REGIONAL CONSULTATION ON WORLD REPORT ON VIOLENCE AND HEALTH
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RF_COM_H_47_SUDHA_PART_1.
WORLD HEALTH
ORGANIZATION
I
Regional Consultation on World Report on
Violence and Health, SEARO, New Delhi
16-17 November 2000
REGIONAL OFFICE FOR
SOUTH-EAST ASIA
SEA/DPR/Meet/2/1
14 November 2000
Registry file No. R4/48/1
OBJECTIVES
1.
To summarize report goals, objectives, methodology and
progress made to date;
2.
Provide an overview of the report’s content (major pattern, risk
factors, prevention and policy responses for the various types
of violence) and to identify important gaps;
3.
To solicit regional perspectives on future directions for violence
prevention; and
4.
To determine regional strategies for the release of report.
WORLD HEALTH
ORGANIZATION
»
REGIONAL OFFICE FOR
SOUTH-EAST ASIA
Regional Consultation on World Report on
Violence and Health, SEARO, New Delhi
16-17 November 2000
SEA/DPR/Meet/2/2
14 November 2000
Registry file No. R4/48/1
PROVISIONALAGENDA
1.
Inauguration
2.
Opening of the Consultation
3.
Goal, objectives and methodology for development of World Report
on Violence and Health
4.
Regional public health challenges in the field of violence
5.
Regional activities involving release of the Report
6.
Closing
WORLD HEALTH
ORGANIZATION
I
REGIONAL OFFICE FOR
SOUTH-EAST ASIA
SEA/DPR/Meet/2/3
14 November 2000
Regional Consultation on World Report on
Violence and Health, SEARO, New Delhi
16-17 November 2000
Registry file No. R4/48/1
TENTATIVE PROGRAMME
(VENUE: COMMITTEE ROOM, 1st FLOOR)
Registration for the meeting will begin at 8:30 on 16th November in the Conference Hall Lobby ofSEARO
DAY ONE:
Thursday, 16 November 2000
09:00-9:30
Inauguration
09:30-09:45
Tea/Coffee Break
9:30-10:00
World Report on Violence and Health:
goals, objectives, methodology,
content and progress made to date
Etienne Krug WHO HQ
Presentation of format of consultation
Introduction of five discussion points
on regional public health challenges in
the field of violence prevention
10:15-12:00
Availability and collection of data
Discussions
12:00-13:00
Lunch
13:00-14:45
Improving our understanding of the
aetiology of violence
•
•
Wang Yan (WPR)
Gopalkrishna Gururaj
(SEAR)
•
•
Liz Eckerman (WPR)
Srikala Barath (SEAR)
•
•
Simon Yanis (WPR)
Panpimol Lotrakul (SEAR)
Discussions
14:45-15:00
15:00-16:30
Tea/Coffee Break
Prevention and policy responses
Discussions
DAY TWO: Friday, 17 November 2000
09:00-10:45
Contributions and limitations of the
public health approach to violence
•
•
Sham Kasim (WPR)
Mintasih Latief (SEAR)
Discussions
10:45-11:00
Tea/Coffee Break
11:00-12:45
Role of the health sector and other
sectors
Bernadette Madrid
(WPR)
Prawate
T antipi watanaskul
(SEAR)
Discussions
12:45-14:00
Lunch
14:00-15:00
Regional strategies for the release of
the report
Harsaran Bir Kaur
Pandey, Information
Officer SEARO
Discussions
15:00-15:15
Tea/Coffee Break
15:15-16:30
Reporting on the out come of the
consultation
•
•
CLOSING
Saw at Ramaboot
(SEARO)
Pang Ruyan (WPRO)
REGIONAL OFFICE FOR
SOUTH-EAST ASIA
WORLD HEALTH
ORGANIZATION
Regional Consultation on World Report on
Violence and Health, SEARO, New Delhi
16-17 November 2000
SEA/DPR/Meet/2/4
13 November 2000
Registry file No. R4/48/1
LIST OF PARTICIPANTS
AUSTRALIA
Dr. Liz Eckerman:
Senior Lecturer in Health Sociology
Deakin University,
Geelong, Victoria, Australia.
CHINA
Dr Wang Van
Professor, Director
Department of Maternal and Child Health, School of
Public Health, Beijing Medical University,
Beijing, China
INDIA
Dr Thelma Narayan
Director
Community Health Cell,
Bangalore, India
Dr (Ms) Srikala Barath
Associate Professor of Psychiatry
National Institute of Mental Health, and Neuro Sciences
Bangalore, India
Dr Gopalkrishna Gururaj
Additional Professor and Head
Department of Epidemiology, National Institute of Mental
Health and Neuro Sciences,
Bangalore, India
Prof. Dinesh Mohan
Director, Indian Institute of Technology, New Delhi
INDONESIA
Dr Mintarsih Latief
Psychiatrist
Jakarat State Hospital
Jakarta, Indonesia
MALAYSIA
Dr Mohd Sham Kasim
Dean, Faculty of Medicine and Health Sciences
Universiti Putra Malaysia
Selangor, Malaysia
PAPUA NEW GUINEA
Mr Simon Yanis
Civil Registry
Department of Home Affairs
Waigani, Papua New Guinea
PHILIPPINES
Dr Bernadette Madrid
Department of Pediatrics
Philippines General Hospital
University of Philippines
Manila, Philippines
THAILAND
Dr Panpimol Lotrakul
Director of Mental Health Promotion and Prevention
Section, Department of Mental Health
Ministry of Public Health
Nonthaburi, Thailand
Dr Prawate Tantipiwatanaskul
Director
Child Mental Health Centre
Bangkok, Thailand
WHO SECRETARIAT
WHO HEADQUARTERS
Dr Etienne Krug
Director Department of Injuries and Violence Prevention
(VIP)
Dr Linda Dahlberg
WHO STC, World Report on Violence and Health
WHO-SEARO
Dr Imam S. Mochny
Director, Social Change and Non-Communicable
Diseases Department (SCN)
Dr Vijay Chandra
Regional Adviser, Health and Behaviour (H&B)
Dr Sawat Ramaboot
Regional Adviser, Disability, Injury Prevention and
Rehabilitation (DPR)
Dr Sawat Ramaboot
Regional Adviser, Disability, Injury Prevention and
Rehabilitation (DPR)
Ms Harsaran Pandey
Information Officer (IO)
Mr J.S. Narula
Administrative Assistant
Mr Naresh Mitroo
Senior Administrative Secretary
Mr Kalipada Das
Administrative Secretary
WPRO
Dr. Pang Ruyan
Regional Adviser, Reproductive Health
SEA/DPR/Meet/2/5
Regional Consultations
Public Health Challenges
Guidelines for Brief Presentations and Discussion
The regional consultations will focus on five major public health challenges. For each challenge,
there will be a 15-minute presentation by a member of the region, a discussion period, and a
summary of the top 5 recommendations related to the particular challenge. The purpose of the
brief presentations is to provide background information to help guide and facilitate the
discussion. The presentations should be brief - no more than 15 minutes - and should provide
an overview of what is known in the region with respect to the particular challenge. Listed
below are guidelines for the regional members to consider when developing the presentations.
Challenge 1: Improving the Availability, Collection and Quality of Data
1. Provide a brief overview of the types of data available within the region to describe the
magnitude and impact of violence (e.g., vital statistics, data from other registries, police,
health, judiciary data, crime surveys, community surveys, etc.).
2. Provide an overview of what types of information are collected across these various data
sources; how often is information collected, etc.
3. Discuss the adequacy of the data for capturing different types of violence and for measuring
fatal and non-fatal outcomes, morbidity, and other health consequences.
4. Provide a brief overview of the major strengths and limitations of the available data sources.
What are some possible strategies for improving the availability, collection, and quality of
data?
Challenge 2: Improving Our Understanding of the Etiology of Violence
1.
Provide an overview of how well the problem of violence is understood in the region (i.e.,
how much research on violence is being conducted in the region, by whom, and for what
purposes?).
2.
Are all types of violence (e.g., child abuse, youth violence, violence against women, elder
abuse, suicide, collective violence, etc.) being adequately researched or are some receiving
more widespread attention?
3.
Which groups, agencies, or institutions are primarily involved in the study of violence within
the region? Are any agencies or groups responsible for stimulating or coordinating violence
research?
4.
Is research primarily focused on individuals? Any research being conducted on ecological
factors (e.g., larger social, economic, and cultural factors)?
5.
What are some of the major barriers to studying violence in the region? What are some of
the possible avenues for overcoming these barriers?
Page 2
Challenge 3: Prevention and Policy Responses
1. Provide a brief overview of the nature and extent of prevention and policy responses within
the region?
2. Are some types of violence receiving more attention than others?
3. Which groups, agencies, or institutions are primarily involved in developing, implementing,
and evaluating prevention programs and policy responses?
4. What are the major barriers to developing and implementing prevention programs? What
are some of the possible avenues for overcoming these barriers?
5. Are prevention programs ever evaluated? What is the nature and extent of evaluations (e.g.,
process evaluations, impact or outcome evaluations?).
Challenge 4: Contributions and Limitations of the Public Health Approach
1. Provide a brief overview of the public health approach to violence.
2. How well is the public health approach understood and practiced in the region?
3. Describe how the public health approach can possibly contribute to understanding violence
within the region.
4. What are some of the major drawbacks to using this approach?
Challenge 5: Role of the Health Sector and Other Sectors
1. To what extent is the health sector in your region involved in violence prevention efforts?
2. How can the health sector within your region be better utilized for data collection, research
and prevention purposes?
3. Are other sectors within the region involved in violence prevention efforts?
4. What are some of the major barriers limiting involvement of the health sector and other
sectors (e.g. criminal justice, education, labour, and social services) in violence prevention
efforts?
5. What are some of the possible avenues for advocating or facilitating the involvement of these
sectors in violence prevention efforts?
World Health Organization
Organisation mondiale de la Sante
i
Violence and Injury Prevention Department
Non-communicable Disease and Mental Health
World Report on Violence and Health
Review Form for Participants in Regional Consultations
Thank you very much for your willingness to provide comments on the draft World
Report on Violence. Your input is very valuable. We ask that you make your comments
in writing, in advance ofthe consultation and bring them with you to the consultation or
send them by e-mail to Ms L. Sminkey at sminkeyl@who.int Please use this form to
make your comments and add additional pages ifneeded. We will also send the form to
you by e-mail. Ifyou have not received the electronic version ofthis form at the time of
receiving the draft report by express mail, then please let Ms Sminkey know and we will
send it again.
We will try as much as possible to address the comments that you will make. To facilitate
that process, please make your suggestions as specific and concrete as possible. For
example, ifyou would like additional information to be discussed, suggest the topic, the
chapter in which to include it, the experts to approach, citations for the relevant
literature to include, case studies or country examples, etc. Ifpossible bring copies of
the material that should be incorporated/cited to the consultation. The more concrete you
will be, the more likely it is that we will be able to include this additional information.
1
World Report on Violence and Health
Review Form for Participants in Regional Consultations
Name participant:
Date of review:
1. Even though the report is in draft form, do you feel that it will achieve the
planned objectives as discussed in “Why this Report”?
Yes
No. If no, please explain why not and how this could be addressed:
2. Please describe how useful the Report will be for violence prevention in your
region.
3. Does the Report address the issue of violence in a cross-cultural/international
way?
4. What are the main strengths of the report?
2
"7
5. What are the main weaknesses of the report?
6. How should these weaknesses be addressed?
7. Is the style appropriate for the target audience as described in “Why this
Report”?
8. Is the content of the Report relevant for your region?
9. Are there important violence-related issues in your region that should have been
included in the Report or should have been discussed in more detail? Please
explain which, why they should be included, and provide suggestions on how to
do that.
3
10. Please provide chapter specific comments on:
Introduction:
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
Youth violence
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
Child Maltreatment
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
4
Intimate partner violence
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
Elderly abuse
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
Sexual violence
□ I did not read this outline
□ I read this outline and have no comments
□ I read this outline and would like to make the following
suggestions:
5
Organized violence:
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
Self-directed violence:
□ I did not read this chapter
□ I read this chapter and have no comments
□ I read this chapter and would like to make the following
suggestions:
List of tables:
□ I did not read the list of tables
□ I read the list of tables and have no comments
□ I read the list of tables and would like to make the
following suggestions:
6
f
Table with proposed testimonies:
□ I did not read this table
□ I read this table and have no comments
□ I read this table and would like to make the following
suggestions:
Useful resources:
□ I did not read this section
□ I read this section and have no comments
□ I read this section and would like to suggest that the
following resources be added:
11. Other comments?
12. Overall rating of the Report: 1.....
Very weak
5
....10
Excellent
7
\i
6
CDC
October 27, 2000 / Vol. 49 / No. RR-11
CENTERS FOR DISEASE CONTROL
AND PREVENTION
MORBIDITY AND MORTALITY
WEEKLY REPORT
Recommenda tions
and
Reports
Building Data Systems for
Monitoring and Responding to
Violence Against Women
Recommendations from a Workshop
f-
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention (CDC)
Atlanta, GA 30333
SERV!cfj.
I
o
t
The MMWR series of publications is published by the Epidemiology Program Office,
Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Hu
man Services, Atlanta, GA 30333.
SUGGESTED CITATION
Centers for Disease Control and Prevention. Building data systems for monitoring
and responding to violence against women: recommendations from a workshop.
MMWR2000;49(No. RR-11):[inclusive page numbers].
Jeffrey P. Koplan, M.D., M.P.H.
Director
Centers for Disease Control and Prevention
The material in this report was prepared for publication by
National Center for Injury Prevention and Control .. Stephen B. Thacker, M.D., M.Sc.
Acting Director
Rodney W. Hammond, Ph.D.
Director
Division of Violence Prevention
Edward J. Sondik, Ph.D.
Director
National Center for Health Statistics
Office of Analysis, Epidemiology, and
Health Promotion
Jennifer H. Madans, Ph.D.
Acting Associate Director
The production of this report as an MMWRserial publication was coordinated in
Epidemiology Program Office
Barbara R. Holloway, M.P.H.
Acting Director
Office of Scientific and Health Communications
CDC Surveillance Summaries
John W. Ward, M.D.
Director
Editor, MMWR Series
....Suzanne M. Hewitt, M.P.A.
Managing Editor
Rachel J. Wilson
Project Editor
Beverly J. Holland
Visual Information Specialist
Michele D. Renshaw
Erica R. Shaver
Information Technology Specialists
Vol. 49/No. RR-11
MMWR
i
Contents
1
Background.............................................................................................
1
Introduction.............................................................................................
3
The Work Groups...................................................................................
3
Work Group on Defining and Measuring VAW..........................
Work Group on State and Local Data for Studying and
4
Monitoring VAW............................................................................
Work Group on National Data for Studying and
4
Monitoring VAW............................................................................
4
Work Group on New Research Strategies for Studying VAW..
6
Recommendations...............................................................................
6
Defining the Scope of the Problem...............................................
Need for Multiple Measures/Collaboration Across Disciplines
.8
and Agencies....................................................
.9
Developing Strategies to Collect Data on VAW..........................
13
Methodologic Concerns..................................................................
14
Confidentiality and Safety...............................................................
15
Conclusions...........................................................................................
16
References...............................................................................................
MMWR
ii
October 27, 2000
Workshop on Building Data Systems for Monitoring and Responding to
Violence Against Women (VAW)
Participants from the U.S. Department of Justice
Bernard Auchter, M.S.W.
National Institute of Justice
Washington, DC
Michael Rand
Bureau of Justice Statistics
Washington, DC
Noel Brennan, M.A., J.D.
Office of Justice Programs
Washington, DC
Leora Rosen, Ph.D.
National Institute of Justice
Washington, DC
Jan Chaiken, Ph.D.
Bureau of Justice Statistics
Washington, DC
Kathy Schwartz
Office of Justice Programs
Washington, DC
Sally Hillsman, Ph.D.
National Institute of Justice
Washington, DC
Jeremy Travis, J.D.
National Institute of Justice
Washington, DC
Rebecca Kraus, Ph.D.
National Institute of Justice
Washington, DC
Christy Visher, Ph.D.
National Institute of Justice
Washington, DC
Angela Moore-Parmley, Ph.D.
National Institute of Justice
Washington, DC
Participants from the U.S. Department of Health and Human Services
Caroline Aoyama, M.P.H.
Health Resources and Services
Administration
Bethesda, MD
Marla Aron, M.A.S.
Health Care Financing Administration
Baltimore, MD
Katie Baer, M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
Kate Brett, Ph.D.
Centers for Disease Control and Prevention
Hyattsville, MD
Cathy Burt, Ed.D.
Centers for Disease Control and Prevention
Hyattsville, MD
Marsha Davenport, M.D.
Health Care Financing Administration
Baltimore, MD
Janet Fanslow, Ph.D.
Centers for Disease Control and Prevention
Atlanta, GA
Lois Fingerhut, M.A.
Centers for Disease Control and Prevention
Hyattsville, MD
Mary Goodwin, M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
Malcolm Gordon, Ph.D.
National Institute of Mental Health
Rockville, MD
Marcy Gross
Agency for Health Care Policy and Research
Rockville, MD
Rodney Hammond, Ph.D.
Centers for Disease Control and Prevention
Atlanta, GA
Vol. 49/ No. RR-11
MMWR
iii
Workshop on Building Data Systems for Monitoring and Responding to
Violence Against Women (VAW) — Continued
Participants from the U.S. Department of Health and Human Services
Martha Highsmith
Centers for Disease Control and Prevention
Atlanta, GA
Francess Page, R.N., M.P.H.
Office of Women's Health
Washington, DC
John Horan, M.D., M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
Curtis Porter, M.P.A.
Administration for Children and Families
Washington, DC
Sandra Howard
Office of the Assistant Secretary for
Planning and Evaluation
Washington, DC
Carolina Reyes, M.D.
Agency for Health Care Policy and Research
Rockville, MD
Susan Jack, M.S.
Centers for Disease Control and Prevention
Hyattsville, MD
Lynn Jenkins, M.A.
Centers for Disease Control and Prevention
Washington, DC
Mark Rosenberg, M.D., M.P.P.
Centers for Disease Control and Prevention
Atlanta, GA
Ann Rosewater, M.A.
Immediate Office of the Secretary
Washington, DC
Wanda Jones, Dr.P.H..
Office of Women's Health
Washington, DC
Beatrice Rouse
Substance Abuse and Mental Health Services
Administration
Rockville, MD
Ken Kochanek, M.A.
Centers for Disease Control and Prevention
Hyattsville, MD
Linda Saltzman, Ph.D.
Centers for Disease Control and Prevention
Atlanta, GA
Jean Kozak, Ph.D.
Centers for Disease Control and Prevention
Hyattsville, MD
Fred Seitz, Ph.D.
Centers for Disease Control and Prevention
Hyattsville, MD
Mary Ann MacKenzie
Administration for Children and Families
Washington, DC
Jerry Silverman, M.S.W.
Office of the Assistant Secretary for
Planning and Evaluation
Washington, DC
Pamela McMahon, Ph.D., M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
James Mercy, Ph.D.
Centers for Disease Control and Prevention
Atlanta, GA
Jo Mestelle
Administration for Children and Families
Washington, DC
Edward Sondik, Ph.D.
Centers for Disease Control and Prevention
Hyattsville, MD
Daniel Sosin, M.D., M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
MMWR
iv
October 27, 2000
Workshop on Building Data Systems for Monitoring and Responding to
Violence Against Women (VAW) — Continued
Other Participants
Ronet Bachman, Ph.D.
University of Delaware
Newark, DE
Patricia Edgar, Ph.D.
Carnegie Mellon University
Pittsburgh, PA
Carolyn Rebecca Block, Ph.D.
Illinois Criminal Justice Information
Authority
Chicago, IL
Bonnie Fisher, Ph.D.
University of Cincinnati
Cincinnati, OH
Ruth Brandwein, Ph.D.
State University of New York
Stony Brook, NY
Tim Bynum, Ph.D.
Michigan State University
East Lansing, Ml
Donald Camburn, B.G.S.
Research Triangle Institute
Research Triangle Park, NC
Jacquelyn Campbell, Ph.D., R.N.
Johns Hopkins University
Baltimore, MD
Linda Chamberlain, Ph.D.
Alaska Department of Health and
Social Services
Anchorage, AK
Kathleen Chard, Ph.D.
University of Kentucky
Lexington, KY
Mary Ellen Colten, Ph.D.
University of Massachusetts at Boston
Boston, MA
Andrea Craig, M.P.H., M.S.W.
San Francisco Injury Center for
Research and Prevention
San Francisco, CA
Walter DeKeseredy, Ph.D.
Carleton University
Ottawa, Ontario, Canada
Mary Ann Dutton, Ph.D.
George Washington University
Bethesda, MD
Richard Gelles, Ph.D.
University of Pennsylvania
Philadelphia, PA
Marijan Grogoza
Mansfield Police Department
Mansfield, OH
Jeanne Hathaway, M.D.
Massachusetts Department of Public Health
Boston, MA
Nancy Isaac, Ph.D.
Northeastern University
Roxbury, MA
Susan Keilitz, J.D.
National Center for State Courts
Williamsburg, VA
Dean Kilpatrick, Ph.D.
Medical University of South Carolina
Charleston, SC
Mary Koss, Ph.D.
University of Arizona
Tucson, AZ
Colin Loftin, Ph.D.
University at Albany
State University of New York
Albany, NY
James Lynch, Ph.D.
American University
Washington, DC
Eleanor Lyon, Ph.D.
University of Connecticut
Storrs, CT
Michael Maltz, Ph.D.
University of Illinois at Chicago
Chicago, IL
MMWR
Vol. 49 / No. RR-11
Workshop on Building Data Systems for Monitoring and Responding to
Violence Against Women (VAW) — Continued
Other Participants
Sandra Martin, Ph.D.
University of North Carolina at Chapel Hill
Chapel Hill, NC
Joslan Sepulveda, M.P.H.
University of California, Los Angeles
Los Angeles, CA
Wendy Max, Ph.D.
University of California
San Francisco, CA
Anuradha Sharma, M.P.H.
National Resource Center on Domestic
Violence
Harrisburg, PA
Anne Menard
National Resource Center on Domestic
Violence
Harrisburg, PA
Jay Silverman, Ph.D.
Massachusetts Department of Public Health
Boston, MA
Susan Murty, Ph.D., M.S.W.
University of Iowa
Iowa City, IA
Patricia Smith, M.S.
Michigan Department of Community Health
Lansing, Ml
Stan Orchowsky, Ph.D.
Justice Research and Statistics Association
Washington, DC
Paula Kovanic Spiro, M.P.H.
University of Pittsburgh
Pittsburgh, PA
Miriam Ornstein, M.P.H.
Research Triangle Institute
Research Triangle Park, NC
Murray Straus, Ph.D.
University of New Hampshire
Durham, NH
Carol Petrie
National Research Council
Washington, DC
Nancy Thoennes, Ph.D.
Center for Policy Research
Denver, CO
Mark Prior, M.S.
Administrative Office of the Trial Court
Boston, MA
Patricia Tjaden, Ph.D.
Center for Policy Research
Denver, CO
Claire Renzetti, Ph.D.
St. Joseph's University
Philadelphia, PA
Wendy Verhoek-Oftedahl, Ph.D.
Brown University
Providence, Rl
Sarah Ryan
University of Nevada
Las Vegas, NV
Anna Waller, Sc.D.
University of North Carolina
Chapel Hill, NC
Laura Sadowski, M.D., M.P.H.
Cook County Hospital
Chicago, IL
Linda Williams, Ph.D.
Wellesley College
Wellesley, MA
Joanne Schmidt, M.S.W.
City of New Orleans
New Orleans, LA
Susan Wilt, Ph.D., M.D.
New York City Department of Health
New York, NY
Martin Schwartz, Ph.D.
Ohio University
Athens, OH
v
vi
MMWR
October 27, 2000
The following CDC staff members prepared this report:
Linda E. Saltzman, Ph.D.
Division of Violence Prevention
National Center for Injury Prevention and Control
Lois A. Fingerhut, M.A.
Office of Analysis, Epidemiology, and Health Promotion
National Center for Health Statistics
in collaboration with
Michael R. Rand
Bureau of Justice Statistics
U.S. Department of Justice
Christy Visher, Ph.D.
National Institute of Justice
U.S. Department of Justice
MMWR
Vol. 49/ No. RR-11
1
Building Data Systems for Monitoring and
Responding to Violence Against Women
Recommendations from a Workshop
Summary
This report provides recommendations regarding public health surveillance
and research on violence against women developed during a workshop,
"Building Data Systems for Monitoring and Responding to Violence Against
Women." The Workshop, which was convened October 29-30, 1998, was co
sponsored by the U.S. Department of Health and Human Services and the U.S.
Department of Justice.
BACKGROUND
<
Available data suggest that violence against women (VAW) (i.e., both adolescents
and adults) is a substantial public health problem in the United States. Law enforce
ment data indicate that 3,419 females died in 1998 as a result of homicide (7), and
approximately one third of these women were murdered by a spouse, ex-spouse, or
boyfriend. Data regarding nonfatal cases of assault are less accessible and are often
inconsistent because of methodologic differences. However, recent survey data col
lected during 1995-1996 suggest that approximately 2.1 million women are physically
assaulted or raped annually; 1.5 million of these women are physically assaulted or
raped by a current or former intimate partner (2). Based on survey data from the Bu
reau of Justice Statistics' National Crime Victimization Survey, in 1998, women were
victims in nearly 900,000 violent crimes committed by an intimate partner (3). Although
these and other statistics suggest the magnitude of the problem, some experts believe
that statistics on violence against women underrepresent the problem; others believe
that some studies overestimate the extent of violence against women. Such lack of
consensus and confusion about the different findings from various data sources
prompted the establishment of the Workshop in October 1998.
INTRODUCTION
The U.S. Department of Health and Human Services (DHHS) and the U.S. Depart
ment of Justice (DOJ) co-sponsored the workshop "Building Data Systems for Moni
toring and Responding to Violence Against Women" in October 1998. The 2-day
invitational workshop, funded by CDC's National Centerfor Injury Prevention and Con
trol (NCIPC) and National Center for Health Statistics (NCHS) along with the Bureau of
Justice Statistics (BJS) and the National Institute of Justice (NIJ), brought together
researchers and practitioners from the public health and criminal justice fields.
Earlier in 1998, the U.S. Secretary of Health and Human Services and Attorney Gen
eral held a joint briefing that focused on the nature and extent of \I/\\N. During the
briefing, concerns were raised over differences among published estimates of rape,
sexual assault, and intimate-partner violence and the resulting difficulties for develop
ing and implementing effective programs and policies. The briefing also highlighted
MMWR
2
October 27, 2000
current knowledge about the magnitude of violence against women and identified ar
eas in which more information is needed. The Workshop was an outcome of this brief
ing and was conceived as a first step in a long-term effort to more accurately measure
VAW and to conduct sound research.
In planning the Workshop, the Steering Committee* conceptualized VAW as encom
passing many types of behaviors and relationships between victims and perpetrators.
The Committee decided to focus on that subset of VAW categorized as intimate-partner
violence and sexual violence by any perpetrator (Figure 1). In addition, several issues
FIGURE 1. Categories of interpersonal violence
Interpersonal
Violence
Violence
Against
Women
Sexual Assault
Intimate-Partner Violence
NOTE: Because the exact proportions of these categories are unknown, the areas in the figure
are not drawn to scale.
*Steering Committee members from the U.S. Department of Health and Human Services (DHHS)
included Linda E. Saltzman (National Center for Injury Prevention and Control [NCIPC], CDC),
Lois A. Fingerhut (National Center for Health Statistics, CDC), James A. Mercy (NCIPC, CDC),
Jerry Silverman (DHHS), and Malcolm Gordon (National Institute of Mental Health, National
Institutes of Health). Members from the U.S. Department of Justice included Christy Visher
(National Institute of Justice [NIJ], Office of Justice Programs [OJP]), Michael R. Rand (Bureau
of Justice Statistics, OJP), and Bernard Auchter (NIJ, OJP).
Vol. 49/ No. RR-11
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were identified as needing to be addressed, including a) collection of national, state,
and local VAW data from both public health and criminal justice sources to represent
different perspectives; b) definitions and methodologies; and c) concerns about the
availability of social services for VAW victims. The Steering Committee commissioned
six background papers that targeted these issues. All Workshop participants were pro
vided copies of these papers before the workshop. Each paper was presented at the
Workshop, followed by comments from one or more respondents.*
This Workshop addressed the opportunities and challenges associated with public
health surveillance (i.e., the ongoing and systematic collection, analysis, and interpre
tation of information) and research relating to VAW. The goals of the workshop were to
• develop information and make recommendations enabling researchers to better
describe and track VAW;
• share information about data collection for VAWZ with emphasis on intimate
partner violence and sexual violence; and
• identify gaps and limitations of existing systems for ongoing data collection
regarding VAW.
THE WORK GROUPS
Workshop attendees were divided into four work groups that met twice during the
2-day meeting. The groups were asked to develop recommendations on the following
four topics related to the background papers and presentations:
• defining and measuring VAW;
• state and local data for studying and monitoring VAW;
• national data for studying and monitoring VAW; and
• new research strategies for studying VAW.
Work Group on Defining and Measuring VAW
The purpose of this work group was to identify and make recommendations about
resolving problems resulting from the absence of uniform definitions associated with
VAW. VAW is a broad term, encompassing a wide range of behaviors. Definitions of
VAW should be established that are comprehensive enough to encompass women's
physical and psychological experiences of violence, yet that are not so broad that they
encompass behaviors that cannot be validly defined as VAW. It is unknown which data
elements are most critical, or even possible, to collect. In addition to identifying compo
nents that are critical to defining and measuring VAW, this work group was asked to
address questions about how to develop new measurement instruments or enhance
existing ones to improve the quality of VAW data collected. The work group was di
rected to address which aspects of VAW should be measured (e.g., the occurrence of
acts and the number of victims).
*Revisions of the background papers have been peer-reviewed and published (4-77).
4
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October 27, 2000
Work Group on State and Local Data for Studying and
Monitoring VAW
This work group was charged with developing recommendations regarding how
state and local data systems could be improved for monitoring and characterizing VAW.
They were asked to identify the key opportunities and methodologic challenges in us
ing state and local data sources and to offer potential solutions for overcoming the
identified challenges. The work group considered what types of data items should be
collected; which data systems have the greatest utility for monitoring and characteriz
ing VAW at the state and local levels; how greater uniformity in definitions and types of
data collected on VAW can be fostered; and the challenges of data linkage.
Work Group on National Data for Studying and
Monitoring VAW
This work group was charged with developing recommendations regarding howto
improve and optimize national data for monitoring and characterizing VAW and its key
dimensions (e.g., intimate-partner violence and sexual assault). The workgroup recog
nized that national data are collected from various data sources designed for different
purposes. The group considered 18 surveys and surveillance systems that either con
tribute data or have the potential to contribute data toward measuring some aspect of
VAW (Table 1). Although this list is not comprehensive, it served as a reference for a
discussion about what makes a survey or a data system useful for monitoring VAW.
In addition, the group considered some of the factors that determine the utility and
reliability of VAW estimates (Table 2). None of the 18 surveys or surveillance systems
considered by the work group are ideal for measuring VAW; however, four surveys (i.e.,
the National Crime Victimization Survey, the National Violence Against Women Sur
vey, the National Youth Survey, and the National Women's Study) are likely the most
useful and reliable. Data from each of these surveys can be used to produce estimates
of prevalence, incidence, and chronicity.
Some surveys (e.g., the National Family Violence Survey) can be used to derive
prevalence estimates but are not conducted on an ongoing basis. One reporting sys
tem, the National Incident-Based Reporting System, is ongoing but is being used by
only a few states and thus does not provide nationally representative data. In addition,
none of the ongoing surveys collect detailed VAW data. Some of the surveys and sur
veillance systems could potentially be modified to include additional questions related
to VAW (e.g., the National Health Interview Survey and the National Electronic Injury
Surveillance System). Although several factors (e.g., comorbidity and etiology) are
addressed by a few surveys, these surveys do not provide incidence or prevalence
estimates.
Work Group on New Research Strategies for Studying VAW
The purpose of this work group was to make recommendations for new methods of
data collection and data analysis to better understand and characterize VAW. The group
considered new data sources, ways to improve identification of VAW in existing data
bases, and data linkages. In addition, they discussed new methods of assessing
a) exposure to violence and b) intervention outcomes, with emphasis on service deliv
ery settings that can become sources of data regarding the prevalence and experiences
of battered women.
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TABLE 1. Sources and potential sources of national data on violence and abuse against
women
Source
Criminal justice
Supplementary Homicide
Reports (SHR)*
Web site(s)
Sponsor(s)
www.fbi.gov/ucr.htm
www.ojp.usdoj.gov/bjs/homicide/
addinfo.htm
FBI
National Crime
Victimization Survey*
www.ojp.usdoj.gov/bjs/
BJS
National Incident-Based
Reporting System*
www.fbi.gov/ucr.htm
FBI
www.cdc.gov/nchs/about/major/ahcd/
namcsdes.htm
www.cdc.gov/nchs/about/major/ahcd/
nhamcsds.htm
CDC (NCHS)
National Hospital
Discharge Survey
National Health Interview
Survey
www.cdc.gov/nchs/about/major/hdasd/
nhds.htm
www.cdc.gov/nchs/nhis.htm
CDC (NCHS)
National Survey of Family
Growth
www.cdc.gov/nchs/nsfg.htm
CDC (NCHS)
National Vital Statistics
System
www.cdc.gov/nchs/about/major/dvs/
mortdata.htm
cpsc.gov/cpscpub/pubs/3002.html
CDC (NCHS)
165.112.78.61/DESPR/MTF.html
SAMHSA, University
of Michigan
www.cdc.gov/nccdphp/dash/yrbs/ov.htm
CDC (NCCDPHP)
Behavioral Risk Factor
Surveillance System
www.cdc.gov/nccdphp/behavior.htm
CDC (NCCDPHP)
National Violence Against
Women Survey
(1995-1996)*
National Family Violence
Survey (1975,1985)*
ncjrs.org/pdffiles1/nij/181867.pdf
ncjrs.org/pdffiles/172837.pdf
ncjrs.org/pdffiles/169592.pdf
www.icpsr.umich.edu/cgi/ab.prl?file=9211
www.icpsr.umich.edu/cgi/ab.prl?file=7733
socio.com/srch/summary/afda/fam31.htm
socio.com/srch/summary/afda/fam32.htm
NIJ, CDC(NCIPC)
National Youth Survey
(1976-1989)*
www.sscnet.ucla.edu/issr/da/index/techinfo/
m2491.htm
National Survey of Family
and Households (19871988 and 1992-1994)*
156.40.88.3/about/cpr/dbs/
res_national4.htm
socio.com/srch/summary/afda/
fam01-05.htm
www.musc.edu/CVC/NIDApubs/htm
NIH (NIMH, NIDA),
OJJDP, NIJ
NIH (NICHHD)
Health care
National Ambulatory
Medical Care Survey
National Hospital
Ambulatory Medical
Care Survey
National Electronic Injury
Surveillance System
Monitoring the Future
Other
Youth Risk Behavior
Surveillance System
National Women's Study
(1989)*______________
CDC (NCHS)
CDC (NCHS)
CPSC
NIH (NIMH)
NIH (NIDA)
NOTE: FBI=Federal Bureau of Investigation; BJS=Bureau of Justice Statistics; NCHS=National Center for Health
Statistics; CPSC=Consumer Product Safety Commission; SAMHSA=Substance Abuse and Mental Health
Services Administration; NCCDPHP=National Center for Chronic Disease Prevention and Health Promotion;
NIJ=National Institute of Justice; NCIPC=National Center for Injury Prevention and Control; NIH=National
Institutes of Health; NIMH=National Institute of Mental Health; NIDA=National Institute of Drug Abuse;
OJJDP=Office of Juvenile Justice and Delinquency Prevention; NICHHD=National Institute of Child Health
and Human Development.
includes specific data or direct questions regarding violence against women.
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TABLE 2. Questions to consider in determining the utility and reliability of surveillance
based estimates of violence against women (VAW)________________________________
Factor
Periodicity
Questions to consider__________________________________________
Is the survey ongoing or periodic (i.e., repeated overtime), as opposed to
a one-time survey?
Precision
Are the survey results based on large samples so that standard errors are
minimized, or are data based on a census or complete count?
Supplement
Does the survey include or have the potential to include a supplement or
a follow-back component (i.e., a mechanism to recontact survey respon
dents for additional information) to better estimate VAW?
Health services
Does the survey measure health-care utilization for VAW?
Social services
Does the survey measure social-services utilization for VAW?
Etiology
Can risk factors be estimated?
Co-morbidity
Does the survey include drug or alcohol abuse or other conditions that
could affect the magnitude of VAW?
Methodology
Can the survey be used to explore methodologic questions?
Prevalence
Can the survey be used to estimate annual or lifetime prevalence of
VAW?
Incidence
Can the survey be used to estimate incident cases of VAW?
Chronicity
Can the survey be used to estimate the number of episodes of violence/
abuse per victim per year?
RECOMMENDATIONS
The following recommendations, which were developed by the four work groups,
are categorized by several broad topics. Because the workshop was organized into four
work groups, similar recommendations were conceived for several topics. Some of the
recommendations could have been categorized under more than one topic; however,
to avoid repetition, these recommendations are listed only in the most appropriate
category.
Although some recommendations may seem similar, they are not identical and were
developed by different work groups and from different perspectives. The recommen
dations do not reflect consensus from the entire workshop. Thus, for each bulleted
recommendation, the work group responsible for its conception is identified in paren
theses following the statement.
Defining the Scope of the Problem
• CDC has initiated a process to develop and pilot test uniform definitions
associated with intimate-partner violence (12). These uniform definitions should
be used as the basis for defining and measuring VAW, with the following
modification. The term "violence and abuse against women" (VAAW) should
become standard. The "VAAW" term can provide a middle ground between the
desire not to muddle the generally understood meaning of the term "violence"
(i.e., actions that cause or threaten actual physical harm) and the desire not to
overlook psychological/emotional forms of abuse and the trauma and social costs
Vol. 49 /No. RR-11
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they cause to victims. Continuing to use only the term "VAW" supports the
misconception that a woman is only abused if she has broken bones or other
physical injuries. Both practice guidelines and published research document the
psychological and psychiatric sequelae of violence against women (13} and the
substantial use of mental health services by victims of intimate-partner violence
(74).* (Work Group on Defining and Measuring VAW)
• "Violence" is a term that encompasses a broad range of maltreatment against
women. The phrase "violence and abuse against women" should be used to refer
to the combination of all five of the following major components of such
maltreatment:
- physical violence;
- sexual violence;
-threats of physical and/or sexual violence;
- stalking; and
- psychological/emotional abuse.
The first three components — physical violence, sexual violence, and threats
of physical and/or sexual violence — should comprise a narrower category of
VAW. Accusations have been made that VAW statistics are falsely inflated with
subjective measures of psychological abuse (5). With the recommended termi
nology and classification scheme, the first three categories can be combined and
reported as VAW. All five components of maltreatment against women can still
be used to represent a larger spectrum of behaviors harmful to women.
Consensus was reached that stalking should be included as a component of
VAAW; however, no consensus was reached regarding whether stalking should
be included in the narrower category of VAW, considered psychological/emo
tional abuse, or treated as a discrete category. Whether stalking requires the
presence of a clear threat to do physical harm is an unresolved issue. Future
research on stalking may help clarify the category in which stalking should be
included.* (Work Group on Defining and Measuring VAW)
• Data should be collected on as many of the five major components of VAAW as
possible, and data collection should allowfor examination of the co-occurrence of
the components.* (Work Group on Defining and Measuring VAW)
• Research, program, and public health surveillance data should report
disaggregated statistics for each of the five forms of VAAW. Presentations of
VAAW data should show cross-tabulations or Venn diagrams for all of the forms
of maltreatment.* (Work Group on Defining and Measuring VAW)
*ln this report, the terms "VAW" and "VAAW" are used by the Work Group on Defining and
Measuring VAW to represent different components of violence against women. This work group
suggested the use of specific terminology to differentiate the term "violence" from "abuse."
Because each work group's recommendations were not presented to the other groups until the
conclusion of the workshop, whether consensus might have been reached by the entire workshop
is unknown. In this report, the term "VAAW" was not incorporated into recommendations from
other work groups.
8
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October 27, 2000
• The use of common definitions and data elements should be encouraged.
Uniformity of definitions and data elements will increase the reliability of VAW
estimates across locale and time. A CDC-sponsored panel of invited experts
developed uniform definitions and a recommended set of data elements for
intimate-partner violence surveillance that are being tested by three states (12). In
addition, guidelines for public health surveillance of intimate-partner violence are
needed on local levels, potentially serving as a model for surveillance of other
forms of VAW. Federal agencies (e.g., those responsible for addressing the legal
or public health consequences of VAW) should jointly fund local surveillance
efforts. (Work Group on State and Local Data for Studying and Monitoring VAW)
Need for Multiple Measures/Collaboration Across Disciplines
and Agencies
• Personal interview surveys (national, state, and local) are a better tool for
measuring the extent ofVAWthan record reviews (e.g., medical, crime, and other
service delivery); however, no single or existing tool is sufficient to gauge and
track all dimensions of VAW. Multiple data collection efforts and funding of
health, criminal justice, and social services are needed. (Work Group on National
Data for Studying and Monitoring VAW)
• Because no single measurement tool can capture all of the elements of VAAW,
researchers and programs must continue drawing from existing tools and
developing new measures.* (Work Group on Defining and Measuring VAW)
• Multi-disciplinary research should be strongly encouraged. (Work Group on New
Research Strategies for Studying VAW)
• Experts in several different disciplines should be encouraged to collaborate with
researchers who specialize in VAW and to initiate similar research in their own
fields. Disciplines that currently or could potentially conduct research on VAW
include anthropology, business/management, criminal justice, demography,
economics, education, epidemiology, geography, journalism/mass communica
tion, philosophy/ethics, psychology, public health, social work, sociology,
substance abuse, suicidology, system analysis/operations research, theology,
urban/rural planning, and women's studies. In addition to these discipline-based
groups, such collaboration might also include persons whose research areas
focus on ethnicity, the behavior of boys and men, and research methodology (e.g.,
survey methodologists). (Work Group on New Research Strategies for Studying
VAW)
*ln this report, the terms /yVAW" and "VAAW" are used by the Work Group on Defining and
Measuring VAWto represent different components of violence against women. This workgroup
suggested the use of specific terminology to differentiate the term "violence" from "abuse."
Because each work group's recommendations were not presented to the other groups until the
conclusion ofthe workshop, whether consensus might have been reached by the entire workshop
is unknown. In this report, the term "VAAW" was not incorporated into recommendations from
other work groups.
Vol. 49 /No. RR-11
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• A chartbook or annual report should be produced to present the current available
data regarding VAW. In addition to describing the current state of VAW, such a
report would help identify areas in the data systems that need improvement or
areas in which more information is needed. (Work Group on National Data for
Studying and Monitoring VAW)
• DHHS and DOJ should jointly conduct methodologic research on VAW. Such
research could focus on several issues, such as the effect of context on prevalence
estimates (e.g., health versus criminal justice) and definitions (e.g., narrow versus
broad). (Work Group on National Data for Studying and Monitoring VAW)
• Collaboration between service providers and researchers in the conduct of
research activities will improve the quality of information collected about VAW.
Such collaboration requires the development of a true partnership at the start of
research activities (i.e., a partnership that includes the joint planning and
implementation of the research methodology, presentation and dissemination of
study findings, and using the research results to refine the services for victims and
perpetrators of violence). Such partnerships between researchers and service
providers should be studied to identify the types of activities and procedures that
are most useful. (Work Group on New Research Strategies for Studying VAW)
Developing Strategies to Collect Data on VAW
Building/Enhancing Measures of VAW
• The potential of existing data sets for characterizing and monitoring VAW should
be assessed. Data can be organized into four major categories: nationally
representative surveys, local health data, local criminal justice data, and nonnationally representative data from service providers. Ongoing, population
based surveys developed for other local or state purposes should be considered
as potential opportunities for studying VAW. Other ongoing surveys that contain
questions concerning VMV (although not all are currently conducted at the local
level or in all jurisdictions) include the Pregnancy Risk Assessment Monitoring
System (PRAMS) and the National Crime Victimization Survey (NCVS). Modules
or specific questions pertaining to VAW could also be added routinely to the
Behavior Risk Factor Surveillance System (BRFSS) or the Youth Risk Behavior
Surveillance System (YRBSS). Potential sources of local health data include
emergency departments, hospital discharge records, the Health Employer Data
Information System (HEDIS), sexual assault nurse examiner (SANE) programs,
mental health databases, medical examiner data, and trauma registries. Possible
sources for local criminal justice data include databases for misdemeanors,
restraining orders, court probation, and court-case tracking. Police departments,
forensic labs, and district attorney offices may also provide local criminal-justice
data. Service-provider data might be collected from battered women programs,
rape crisis centers, protective-service programs, victim-witness advocates, teen
dating violence prevention programs, child and family services, welfare offices,
and school counselors. (Work Group on State and Local Data for Studying and
Monitoring VAW)
10
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October 27z 2000
• Questions or supplements can be added to existing continuous surveys (e.g., the
National Survey of Family Growth, the National Health Interview Survey, and
BRFSS). Although supplements to surveys can be costly, adding questions to
ongoing surveys or conducting periodic supplements can be more cost-effective
in producing detailed data sets than creating new surveys. (Work Group on
National Data for Studying and Monitoring VAW)
• Asa cost-effective and efficient strategy for gathering data, questions or modules
concerning VAW could be added to numerous ongoing surveys. This activity
might be particularly useful if the survey is representative of a well-defined
population (e.g., persons living within a particular geographic region or persons
with other common characteristics) and is ongoing (e.g., following the same
persons or monitoring a changing population overtime). (Work Group on New
Research Strategies for Studying VAW)
• Monitoring efforts should focus on counting the number of women who are
victimized by VAAW. Future consideration should also be given to adding
measures that capture more accurately the number of perpetrators in the
population for each of the components of VAAW.* (Work Group on Defining and
Measuring VAW)
• Data used for monitoring should include past year prevalence, past year
frequency, and lifetime prevalence. The lifetime prevalence calculation
represents the physical health, mental health, and social consequences that can
occur years after violence or abuse has stopped. (Work Group on Defining and
Measuring VAW)
• Improved estimation of lifetime prevalence of VAW is needed. Of the ongoing
surveys, none can estimate lifetime prevalence of violence. (Work Group on
National Data for Studying and Monitoring VAW)
• Etiologic and co-morbidity information periodically should be collected (e.g.,
approximately every 5 years) as a supplement to a more routine monitoring
system because these data are relatively stable and because including such
information on a more frequent basis is costly. (Work Group on National Data for
Studying and Monitoring VAW)
• Collecting data within various settings and populations enhances perspectives
about VAW. Data from diverse settings and populations can provide information
regarding risk factors, consequences of violence, and service needs of particular
populations as well as how victims of violence fare in different health, judicial, or
social service systems. Settings and sources of information concerning VAW
include employment locations; faith communities; health-care settings (e.g.,
*ln this report, the terms "VAW" and "VAAW" are used by the Work Group on Defining and
Measuring VAW to represent different components of violence against women. This work group
suggested the use of specific terminology to differentiate the term "violence" from "abuse."
Because each work group's recommendations were not presented to the other groups until the
conclusion of the workshop, whether consensus might have been reached by the entire workshop
is unknown. In this report, the term "VAAW" was not incorporated into recommendations from
other work groups.
Vol. 49 / No. RR-11
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emergency departments, migrant-health programs, community-health pro
grams, maternal- and child-health programs, managed care programs, and
military/veterans health services); community-based service agencies (e.g.,
welfare offices, child development and child care services, Head Start locations,
and day care centers); and programs for children (e.g., schools, Boys and Girls
Clubs, gang programs, and programs for runaway children). In addition, other
places where women and men congregate may provide venues for collecting
information, including laundromats, hair salons, Internet chat rooms, and job
training programs. Data should be collected from underserved populations,
including Native American, Asian, Latino, and African-American communities.
(Work Group on New Research Strategies for Studying VAW)
• Because some victims and perpetrators of violence never seek violence-related
services, monitoring systems should be implemented to estimate a) the
prevalence and incidence of VAW in the general community and b)the number of
persons in need of services who are not receiving them. Persons who seek such
services are not likely to be representative of all victims or perpetrators of
violence. (Work Group on New Research Strategies for Studying VAW)
• A nationally representative system for monitoring VAW should be developed.
Although data from state and local agencies (e.g., social service and criminal
justice agencies) help document the extent of the problem, data from these
sources are likely to be skewed because few female victims of violence ever seek
help from those agencies. Therefore, core monitoring efforts should be based on
national samples of the total population (i.e., population-based). In addition, BUS
should explore the feasibility of developing local or state estimates of VAW from
representative samples in states, cities, or defined metropolitan areas. However,
measuring VAW (especially intimate-partner violence, rape, and sexual assault) in
smaller geographic areas is problematic because of infrequent occurrence of
VAW. (Work Group on State and Local Data for Studying and Monitoring VAW)
• Incident-based reporting that includes information on the victim-perpetrator
relationship should be employed within the criminal justice system. Use of
incident-based data would allow estimation not only of how many women are
affected by VAW but the frequency of its occurrence. (Work Group on State and
Local Data for Studying and Monitoring VAW)
• Offender-based data systems should be considered for measuring and tracking
VAW. Offender-based data sources (e.g., arrests and court-based statistics) can
help estimate some elements of the VAW problem. However, these data sources
exclude victims and offenders who do not come to the attention of the criminal
justice system; hence, these data sources should not be used as a sole method for
estimating VAW. (Work Group on State and Local Data for Studying and
Monitoring VAW)
• An improved identification system for homicides is needed. Only three identified
data systems—the Supplementary Homicide Reporting System (SHR) and NIBRS
(both part of the Uniform Crime Reporting System) and the National Vital
Statistics System (NVSS) — measure the incidence of homicide. However, NIBRS
has not been implemented nationally, SHR is missing substantial amounts of data
MMWR
12
October 27, 2000
regarding victim-offender relationships, and NVSS can not identify offenders or
specifical ly identify victims of intimate-partner violence. (Work Group on National
Data for Studying and Monitoring VAW)
Building Partnerships
• Each state should provide funds for a position to oversee data collection and
monitoring of VAW. The interests of both the criminal justice and health fields
must be represented, and technical assistance must be provided to state and local
entities collecting data for studying VAW. (Work Group on State and Local Data
for Studying and Monitoring VAW)
• Stakeholders should be involved in the development of data systems. From its
inception, any data system should include input from victims and service
providers. Service providers need to be better informed about data systems to
understand the purposes of public health surveillance and the usefulness of the
information that such systems provide. (Work Group on State and Local Data for
Studying and Monitoring VAW)
Developing Strategies Related to Subpopulations
• Data should be gathered for groups that have been omitted from national surveys.
No national studies focus on immigrant or homeless women, women with
disabilities, women in the military, or women in other institutional populations.
(Work Group on National Data for Studying and Monitoring VAW)
• The terms "cultural sensitivity" and "competency" must be clearly defined.
Research strategies should then be designed to meetthose definitions and should
be sensitive to the situations of victims of violence. Populations at higher risk for
VAW must be identified to ensure the implementation of appropriate preventive
and therapeutic services. Several methodologic concerns may arise when
researching VAW among persons in these high-risk groups. The research
conducted must be relevant to the community being studied. In addition, to
thoroughly understand the role of violence in the lives of culturally diverse
populations, researchers must examine both protective factors and risk factors
that may affect those populations. Developing true partnerships with service
providers and recipients may improve data quality. (Work Group on New
Research Strategies for Studying VAW)
Improving Measures of Service Provision
• Service providers should be involved in local data-collection efforts, both to
enhance data collection and to encourage wider acceptance, use, and
dissemination of results. (Work Group on Defining and Measuring VAW)
• Data concerning how VAW victims utilize health and social services should be
collected periodically. Collection of such data has been limited, often because of
ethical issues (e.g., privacy, confidentiality, and safety). Methods of documenting
the use of health, social, and legal services that will not compromise the privacy
Vol. 49/ No. RR-11
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and safety of the respondent should be developed. (Work Group on National Data
for Studying and Monitoring VAW)
• Rigorous evaluations of the effectiveness of various services are needed. Limited
information is available regarding the effectiveness of services for victims and
perpetrators, and this information is needed to guide program and policy
development. Service providers and recipients may define positive outcomes in
different ways. Evaluation activities should address the financial costs of various
violence-related services, including primary prevention activities. (Work Group
on New Research Strategies for Studying VAW)
• The feasibility of universal screening and documentation within local health
systems (e.g., emergency departments, health departments, mental health
centers, primary outpatient care centers, and school health centers) should be
investigated as a possible mechanism for surveillance of VAW. In addition, the
reliability and validity of screening questions should be assessed. Consensus has
not been reached regarding whether universal documentation of intimate
partner violence should be used within health-care settings, because such
documentation could have negative effects for victims of VAW. For example,
documentation of repetitive injuries resulting from intimate-partner violence
could result in denial of health insurance claims or future denial of health
insurance benefits. (Work Group on State and Local Data for Studying and
Monitoring VAW)
Methodologic Concerns
• When feasible, measurements should include open-ended questions or
variables. Data from such questions can be re-coded into existing categories or
may serve to clarify the need for additional categories. In situations where data
are gathered using survey methodology, these open-ended questions can serve
to humanize the data-collection process and add rapport with the respondents.
(Work Group on Defining and Measuring VAW)
• Questions and data elements should be pretested (e.g., through focus groups and
in-depth interviews) to explore how respondents interpret questions. (Work
Group on Defining and Measuring VAW)
• Information is needed regarding which data elements are common across
surveys and whether data can be linked. Data rarely are coordinated between
existing data sources, despite the need for comparability of estimates across data
systems. With new data sources, using variables and questions similar to those
used in existing surveys should be explored. (Work Group on National Data for
Studying and Monitoring VAW)
• Several scientific methods should be used to study VAW. No "gold standard"
scientific methodology exists. The study methodology should fit the study
question being posed, and some study questions may be best addressed by using
multiple types of study designs and assessment measures. (Work Group on New
Research Strategies for Studying VAW)
MMWR
14
October 27, 2000
• Both quantitative and qualitative methods may be useful in the study of VAW,
particularly when used in combination. To better understand the complexity of
VAW, study methodologies should account for contextual issues surrounding the
violence (e.g., whether a violent episode represented a discrete event or was part
of ongoing violence in the relationship or whether violence was defensive in
nature). (Work Group on New Research Strategies for Studying VAW)
• The development and use of psychometrically sound assessment techniques
should be encouraged within all areas of VAW research, including assessments
based in service settings. Research on the reliability and validity of various
assessment techniques for measuring VAW is limited. (Work Group on New
Research Strategies for Studying VAW)
• Whenever data about VAAW are reported, the actual data elements or questions
used to gather the information (i.e., the operational definitions of VAAW) and a
description ofthe human subjects methods used to protectthe confidentiality and
safety of those from whom data are gathered should also be reported. Because
data on VAAW can be affected by the wording of a survey question or the method
of data collection used, making this information available allows users ofthe data
to more accurately interpret the numbers presented.* (Work Group on Defining
and Measuring VAW)
• Establishing a unique identifier for victims of VASN is essential for recordkeeping
and protecting confidentiality. However, each system may have its own method
of coding: one victim may be assigned a unique identifier by the local police
department and another by a rape crisis center. The feasibility of using common
unique identifiers to enhance linkage across data systems and to ensure that
victim safety is not compromised should be explored. Linking criminal-justice,
health, and service-provider data for monitoring purposes could minimize the
probability of duplicating counts and allowforthe analysis of repeat victimization.
Common unique identifiers would make such a linkage feasible. (Work Group on
State and Local Data for Studying and Monitoring VAW)
• The context of a survey (e.g., whether it addresses health, crime, or personal
safety issues) should be explicit to allow appropriate interpretation of findings.
(Work Group on National Data for Studying and Monitoring VAW)
Confidentiality and Safety
• The safety of victims and the confidentiality of data collected must be given a high
priority. Data collected regarding VAW must be designed to ensure confidentiality
*ln this report, the terms "VAW" and "VAAW" are used by the Work Group on Defining and
Measuring VAW to represent different components of violence against women. This work group
suggested the use of specific terminology to differentiate the term "violence" from "abuse."
Because each work group's recommendations were not presented to the other groups until the
conclusion ofthe workshop, whether consensus might have been reached by the entire workshop
is unknown. In this report, the term "VAAW" was not incorporated into recommendations from
other work groups.
Vol. 49/ No. RR-11
MMWR
15
and to avoid potentially dangerous situations that could compromise the safety of
victims. (Work Group on State and Local Data for Studying and Monitoring VAW)
• The confidentiality and safety of VAW study participants must be protected.
Although standard procedures used in conducting research with human
populations should be followed, sometimes procedures must be modified to
ensure the safety of VAW victims. Although several specific actions have been
developed to increase safety for victims, no guidelines are available for
researchers concerning the safety and confidentiality issues that can arise in VAW
studies and the practices that have been used to address these issues. Therefore,
guidelines concerning confidentiality should bedeveloped and disseminated. For
example, federal agencies could solicit papers on these issues and then use them
to prepare a handbook to guide future research. (Work Group on New Research
Strategies for Studying VAW)
• The safety of staff members who conduct research (e.g., interviewers) should also
be considered. Study staff may suffer psychological distress after interviewing
multiple violence victims or may fear attack from violent perpetrators. (Work
Group on New Research Strategies for Studying VAW)
• Research should be conducted on the potential effects of participating in VAW
studies. Limited empirical evidence exists concerning how participating in such
research affects study participants. (Work Group on New Research Strategies for
Studying VAW)
CONCLUSIONS
Summary remarks presented by representatives from all four work groups empha
sized that the work group deliberations represented only a beginning to the process of
developing uniformity across the numerous sectors and disciplines concerned with
VAW. Further input from researchers and practitioners concerning the feasibility of
these recommendations is needed. In addition, the specific recommendations that are
most essential to the process of building VAW data systems must be identified. Agency
leaders from BJS, NIJ, and two centers within CDC (NCHS and NCIPC) affirmed that the
Workshop itself was an initial cross-departmental step in a long-term, coordinated effort
to improve the monitoring of VAW and to develop programs to respond to such
violence.
Acknowledgment
The following persons are acknowledged for their efforts in initiating the Workshop: Jan
Chaiken, Ph.D., Director, Bureau of Justice Statistics, Department of Justice; Mark Rosenberg,
M.D., M.P.R, Director, National Center for Injury Prevention and Control, CDC; Edward Sondik,
Ph.D., Director, National Center for Health Statistics, CDC; and Jeremy Travis, J.D., Director, Na
tional Institute of Justice, Department of Justice. The following persons are also acknowledged
for their leadership within the four work groups: Tim Bynum, Ph.D. (Work Group on State and
Local Data for Studying and Monitoring VAW); Nancy Isaac, Ph.D. (Work Group on Defining and
Measuring VAW); Sandra Martin, Ph.D. (Work Group on New Research Strategies for Studying
VAW); and Carol Petrie (Work Group on National Data for Studying and Monitoring VAW). Addi
tionally, Nancy Isaac, Ph.D., Sandra Martin, Ph.D., and Pamela McMahon, Ph.D., M.P.H. are ac
knowledged for their contributions to the writing of this report.
16
MMWR
October 27, 2000
References
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3. Rennison CM, Welchans S. Intimate partner violence. Washington, DC: Bureau of Statistics
special report. May 2000. NCJ 178247.
4. Campbell JC. Promise and perils of surveillance in addressing violence against women.
Violence Against Women 2000;6(7):705-27.
5. DeKeseredy WS. Current controversies on defining nonlethal violence against women in
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2000;6(7):728-46.
6. Gordon M. Definitional issues in violence against women: sureillance and research from a
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data systems and sources. Violence Against Women 2000;6(7):784-804.
8. Schwartz MD. Methodological issues in the use of survey data for measuring and
characterizing violence against women. Violence Against Women 2000;6(8):815-38.
9. Bachman R. A comparison of annual incidence rates and contextual characteristics of intimate
partner violence against women from the National Crime Victimization Survey (NCVS) and
the National Violence Against Women Survey (NVAWS). Violence Against Women
2000;6(8):839-67.
Waller
AE, Martin SL, Ornstein ML. Health related surveillance data on violence against
10.
women: state and local sources. Violence Against Women 2000;6(8):868-903.
11. Orchowsky S, Weiss J. Domestic violence and sexual assault data collection systems in the
United States. Violence Against Women 2000;6(8):904—11.
12. Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate partner violence surveillance:
uniform definitions and recommended data elements. Version 1.0. Atlanta, GA: Centers for
Disease Control and Prevention, National Center for Injury Prevention and Control, 1999.
13. American Medical Association. Diagnostic and treatment guidelines on domestic violence.
Chicago, IL: American Medical Association, 1992.
14. Wisner CL, Gilmer TP, Saltzman LE, Zink TM. Intimate partner violence against women: do
victims cost health plans more? J Fam Pract 1999;48:439-43.
Use of trade names and commercial sources is for identification only and does not
imply endorsement by the U.S. Department of Health and Human Services.
References to non-CDC sites on the Internet are provided as a service to MMWR
readers and do not constitute or imply endorsement of these organizations or their
programs by CDC or the U.S. Department of Health and Human Services. CDC is
not responsible for the content of pages found at these sites.
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1
g^^ ^Hrnprovinq our
•V' - |
Imping of the etiology
~~~
iMio^pEd in the Western
pacific Region
■
/
Dr Liz Ecferrnann
Temporary adviser WHO, WPRO.
..
data on^&lence In war (Cambodia),
i ^iSTOMWSimjapore), child abuse
^P,SSWHong Kon9)' trafficking in
wdflW^tcf^PDR, Cambodia), sexual abuse
(Philippine bullying in schools(Australia),
workplace violence (NZ).
Some data on suicide (all countries)
increasing data on domestic violence but still
only the tip of the Iceberg (Cambodia,
Malaysia, Philippines, Australia, Pacific Is)
GAMBDDIA^iMi iestic violence is a burden
p/J
of the social system
^gSpui'sW;^tWamatically,
y^«i
affects the
a nation ... batterers cost
naiws"is|fortunes in law enforcement,
health |<Wi;e, lost labour and general
progra development. These costs do
not only affect the present generation;
what begins as an assault by one person
on another reverberates through the
family and the community into the future'
(Zimmerman, 1994:184)
'1^®
:’d... :
& ^^^ywhom
•
2;WVn in WPR
|
■MMMMMMM
^estic Violence: Major GBD
M / wHOJ'#^§98-9 multi-country study
*UNi
■‘^Bra-2000: 7 Pacific Islands
Malay^n^oVt
Philippines govt and NGOs
Govt/NGO Cambodian study
Hong Kong: Chinese govt/courts/
welfare/police/NGOs
Australia: longitudinal study (University of
■
______ Npwraqtlp)
'^llUr
..-•.
■■
■'
.■'■
'
■'
«5W~- ■ ■
c,l^bal Concern
,... (.
of Human Rights
<4.1966llfe^ational Covenant on Civil
an^Wltral rights
1975 Nairobi Forward Looking Strategy
1979 Convention on the Elimination of
Discrimination Against Women
1984 Convention against Torture and
Other Cruel, Inhuman or Degrading
Treatment or Punishment
c>^<2-XL
+ f-r
_ 11 Concern
Weapon the Rights of the
D
cl
w •vo'id Bank Report: GBD
1994ICPD
1995 BPFA
1996 WHA 49.25 Violence a public
health priority issue
£)
1
; p.,..
domestic Violence
1
violence evident to some
dcgrcn -n.evcry society in the world.
Te^^l i consistently demonstrates
that a woman is more likely to be
injured, raped or killed by a current or
former partner than by any other
person'
for a multi-level
■/rrlidd^|in the family
_________
< ’/Q;,;.. ,in , ap(, amj Vj0|ence injury, from
a twr«>iendly hospital in Cebu, the
Pliil®®'6? reveals that in 1997, of the
218 cSSe§.0f rape which were treated in
the hospital 50 per cent had been
committed in the victim's or the
offender's house and less than 10 per
cent of rapes were committed by a
person unknown to the victim.
heory: Adapting
model to WPR
■..... ......
•'...... '
-
C
■'
tftgoi y inust be able to account for
both, v$Individual men become
viofefiM® why women as a class are
so ofteh their target' (Heisse, 1997).
Theory must be adaptable to move
beyond a Eurocentric orientation
Meg
»-v% J>w4!^|
ftMple and complex.
Patnardiy^ncl
stress
social leaning,
personality disorders
alcohol abuse
proximity(paradox)
EC0]d§Jd3
wfe
argues for the adoption
Of M i^^gical approach to abuse'
wh^^offceptualizes violence as a
multifaceted phenomenon grounded in
an interplay between personal,
situational and sociocultural factors'.
2
' III iiple levels
Culture I Economy
Communrty
eeiiings
•'"'Proiiinul''
relationships
/Individual's
*1'315^
'I
|
historyOt the individual level)
(at the family level),
icietaT level) and COmmunity and
SOt
VIOUNCK
macrosystems (at the cultural and belief
system level).
In developing prevention programmes
all levels must be addressed.
JI FrlWI.R ilstory includes
?
'>f
-■ such as:
. ...... ....
asacMW
Being ahuned oneself as a child
Absent or rejecting parent
Unresolved anger
Feeling powerless
emotional violence (e.g. unintended
consequences of China's one child
iMtors include:
stafi.is/nncmiDloyrnent
Isolation of woman and family
Delinquent peer associations
Environmental factors (e.g. haze
=closed windows=less neighbour
surveillance=more family violence)
(Singapore)
recent migration (Hong Kong)
Orem influences
in the family
of wealth in the family
Use^lcqhol
>e of alcohol
proximitfand intimacy (paradox in
prO'XinWp&nd
Cambodia)
Mafital/verbal conflict.
Backlash against women's changed
roles (Solomon Is)
jn factors include:
'WI©OTtlKgept-/ownership of women
(c,g, poiyriarny in Hong Kong)
Ma^fnlty linked to aggression and
dominance
Rigid gender roles
Cultural acceptance of interpersonal
violence and physical chastisement
(adapted from Heisse, 1997:3)
3
S2
Explanations
Tribjjfie "How do I protect my
^aDuse?"
i i-i^udons-offered were all
individiia)^ oriented and included
support, security and confrontation.
The key tips offered to parents were:
-;
explanation
’ *w||epipt. was made to address
familial, community,
soEiggl or cultural factors that
contribute to child abuse or to
acknowledge that the people in
charge of the child's welfare may
be the actual perpetrators of the
f
:
‘
t0 say no to those
as t0 strangers
MpmBren to trust their instincts
OfiWgOftifort: and support if they
have had a bad experience
Reassure the victim that they have
done nothing wrong.
(Sarawak Tribune, March 251998,
Outlook page 3)
Levels (Macro -'0*1,igWe.g.
of femininity and
niasW^(inacrosysytem)
of proximity (exosystem)
[helps ex^iin many cases of domestic
violence in Cambodia]
3.use of alcohol (microsystem)
pj|ij
al construction of
niasculinity
1
1
Rfe^ance ’n domestic
violcncei^ pat fly related to differences
ln WB?^!?ngtR and size.
BecaufejWfiiales are typically shorter
and lighter than males, and have
learned fewer skills of self-defence,
women are often poorly equipped to
protect themselves if their partner
becomes violent. (Broom, 1998:45)
55felization
.......................
f *■ W?V£ I h1lteh Of the disparity relates
l? ™fT®»«nd women are socialized
lf1t^ Winder roles in different
sodggg; throughout the world. In
societies with a patriarchal power
structure ’definitions of femininity
(dependence, fearfulness) amount to a
cultural disarmament that may be quite
as effective as the physical kind'
(Connell, 1995:83).
4
.g;-
.
HU■
■
Gsrider'roles
dimensions
playing out of definitions
d^nuerstiWidings of femininity and
fnasJS|fel^eply enibedded in the culture
ancfifnpe psyches of both men and women
within tWftilture. i.e. "normalized"
but resistance possible (e.g. Malaysian
woman who challenged syariah law)
"This is the woman who would prostrate to
kiss her husband's hands and feet to pacify
him so that he would not continue hitting
_hgrl/7Vpi4/Timpt;. Malaysia. 1998).
use violence to sustain their
-rHdatibn of women ranges
»• -r
die street to office
g^/fappand domestic assault, to
ifhan's separated husband.
"
com™nly accompanied by
verbal abw^ealling women "whores" and
"bitches"...). Most men do not attack or harass
women; but those who do are unlikely to think
themselves deviant. On the contrary they
usually feel they are entirely justified, that they
are exercising a right...authorized by an
ideology of supremacy'. (Connell, 1995:83)
Wiygn. can Jie.perpetrators of violence,
wiefft^fenot an exclusively male
'husbalWib’attcring' maybe underreported: given that 'confessing to
being knocked around by another man
is a piece of cake compared to
admitting being victimized by a woman'
(Brott, 1993).
Hpty & intimacy
■
_
v
;
'JrOxitT,itV/^nd emotional intimacy of
makes it the most likely site
Or pWfC^ical and emdt,'onal abuse.
CcHribodw: - ij of so women reported
physical abuse by husbands, 24 reported
physical abuse of their children by their
husbands yet only 7 of 50 reported husbands
abusing people outside of the household.
But proximity (geographical and emotional)
of parents prophylactic against violence.
finger = heffpr niitrnmp.
Vs"
____ VC’/JJiil:ty and intimacy
......
^bMppi'pes violence injury, 363
.-■'fW h'oerahn 1997,
73.%
place In the victim's own
home and
only 6 % perpetrators were not related
or not in a relationship with the victim.
76 % of perpetrators were husband, a
live-in partner or a boyfriend. (Vincente
Sotto Memorial Center, 1997).
__ _
,»| a g
leohoi
r J.^^Mtoept^nce of alcohol as a
■■■G( ial du.ig, exacerbates domestic
violence
often involves complicity from the
victim of violence.
"out of character" behaviour often
excused by the perpetrator and the
victim of the violence
5
~ j
/Mcohol
■Icohol
'Ck'.-Wdi’t Iddlly mcyhim, it was the
with alcohol problems
im ^y^feviblenl
more frequently and
____
■
'
'sor^Jadividuals become intoxicated in
order Wry out the violent act'.
alcohol operates largely as 'a situational
factor, increasing the likelihood of
violence, by removing inhibitions,
clouding judgement, and impairing an
individuals ability to interpret cues',
■■
serious injuries on their
partnfetl^n do men without alcohol
problems’.
'treating an underlying alcohol problem
can help reduce the incidence and
severity of assaults, but it seldom
"solves' the violence' (Heisse,
1QQ7’QA
r
relativity vs
^^g^al^rinciples
__
'
not negotiable
< T^y/JAdoniesht violence a problem if
’■
consensus between men
a}idt.v®nieh in particular cultures as to
its roBa^/a’ normal part of social life?
Why should universal values be
imposed on situations which appear to
be an integral part of specific cultures.
wslics ar.; negotiable and can take
“W^itural sensitivities and customs,
t,10se
compromise
tncWdiPraud wellbeing of particular groups
in society;>are not negotiable. Domestic
violence fits the latter categoiy because of its
devastating short term and long term
physical, psychological, emotional and social
effects on the victims of such violence, in this
case predominantly women and children.
r
__ Itters
r^„
•
ggtilifgJgrWPR reports difficulty
-JWilpI ^curate data on violence.
praMI
the soi^itMty of the topic and cultural
taboos surrounding discussion of it,
the 'normalcy' of domestic violence
lack of public authority recognition of
violence as a public health issue worthy
of investigation.
KJ^Bf^cont:
1
,s available for most
- OTm|^'the Western Pacific Region.
ex^G^ons :Cambodia, the Philippines
and M^lay^la comprehensive data has
been gathered by NGOs and U N
funded research
Even in these countries, information
represents only the tip of the violence
iceberg.
6
fcierrdations 1
ectoral approach, violence is a
human rights, education,
r
tioiisj
ggate violence statistics by
f^by source (police, courts,
Clinics, social services,
ncighljbu/3, family members).
If direct data is not available, use
indirect indicators e.g. level of family
support, level of alcohol consumption,
customs relating to women, suicide
rates?, divorce rates.
Jbaliwnsensus to override specific
cultural hWclftions of violence
political will to declare violence a public
health priority issue
translate CEDAW etc. commitments into
policies, laws, services and grass root
activities.
:
^^yiendations 2
■
1
..............................................
•
.V
•
1
mpst be complemented with
■> qilbiltBlfedata and explanations of the
relag^shlp between the indirect
indicator ahd domestic violence
collect data which reflects that violence
is a complex behavioural phenomenon
involving emotional, physical and sexual
abuse against a partner, not just simply
physical incidents’ (Hegarty & Roberts,
1 aoQ.zicn
I. implications
....... -........... ■
■■
or measures (mortality, morbidity.
quality of lile)
violence multi-levelled
(individual -macro)
examine across cultures and contexts
across time (intergencrational effects).
Collaboration between governments.
international agencies, universities, NGOs
__ eencric causes and effects c.v. war# dv
■’
"1
the bgdy mends soon
________ scars remain...But
r :'y|j@5W00fjdyinflicted upon the soul
longer to heal. And each
tim®i r^ve t*1ese rnoments, they
stSOIeeding all over again. The
broken spirit has taken the longest to
mend; the damage to the personality
the most difficult to overcome."
(Domestic violence survivor quoted
I
in WHO, 1996b)
E Awls With PTSD
• Theological effects of domestic
violence In a Cambodia resemble the
symptoms of post traumatic stress
disorder experienced by Cambodian
refugees after the Khmer Rouge period.
(Zimmerman (1994:94
7
>
‘*
feW'
i
—. .
.
•;
Cambodia
-Cambodia
■
•
fw'biKj i
you.ne going crazy
no»
torgettingthlhgs easily
feeling ashamed
difficulty concentrating
low energy
difficulty performing daily activities'
ODel^^anxipty., PTSD, weight loss,
lethargy,
loss, disorientation,
inablityj^ontenhate, mental illness,
suicide attempts.
Shame and humiliation
8
1
Challenge 1:
Contents
Improving the Availability,
Collection and Quality of Data
H
Dr. Yan Wang
Department of Maternal and Child Health
Beijing Medical University
• Available Data and Provided
Information on Violence
I HOBI
I
• Limitations of Available Data
J
• Strategies for Improving the
Availability, Collection, and
Quality of Data
r"'
I
I
I
I
Sources : vital statistics
the most widely collected and available data;
mortality caused by homicide by sex, age, areas;
mortality caused by suicide by sex, age, areas;
neonatal/ Infant/ child mortality by sex, cause, which
could provide Information on neglect of children.
[ Usually reported annually with other death rates;
providing information on:
s, - comparison with other deaths;
I - trend analysis;
i - Identifying high risk groups (age/sex);
rn: “the tip of violence iceberg”
■ - within country or between country comparison.
1
I Sources: Records
■
II 1
I
I
r
I
I
I
p
I
• non-fatal violence
• marriage & the family survey:
providing Information on physical fighting, sexual
assaults in the family by intimate partner.
• health survey:
providing Information on injury or disability
caused by violence;
• special studies/ surveys on violence to different
population group (women/ elder/ children):
providing any certain issue on violence.
Sources:Records
• Hospital or clinic records
the Information on diseases/ Injury as well
as mental disorders caused by violence and
the cost of medical treatment for the
disease/ injury.
!
j
Sources: Surveys
I I
i 1
I I
1Ih)1
• Records from civil administration
office, e.g. divorce registry.
A report indicated that the reason of divorce,
for one fourth of divorced couples (1 +
million a year) In China, was due to the
violence.
He c>
.2^
F’
B
I II
I
I
I
M
I._ I
r
• Records from police/judiciary
departments:
the information on the violence offenders, such
as their demographic characteristics,
relationship with the victim, methods used, the
motivation of perpetrating and so on.
• Records from telephone hot-line
1
Limitations
i
Limitations
a
;L Even if the vital statistics could only
capture “the tip of violence iceberg”, it
K.
could be incomplete or under-report, and
in some counties it is still unavailable.
i
H
I
|E
I1®8
s
H
I
2. For the data from survey, the
comparability is poor. The prevalence
figures on violence from different studies
usually were not comparable due to:
•the inconsistencies in the way that violence
is defined and measured;
•the skill of survey (how to enhance
disclosure);
•the ethical reasons;
•the selection of study population.
Limitations
Limitations
I |4. There is still gap in (he availability of information
H
OB
3. Hospital/clinic records could be
unusable/ unsuitable for violence
measure, since the medical records,
which usually served to medical
treatment, did not necessarily include
the causes/ reasons of injury or
diseases.
I
H
1
i
I
__ I
I
Strategies
a 1. For the countries of the Region, where vital
.statistics on death from violence arc currently
hacking, it is urgent to built surveillance or registry
[system to report the fatal losses due to suicide or
[homicide.
[2. To set uniform standards for defining and
[ measuring different types of violence. Thus,
I • need to develop uniform indicators,
• need to develop comparable tools,
questionnaires, scales
“I
Ion the magnitude and characteristics of violence,
especially,
|* lack of data on elder abuse;
I* lack of data on morbidity caused by violence;
b lack of the utilization of the data from police office/
Ijudiciary office by public health professionals in order to get
|the characteristics of offenders;
lack of data on the effectiveness of the intervention
’programs against violence;
[ • lack of the use of qualitative methods in research violence,
; • insufficiency of specific studies on risk factors or protect
Ifactors related with violence;
Strategies
To develop guidelines for rapid assessment on
in!|3.perspective
and magnitude of violence.
[®lj4. To set clinic/ hospital- based surveillance system
(
Ifor reporting the incidence of injuries, diseases or
Imental disorders caused by violence.
5. To set coordination between different agencies
^(health, police, school, women's federation, elderly
lunion, bureau of statistics, etc.) to collect and
jshare the information.
I I
2
7 .
Strategies
I
6. To develop a simple question list
regarding violence, in order to integrate
the question list into other national
surveys.
L
I
hi
Ian]
7. To pay attention to collect data on
assessment of the effectiveness of any
intervention strategies/ program on
violence prevention.
II' I
3
f f
t
<4
Health Organization
Ml $ World
Organisation Mondiale de la Sante
Violence and Injuries Prevention Department
Non-communicable Diseases and Mental Health Cluster
DRAFT AGENDA
REGIONAL CONSULTATIONS
WORLD REPORT ON VIOLENCE AND HEALTH
Objectives:
1. Summarize Report goals, objectives, methodology, and progress made to date
2. Provide an overview of the report’s content (major patterns, risk factors,
prevention and policy responses for the various types of violence). Identify
important gaps.*
3. Solicit regional perspectives on future directions for violence prevention
4. Determine regional strategies for the release of the Report
The information gained from the discussion of point 3 will form the basis of the
Report’s summary chapter and concluding remarks.
*Participants will receive a copy of the report in advance of the meeting and a review
form to provide written input on the report.
z-
1
Day 1
9:00-9:15
Opening and adoption of the agenda
9:15-9:30
Goals and objectives of the report; methodology used to
develop the report; progress made to date
9:30-10:00
Overview of the report’s content (major patterns, risk factors,
prevention and policy responses for the various types of
violence)
10:00-10:15
Coffee Break
10:15-10:30
Introduce five discussion points on regional public health
challenges in the field of violence (Appendix I)
10:30-12:30
Challenge 1: Availability and Collection of Data
a) Overview of what is known in the region - 15 minute
presentation by member of the region
b) Discussion
c) Summary of top 5 recommendations to improve the
collection, availability, and quality of data in the region
12:30-13:30
Lunch
13:30-15:30
Challenge 2: Improving our understanding of the etiology of violence
a) Overview of what is known in the region - 15 minute
presentation by member of the region
b) Discussion
c) Summary of top 5 recommendations for improving our
understanding of the etiology of violence in the region and
the contribution of social and cultural factors to violence.
15:30-15:45
Coffee Break
15:45-17:45
Challenge 3: Prevention and Policy Responses
a) Overview of what is known in the region - 15 minute
presentation by member of the region
b) Discussion
c) Summary of top 5 recommendations for developing,
implementing, and evaluating prevention programs and
policy responses throughout the region.
Day 2
9:00-10:00
Challenge 4: Contributions & Limitations of the Public Health
Approach to Violence
a) Overview of what is known in the region - 15 minute
presentation by member of the region
b) Discussion
10:00-10:15
Coffee Break
10:15-11:00
c) Summary of top 5 contributions and limitations of the public
health approach to violence
11:00-12:30
Challenge 5: Role of the Health Sector and Other Sectors
a) Overview of what is known in the region - 15 minute
presentation by member of the region
b) Discussion
12:30-13:30
Lunch
13:30-14:00
Challenge 5 cont’d
c) Summary of top 5 recommendations for the health sector;
major priorities for the health sector; involvement of other
sectors
14:00-14:30
Open Discussion of Other Challenges and Questions
14:30-14:45
Coffee break
14 45-15 30
Discuss and plan regional activities involving the release of the
Report
15:30-16:00
Steps ahead and closing.
*
World Perspectives on
CHILD ABUSE
ft
v.':?.r ?sSSRi
■' ‘
The Fourth InlerStiorfa ^Resource Book"
An Official Publication of the
International Society for Prevention of Child Abuse & Neglect
Prepared by
KEMPE CHILDREN’S CENTER
University of Colorado School of Medicine
c
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1
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If- . .
■■■• '■
That Have An Official
I' Countries
Government Policy Regarding Child
Iik"
fc- Abuse fit Neglect
P
F-
fcB
F
KOREA
MALAYSIA
F
PHILIPPINES
r
I
SINGAPORE
?■/
•
TAIWAN
■
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Br
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B:
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Type of Reporting System
MANDATORY REPORTING VOLUNTARY REPORTING
_______SYSTEMS_______ _______SYSTEMS______
Australia
Malaysia
Philippines
Singapore
South Korea
Sri Lanka
Taiwan
Hong Kong_________
Indonesia
New Zealand
1
Typical Response to a Reported Case
fe'" of Physical Abuse
B ■
b'
1
I
ft:
RESPONSE
If enough evidence, criminal charges
against abuser__________________
Child treatment required by
formal/informal processes
NUMBER
52
PERCENT
41
70.7
Child removed during investigation
40
69
32
55.2
within 2 weeks
31
53.5
treatment
by
formal/informal processes
31
53.5
5
8.6
fc' Investigation within 48 hours
Investigation
I Parent
required
Bp
ir Other
t'
89.7
- 7 > B Y-tTo
Ji
...
■
■ :•>?<'■ •r-:
.fe-
Activity Level of Each Type of Organization
Ithat Provides Child Abuse Treatment or
Prevention Services by Country
AUSTRALIA
II
te-
I
HONG KONG
Hospital
Totally Active
Totally Active
Mental Health
Totally Active
Somewhat Active
Other Health
Providers
Totally Active
Somewhat Active
Business/Factory
Totally Inactive
Somewhat Inactive
Schools
Totally Active
Somewhat Active
Social Service
Totally Active
Somewhat Active
Volunteer
Organization
Totally Active
Somewhat Active
Religious Institutions Totally Active
Somewhat Inactive
Juvenile or Family
Somewhat Active
Totally Active
Court
2
Activity Level of Each Type of Organization
that Provides Child Abuse Treatment or
| Prevention Services by Country
(continued)
I
INDONESIA
JAPAN
Hospital
Somewhat Active
Totally Inactive
Somewhat Inactive
Mental Health
Somewhat Active
Other Health
Providers
Somewhat Active
Totally Inactive
Totally Inactive
R Business/Factory
Somewhat Inactive
Totally Inactive
Totally Inactive
Somewhat Inactive
Somewhat Active
Totally Active
Somewhat Active
Totally Active
Religious Institutions
Somewhat Active
Totally Inactive
Somewhat Active
Juvenile or Family
Court
Somewhat Active
Totally Inactive
Somewhat Inactive
I
I
I
f'r'
Schools
Somewhat Inactive
Social Service
Volunteer
Organization
KOREA
Somewhat Active
K..
.. ..........
k Activity Level of Each Type of Organization
that Provides Child Abuse Treatment or
| Prevention Services by Country
(continued)
I
I
Ip
I
I
----------------------- --------- -—------------------------------------------------
MALAYSIA
Hospital
NEW ZEALAND
PHILIPPINES
Somewhat Inactive
Totally Active
Mental Health
Totally Inactive
Other Health
Providers
Somewhat Inactive
Totally Inactive
BusInes s/Factory
Somewhat Inactive
Schools
Somewhat Active
Social Service
Totally Active
Somewhat Active
Totally Active
Somewhat Active
Rellgioun Institutions
Somewhat Active
Totally Inactive
Juvenile or Family
Court
Somewhat Inactive
Somewhat Active
Rr Volunteer
Totally Active
Totally Inactive
Organization
r
3
■Hi
•■7-J.--■
'
Activity Level of Each Type of Organization
that Provides Child Abuse Treatment or
|k';: Prevention
Services by Country
(continued)
' _____
SINGAPORE
i
I
Totally Active
Somewhat Active
Somewhat Active
Mental Health
Somewhat Active
Somewhat Inactive
Somewhat Inactive
Other Health
Providers
Somewhat Active
Busincss/Factory
Somewhat Inactive
Somewhat Inactive
Totally Inactive
Schools
Somewhat Active
Somewhat Inactive
Somewhat Active
Sochi Service
Totally Active
Somewhat Active
Totally Active
Volunteer
Organization
Totally Active
Somewhat Active
Somewhat Active
Religious Institutions
Somewhat Active
Somewhat Inactive
Totally Inactive
Juvenile or Family
Somewhat Active
Somewhat Active
Somewhat Inactive
fh-'
I
TAIWAN
Hospital
I
p
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SRI LANKA
fe
Somewhat Inactive
Court
■
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Tr i * ■'
r
Number of Organizations That Provide "Active”
Child Abuse Treatment or Prevention Services
by Country*
AUSTRALIA HONG KONG
1998 Active
JAPAN
MALAYSIA
4
7
1
3
10
8
1
5
10
2
0
3
2000
Somewhat or
feF'- Totally
Active
fe/
fey,
fe ■ 2000 Totally
Active
fe
I"
4
■ -3
'F.
0 Number of Organizations That Provide "Active”
y
Child Abuse Treatment or Prevention Services
fey
K by Country*
grNEW
ZEALAND
SINGAPORE
SRI LANKA
TAIWAN
1998 Active
2
9
0
3
2000
Somewhat or
Totally
1
10
6
5
1
4
0
2
I
I
fe ■'
I
Active
2000 Totally
Active
.. .
IF
ft
I'
fe\
liV ■ ■
I
P
$
bF
■
b
i
Four
Years of Data That Depicts Activity Level
of Each Organization Which Provides Child
Abuse Treatment of Prevention Services SA
Somewhat
Active
HOSPITAL
COUNTRY
Australia
Hong Kong
Japan
Malaysia
New Zealand
Philippines
Singapore
Sri Lanka
Taiwan
2000 1998 1996 1992
TA
TA
Y
TA
TA
Y
T1
NU
TA
TA
Y
TA
Totally Active
NU
SA
SI
Y
Y
Y
TA
TA
SA
NU
SA
SI
Neutral
SI
Y
Somewhat
Inactive
Tl
Totally
Inactive
UK
Unknown
Y
»■
Yet
5
Il
|
■.
fe
Four Years of Data That Depicts Activity Level
of Each Organization Which Provides Child
Abuse Treatment of Prevention Services SA
B.
COUNTRY
b".
I
1■
k
Somewhat
Active
MENTAL HEALTH
2000 1998 1996 1992
TA
Totally Active
Australia
Hong Kong
Japan
Malaysia
New Zealand
TA
SA
SA
SA
Philippines
Singapore
Sri Lanka
TI
SA
TA
SI
TI
Unknown
Taiwan
si
TI
Y
Y
Y
NU
Neutral
SI
SI
Somewhat
Inactive
SI
Y
TI
Totally
Inactive
Y
Y
UK
Yes
■ r
i
II
y '"1 i... ;
-
.......
Four Years of Data That Depicts Activity Level
of Each Organization Which Provides Child
Abuse Treatment of Prevention Services SA
Somewhat
Active
OTHER HEALTH
COUNTRY
2000 1998 1996 1992
'■
feres
It
fc.1'
IB-
Australia
Hong Kong
Japan
Malaysia
New Zealand
Philippines
Singapore
Sri Lanka
Taiwan
TA
Totally Active
TA
NU
Y
Y
SA
NU
Y
Y
TI
TI
SI
SI
SI
Somewhat
Inactive
NU
NU
Y
TA
Y
TI
SA
Neutral
TI
Totally
Inactive
UK
Unknown
SI
TI
Y
Yes
6
\
II
It
ibv
Four Years of Data That Depicts Activity Level
• of Each Organization Which Provides Child
Abuse Treatment of Prevention Services SA
BUSINESS
COUNTRY
2000 1998 1996 1992
Australia
TI
SI
Hong Kong
si
si
Japan
Malaysia
si
NU
Neutral
TI
SI
si
Somewhat
Inactive
TI
Philippines
I
I!
TA
Totally Active
TI
New Zealand
Somewhat
Active
Totally
Inactive
Singapore
SI
TA
Sri Lanka
TI
TI
Unknown
Taiwan
SI
TI
Y
UK
Yes
1
•4-xi
Four Years of Data That Depicts Activity Level
of Each Organization Which Provides Child
Abuse Treatment of Prevention Services SA
|
SCHOOLS
■
Kt
I
&
I•
-
COUNTRY
2000 1998 1996 1992
Somewhat
Active
TA
Totally Active
Australia
TA
NU
Y
Hong Kong
SA
SA
Y
Japan
TI
TI
SI
Malaysia
SA
NU
Somewhat
Inactive
New Zealand
TA
SI
Philippines
TI
Singapore
SA
TA
Sri Lanka
Taiwan
SI
TI
SA
SI
NU
Y
Y
Y
Neutral
TI
Totally
Inactive
UK
Unknown
Y
Yes
7
- s*
3
of Data That Depicts Activity Level
i ofFourEachYears
Organization Which Provides Child
Bl Abuse Treatment of Prevention Services SA
ib
Somewhat
Active
SOCIAL SERVICE
COUNTRY
i
i
■■
I
2000 1998 1996 1992
Australia
TA
TA
Y
Hong Kong
Japan
SA
TA
Y
SI
NU
Y
Malaysia
TA
TA
Y
NU
Y
p
fc
I
Totally Active
NU
New Zealand
g'
Y
TA
Neutral
SI
Y
Somewhat
Inactive
Tl
Y
Philippines
SA
Singapore
Sri Lanka
Taiwan
TA
TA
SA
NU
Unknown
TA
SA
Y
Totally
Inactive
Y
UK
Yes
toy
■
| Major Reasons for an Increase in Public
Awareness Concerning Child Abuse & Neglect
|
I
I
I
I
COUNTRY
PUBLIC
AWARENESS
PROFESSIONAL
EDUCATION
GOVERNMENT
ACTION
DEAAAND
FOR
CHANGE
Australia
YES
YES
YES
YES
Hong Kong
Japan
Korea
Malaysia
New Zealand
Philippines
Singapore
Sri Lanka
Taiwan
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
L
g[
OTHER
YES
YES
YES
YES
8
V.
/ c
I
It
■
Major Barriers Limiting Involvement
t of the Health Sector & Other Sectors
I ■ Resources
„
I ■ Political Will
Lack of Awareness of the Problem
I ■■ Lack
of Trained Personnel x
fe’*'
Wv'-'Cj
R ■ Prevailing Attitudes - roles, territory
k)
Ip ■ Lack of Research on “What Works”
I
r
L'' ■
ESI
"■
’
; s^r‘"*kW'?3
F- Possible Avenues for Increased
Involvement of Different Sectors In
I Violence Prevention Efforts
gfe
• f.'VrV ■•'
;'■
A
‘a,
'• ..'•?_>'t.r1-V';-
*
■ Recruitment of Key Persons per Agency
H ■ Preferred Funding Streams
■ Partnerships between NGOs/Private Academic & Government Agencies
■ Identification of “Champions”?
EI
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9
Position: 688 (10 views)