Violence in public health and preventive medicine

Government political structure and violent death rates: A longitudinal analysis of forty-three countries, 1960-2008

OBJECTIVES

Currently, little is known regarding the effect of regime type on mortality on a global level. The purpose of this study is to examine the effect of regime type on the rates of violent deaths (homicide, suicide, and combined rates).

METHODS

Three measures of democracy were used to quantify regime type, the independent variable. Homicide and suicide rates were obtained from the World Health Organization. Multivariate conditional fixed-effects models were run to examine associations between regime characteristics and logged rates of homicide, suicide, and violent deaths. Models were adjusted for unemployment and economic inequality.

RESULTS

Nations that scored higher on democracy indices, especially emerging democracies, experienced increased mortality due to violence. Homicide and suicide were divergent, showing a different time course and decreasing statistical power as a combined variable. Unemployment and inequality were associated with higher violence-related mortality.

CONCLUSIONS

Homicide and suicide appear to be more prevalent in democracies. Future analyses should examine which aspects of democracies lead to higher rates of violent death and should seek to use independently collected mortality data.

Small and light arms violence reduction as a public health measure: the case of Libya

The conflict environment in Libya is characterized by continued pervasive insecurity amidst the widespread availability of small arms and light weapons (SALW). After the First Civil War, armed brigades took the law into their own hands and the resulting violence terminated a short-lived post-conflict period that has relapsed into a Second Civil War. The Libyan government has struggled to assert authority over armed groups and these brigades, refusing to disarm have contributed directly the initiation of a second conflict; some are motivated by self-defense, status, criminality, vindication or political aims.

Once, a bastion of public health in the Middle East and North Africa (MENA), the country now faces a substantial and unprecedented challenge: to rebuild a devastated health system amidst the burden of armed violence and the proliferation of small and light weapons (SALW) especially firearms of various kinds. The health system in Libya is compromised; healthcare professionals have little time to record or document such cases given the immediate clinical needs of the patient. This corresponding decreased capacity to deal with an increasing demand on services caused by SALW-related morbidity compounds the challenge of data collection and indicates that external support and advocacy are required.

A public health strategy towards effective SALW armed violence reduction and injury prevention requires the interdisciplinary advocacy of practitioners across the fields of justice, security, development, health and education. Through surveillance of firearms and injuries in the post-conflict environment we can better evaluate and respond to the burden of armed violence in Libya. In order to reduce armed a reconceptualisation of arms reduction campaigns must occur. Notable emerging evidence recommends the inclusion of community-based interventions and development programs which address local motivations for firearms ownership alongside improved international coordination. This renewed approach holds importance for recovery, development and securing the transition to peace.

The high prevalence of firearm ownership, weak institutions, nascent security forces, porous borders, inadequate weapons stockpiles, combined with high military spending, compounds public weaponisation as a health crisis for the entire MENA region.

Bridging risk and enactment: the role of psychology in leading psychosocial research to augment the public health approach to violence in South Africa

In the wake of apartheid, many in the South African health and social sciences shifted their orientation to understanding violence. Rather than approaching violence as a criminal problem, post-apartheid scholarship surfaced violence as a threat to national health. This re-orientation was well aligned with a global groundswell that culminated in the World Health Assembly’s 1996 declaration of violence as a public health problem. In response, researchers and other stakeholders have committed to the public health approach to violence in South Africa. Despite some unquestionable successes in applying this approach, violence remains a critical social issue and its recalcitrantly high rates signal that there is still much work to be done. One avenue for more focussed research concerns understanding the mechanisms by which upstream risk factors for violence are translated into actual enactments. We argue that South African psychology is well placed to provide greater resolution to this focus. We begin by providing a brief overview of the public health approach to violence. We then point to three specific areas in which the limits to our understanding of the way that downstream psychological and upstream social risk factors converge in situations of violence, compromise the theoretical and prevention traction promised by this approach and chart several basic psychosocial research coordinates for South African psychology. Steering future studies of violence by these coordinates would go some way to addressing these limits and, in so doing, extend on the substantial gains already yielded by the public health approach to violence in South Africa.

Common mental disorders in a young urban population in Colombia

BACKGROUND

There are few studies of mental ill health among young people in developing countries.

AIMS

To measure the prevalence of common mental disorders among low-income young people in the city of Cali, Colombia and to examine associations with violence and social capital.

METHOD

The Self-Reporting Questionnaire was administered to 1057 young people aged 15-25 years. Social capital, violence, alcoholism and socio-demographic variables were also measured.

RESULTS

We found 255 young people (24%) with common mental disorders. Being a woman, having limited education and experiencing high levels of violence were the main risk factors for common mental disorders. Social capital did not emerge as a risk factor.

CONCLUSIONS

A large burden of mental ill health among young people was found; this requires urgent interventions and more research on the mechanisms which link mental health and violence.

Preventing lethal violence in schools: the case for entry-based weapons screening

Violence-related behavior in schools has declined in recent years, but the perception of risk remains high. Disturbingly high percentages of students and teachers report staying home out of fear, and many students bring weapons to school for protection. Current proposals for preventing school violence include punishing the violence-prone, expulsion for weapon carriers, and creating a culture of nonviolence through various behavioral methods like conflict resolution. None of these proposals address the issue of lethal violence and hence personal safety. The risk of lethal violence in schools (related mainly to firearms) could be substantially reduced by creating an effective barrier between firearms and people. This could be achieved by using entry-based weapons detection systems similar to those now used in airports and courts. Decreasing the risk and fear of violence by converting schools into weapons-free zones would also be expected to increase attendance and improve scholastic performance. Randomized, controlled studies should be undertaken to evaluate the efficacy and cost-effectiveness of entry-based weapons detection systems for achieving these outcomes.

Criminal deterrence as a public health strategy

Deterrence is an established theme in criminal justice, but its role in prevention of assault has been treated with ambivalence and even hostility in medicine. The extent to which offenders can be persuaded, through knowledge of criminal and health risks, not to injure others is emerging from studies of the health effects of firearm and other crime legislation, and from macro-level studies and controlled experiments of police interventions. There is convincing evidence that motorists can be deterred from alcohol-impaired driving, and recognition that specific, targeted, and visible police work and increasing certainty of punishment are effective interventions. By contrast, duration of imprisonment and generic police initiatives such as blanket increases in police numbers seem to have little effect on deterrence, at least in the context of the decline in US homicide rates since 1991, to which demographic and economic factors seem to have contributed little. Together with established and cost-effective preschool education and early family support, targeted policing and increasing rates of conviction should be integrated into strategies for injury prevention.