PAHO - WHOPAHO - WHO PAHO - WHOPAHO - WHO

PAHO/WHOViolence is preventable

The Inter-American Coalition for the Prevention of Violence –IACPV-

PAHO/WHOViolence is preventable

The Inter-American Coalition for the Prevention of Violence –IACPV-

Alberto Concha-Eastman, MD, MScAlberto Concha-Eastman, MD, MScRegional AdvisorRegional Advisor

Violence and Injuries PreventionViolence and Injuries Preventionconchaal@paho.orgconchaal@paho.org

PAHO / WHOPAHO / WHOWashington, DCWashington, DC

Alberto Concha-Eastman, MD, MScAlberto Concha-Eastman, MD, MScRegional AdvisorRegional Advisor

Violence and Injuries PreventionViolence and Injuries Preventionconchaal@paho.orgconchaal@paho.org

PAHO / WHOPAHO / WHOWashington, DCWashington, DC

Organization of American StatesOrganization of American StatesCommittee on Hemispheric SecurityCommittee on Hemispheric Security

12 February 200712 February 2007

PAHO - WHOPAHO - WHO PAHO - WHOPAHO - WHO

Content:1. The IACPV2. The WHO World Report on Violence and Health - Violence is Preventable3. Youth Violence is a social conflict

Content:1. The IACPV2. The WHO World Report on Violence and Health - Violence is Preventable3. Youth Violence is a social conflict

Inter-American Coalition for the Prevention of Violence

INTER-AMERICAN COALITION FOR INTER-AMERICAN COALITION FOR THE PREVENTION OF VIOLENCETHE PREVENTION OF VIOLENCE

An Unprecedented Effort in the Americas

Coalition Founders, June 2000:• The Centers for Disease Control

• Inter-American Development Bank• Organization of American States

• Pan American Health Organization/World Health Organization

• United Nations Educational, Scientific, and Cultural Organization

• The World Bank

VIOLENCE IS A MAJOR HEALTH PROBLEM

• IN THE AMERICAS:

– +110,000 Homicides, 840,000 intentional injuries/year (91,523 AIDS;6 cholera cases/year)

– 1st cause of death in many countries– 2.6 days/person/year are lost to violence– 30-60% emergency visits to hospitals

are due to violence

VIOLENCE IS A MAJOR ECONOMIC OBSTACLE:

–IN THE AMERICAS:

–14.2% of G.N.P. (168,000 US million) is lost or transferred due to violence

–1.9% of G.N.P. is lost in human capital (equivalent to expenditures in primary education)

VIOLENCE IS AN OBSTACLE TO SOCIAL, ECONOMIC, POLITICAL

DEVELOPMENT• Violence and insecurity are major

sources of concern, even in countries with low levels of violence.

• Violence affects social capital.

• Involvement of civil society, private sector, religious communities is not as needed

• Is affecting governability at country and city levels

SYNERGIES

• NO SINGLE SECTOR (INSTITUTION) CAN SOLVE EXPRESSED NEEDS

• EFFECTIVE SOLUTION REQUIRES A MULTISECTORAL APPROACH

• DIVERSITY OF INSTITUTIONAL STRENGTHS

• JOINT EFFORTS ADDS CREDIBILITY AND POLITICAL CLOUT

Summit of the Americas Quebec 2001

The General Assembly of the Summit

“encourages national institutions to work together and coordinate with all appropriate multilateral organizations to implement comprehensive violence prevention initiatives”

and calls for the

“multilateral and other organizations that participate in the Inter-American Coalition for the Prevention of Violence to intensify their support and technical assistance to countries”

WHOWorld report

on violence and health

WHOWorld report

on violence and health

2002200220022002

PAHO - WHOPAHO - WHO PAHO - WHOPAHO - WHO

Health and Well-beingHealth and Well-being

EducationAgriculture - FoodPotable Water/SewerageHousing

EducationAgriculture - FoodPotable Water/SewerageHousing

WorkEnvironmentEmployment

WorkEnvironmentEmployment

Violence, insecurity unintentional injuriesAddiction to narcotics

Violence, insecurity unintentional injuriesAddiction to narcotics

Social and Economic Development

Social and Economic Development

Health care 1. Resources2. Administration and management3. Opportunities Access Quality Users’ perception

Health care 1. Resources2. Administration and management3. Opportunities Access Quality Users’ perception

Social Network Condition of LifeFamily size

Social Network Condition of LifeFamily size

AgeGenderGeneticsLifestyle

AgeGenderGeneticsLifestyle

Adapted from the WHO

HEALTH DETERMINANTS

DefinitionDefinition

“Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm,maldevelopment or deprivation”

World report on violence and health

“Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm,maldevelopment or deprivation”

World report on violence and health

TypologyTypology

DefinitionsDefinitions

InterpersonalInterpersonal

CommunityCommunityFamily/partnerFamily/partnerFamily/partnerFamily/partner

Nature of violenceNature of violence

PhysicalPhysicalPhysicalPhysical

SexualSexualSexualSexual

PsychologicalPsychologicalPsychologicalPsychological

Deprivation or neglectDeprivation or neglectDeprivation or neglectDeprivation or neglect

ChildChildChildChild PartnerPartnerPartnerPartner ElderElderElderElder AcquaintanceAcquaintanceAcquaintanceAcquaintance StrangerStrangerStrangerStranger

Interpersonal violenceInterpersonal violence

NumbersNumbers

Global homicide rates, 2000

Source: WHO database, 2000

Risk factors - ecological modelRisk factors - ecological model

Risk factorsRisk factors

IndividualRelationshipCommunitySocietal

Examples• Demographic factors• Psychological and personality disorders• History of violent behaviour• Experienced abuse

Examples:• Poor parenting• Marital conflict• Friends who engage in violence

Examples:• Concentration of poverty• High residential mobility• High unemployment• Social isolation• Local illicit drug trade

Examples:• Inequalities• Norms that support violence• Availability of means• Weak police/criminal justice

PAHO - WHOPAHO - WHO PAHO - WHOPAHO - WHO

PAHOPAHO

Youth Gangs: increasing into the thousands SOCIAL CONFLICT

+30.000 boys & girls involved in El Salvador & Honduras

Jam., C. Rica, Mex., Col., Nic., Gut., Peru, U.S.A., Brazil, others

Drugs, killings, rapes, assaults, robberies, move to organized crime

Youth Gangs: increasing into the thousands SOCIAL CONFLICT

+30.000 boys & girls involved in El Salvador & Honduras

Jam., C. Rica, Mex., Col., Nic., Gut., Peru, U.S.A., Brazil, others

Drugs, killings, rapes, assaults, robberies, move to organized crime

BACKGROUNDBACKGROUND. Factors . Factors Related to the Increase in Related to the Increase in Juvenile GangsJuvenile Gangs

Accelerated UrbanizationAccelerated Urbanization Armed ConflictsArmed Conflicts Privatization of Public AreasPrivatization of Public Areas Loss of Family StructureLoss of Family Structure Intra-family ViolenceIntra-family Violence Lack of Role Models for Child SocializationLack of Role Models for Child Socialization Violent CultureViolent Culture

BACKGROUNDBACKGROUND: Factors : Factors Related to the Increase in Related to the Increase in Juvenile GangsJuvenile Gangs

PovertyPovertyExclusion of young people from Exclusion of young people from

work forcework forceExclusion from formal schoolingExclusion from formal schoolingDifficulty with Self-identityDifficulty with Self-identity

Unfavorable Life Unfavorable Life ConditionsConditions

Family disruptionFamily disruption

““Cost Benefit” being in GangsCost Benefit” being in Gangs

Hanging Out leads to Social RecognitionHanging Out leads to Social Recognition

Access to DrugsAccess to Drugs

Involvement in GangsInvolvement in Gangs

Socialization learned in the Socialization learned in the StreetStreet

Increase in Drug useIncrease in Drug use

Fulfilling Violent Fulfilling Violent Obligations to Remain Obligations to Remain in the Gangin the Gang

Risk Factors for gang involvementRisk Factors for gang involvement

Perceived Reasons for Gang InvolvementPerceived Reasons for Gang Involvement

Barrio Adentro

Group involved LEVEL AND DEGREE OF VIOLENCE - CRIME

HOMICIDES ROBBERIES (BANKS, ETC...)

DRUGTRAFFICKING

VIOLATIONS ROBBERIES INJURIES HOMICIDES

MINOR OFFENSESTHEFTS

FIGHTS : INJURIES

SOCIAL TROUBLE

CONFLICTS- VIOLENCE

VICT/WITNESS

ORGANIZED CRIME

GANGS (JUVENILES)

HANGING AROUND-

JUVENILE GROUPS -

FAMILY - ENVIRONMENT - SOCIOECONOMIC

The “COURSE” OF VIOLENCE

MODEL 2

A. Concha-Eastman

INTERVENTIONS LEVEL AND DEGREE OF VIOLENCE - CRIME

HOMICIDESROBBERIES (BANKS, ETC...)DRUGTRAFFICKING

RAPES - ASSAULTS - INJURIES HOMICIDES

MINOR OFFENSESTHEFTS-

FIGHTS: INJURIES

SOCIAL TROUBLE

CONFLICTS- VICTIMS/ WITNESS OF VIOLENCE

ORGANIZED CRIME

Youth gangs

Hangingaround

Youth groups -

Family- socioeconomicenvironment

What to do

PRIMARY

PRIMARy

2ary.

LAW

2ary-3ary

IndividualFamilyCommunitySocietal

Preventing violence - ecological modelPreventing violence - ecological model

SolutionsSolutions

Examples •Pre-school enrichment •Social development progs.• Vocational training

Examples • Parenting programmes• Home visitation• Family therapy

Examples• Reducing alcohol availability • Modify physical environment (lights, etc)• Identify and refer people at risk for violence• Improving trauma care and health care access

Examples• Public information • Strengthen police and judicial systems• Reduce poverty and inequality • Educational reform • Reduce access to means • Job creation programmes

Questions:Questions:

• Who to blame? Who to blame?

• What do gang members What do gang members want? want?

• What life expectatives What life expectatives and expectancy they and expectancy they have?have?

Youth gangs

Proposal: To define that youth violence represents a social conflict to be solved through a social public policy based on prevention

Proposal: To define that youth violence represents a social conflict to be solved through a social public policy based on prevention

CP17602