Violence Prevention A CARICOM Developmental Imperative

Izben C Williams, MD MPH

Report of Caribbean Commission • Caribbean Commission on Health and Caribbean Commission on Health and • Development (2005) identified three health Development (2005) identified three health

issues with significant ramifications for issues with significant ramifications for development if not specifically addresseddevelopment if not specifically addressed• HIV / AIDSHIV / AIDS• Chronic Non-communicable Diseases (NCD)Chronic Non-communicable Diseases (NCD)• Violence and Injuries Violence and Injuries

Actions consequent from report

• 1. 1. Pan Caribbean Partnership against HIV Pan Caribbean Partnership against HIV and AIDS (PANCAP)and AIDS (PANCAP)

• 2.2. UN Resolution April 2010 UN Resolution April 2010 andand Global Global Summit October 2011 on NCDsSummit October 2011 on NCDs

• 3.3. On On Violence Prevention Violence Prevention Regional Regional coordinated action lagging (needs impetus) coordinated action lagging (needs impetus)

The Situation (WB/UNODC 2007)

The Situation in seven selected

The Situation• Canada (Hemispheric Low: 1.8 X 10Canada (Hemispheric Low: 1.8 X 1044))

The Situation I• Barbados (Caribbean low: 7.5 / 10Barbados (Caribbean low: 7.5 / 1044))

The Situation II• Guyana (15.3 / 10Guyana (15.3 / 1044))

The Situation III • St. Lucia (23.0 X 10St. Lucia (23.0 X 1044))•

The Situation IV• St. Vincent and the Grenadines (54.8 X 10St. Vincent and the Grenadines (54.8 X 1044 ) )

The Situation - V• Trinidad & Tobago (38 X 10Trinidad & Tobago (38 X 1044 ) )

The Situation - VI• St. Kitts and Nevis (54.8 X 10St. Kitts and Nevis (54.8 X 1044))

The Situation VII• Jamaica (62.4 X 10Jamaica (62.4 X 1044))

Youth Violence• 75% of homicides committed by youth under 75% of homicides committed by youth under

30 years of age - Jamaica)30 years of age - Jamaica)

Hemispheric Rankings I• Homicide rate <10/100,000Homicide rate <10/100,000

Canada 1.8United States 5.2Argentina 5.3Uruguay* 5.8Chile 8.1

Costa Rica 8.3 Grenada 8.4Barbados 10.0

Hemispheric Rankings I• Homicide rate 10-20/100,000Homicide rate 10-20/100,000

Peru 10.2Paraguay 12.3Bolivia 12.5Panama 12.9Nicaragua 13.0Ecuador 13.8

Mexico 14.7Guyana 15.3Ant & Bar 16.4Dominica 17.8Dom Rep 18.4Haiti* (2002) 19.0

Hemispheric Rankings I• Homicide rate 20-30/100,000Homicide rate 20-30/100,000

Suriname 20.5St. Lucia 22.9St. Vinc & Gre 24.0

Bahamas 25.4Brazil 25.8Belize 29.1

Hemispheric Rankings I• Homicide rate >30/100,000Homicide rate >30/100,000

Colombia 34.6Venezuela* 37.0 Trin & Tob 37.8 Honduras 42. 9

Guatamala 46.3St. Kit & Nev 54.9Jamaica 62.5El Salvador 70.6

Homicides - fraction of the tip

• Homicides are symptomatic of a larger Homicides are symptomatic of a larger problem – an epidemic of violent behaviorproblem – an epidemic of violent behavior• For every homicide there are 20-40 violence-For every homicide there are 20-40 violence-

related injuries requiring emergency medical carerelated injuries requiring emergency medical care• For every emergency medical intervention there For every emergency medical intervention there

substantial unreported or hidden incidents substantial unreported or hidden incidents (particularly among vulnerable populations) (particularly among vulnerable populations)

The costs of violence and crime• Violence exacts human and economic toll on Violence exacts human and economic toll on

nationsnations• Personal health and insecurity (physical, psychological Personal health and insecurity (physical, psychological

and social)and social)• Economic:Economic:

• GDP per capita ↓5.4% due to homicides (Jamaica, Haiti) GDP per capita ↓5.4% due to homicides (Jamaica, Haiti) [UNODC][UNODC]

• Direct prevention costs (police, justice, prison etc)Direct prevention costs (police, justice, prison etc)• Non-monetary costs (mortality, morbidity etc)Non-monetary costs (mortality, morbidity etc)• Economic and social multiplier effects Economic and social multiplier effects

VIOLENCE IS PREVENTABLE (THE PUBLIC HEALTH MODEL)

• Defining and monitoring the extent of the Defining and monitoring the extent of the problem problem

• Identifying the causes of the problemIdentifying the causes of the problem• Formulating and testing ways of dealing with Formulating and testing ways of dealing with

the problemthe problem• Applying widely the measures that are found to Applying widely the measures that are found to

workwork• Evaluating interventionsEvaluating interventions

Benefits of inter-sectoral action• Collective impact of inter-linkagesCollective impact of inter-linkages• Improving effectiveness of interventionsImproving effectiveness of interventions• Avoiding duplication of effortsAvoiding duplication of efforts• Increasing available Increasing available resourcesresources through pooling through pooling• Collaboration on and coordination of researchCollaboration on and coordination of research•

ROLE OF OAS-SMS• Currently secretariat for IACPVCurrently secretariat for IACPV• SMS particularly Dept of Public Security SMS particularly Dept of Public Security

providing leadership (Observatory etc)providing leadership (Observatory etc)• Other Secretariats and Departments Other Secretariats and Departments

addressing one or more risk factorsaddressing one or more risk factors• Many mandates, resolutions, new impetus Many mandates, resolutions, new impetus • Member States strong interest (themes of GA)Member States strong interest (themes of GA)

TEN RECOMMENDATIONS FOR ACTION

• Create National Violence-Prevention Action Create National Violence-Prevention Action Plans Plans

• Enhance data-collecting capacityEnhance data-collecting capacity• Support prevention research (prioritizing)Support prevention research (prioritizing)• Promote primary prevention responsesPromote primary prevention responses• Strengthen responses for victims of violenceStrengthen responses for victims of violence

TEN RECOMMENDATIONS FOR ACTION

• Integrate violence prevention into social and Integrate violence prevention into social and educational policieseducational policies

• Increase collaboration and information Increase collaboration and information exchangeexchange

• Promote and protect human rightsPromote and protect human rights• Develop practical drug and arms policyDevelop practical drug and arms policy• Establish effective regional and national Establish effective regional and national

coordination coordination

WHO Report

VIOLENCE IS PREVENTABLE• BY:BY:

• Developing safe stable and nuturing relationships Developing safe stable and nuturing relationships between children and their parentsbetween children and their parents

• Developing life skills, in children and adolescentsDeveloping life skills, in children and adolescents• Reducing the availability and harmful use of Reducing the availability and harmful use of

alcohol alcohol

VIOLENCE ISSPREVENTABLE• BY:BY:

• Reducing access to guns, knives and pesticides (or Reducing access to guns, knives and pesticides (or other self harm agents)other self harm agents)

• Promoting gender equality to prevent violence Promoting gender equality to prevent violence against womenagainst women

• Changing social and cultural norms that support Changing social and cultural norms that support violenceviolence

• Victim identification, care and support programs Victim identification, care and support programs

Colombia – evidence in results• A 30% serial decline in homicide rates over six A 30% serial decline in homicide rates over six

years with an integrated, multi-sectoral years with an integrated, multi-sectoral approach (and Plan Colombia)approach (and Plan Colombia)