Canadian Aboriginal communities: a framework for injury surveillance

At the international level, evidence supports the position that regardless of whether a country is industrialized or less developed, vulnerable populations living in poor social conditions are at disproportionate risk of injury. The Aboriginal population of Canada is one such vulnerable population. In addition to poor social conditions and marginalization related to historical injustices, this population is faced with the challenge of working with little or no descriptive injury data relevant to the community level. It has been and continues to be a significant barrier to the adoption and implementation of injury prevention strategies and programs. Recognizing that surveillance is an intrinsic component of public health practice, this study was undertaken to address a critical data gap facing Aboriginal communities. The objective of the study was to develop the conceptual design of an injury surveillance framework that would be culturally relevant, that is 'acceptable and owned by the target population', and would meet the specific requirements for injury data and data collection methods for the study population. The methodology was undertaken with focus groups at national and community levels, and relied on the use of strategic activities such as benchmarking, guided discussions, nominal group technique exercises and critical document reviews. The process of benchmarking served to identify that injury surveillance systems described in the literature, linking data to action, are not a predominant reality. The locus of control is often removed from the population of interest and resides primarily with experts under the jurisdiction and control of designated authorities. In order for the surveillance system to have cultural relevance, the focus group identified that the locus of control must be defined by the population of interest at the community level, and that the system must be germane and flexible to consider the local environment. The Aboriginal framework proposed places the locus of control with the community, in partnership with its data sources. Surveillance activities remain largely distinct from communities of interest, leading us to consider whether structural changes can serve to promote a link between data and action. Traditional or standard surveillance systems, by virtue of their structure, promote a disassociation between information and community action. Data management under the complete jurisdiction of sources external to a community appears to obstruct potential linkages between information and action.