transforming our world: implementing the 2030 agenda

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Transforming Our World: Implementingthe 2030 Agenda Through SustainableDevelopment Goal Indicators

Bandy X. Leea,*, Finn Kjaerulfb, Shannon Turnerc, Larry Cohend,Peter D. Donnellye, Robert Muggahf, Rachel Davisd, Anna Realinid,Berit Kieselbachg, Lori Snyder MacGregorh, Irvin Walleri,Rebecca Gordonj, Michele Moloney-Kittsj, Grace Leea andJames Gilligank

aLaw and Psychiatry Division, Yale University, 34 Park Street, New Haven, CT 06519,USA

bDIGNITY – Danish Institute Against Torture, Copenhagen, Denmark

cPrevention of Violence Canada-Prevention de la violence, Quebec City, Canada

dPrevention Institute, Oakland, USA

ePublic Health Ontario, Toronto, Canada

fIgarape Institute (Brazil) and the SecDev Foundation (Canada), University of Oxfordand the Graduate Institute of International Studies in Geneva, Geneva, Switzerland

gWorld Health Organization, Geneva, Switzerland

hRegion of Waterloo Public Health and Emergency Services, Waterloo, Canada

iUniversity of Ottawa, Ottawa, Canada

jTogether for Girls, Washington, DC, USA

kNew York University, New York, NY, USA

*Corresponding author. E-mail: [email protected]

Abstract The United Nations’ 2030 Agenda for Sustainable Developmentrecognizes violence as a threat to sustainability. To serve as a context, we providean overview of the Sustainable Development Goals as they relate to violence pr-evention by including a summary of key documents informing violence preventionefforts by the World Health Organization (WHO) and Violence Prevention Alli-ance (VPA) partners. After consultation with the United Nations (UN) Inter-Ag-ency Expert Group on Sustainable Development Goal Indicators (IAEG-SDG), we

� 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 37, S1, S13–S31www.palgrave.com/journals

select specific targets and indicators, featuring them in a summary table. Using thediverse expertise of the authors, we assign attributes that characterize the focusand nature of these indicators. We hope that this will serve as a preliminaryframework for understanding these accountability metrics. We include a briefanalysis of the target indicators and how they relate to promising practices inviolence prevention.Journal of Public Health Policy (2016) 37, S13–S31.doi:10.1057/s41271-016-0002-7

Keywords: sustainable development; violence prevention; indicators;accountability measures

What Can and Should be Done to Sustain Momentumand Strategic Direction for Global Violence Prevention?

The 2030 Agenda for Sustainable Development will shape globaldevelopment policy and actions for the next 15 years.1 Ensuringmomentum and strategic direction for global violence prevention willrequire concerted action to kick-start the process in the next 2–5 years.On 22–23 September 2015, in Geneva, the World Health Organization(WHO) hosted the 7th Milestones of a Global Campaign for ViolencePrevention Meeting for violence prevention researchers and practition-ers from all over the world. The conference theme, ‘‘ViolencePrevention and the 2030 Agenda for Sustainable Development,’’encouraged discussion of the need for specific indicators for measure-ment, and about priorities for data collection related to the violencereduction targets. We outline selected conclusions below. The ViolencePrevention Alliance (VPA) is a network of 63 institutions involved inviolence prevention worldwide, bringing together WHO MemberStates, international agencies, civil society organizations, and academicinstitutions. The VPA plays a key role in uniting a vision of effectiveviolence prevention through multi-sectoral collaboration. Because of itsunique forum, which includes sectors at all levels (community,national, regional, and international) the VPA offers an invaluableopportunity for bridging the gap between theory and practice, evidenceand implementation, to identify priority areas for global leadership inviolence research.

Figure 1 provides a timeline and summary of key references designedto support the Global Campaign to Prevent Violence. A Global Plan ofAction to strengthen Health Services is under development and will bean important strategy for achieving SDG’s (Table 1).

Lee et al

S14 � 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 37, S1, S13–S31

2002First report on the scope and scale of violence around the globe. Introduced a Typology of Violence and ecological model for understanding violence. Explained the public health approach to addressing and preven�ng violence. Helped to launch the Global Campaign for Violence Preven�on

2008Preven�ng violence and reducing its impact How development agencies can helpA key aim is to s�mulate dialogue on the role of interna�onal development agencies in the preven�on of violence globally, and ul�mately to increase investment in a commonly agreed set of applied violence preven�on strategies.

2009 Violence preven�on: the evidence is a set of briefings on what works to prevent interpersonal violence (including against women and girls), and self-directed violence The Evidence includes: promo�ng safe, stable and nurturing rela�onships between children and their parents and caregivers; developing life skills in children and adolescents; reducing availability and harmful use of alcohol; reducing access to guns, knives and pes�cides; promo�ng gender equality; changing cultural norms that support violence; and vic�m iden�fica�on, care and support.

2012The Global Ac�on Plan calls for countries to: Inrease the priority of evidence-informed violence preven�on as a global public health and development issue . Build the founda�ons for violence preven�on. Implement Violence preven�on strategies

2014 - Jointly published by WHO, UNDP, UNODCData from 133 countries assess na�onal efforts to address interpersonal violence, namely child maltreatment, youth violence, in�mate partner and sexual violence, and elder abuse.Report calls for a scaling up of violence preven�on programmes; stronger legisla�on and enforcement of laws relevant for violence preven�on; and enhanced services for vic�ms of violence.

2015World Health Assembly Resolu�on May 2015 -WHA67.15Calls for the crea�on of a Global Plan of Ac�on to strengthen the role of the health systems to address interpersonal violence, in par�cular against women and girls, and against children

2015• Goal 5: Achieve gender equality and empower all women and girls• Goal 16: promote peaceful and inclusive socie�es for sustainable development, the provision of access to jus�ce for

all, and building effec�ve, accountable ins�tu�ons at all levels.

Targets:5.1 End all forms of discrimina�on of women and girls everywhere5.2 Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and other types of sexual esploita�on5.3 Eliminate all harmful prac�ces , such as child, early and forced marriage, and female genital mu�la�on

TARGETS:16.1 Significantly reduce all forms of violence and related death rates everywhere16.2 End abuse , exploita�on, trafficking and all forms of violence against and torture of children16.7 Ensure responsive, inclusive, par�cipatory and representa�ve decision-making at all levels

Global Campaign for Violence Preven�on

Figure 1: Global violence prevention policy and planning documents.

Source: World Health Organization: http://www.who.int/violence_injury_prevention/violence

https://sustainabledevelopment.un.org/?menu=1300.

Transforming Our World

� 2016 Macmillan Publishers Ltd. 0197-5897 Journal of Public Health Policy Vol. 37, S1, S13–S31 S15

http://www.who.int/violence_injury_prevention/violence

https://sustainabledevelopment.un.org/?menu=1300

Table

1:

Vio

lence

-rel

ate

dSD

Gin

dic

ato

rsby

tim

efra

me,

gover

nan

ce,

statu

s,and

type

Target

Objective

ProposedIndicator

Tim

eframe:

immediate

medium

term

long(I

ML)

term

Governan

ce:

localregional

national

(LRN)

Status:

Population

service

environment

(PSE

)

Typ

e:structural

driver

behav

iour/

Exposure

medical

condition

(SBM)

Goal5:

Ach

ieve

gen

der

equali

tyand

empow

erall

wom

enand

gir

ls5.2

Eli

min

ate

all

form

sof

vio

lence

again

stall

wom

enand

gir

lsin

the

publi

cand

pri

vate

spher

es,

incl

udin

gtr

affi

ckin

gand

sexual

and

oth

erty

pes

of

explo

itati

on

5.2.1

Pro

port

ion

of

ever

–part

ner

edw

om

enand

gir

ls(a

ged

15-49)

subje

cted

tophysi

cal

and/o

rse

xual

vio

lence

by

acu

rren

tor

form

erin

tim

ate

part

ner

,in

the

last

12m

onth

s

Imm

edia

teL

RN

PB

/E

5.2.2

Pro

port

ion

of

wom

enand

gir

ls(a

ged

15–49

)su

bje

cted

tose

xual

vio

lence

by

per

sons

oth

erth

an

an

inti

mate

part

ner

,si

nce

age15

Imm

edia

teL

RN

PB

/E

5.3

Eli

min

ate

all

harm

ful

pra

ctic

es,

such

as

earl

yand

forc

edm

arr

iage

and

fem

ale

gen

ital

muti

lati

on

5.3.1

Per

centa

ge

of

wom

enaged

20–24

who

wer

em

arr

ied

or

ina

unio

nbef

ore

age18

(i.e

.ch

ild

marr

iage)

med

ium

LR

NPE

B/E

5.3.2

Per

centa

ge

of

gir

lsand

wom

enaged

15–49

yea

rsw

ho

have

under

gone

FG

M/C

by

age

gro

up

(for

rele

vant

countr

ies

only

)

Med

ium

LR

NP

EB

/E

Lee et al


Goal16

:Pro

mote

pea

cefu

land

incl

usi

ve

soci

etie

sfo

rsu

stain

able

dev

elopm

ent,

pro

vid

eacc

ess

toju

stic

efo

rall

and

buil

def

fect

ive,

acc

ounta

ble

and

incl

usi

ve

inst

ituti

ons

at

all

level

s16

.1Sig

nifi

cantl

yre

duce

all

form

sof

vio

lence

and

rela

ted

dea

ths

ever

yw

her

e16

.1.1

Num

ber

of

vic

tim

sof

inte

nti

onal

hom

icid

eby

age,

sex,

mec

hanis

mand

wher

eposs

ible

type

of

per

pet

rato

r,per

100,00

0popula

tion

Imm

edia

teL

RN

PB

/E

16.1

.2T

his

indic

ato

ris

stil

lunder

dis

cuss

ion

–G

rey

Conflic

t-re

late

ddea

ths

per

100,00

peo

ple

(dis

aggre

gate

dby

age,

sex,

and

cause

)im

med

iate

LR

NP

ES

B/E

16.2

End

abuse

,ex

plo

itati

ons,

traffi

ckin

gand

all

form

sof

vio

lence

again

stand

tort

ure

of

chil

dre

n16

.2.1

Per

centa

ge

of

chil

dre

naged

1–14

yea

rsw

ho

exper

ience

dany

physi

cal

punis

hm

ent

by

care

giv

ers

inth

epast

month

med

ium

LR

NP

B/E

16.2

.2N

um

ber

of

det

ecte

dand

non-d

etec

ted

vic

tim

sof

hum

an

traffi

ckin

gper

100,00

0;by

sex,

age

and

form

of

explo

itati

on

imm

edia

teL

RN

PE

SB

/E

Addit

ional

This

indic

ato

ris

stil

lunder

dis

cuss

ion-

Gre

y

Per

centa

ge

of

young

wom

enand

men

aged

18–24

yea

rsw

ho

exper

ience

dse

xual

vio

lence

by

age18

Long

Ter

mL

RN

PE

B/E

16.3

Pro

mote

the

rule

of

law

at

the

nati

onaland

inte

rnati

onalle

vel

sand

ensu

reeq

ualacc

ess

toju

stic

efo

rall

16.3

.1T

his

indic

ato

ris

stil

lunder

dis

cuss

ion

-G

rey

Per

centa

ge

of

vic

tim

sof

vio

lence

inth

epre

vio

us12

month

sw

ho

report

edth

eir

vic

tim

izati

on

toco

mpet

ent

auth

ori

ties

or

oth

eroffi

ciall

yre

cogniz

edco

nflic

tre

solu

tion

mec

hanis

ms

(als

oca

lled

crim

ere

port

ing

rate

)

Imm

edia

teL

RN

PSE

SB

/E

16.3

.2U

nse

nte

nce

ddet

ain

ees

as

aper

centa

ge

of

the

over

all

pri

son

popula

tion

Imm

edia

teL

RN

PS E

SB

/E



Table

1:continued

Target

Objective

ProposedIndicator

Tim

eframe:

immediate

medium

term

long(I

ML)

term

Governan

ce:

localregional

national

(LRN)

Status:

Population

service

environment

(PSE

)

Typ

e:structural

driver

behav

iour/

Exposure

medical

condition

(SBM)

16.4

By20

30,

signifi

cantl

yre

duce

illi

cit

financi

al

and

arm

sflow

s,st

rength

enth

ere

cover

yand

retu

rnof

stole

nass

ets

and

com

bat

all

form

sof

org

aniz

edcr

ime

16.4

.1T

his

indic

ato

ris

stil

lunder

dis

cuss

ion

-G

rey

Tota

lvalu

eof

inw

ard

and

outw

ard

illi

cit

financi

al

flow

s(i

ncu

rren

tU

S$)

Imm

edia

teR

NE

S

16.4

.2T

his

indic

ato

ris

stil

lunder

dis

cuss

ion

-G

reen

Per

centa

ge

of

seiz

edand

coll

ecte

dfire

arm

sth

at

are

reco

rded

and

trace

d,

inacc

ord

ance

wit

hin

tern

ati

onal

standard

sand

legal

inst

rum

ents

Imm

edia

teL

RN

ES

Addit

ional

-G

reen

Per

centa

ge

of

small

arm

sm

ark

edand

reco

rded

at

the

tim

eof

import

inacc

ord

ance

wit

hin

tern

ati

onal

standard

s

Imm

edia

teN

ES

16.7

Ensu

rere

sponsi

ve,

incl

usi

ve,

part

icip

ato

ryand

repre

senta

tive

dec

isio

n-m

akin

gat

all

level

s16

.7.1

Pro

port

ions

of

posi

tions

(by

age

,se

x,

dis

abilit

yand

popula

tion

gro

ups)

inpublic

inst

ituti

ons

(nati

onal

and

loca

lle

gis

latu

res,

public

serv

ice,

and

judic

iary

)co

mpar

edto

nat

ional

dis

trib

uti

ons

Imm

edia

teL

RN

SE

S

Lee et al


16.10

Ensu

republi

cacc

ess

toin

form

ati

on

and

pro

tect

fundam

enta

lfr

eedom

s,in

acc

ord

ance

wit

hnati

onal

legis

lati

on

and

inte

rnati

onal

agre

emen

ts16

.10.1

This

indic

ato

ris

stil

lunder

dis

cuss

ion

-G

rey

Num

ber

of

ver

ified

case

sof

kil

ling,

kid

nappin

g,

enfo

rced

dis

appea

rance

,arb

itra

rydet

enti

on

and

tort

ure

of

journ

ali

sts,

ass

oci

ate

dm

edia

per

sonnel

,tr

ade

unio

nis

tsand

hum

an

rights

advoca

tes

inth

epre

vio

us12

month

s

Imm

edia

teL

RN

PE

SB

/E

16.a

.Str

ength

enre

levant

nati

onal

inst

ituti

ons,

incl

udin

gth

rough

inte

rnati

onal

cooper

ati

on,

for

buil

din

gca

paci

tyat

all

level

s,in

part

icula

rin

dev

elopin

gco

untr

ies,

topre

ven

tvio

lence

and

com

bat

terr

ori

smand

crim

e16

.a.1

This

indic

ato

ris

stil

lunder

dis

cuss

ion

-G

rey

Per

centa

ge

of

vic

tim

sw

ho

report

physi

cal

and/o

rse

xual

crim

eto

law

enfo

rcem

ent

agen

cies

duri

ng

the

past

12m

onth

sD

isaggre

gate

dby

age,

sex,

regio

nand

popula

tion

gro

up

med

ium

LR

NP

SB

/E

16.b

.Pro

mote

and

enfo

rce

non-d

iscr

imin

ato

ryla

ws

and

poli

cies

for

sust

ain

able

dev

elopm

ent

16.b

.1Per

centa

ge

of

popula

tion

havin

gper

sonall

yfe

ltdis

crim

inate

dagain

stor

hara

ssed

wit

hin

the

last

12m

onth

son

the

basi

sof

agro

und

of

dis

crim

inati

on

pro

hib

ited

under

inte

rnati

onal

hum

an

rights

law

.D

isaggre

gate

by

age,

sex,

regio

nand

popula

tion

gro

up

Long

Ter

mL

RN

PE

B/E

S



Next Steps and Specific Recommendations for the Way Forward

It is important to increase our focus on risk and resilience factors thatconcern violence. The three keys to preventing violence are as follows:

(1) Understanding that violence is a complex issue and requires acomprehensive approach.

(2) Addressing risk and resilience factors with attention to increasedvulnerability due to gender inequality, age, etc.

(3) Developing an integrated strategy for action.

While investments in violence prevention and response haveincreased in recent years, overall they have been woefully inadequateand highly disproportionate to the magnitude of the problem. Com-munity and interpersonal violence not only cause immediate health andsafety issues — including injuries, death, and emotional trauma — butalso long-term sequelae affecting the financial and personal capital ofentire communities and societies. Currently, the social welfare, criminaljustice, and health sectors bear the largest burden for dealing with theconsequences of violence, while programs focus on responses afterviolence occurs. However, high levels of violence and conflict are majorobstacles for inclusive socio-economic development, not to mention adrain to resources.2 We now know that violence is preventable withcommitment and sustained attention. A great deal of research nowhighlights key societal, community, familial, and individual risk andresilience factors, and we have a growing understanding of interven-tions that work and are ready for implementation.

The next step, then, requires expanding approaches that preventviolence before it occurs — not only through programs, but throughsystemic changes in environmental factors and a more comprehensiveset of prevention activities, including changes in social norms aroundgender inequality and violence acceptance; improving and enforcinglaws and policies, institutional practices, and public education; andcooperating among multiple partners. Addressing the ‘determinants ofhealth’3 includes prioritizing data collection on a few known, universalrisk factors, such as firearms ownership and access; alcohol use andaccess; illicit drug use and drug-trafficking; exposure to violence; socialdeterminants/inequality measures and institutional legitimacy. It alsorequires looking at the underlying elements that allow these factors to

Lee et al


proliferate in the first place. In each of these areas there is strongevidence for interventions that work.

Sustainable violence prevention requires transformation of thesystems and institutions committing and supporting state-sanctionedviolence into systems supporting legitimacy and inclusiveness, amedium- to long-term undertaking that requires additional qualitydata. This will require a better understanding of all forms of violence,including collective and structural violence. A stronger focus oninnovative studies in this area can create new insights and contributeto the development of measurable indicators to guide global develop-ment policies and action toward the sustainable transformation ofinstitutions to promote safety and security.

Recommendations for Capacity Development and InstitutionalReform

Preventing violence entails building on partnerships across global andlocal institutions, identifying and using existing United Nations (UN)instruments, and prioritizing multi-sectoral approaches. We need torefine existing knowledge and, more importantly, to support commu-nities and countries to develop the political will to translate thatknowledge into practice. Local authorities and national governmentsmust be the focus and champions of these changes; we must engage keyactors like police, health professionals, and social workers, who havedirect contact with violence on the ground, and support them to buildcapacity; and we need to work with multiple sectors to developguidelines regarding their roles in addressing and preventing violencewithin their own mandates.

Ensuring the SDGs Account for Violence Prevention:A Preliminary Discussion

The SDG’s present a golden opportunity for achieving far-reaching andcollaborative gains on violence prevention around the world.4 Of note,the United Nations (UN) Statistical Commission created an Inter-Agency and Expert Group on SDG Indicators (IAEG-SDGs) in March2015. It comprises Member States as well as regional and international



agencies as observers. The IAEG-SDGs are expected to provide a globalindicator framework — and associated global and universal indica-tors — for consideration by the Statistical Commission at its 47thsession in March 2016 (See http://unstats.un.org/sdgs/iaeg-sdgs/). Afterconsultation with the United Nations UN IAEG-SDG, we selectedpreliminary indicators to facilitate monitoring of progress on SDGs.5

Although we included indicators on lethal and non-lethal violence, wedid not include key metrics associated with violent conflict mortalitydue to political disagreement and concern over their methodologicalrigor.6,7

Whether measuring violence or other development priorities, indi-cators alone do not fully capture the dynamics of all situations equally.We must interpret indicators in the context from which they arise.Their use in isolation from qualitative and other contextual researchinsufficiently captures the experience of a given setting or theunderlying factors influencing a specific environment. Nevertheless,indicators serve as critical markers toward a goal and will helpilluminate progress or failure to meet objective targets.

Two SDGs directly address violence and can play an important rolein shaping global violence prevention efforts. These are SDG 5(‘‘Achieve Gender equality and empower all women and girls’’) andSDG 16 (‘‘Promote peaceful and inclusive societies for sustainabledevelopment, provide access to justice for all and build effective,accountable and inclusive institutions at all levels’’). There are severalother SDGs that address important underlying risk factors forinterpersonal violence like alcohol and drugs and safety in schoolsand cities. SDG 11, for example, has a potential indicator 11.7.2:‘‘Proportion of women subjected to physical or sexual harassment, byperpetrator and place of occurrence (last 12 months)’’ (SDG 11 on safe,inclusive, resilient and sustainable cities also includes some referencesto the promotion of security, but we have chosen not to discuss itwithin the length of this article). Following these SDGs also helpsilluminate conditions that impact rates of violence.

Tracking global, national, regional, and municipal indicators canallow us to achieve some measurements of progress toward the SDGs.Given that many countries, regions, and cities are on an unequalfooting when it comes to data collection, surveillance, and reporting,the road ahead is challenging.8

Lee et al


http://unstats.un.org/sdgs/iaeg-sdgs/

There are other barriers to consider. Standard definitions forcategories of violence and means of validating prevalence are necessarybefore we can analyze and compare the data. Reaching agreement on acore set of indicators among various constituencies is also a contentiousand demanding process. Any final determination of indicators comeswith its own limitations as ‘what gets counted counts’ – and influencesthe comprehensiveness of any assessment. For example, measurementof sexual violence often depends entirely on incident reports. We knowfrom population survey data that many do not report assaults, and thatthe ways in which the law defines sexual violence influence whatappears in reports. When one selects indicators from criminal justice orother systems, it is important to acknowledge that these constituteproxy measures for actual incidence and can vary by a multitude ofsocial and cultural factors, making it likely that we are undercountingtrue incidence. For example, recent analyses of human services datafrom 24 countries suggested that estimates of gender-based violenceprevalence derived from health or police data will result in hugeunderestimates, with at best 9 % of incidents occurring in developingcontexts.9 We also must acknowledge that if violence prevention andresponse are working, rates of violence according to service surveillancemay rise initially, as more people are aware and seek support andservices. One way to address this challenge is to use ancillary data tocontextualize the primary indicators, which the international commit-tee has selected. This helps to make more certain that we understandthe full story surrounding an indicator. For example, ancillary data onthe greater availability of rape kits in emergency rooms in a jurisdictioncould help explain an increase in criminal charges for sexual assaultwithin that jurisdiction; conversely, a lack of access to rape kits couldmean a decrease in criminal charges and investigations regarding sexualassaults.

Metrics can influence the design, implementation, and evaluation ofinterventions. This is a risk in the SDG process of limiting the types andcontext of reporting indicators. The way we frame a ‘problem’ insociety can influence approaches to the solution. For example, whenmeasuring violence and addressing prevention through surveillance,metrics for crime may provide us with some insight. Communitiesaddressing high levels of crime reports can interpret this as a need formore police officers, but a public health approach would indicate theneed to address causal factors through community-based violence



prevention, while understanding (and possibly transforming) how wedefine ‘crime’ and measure it within society. Solutions to violence callfor a public health approach with a focus on evidence-informedinterventions. (For a more comprehensive discussion of this issue,please see Less Law More Order10,11 and A Manifesto for fragilecities12,13).

The SDG process can benefit from learning from countries and citieswhere violence prevention has generated results. For a case study ofthis, we can look to Latin America. After decades of heavy-handedcrime prevention – ‘mano dura’ in the vernacular – some Latin Amer-ican cities such as Bogota, Medellin, and Mexico are changing theirtactics dramatically. Since the 1990s, elected officials, private businesspeople, and civil society groups started experimenting with newapproaches consisting of ‘‘community-level violence prevention’’ insome of the region’s fragile cities.12 (For more about fragile environ-ments, see also in this Special Issue: Kumar and Willman14).

Such approaches involve strategies that target places, people, andbehaviors. After making some important gains, they are today helpingto reshape the global debate on urban safety. Latin America’s newapproach to urban crime prevention is producing some spectaculardeclines in murder and victimization. Even before investing in urbanrenewal, new forms of policing, at-risk youth programs, or alcoholand firearm restrictions, Latin American leaders focused first onattitudes and values. A first step was to craft a new culture ofcitizenship, encouraging locals to regulate themselves and oneanother. In Bogota, for example, local governments paid street mimes(performers who work in public spaces) to deliver ‘behavior cards’ forthose who broke rules. This allowed for modeling desired behaviorsin an often comedic and expansive way, emphasizing the message orsocial norm the governments wanted communicated through theater.City planners also started up women’s nights, cleaned up publicspaces, created amnesties for collecting firearms, reduced alcohol salesand outlets in hot spots, and created national and metropolitanobservatories to track crime and violence. Over time, they comple-mented these investments in social norm and behavior change withconcrete investments in public security and violence preventionprograms.

On the basis of a careful reading of the evidence, civic leaders in somemajor Latin American cities began investing in data-driven and

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community-based policing and gun collection programs. In some cases,they invested in conditional cash transfer programs (welfare programsthat are conditional upon the receivers’ meeting certain criteria), earlychildhood support for single-headed female households, and after-school activities for at-risk young males. The last has been especiallysuccessful in reducing both violent and property-related crime.

Despite ongoing challenges related to collective violence anddisplacement, and interpersonal violence, these holistic approachesrepresent great strides in violence prevention and response, and manyof these Latin American innovations in violence prevention reflect bestpractices now known to the global public health community. Effectiveuse of data and design of comprehensive approaches often succeedswhere narrowly designed law enforcement measures have failed. TheVPA led discussions in Geneva in 2015 that point to a need forindicators to track progress at three levels:

• Immediate effects (‘quick fix’ indicators measuring short term visiblegains and creating and/or sustaining political will for ongoingviolence prevention actions).

• Medium-term effects (‘proximate’ indicators that can track outcomemetrics and measure the intermediate effects of violence preventionon communities).

• Long-term effects (‘structural’ indicators that can measure sustainedreductions in the underlying risks of violence in institutions, societies,and at-risk population groups).

Researchers can choose several indicators at all three levels ofanalysis. Possible immediate effect indicators could track theprevalence of firearms, alcohol and drugs; increases in trauma-informed care, treatment and intervention for offenders and potentialperpetrators, parenting support, early childhood development pro-grams, life skills training, community-based social norms change;and promotion of peace education in schools. Medium-term effectindicators could measure social norms and behavior change; urbanupgrading and poverty de-concentration programs; reduced commu-nity-level trauma; and increased social protection with an emphasison human dignity. Long-term effect indicators should consist ofsociety-level poverty and inequality reduction, institutional reform,and improved governance.



SDG Indicators for Sustaining and Directing Momentum:An Outline for Further Action

We will now examine indicators that the IAEG SDG Indicator expertgroup has selected.15 The IAEG-SDG meets periodically to determinewhich indicators researchers will use to measure the SDG targets(accepted indicators are designated as ‘green’) and to guide the efforts ofnational statistical offices. A critical review of the IAEG-SDG processwill support balancing the SDG indicators framework from a publichealth perspective. Such an analysis can facilitate the implementation ofa public health approach to violence prevention and ensure that weemploy an ecological approach to reduce violence globally.16 It mightalso point the way to future research and partnerships with governmentsand nongovernmental organizations (NGOs).

Drawing from the current indicator framework of the IAEG-SDG,we have mapped each indicator to a number of attributes relevant toviolence prevention. As this is a preliminary analysis and the indicatorframework is still in development, further refinement will be necessary.We also accept that creating community-level indicators will depend ondata that one captures at a different level from national aggregate data.One can capture data from a variety of levels of organization and fromsurveys, incidents, encounters, or transactions. Organization of thesesources can occur at many levels of aggregation — for example, thenumber of liquor outlets in a community versus those in a region orcountry. Community-level indicators may not be of interest to nationalreporting systems. In many cases, community-level indicators areoutside of major reporting systems and therefore not visible as part of anational surveillance strategy. Hospital encounters at the local level canbe very helpful for criminal justice, counseling, and other types ofinterventions. At this time, emergency visits relating to violence have noconnection to criminal justice reporting systems.

We find the examination of indicators that work at multiple levels ofaggregation to be useful to this review, as is the characterization ofindicators by type. We derive the indicator by type category from thehealth equity work by the California-based Prevention Institute,17 aVPA partner and leader in community-level interventions for violenceprevention. In addition, a ‘‘status’’ attribute identifies whether theindicator is status of a population, an indication of infrastructure orservice, or an appraisal of the social environment.

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A review of the table, as we shall see, reveals interesting findings.First, there is agreement within the IAEG-SDG on a ‘‘homicide’’ metric,but there is still disagreement on a ‘‘violent conflict deaths’’ indicator.The latter indicator is a significant marker for any effort to manage andreduce violence globally. We cannot know the true intensity of armedconflict and thus the global burden of violence if we exclude conflictmortality from the SDG framework; and to include this, we need ashared understanding of how to measure conflict-related deaths.18

Second, the majority of the selected indicators register the incidenceand prevalence of some form of victimization and harassment. Many ofthe indicators will help establish a baseline for the targets and thustrack the longer term. These are essential indicators for characterizingthe global scope of violence.

We have noted that there is no specific indicator for violence duringpregnancy, a particularly vulnerable time for the health of mothers andchildren. A lifespan approach that acknowledges the reproductive yearsbeginning in preconception highlights the vulnerabilities as well asopportunities to impact health and well-being. Violence duringpregnancy is a major concern for maternal-child health and is a majorpublic health issue. Under 5.2.1, we recommend for consideration anindicator such as ‘‘Proportion of ever-partnered women and girls (aged15–49) subjected to violence during pregnancy’’.

Third, there are relatively few indicators that reflect structural driversor compliance with international standards, norms, and legislation.Finally, many indicators that we recommend will be very difficult tosource (e.g., victims of human trafficking) but should nevertheless be onour radar if we are to generate a better understanding of the trueimplications of violence around the world.

Importantly, the IAEG-SDG indicator framework also focuses on thedisaggregation of key indicators from the global to regional, sub-regional, and city levels. The UN, however, is still deliberating on thefinal shortlist of metrics. It will develop data on the basis of a three-tierapproach based primarily on the availability and existence of anestablished methodology for producing the indicator in question. Aninformal briefing to the UN shared the following approach fordeveloping the framework globally:

The first important step will be the assessment of the status of theindicators proposed. The indicators will be classified into three



tiers: Tier I: an established methodology exists and data arealready widely available (‘‘green’’); Tier II: a methodology has beenestablished but for which data are not easily available (yellow’’);and Tier III: an internationally agreed methodology has not yetbeen developed (‘‘grey’’).19

The discussion on SDG indicators is evolving. While we are still at apreliminary level, the framework proposes an ambitious high-leveloverview and incentive to measure structural drivers, societal norms,the strengthening of protective factors, and the reduction of risksassociated with violence. What ultimately may be more important forprevention efforts are indicators at the local level that help provide acomprehensive profile of communities, including their social andeconomic characteristics (including employment, education, access tohealthy and nutritious food, social mobility, and wealth distribution),values, norms, and perceptions. A comprehensive approach to mea-suring SDG indicators would benefit from the WHO-recommendedpublic health approach to violence prevention. The overarching focusof sustainability necessitates an engagement at all levels of governanceto establish truly nurturing and thriving human settlements in viableecosystems.

About the Authors

Bandy X. Lee M.D., M.Div., is a faculty member of the Law andPsychiatry Division at Yale University and directs the Violence andHealth Study Group as well as the Academic Collaborators ProjectGroup for the WHO Violence Prevention Alliance.

Finn Kjaerulf M.Sc., is an economist and program manager atPrevention of Urban Violence Theme, DIGNITY – Danish InstituteAgainst Torture, Denmark. Email: [email protected].

Shannon Turner B.A., B.Sc., M.Sc., Ph.Dc., is a Doctoral Fellow at theUniversity of Victoria, British Columbia Canada, National Co-Chair ofPrevention of Violence Canada- Prevention de la violence Canada,Social Innovation Research Lead and Co-Chair of the Global AdvisoryCircle for Bridge For Health. Email: [email protected].

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Larry Cohen M.S.W., is the Founder and Executive Director ofPrevention Institute, a U.S. nonprofit organization dedicated to im-proving community health and equity by taking action to buildresilience and to prevent violence and illness before they occur. Email:[email protected].

Peter Donnelly M.D., is President and CEO of Public Health Ontario.He holds Professorships at the University of Toronto, Queens Univer-sity, and the University of St. Andrews.

Robert Muggah Ph.D., is research director of the Igarape Institute(Brazil) and the SecDev Foundation (Canada) and a fellow at theUniversity of Oxford and the Graduate Institute of InternationalStudies in Geneva, Switzerland. Email: [email protected].

Rachel Davis M.S.W., is Managing Director at Prevention Instituteand Chair of UNITY (Urban Networks to Increate Thriving Youth), anational violence prevention initiative that advances a public healthapproach to violence in the U.S. Email: [email protected]

Anna Realini is the Manager of the Executive Office at PreventionInstitute, a U.S. nonprofit organization dedicated to improving com-munity health and equity by taking action to build resilience and toprevent violence and illness before they occur. Email:[email protected].

Berit Kieselbach M.Sc., is Technical Officer at the World HealthOrganization Department for Management of NoncommunicableDiseases, Disability, Violence and Injury Prevention. Email:[email protected].

Lori Snyder MacGregor R.N., B.Sc.N., M.Ed., is a Public Health Nurseat the Region of Waterloo Public Health and Emergency Servicesand Past Co-Chair and current member of Prevention of ViolenceCanada- Prevention de la violence Canada. Email: [email protected]



Irvin Waller Ph.D., is Professor of Criminology, University of Ottawa,Canada, and President of the International Organization for VictimAssistance.

Rebecca Gordon M.P.H., is the Senior Program Advisor for Togetherfor Girls, based in Washington, DC. Prior to joining Together for Girls,she coordinated violence prevention and response in South Sudan andThailand.

Michele Moloney-Kitts M.S.N., is the Executive Director of Togetherfor Girls and serves as a Senior Advisor to the Executive Director ofUNAIDS. Previously, she served as the Assistant Global AIDSCoordinator for the U.S. President’s Emergency Plan for AIDS Relief(PEPFAR), and for many years as a health officer for USAID. She beganher career as a nurse practitioner and a nurse midwife.

Grace Lee Ed.D., directs the Arts for Social Change Research Groupfor the Education Studies Program at Yale University, exploring therole of creative exchange across age groups for violence prevention andpeace promotion. She is also a psychotherapist, former professor, andauthor.

James Gilligan M.D., is a Clinical Professor of Psychiatry and anAdjunct Professor of Law at New York University. Previously, heserved on the faculty of Harvard Medical School, directing the Instituteof Law and Psychiatry, Bridgewater State Hospital for the criminallyinsane, and Mental Health Services for the Massachusetts prisonsystem.

References

1. United Nations. (2015) General Assembly Resolution A/RES/70/1. Transforming Our World,the 2030 Agenda for Sustainable Development. [cited 2016 Feb 10]. Available from: http://

www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E.2. Pereznieto, P., Montes, A., Routier, S., Langston, L. (2014) The Costs and Economic Impact

of Violence Against Children. London: Overseas Development Institute, Child fund Alliance.3. WHO (1986) Ottawa charter for health promotion. First International Conference on Health

Promotion; 21 November 1986, Ottawa, Canada. Ottawa: World Health Organization.4. Kjaerulf, F., Lee, B., Cohen, L., Donnelly, P., Turner, S., Davies, R., Realini, A., Moloney-

Kitts, M., Gordon, R., Lee, G. and Gilligan, J. (forthcoming) The 2030 Agenda for Sustainable

Lee et al


http://www.un.org/ga/search/view_doc.asp%3fsymbol%3dA/RES/70/1%26Lang%3dE

http://www.un.org/ga/search/view_doc.asp%3fsymbol%3dA/RES/70/1%26Lang%3dE

Development – A golden opportunity for global violence prevention. International Journal ofPublic Health, in press.

5. United Nations Inter-Agency Expert Group on Sustainable Development Goal Indicators.

(2015) Results of the list of indicators reviewed at the second IAEG-SDG meeting. New York,

NY: United Nations Statistics Division. [cited 2016 May 27] Available from: http://unstats.un.

org/sdgs/files/meetings/iaeg-sdgs-meeting-02/Outcomes/Agenda%20Item%204%20-%20Review%20of%20proposed%20indicators%20-%202%20Nov%202015.pdf.

6. Muggah, R. (2015) Counting Conflict Deaths: Options for SDG 16.1. Botafogo, Rio deJaneiro, Brazil: Igarape Institute. 2015 Oct 15. Available from: https://igarape.org.br/wp-

content/uploads/2015/10/counting-conflict-deaths-muggah-2015.pdf.7. Muggah, R. and Mack, A. (2016) An Accounting of Conflict is Central to the Sustainable

Development Goals. ODI HPN. 2016 Jan 20 [cited 2016 Apr 4]. Available from: http://

odihpn.org/blog/an-accounting-of-conflict-deaths-is-central-to-the-new-sustainable-development-goals/.

8. World Health Organization. (2014) Global Status Report on Violence Prevention. Geneva:

World Health Organization, p. viii.9. Palermo, T., Beck, J., and Peterman, A. (2013) Tip of the iceberg: Reporting and gender-based

violence in developing countries. American Journal of Epidemiology 179(5): 602–612.10. Waller, I. (2008) Less Law More Order: The Truth About Reducing Crime. Hamilton: Manor

House Publishing.11. Waller, I. (2013) Smarter Crime Control: A Guide to a Safer Future for Citizens, Commu-

nities, and Politicians. Lahman: Rowman & Littlefield Publishers.12. Muggah, R. (2015) A manifesto for the fragile city–JIA SIPA. Journal of International Affairs

68(2): 19–36.13. OECD. States of fragility 2015. 2015 Mar 26 [cited 2016 Apr 1]. Available from: http://www.

oecd.org/dac/states-of-fragility-2015-9789264227699-en.htm.14. Kumar, D., and Willman, D. (2016) Healing invisible wounds and rebuilding livelihoods:

Emerging lessons for combining livelihood and psychosocial support in fragile and conflict-

affected settings. Journal of Public Health Policy. doi:10.1057/s41271-016-0009-0.15. Table adapted by S. Turner from: http://unstats.un.org/sdgs/files/meetings/iaeg-sdgs-meeting-

02/Outcomes/Agenda%20Item%204%20-%20Review%20of%20proposed%20indicators%

20-%202%20Nov%202015.pdf.16. Donnelly, P.D., Ward, C.L. (eds.) (2014) Oxford Textbook of Violence Prevention: Epi-

demiology, Evidence, and Policy. Oxford: Oxford University Press.17. Cohen, L. and Davies, R. (2006) The Prevention Institute. [Website]. Prevention institute;

2006 [cited 2016 Apr 4]. Available from: http://www.preventioninstitute.org/.18. World Bank. (2011) World Development Report: Conflict, Security and Development: 2011.

Washington, DC: World Bank Publications.19. United Nations General Assembly. (2016) Update on the work of the IAEG- SDGs, Informal

Briefing on the Global Indicator Framework for the SDGs, New York. 2016 Jan 28 [cited

2016 March 6]. Available from: http://unstats.un.org/sdgs/files/ga-briefing-28-Jan-2016/PGA-

Briefing–Status-of-IAEG-SDGs-work-on-global-SDG-indicators-28-Jan-2016.pdf.

Editors’ Note

This article is one of ten papers in a Special Sponsored Issue of theJournal of Public Health Policy in 2016, Violence and Health: MergingEvidence and Implementation.



http://unstats.un.org/sdgs/files/meetings/iaeg-sdgs-meeting-02/Outcomes/Agenda%20Item%204%20-%20Review%20of%20proposed%20indicators%20-%202%20Nov%202015.pdf



https://igarape.org.br/wp-content/uploads/2015/10/counting-conflict-deaths-muggah-2015.pdf

https://igarape.org.br/wp-content/uploads/2015/10/counting-conflict-deaths-muggah-2015.pdf

http://odihpn.org/blog/an-accounting-of-conflict-deaths-is-central-to-the-new-sustainable-development-goals/



http://www.oecd.org/dac/states-of-fragility-2015-9789264227699-en.htm

http://www.oecd.org/dac/states-of-fragility-2015-9789264227699-en.htm

http://dx.doi.org/10.1057/s41271-016-0009-0




http://www.preventioninstitute.org/

http://unstats.un.org/sdgs/files/ga-briefing-28-Jan-2016/PGA-Briefing%e2%80%93Status-of-IAEG-SDGs-work-on-global-SDG-indicators-28-Jan-2016.pdf

http://unstats.un.org/sdgs/files/ga-briefing-28-Jan-2016/PGA-Briefing%e2%80%93Status-of-IAEG-SDGs-work-on-global-SDG-indicators-28-Jan-2016.pdf

http://link.springer.com/journal/41271/37/1/suppl/page/1

http://link.springer.com/journal/41271/37/1/suppl/page/1

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