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Citation: Tavares Cavalcanti ML (2015) Surveillance in Health Care and Domestic Violence. J Eped Comed 1: 1: 100103
Copyrights: Â© 2015 Tavares Cavalcanti ML,
Violence is a social and historical phenomenon with multiple causes and is associated with socially determining factors. Domestic violence and violence in the family take place in interpersonal relationships through physical, sexual and psychological abuse, exploitation, neglect or abandonment. It affects primarily children, teenagers, women and the elderly, and is recognized as an important problem in global public health. It causes injuries and harms physical and mental health, and as a consequence leads victims to seek out public health services. Interpersonal violence expresses relationships of unequal power among people in dependent relationships and if no clear intervention is used to stop it, physical violence, neglect or abuse can usually last for years, in a cycle that tends to reproduce itself. The health sector, a locus of attention to problems resulting from violence, should respond by preventing, identifying and giving attention to situations of interpersonal violence.
The health care model based on family and community care enables an identification of, approach to and intervention in situations of domestic violence. The areas of primary and community health care can offer a major contribution by implementing actions to deal with violence, since care providers are close to and familiar with the families, their location and context. Providing these families with care will increase the likelihood of successful outcomes in the areas of prevention and information dissemination, helping additionally to stop the perverse cycle of violence. An approach that takes responsibility for family care as a whole makes it possible to develop a more comprehensive approach to situations of violence in the family. However, health care providers have not yet completely assimilated the issue of domestic violence as a subject worthy of their intervention that falls under their responsibility. The resistance of health professionals is due to, among other factors, the fact that they feel impotent and unable to help since they cannot solve problems which usually arise outside the health sector. Therefore, the challenge posed in facing domestic violence and violence in the family is that it demands combined intersectoral actions through networks that are incipient in Brazil.
Public health actions plans are prepared based on data on the occurrence of health issues in the target population, using defined variables (people, time and place). The appropriate method to detect, monitor and control adverse health conditions is epidemiological surveillance, a specific public health tool summarized by the logo “information for action”.
In 2006, the Brazilian Health Ministry created the Surveillance System for Violence and Accidents (VIVA) to collect data on acts of violence that are reliable , standardized and comparable in order to identify the magnitude of the issue and aid in the creation of public policies. VIVA is composed of two elements: first, a surveillance system that collects data from hospital emergency records of victims of violence and accidents, through annual surveys at selected urgency and emergency hospital units. The second element is a surveillance system that continuously monitors acts of interpersonal and self-inflicted violence which includes domestic violence, sexual violence, suicide attempts and other types of interpersonal violence . The data collected is integrated into The Complaints Notification Information System (SINAN), of mandatory use across the Brazilian national territory. In addition, it is mandatory to immediately denounce acts of sexual violence and suicide attempts (within 24 hours).
The surveillance of violence is a process that is still being developed in Brazil. It represents the union of two distinct approaches, each with their own rationales: a first approach based on controlling and combating diseases that comes from a traditional, epidemiological, historically based system; and a second approach, based on the promotion of well-being, that concerns the role of health professionals in approaching violence. The epidemiological surveillance approach is based on identifying the etiology of specific diseases and intervening in the causality chain which can be viewed as having single or multiple causes. The second approach focused on the health promotion derives from a broader concept of health that considers quality of life and promotes intersectorial actions targeting socially determining factors of health and disease. This perspective involves an attempt to understand these phenomena, especially situations of violence and violent relationships, according to their social and historical complexity, an approach that unavoidably requires intersectoral and interdisciplinary actions .
We are developing a study to monitor and evaluate the implementation of the violence surveillance system in a Brazilian city. We observed that when health professionals possess a method that has been accepted and recognized by health services, they are able to overcome their resistance to acting on situations of violence, thus enabling the creation of an intersectoral network that promotes health and targets situations of violence.
Ministry of Health (2013) Surveillance System for Violence and Accidents 2009, 2010 and 2011.Brazil.
WHO. Data Global status report on violence prevention 2014.
WHO. The OTAWA Charter for Health Promotion.