Healthcare Getting It Right : Injury and Violence

Global health has done tremendous work addressing the public health components of injury and violence.

Injury and violence reports and data breakdown are well organized, understandable and clear [1]. Thank you.

Injury and violence mitigation and treatment data could be clearer. Access to treatment and indicators for quality of care could be priority, particularly when disability and death are tracked. Additionally, evidence-based practice should be assessed and measured, particularly for trauma care and first response. This would encourage reviews, consensus and minimum expectations for debated issues [2] as well.
Data that addresses exclusions in global health could be accounted for. In example, drug overdose and gun violence are components to injury and violence public health work in the United States. Both adverse childhood experiences (ACEs) and traumatic brain injury (TBI) are also singled out in various country reports, yet not highlighted in this global report. A category such as ‘other causes’ in the global health report, at minimum, could allow for country-specific components. Opportunities for standardization are evident and should be taken.
The WHO response section is meaningful and impactful, thank you. Other WHO and UN reports have multi-agency policy crosswalks; perhaps policy crosswalks could be applied to injury and violence reports as well.
Violence mitigation interventions could also be catalogued and analyzed. This work could be clearer, with potential for research and intervention funding after analysis of evidence in various articles [3].
Global health work could partner to organize the research portfolio, so that major research within countries [4-7], or on behalf of global health interventions [8,9], does not go without follow-up. Piecemeal is inefficient and can be wasteful.
Epidemiology liaisons could be offered at the design phase of the research to improve the quality of the research as well as build for the future.
Consensus on reporting and quality guidelines in the context of injury and prevention research, such as CONSORT [10] or GRADE, could steer funding.
Injury prevention work conducted under partnerships outside of global health, including through UN or charitable organizations, should not negate the need for collaboration and standardization of measures and interventions. Partnerships should also not negate the need for improvements in healthcare delivery that simultaneously assist research design.
Occupational injury work should continue. Public health and public policy ties to global trade could also be sharpened.
There is a lot to injury and a lot to violence. Perhaps these should be separated in health topics, with new definitions to tie the common and overlapping issues.

The US continues to struggle with injury and violence, yet public health attention remains vigilant [11,12].

The US should continue to lead injury and violence prevention efforts. While other countries tackle processes the US already has in place, such as safe packaging and labeling, the US has opportunity to tackle its own pressing issues.
Expert recommendations [13] should be graded, tiered and implemented.

Major causes of injury that require multi-agency collaboration and policy implementation, such as transportation safety, should be funded for the long-term. Road safety could involve national campaigns, improved clarity to how state and local health departments track and intervene, multi-agency collaborations and accountability to state metrics.
Healthcare involvement in violence prevention and management should continue to organize. AHRQ, patient safety and occupational safety work all address patient violence. The tools, screening, management, referrals and follow up should be clearer from aspects of operations, outpatient, reimbursement and insurance. The point of entry into non-emergency healthcare should see standards to injury and violence prevention, just as emergent healthcare should.
Isolated military injury and violence work should be connected to greater public health. How the military funds violence and injury research, and opportunities for collaborative private-public sector approach, should advance. How military statistics are accounted for in local health department reports should be clear and should improve, especially those in which data is dependent on military courts, military emergency treatment billing or military bases. When local public health departments and state public health departments do not account for vehicle injury, substance abuse injury or interpersonal violence involving members of the military within military jurisdictions, local and state public health are not accounting for the entirety of the population.
Multi-disciplinary expertise, including psychiatry, social services and advocacy organizations, should help shape a national strategic gameplan. If these task forces target specific populations, such as children or veterans, then leadership from those groups could be tapped for the national roundtable or research strategy work.
Formal definitions and standards on allostatic load and cumulative effects would benefit all involved with injury and violence prevention. Aggregating and analyzing research in both military [14-17] and civilian [18-21] populations could help organize a path forward. Methodology and definitions on cumulative effects and allostatic load needn’t be so disorganized.
There is a lot to injury and a lot to violence. Perhaps these should be separated in health topics, with new definitions to tie the common and overlapping issues.

References

1. https://www.who.int/publications/i/item/9789240047136

2. https://pubmed.ncbi.nlm.nih.gov/28513531/

3. https://journals.sagepub.com/doi/full/10.1177/0963721416655883

4. https://pubmed.ncbi.nlm.nih.gov/25356696/

5. https://pubmed.ncbi.nlm.nih.gov/20795459/

6. https://pubmed.ncbi.nlm.nih.gov/28039683/

7. https://pubmed.ncbi.nlm.nih.gov/28042961/

8. https://pubmed.ncbi.nlm.nih.gov/16376728/

9. https://pubmed.ncbi.nlm.nih.gov/19474562/

10. https://pubmed.ncbi.nlm.nih.gov/31129675/

11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4958590/