Violence Prevention in Low- and Middle-Income Countries Finding a Place on the Global Agenda: Workshop Summary (2008) / Chapter Skim
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4 The Intersection of Violence and Health
4 The Intersection of Violence and Health
Pages 36-52
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From page 36... ...
Jacquelyn Campbell moderated this session and also closed with a presentation on the intersection of violence and women's health with a focus on HIV/AIDS. Presentations about collective violence and its impact on disease burden, self-directed violence and the crosscutting issues it shares with other types of violence, and the scale and consequences of child abuse and maltreatment for chronic diseases in adulthood were made by Richard Garfield, Eric Caine, and James Mercy, respectively.
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From page 37... ...
For the first time, the prevalence of organized political violence between states or in a military fashion within states is so low that it is has become almost an exception to the political engagement between groups -- a message that seldom gets out to the media or to those who work in violence prevention. These data may be indicative of two of the strategic primary prevention foci outlined by Mercy (see Appendix C, Mercy et al., 2007)
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From page 38... ...
Much of the violence now happens between neighbors versus organized, armed groups; with one in five households reporting a death since peace occurred. Despite this, the Sudanese perceive their situation as much improved -- neighbors now have reduced access to weapons (another strategic primary prevention focus posited by Mercy [see Appendix C, Mercy et al., 2007]
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From page 39... ...
The environmental damage may affect people not only in nations directly engaged in collective violence but in all nations. Much of the morbidity and mortality during war, especially among civilians, has been the result of devastation of societal infrastructure, including destruction of food and water supply systems, healthcare facilities and public health services, sewage disposal systems, power plants and electrical grids, and transportation and communication systems.
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From page 40... ...
Many of the data he discussed were from the United States because more data are available there, but he noted that what is true in the United States is amplified greatly around the rest of the world. The interrelationship of suicide and other adverse outcomes is based on risk factors for a variety of adverse outcomes such as intimate partner violence including homicide and accidental death.
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From page 41... ...
These people are typically parents, have families, are employed, and are relationship filled -- not "the psychiatric patient." Risk Factors for Suicide Many of the data about risk factors come from psychological autopsy data and are generally not helpful in setting up prevention programs, and there are cross-national variations as well. In children and young adults, these factors include but are not limited to major psychopathology, personal or family turmoil, exposure to violence, legal problems, poor school performance, and prior suicide attempts or a family history of suicide.
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From page 42... ...
As an example, he briefly explored a layered, developmental context for suicide prevention for men aged 25-54 years in which the people in this range often, but not always, have 10 to 20 years' worth of what he termed ascending alcohol abuse, ascending family turmoil, partner violence, and eventual unemployment. By and large, the typical scenario in a man's life is a dramatic life event three to six weeks before he kills himself.
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From page 43... ...
Other examples he presented underscored the linkages between alcohol use or dependence, economic stressors, and other indicators of social turmoil, including high rates of HIV/AIDS and intimate partner violence, as drivers of suicide in Russia after the dissolution of the Soviet Union. This is another example of how these issues are linked, with common problems and risk factors at the base, but result in different adverse outcomes.
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From page 44... ...
These homicide rates are highest in Africa and also, interestingly in North America, and represent only a small proportion of the problem. Mercy cautioned that these data were problematic because it is very difficult to get reliable estimates of child homicides, which often get buried in other causes of death, such as unintentional injury or sudden infant death syndrome in the United States.
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From page 45... ...
In addition, data from this study yielded global fractional estimates of the burden of mental disorders and suicidal behavior attributable to child sexual abuse, disaggregated by sex (see Table 4-1)
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From page 46... ...
He acknowledged that there are literally hundreds of research studies linking child maltreatment to many different types of health outcomes, specifically identifying health risk behaviors that are documented to be
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From page 47... ...
In terms of the prevalence of the different types of adverse exposures, 28 percent reported being exposed to physical abuse as a child, along with reports of exposure to other adverse outcomes such as mental illness, parental incarceration, emotional and sexual abuse, intimate partner violence in the home, household substance abuse, and parental separation or divorce. The other point here, he noted, is that many of these adverse exposures often co-occur, so it is not always easy to look at them separately.
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From page 48... ...
• Child maltreatment creates an enormous drag on the socioeconomic progress of developing countries; and though we may not be able to put an economic figure on the effect of this or intimate partner violence on other health outcomes, due to the paucity of economic analyses estimating the relationship of GDP to violence, these problems probably add a much greater cost than is seen in the available figures. However, according to Mercy, it is safe to say that interventions that are effective for preventing child maltreatment in developing countries will have enormous long-term economic benefits.
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From page 49... ...
These data, she pointed out, showed a common, high prevalence of physical partner violence, and of sexual assault as part of intimate partner violence. In some countries, sexual assault is more common than physical violence for some women.
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From page 50... ...
For now, we know that intimate partner violence around the world is significantly associated with unintended pregnancy. Other maternal health correlates mirror those identified by Mercy in his examination of child maltreatment -- depression, substance abuse, low social support, smoking -- with the addition of spontaneous abortion and risk of homicide.
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From page 51... ...
More proactive intimate partner violence prevention messages should be included in women's health campaigns, such as the Safer Motherhood Campaign. Campbell also stated that we need to increase health provider education and awareness about violence against women, as well as clinical initiatives for systematic, confidential, and safe assessments of intimate partner violence; appropriate referrals must be made that link healthcare systems around the world with community-based nongovernmental organizations.
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From page 52... ...
to understand their possible roles as protective factors against the types of violence and the adverse outcomes described in the presentations. Awareness of the issue of the historical trauma of oppression by colonists through time and around the globe, as well as the healing role of restorative justice programs, was also raised as worthy of consideration in global violence prevention efforts.
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