Public Health Approach to Violence Prevention and Treatment

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Public Health Approach to Violence Prevention and
Treatment

• Assoc. Prof. Dr. F. Nur AKSAKAL
• Gazi University Faculty of Medicine
• Department of Public Health
• World Public Health Congress,
• 29.04.2009
• Istanbul

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Content
Violence- definition, burden, facts
Typology of violence
The public health approach to violence prevention
Recommendations
Conclusion
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"I have something in my eye"

• " More than 800 people die every day as a direct
  result of violent conflict more than 30 deaths
  each hour. "

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" I was scratched by the cat"

• "Every 40 seconds 1 person commits suicide
  somewhere in the world."

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"I ran into the door"

• "1 in 4 women experience sexual abuse by an
  intimate partner in their lifetime."

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"I enjoy spending my days alone"

• "1 in 20 older people experience some form of
  abuse in their home."

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"I fell down the stairs"

• "1 in 2 female murder victims are killed by their
  male partners, often during an ongoing abusive
  relationship."

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"I fell out of my cradle"

• "Millions of children suffer abuse and neglect at
  the hands of their parents and other caregivers."

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"I got kicked playing football"

• "More than 540 adolescents and young adults die
  every day as a result of interpersonal violence
  more than 20 deaths occur each hour."

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"I'm playing hide and seek"

• "More than 800 people die every day as a direct
  result of violent conflict more than 30 deaths
  each hour."

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What is public health problem?

• Common
• Effecting many people
• Causing considerable number of deaths and/or
  disabilities
• Causing economic loss
• Mostly preventable.

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Violence Problem

• Violence is a public health problem which needs
  to be adressed in depth

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Violence- Definition (WHO)

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

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Violence- Burden

• Each year, over 1.6 million people worldwide lose
  their lives to violence
• Violence and injuries account for 9 of global
  mortality ( 5 million deaths every year)
• Leading cause of death among 15-44 years
• As many deaths as from HIV malaria tbc
• Eight of the 15 leading causes of death for
  people ages 15 to 29 years are injury-related
  road traffic injuries, suicides, homicides,
  drownings, burns, war injuries, poisonings and
  falls.

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Violence- Facts

• For every person who dies as a result of
  violence, many more are injured and suffer from a
  range of physical, sexual, reproductive and
  mental health problems.
• A massive burden on national economies (billions
  of USD each year in health care, law enforcement
  and lost productivity.)

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Violence

• FALSE
• Violence is inevitable part of human condition
• Prevention is the responsibility of the criminal
  justice system
• Principle role of health sector is the care and
  rehabilitation of the victims only

• TRUE
• Violence has root
• causes of complex conditions
• Health sector has more to do
• Prevention is a multisectorial collaborative task
• Public health response does not replace criminal
  justice and human rights rather complements their
  activities, offers additional tools and sources
  of collaboration

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• Social norms that create a climate in which
  violence is encouraged or inhibited (health,
  economic, educational policies..)

Societal
Violence- Roots

• Social relationship -schools, workplace,
  neighbourhoods (poverty, high population density,
  high levels of residential mobility, low social
  capital)

Community

• With families, friends, intimate partners, peers
  (harsh physical punishment of children, lack of
  affection and bonding, family dysfunction,
  marital/parental conflict)

Relationship

• Biological (age,sex) or personal
  (education,income)
• Psychological or personality disorders (substance
  abuse, aggressive behaviour or experience of
  abuse)

Individual
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Violence- Typology
who has committed the act
e.g. Intimate partner violence
who victims are
e.g. Child maltreatment
Typology
kind of violence subjected
e.g. Sexual violence
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Violence- Typology
Inter-personal violence
e.g. Youth violence Intimate partner violence
Self- targeted
e.g. Suicide and self-harm
Typology
Collective
e.g. Youth violence
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Gender-based violance

• Gender-based violence, or violence against women
  (VAW), is a major public health and human rights
  problem throughout the world (commonly performed
  by a husband or male partner).
• Has profound implications for health but is often
  ignored.
• Frequently invisible since it happens behind
  closed doors,
• Some legal systems and cultural norms do not
  treat as a crime, but rather as a "private"
  family matter, or a normal part of life.

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Intimate partner violance

• physical, sexual, or psychological harm by a
  current or former partner or spouse
• Four main types
• Physical
• Sexual
• Threats of physical or sexual
• Psychological / emotional
• Consequences
• Physical- burns, pain, wounds, system disorders
• Psychological- depression, suicidal behaviour,
  anxiety
• Social- restricted access to services, isolation
  from social networks
• Health behaviours- unprotected sex, early sexual
  initiation, alcohol-cigarette, illicate drug use
  

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Sexual violance

• any sexual act (physical,verbal or
  psychological) that is forced against someone's
  will
• Four main types
• A completed sex act
• An attempted (but not completed) sex act
• Abusive sexual contact
• Non-contact sexual abuse
• Consequences
• Physical- unwanted pregnancy, chronic pelvic
  pain
• Psychological- Shock, denial, fear, confusion,
  anxiety, depression
• Social- Strained relationships with the victim's
  family, friends, and intimate partners, less
  frequent contact with friends and relatives
• Health behaviours- Engaging in high-risk sexual
  behavior, unprotected sex, early sexual
  initiation, using harmful substances

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Suicide and self-harm

• Suicidal behavior exists along a continuum from
  thinking about ending ones life (suicidal
  ideation), to developing a plan, to non-fatal
  suicidal behavior (suicide attempt), to ending
  ones life (suicide).
• Four main types
• Suicidal ideation
• Suicide attempt
• Suicide
• Consequences
• Physical- death, injury
• High cost

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Youth violence

• "the intentional use of physical force or power,
  threatened or actual, against another person or
  against a group or community that results in or
  has a high likelihood of resulting in injury,
  death, psychological harm, maldevelopment, or
  deprivation" (Dahlberg and Krug 2002).
• Types
• includes all acts of violence,
• public or private, reactive, proactive
• criminal or noncriminal.
• Consequences
• Physical- death, injury
• Social- Strained relationships with the victim's
  family, friends, and intimate partners, less
  frequent contact with relatives
• Health behaviours- Engaging in high-risk
  behavior, using harmful substances

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Child maltreatment

• " all forms of physical and emotional
  ill-treatment, sexual abuse, neglect, and
  exploitation that results in actual or potential
  harm to the childs health, development or
  dignity "
• Five main types
• physical abuse
• sexual abuse
• neglect and negligent treatment
• emotional abuse
• exploitation.
• Consequences
• Physical- noncommunicable diseases, death, injury
• Psychological- psychiatric disorders and suicide,
  and has lifelong sequelae including depression,
  anxiety disorders
• Health behaviours- smoking, alcohol and drug
  abuse, aggression and violence towards others,
  risky sexual behaviours and post traumatic stress
  disorders

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Public health approach to violence prevention and
treatment
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• A four-steps process

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Assure widespread adoption
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Develop and test prevention strategies
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Identify risk and protective factors
Define the problem
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1. Define the problem

• Understanding the violence
• Analyzing data
• number of violence-related behaviours, injuries,
  deaths
• How frequent, where, trends
• Who are the victims?
• Who are the perpetrators?
• Data source Police records, vital records,
  population-based surveys
• Establishing surveillance systems
• Primary health care level,
• secondary health care level,
• first-aid or hospital emergency level

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2. Identify risk and protective factors

• Understand what factors protect people or put
  them at risk for experiencing or perpetrating
  violence
• Risk factors point out where protective efforts
  point out
• Risk factors do not cause violence
  (risk?violence)
• Protective factors act as a buffer (improvement
  of social environment, decreasing inequalities,
  education)

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3. Develop and test prevention strategies

• Evidence-based approach to program planning
• Research data and findings from
• Needs assessment
• Community surveys
• Stakeholder interviews
• Focus groups

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4. Assure wide-spread adoption

• Involvement of governments and public
• and private partners
• Political commitment
• Population based training and monitoring
  programmes
• Improving services for victims and survivors

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Public Health Interventions
Addressing individual risk factors
Increase access to means to reduce homicide and
suicide
Address gender inequality
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Violence -experience

• It is often predictable and preventable
• Upstream investment brings downstream results
• Resources should be focused on the most
  vulnerable groups
• Political commitment to tackling violence is
  vital to the public health effort

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Recommendations for action-1

• Create, implement and monitor a
• national action plan for violence prevention
• Enhance capacity for collecting data on violence
• Define priorities for, and support research on,
  the causes, consequences, costs and prevention of
  violence
• Promote primary prevention responses
• Strengthen responses for victims of violence

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Recommendations for action-2

• Integrate violence prevention into social and
  educational policies, and thereby promote gender
  and social equality
• Increase collaboration and exchange of
  information on violence prevention
• Promote and monitor adherence to international
  treaties, laws and other mechanisms to protect
  human rights
• Seek practical, internationally agreed responses
  to the global drugs trade and the global arms
  trade

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Conclusion

• There is a profound data in some but scarce data
  in other countries

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Conclusion
Violence is mostly hidden but not inevitable
There is a profound data in some but scarce data
in other countries
A number of initiatives are launched
There is a need for increased cooperation,
innovation and commitment to preventing violence
around the world
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The posters, prepared by Fabrica, the renowned
creative design company based in Venice, Italy,
serve as visual support to the awareness-raising
Global Campaign for Violence Prevention and the
World report on violence and health. WHO
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Thank You...

• nuraksakal_at_gmail.com