries of the Region. Within countries the burden is borne to a larger extent by economically and socially vulnerable groups, as well as by children and young people under 45 years old. Injuries and violence have a very significant effect on health, on health systems and on the economic and social development of Europe. Following recent World Health Assembly (WHA) resolutions, violence and road traffic injury prevention have been given increased priority in the European Region. In line with these WHA resolutions, Member States were invited to appoint National Focal Points for violence and injury prevention, with a view of facilitating the exchange of relevant information and experiences across the Region, and strengthening the regional and national capacity to advocate for injury and violence prevention, promote evidence-based preventive strategies and develop cross-sectoral partnerships. In response to the WHO invitation, Focal Points have been appointed by fifty Member States, confirming the increasing interest and commitment to address this important public health issue. European policy developments include the WHO European Regional Committee resolution RC55/R9 on the prevention of injuries and the European Council recommendation on the prevention of injuries and promotion of safety. These underpin the importance of the leadership role that the health sector should take in engaging other sectors, through national policy development, advocacy, surveillance and evidence based practice. Scope of the meeting

There have been five previous meetings of the European Network of Ministry of Health Focal Persons for Violence and Injury Prevention (VIP) that have been held annually. Since 2005 these have been hosted consecutively by the Netherlands, Austria, Portugal, Finland and Germany. These have been well attended, with 60-80 focal persons from most of the European Member States, together with representatives of the European Commission, the Council of Europe, UNICEF and civil society (EuroSafe). These meetings have contributed to firmly establishing the network of European national VIP focal persons with increased collaboration between them and WHO. The network has adopted a vision called LIVE or “Life without Injuries and Violence in Europe”. Collaborative working has mainly focused on the implementation of the Regional Committee resolution EUR/RC55/R9 and the European Council recommendation on the prevention of injuries. Activities undertaken jointly have focused on key areas such as national policy development, violence prevention, road safety, surveillance, capacity building and joint advocacy events. This past year has seen much collaborative work for the development of reports such as Preventing injuries in Europe: from international collaboration to local implementation and the European report on preventing violence and knife crime among young people. This has been achieved by the active collaboration of Focal Persons by participating in surveys and technical meetings. The main aim of the 6th network meeting which is being hosted by the Norwegian Directorate of Health is to review progress in implementing the WHO Regional Committee resolution and the European Council recommendation on the prevention of injuries and to discuss next steps in collaborative working.

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The specific objectives of the meeting are to:

• review progress achieved in the implementation of the joint activities undertaken by the network as defined in the WHO resolution and Council recommendation;

• discuss lessons learnt related to launches of the World and European reports on child injury prevention and on how best to follow up on the implementation of international policy developments in this field;

• deliberate on joint actions for the Decade of Road Safety 2011-2020 and learn about progress with the second survey of the Global status report on road safety;

• seek opportunities for joint working in advocacy and violence prevention following reports by WHO in areas such as youth violence, intimate partner violence and elder abuse;

• stimulate discussion on a major theme related to the prevention of violence and injury through a key note lecture; and

• Provide focal persons with an opportunity for networking and exchanging country experiences.

Format of the meeting

The meeting will consist of plenary and break out sessions, to allow in-depth discussions about the implementation of policy developments for the prevention of violence and injuries in the European Region and to allow the exchange of country experience. Preparations prior the meeting

All focal persons will be asked to develop brief mini-papers to report national initiatives prior to the meeting. These will be used as a basis of exchanging best practices and will provide the background information for breakout sessions. Expected outcomes of the meeting

By the end of the meeting, it is expected that participants will be informed about recent developments in the area of violence and injury prevention, understand the goals achieved through joint working, be informed of good practice initiatives in the Region, and have a clearer picture of future directions for collaborative action in the prevention of injuries and violence. Meeting report

A meeting report will be developed and the best practice example received from focal persons will be documented and also entered onto the WHO website as a repository for future reference and exchange.

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ANNEX 3: PROGRAMME

DAY 1 – TUESDAY 11 OCTOBER 2011

11.3013.00 Registration and lunch

13.0015.00 Session 1: opening session

Plenary: coming together again

Welcome of participants by WHO Welcome of participants by host Welcome by European Commission Introduction by participants Appointment of rapporteurs and chairpersons and adoption of agenda

Dr JM Moreno, DPM, WHO A Strøm-Erichsen, Minister of Health, Norway N Grenier, EC All Chair: F Karki

Key note speech: violence prevention in Norway. Activities and programs with emphasis on violence in intimate relations

T Heir and R Saur

15.0015.30 Coffee break

15.3017.30 Session 2: achievements

Progress made in Europe since 2010 D Sethi

Introduction to group work

Group 1: global status report on road safety All and F Mitis

Group 2: adverse childhood experience surveys

All and D Sethi

Group 3: advocacy and the Decade of action on road safety

All, F Zambon and S Sener

Group 4: intimate partner violence All and D Jordanova Pesevska

17.3018.30 Plenary: feedback from groups All

19.3020.00 Let’s get together (welcome drinks)

20.0023.00 Social dinner

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DAY 2 – WEDNESDAY 12 OCTOBER 2011

08.4509.00 Feedback from day 1 F Mitis

09:0010:40 Session 3: Keynotes on the state of art Chair: J Linhave

09.0009.30 Future global directions for violence prevention activities

A Butchart

09.3009.50 Addressing children in shelters for abused women C Øverlien

09.5010.10 Coping with the aftermath of terror G Dyb

10.1010.40 Injury surveillance with a focus on prevention K Melhuus


11.1012.30 Session 4: small group working

Group 1: injury surveillance All and J Lund

Group 2: child injury prevention All, F Zambon and S Sener

Group 3: alcohol and youth violence prevention All and F Mitis

Group 4: elder maltreatment All and F Kärki

12.3013.00 Plenary: feedback from small groups All

13.0014.00 Lunch break

14.0014.30 Plenary: feedback from small groups (cont) All

14.3015.45 Session 5: next steps

Panel discussion on next steps for violence and injury prevention in Europe: unmet needs and can the Network of VIP focal persons and WHO help

Session chair J. Linhave, Panellists: F Karki (MoH FP), A Butchart (WHO HQ), J Lund (EUPHA), D Sethi (EURO), W Rogmans (EuroSafe), M Bellis (WHO CC)


16.0516.20 Next steps in Europe for the network of focal persons

D Sethi

16.2016.40 Any other business All

16.4016.55 Concluding remarks WHO and J Linhave Directorate of Health

16.5517.00 Evaluation forms All

17.00 Close

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ANNEX 4. EVALUATION QUESTIONNAIRE RESULTS

The 19 evaluation forms received back showed that 85% of participants assessed the meeting to be either good or excellent (they assessed the meeting as 4 or above). The remaining 15% did not answer (Figure 1). No particular preference was given to selected topics but the presentations delivered by Norwegian colleagues were particularly appreciated. All the respondents said that both the objective of the meeting and the personal expectations were met (in this last case one person did not answer). Almost all the respondents stated that they thought that the meeting will be “definitely” or “mostly” useful for their daily job. One participant said it will be “somewhat” useful. There were a few complaints on the logistical aspects, since a minor part of the participants judged the accommodation too far from both the city centre and the airport and one respondent said it was too expensive. There were no particular suggestions for improving the meeting. One participant said that he would have liked to have more time dedicated to discussions in groups and less to presentations. However, the majority of the respondents said that the meeting was very effective and no additional suggestions for improvement were provided. Figure 1. What is your overall assessment of this meeting? (from 1=insufficient to 5=excellent)

0%

10%

20%

30%

40%

50%

60%

no answer 1 2 3 4 5

The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves.

Member States: Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan Original: English

On 11-12 October 2011 the WHO Regional Office for Europe convened in Oslo the 6th network meeting of the violence and injury prevention national focal persons of the Ministries of Health. The meeting, hosted by the Norwegian Directorate of Health, was attended by 70 participants, with focal persons from 37 countries, as well as representatives from WHO, European Commission, and nongovernmental organizations. Key note presentations made on services for victims of violence and injury surveillance in Norway were much appreciated as were those on global and regional developments on the prevention of violence. Progress in the Region on violence and injury prevention was reviewed and ongoing activities discussed. These included lessons learnt from the launches of the European report on prevention of knife crime and violence among young people and the European report on preventing elder maltreatment, the on-going activities such as the survey for the second Global status report on road safety, the launches for the Decade of Action for Road Safety, the Road Safety in 10 countries project, and on promoting violence prevention, in particular through national surveys on adverse childhood experiences in several countries. The meeting agreed on the following priorities:

o continuing to support Member States in advocating for road safety through activities such as the Decade of Action and the second Global status report on road safety;

o Give renewed attention to capacity building using the Training, Education, and Advancing Collaboration in Health on Violence and Injury Prevention (TEACH-VIP) curriculum with the train the trainer approach both at sub-regional level and national level;

o supporting the drafting of a Regional action plan and resolution on child maltreatment prevention and other adverse childhood experiences; and

o seeking opportunities to advocate for child injury prevention.

WHO wishes to thank the Norwegian Ministry of Health for kindly hosting 6th network meeting of the Ministry of Health Focal Persons for Violence and Injury Prevention. This report has been prepared by Francesco Mitis, Francesco Zambon, Dimitrinka Jordanova Pesevska and Dinesh Sethi.

Documents

WHO Report of the sixth annual European meeting of ......In spite of estimates from the Global Burden of Disease1 which suggest that injury deaths (both intentional and unintentional)