Quantifying the Ripple Effects of Civil War: How Armed Conflict Is Associated with More Severe Violence in the Home

Both the fields of public health and that of human rights seek to improve human well-being, including through reducing and preventing all forms of violence, to help individuals attain the highest quality of life. In both fields, mathematical methods can help “visibilize” the hidden architecture of violence, bringing new methods to bear to understand the scope and nuance of how violence affects populations. An increasing number of studies have examined how residing in a conflict-affected place may impact one of the most pervasive forms of violence—intimate partner violence (IPV)—during and after conflict. This paper contributes to this effort by examining whether severe forms of IPV are associated with previous experience of political violence in one conflict-affected country: Liberia. Our findings indicate that living in a district with conflict fatalities increased the risk of IPV among women by roughly 60%. Additionally, living in a district with conflict fatalities increased the risk of a past-year injury from IPV by 50%. This analysis brings to light links between two of the most pervasive forms of violence—political violence and violence against women. The findings suggest that women residing in a district that is more highly affected by conflict, not only people experiencing direct trauma during conflict, may be at risk of increased violence long after peace is declared. These findings point to the need for targeted programs that address IPV postconflict.     

Poverty,policy, and pathogenesis: Economic justice and public health in the US

This paper addresses public health and access to care for the urban poor in the context of US urban, economic, and industrial policy. The pathogenic deterioration of 'inner city' neighbourhoods is a direct result of political and economic strategies to facilitate capital accumulation and consolidation, manifested in geographic patterns of uneven development that mirror the relationship between First and Third World countries. The deleterious public health effects of these trends include reduced access to care; medical indigence in the wake of deindustrialization and the restructuring of the blue-collar workforce; and the spread of social epidemics such as AIDS, violence, and substance abuse. Contemporary health policy and 'reform' debates, however, have virtually ignored the pathogenic role played by economic and social inequality in the etiology and dispersion patterns of disease. To confront the health crisis that currently threatens poor and minority communities in the US, economic justice must be explicitly acknowledged as a public health issue, alongside more traditional concerns such as access to care, immunization, vector control, and behaviour modification. It will be necessary to challenge political and economic policies that shore up corporate power at the expense of community development; spur capital accumulation at the expense of social programs and economic opportunity for the poor and politically disenfranchised; and actively facilitate the continued exploitation of, and withdrawal of resources from, the nation's most vulnerable citizens and their communities.     

Rural youth violence: it is a public health concern!

Youth violence is a significant issue for public health because of the potential for long-term impacts on individuals, families and communities. Limited exposure to violence is seen as a component of healthy living. However, there is limited understanding of violence from a public health perspective within rural communities. Rural refers to those communities with a population less than 10,000 outside the main commuting zone of a large urban area. Population health approaches, including the social determinants of health, are well supported by public health officials. Generating information about rural youth violence from a Canadian perspective would add to our understanding of these social determinants while providing guidance for policy and program development. Current understandings of youth violence are limited to an urban, and oftentimes, American perspective. An ongoing two-phase Canadian study on rural youth violence included qualitative interviews with 52 youth and the completion of a questionnaire that had been developed from the qualitative responses. The questionnaire has been completed by a larger sample of rural youth. The findings generated from this ongoing study will be useful in linking violence with social factors that impact health and thereby guide population health programs and policies. In this way, the role of public health to develop policies and implement programs will be directly influenced by evidence while addressing an ongoing public health concern.     

Is violence a disease? Situating violence prevention in public health policy and practice

The paper provides a review of some of the thoughts, ideas, and opinions that pervade the public health literature concerning how to classify or conceptualise violence. It is argued that violence transcends classic distinctions between communicable and non-communicable diseases, distinguishes itself from the discipline of injury control, and is influenced by wider, social determinants. Through a discussion of these varied perspectives it is concluded that a fourth revolution in public health is needed – a ‘change in scope’ revolution – that recognizes the influence of social justice, economics, and globalization in the aetiology of premature death and ill health, into which violence fits. However, rather than be shackled by debates of definition or classification, it is important that public health acknowledges the role it can play in preventing violence through policy and practice, and takes unified action.     

‘I feel safer in the streets than at home’: Rethinking harm reduction for women in the urban margins

ABSTRACT

Through qualitative data collected with women affected by drug use and drug-related violence in Bogotá, this article explores the convergence of harm reduction rationales and violence prevention programming in the urban margins to advocate for women’s health empowerment and health rights as victims of intergenerational trauma and violence. We propose a methodological shift of public health praxis from street-based outreach models to intimate spaces of intervention for health outcomes embodiment ¹ 1 Drawing from Krieger’s (2004) conceptualisation, we define embodiment as the stories our bodies hold and how they interact with the urban environment. as we continue to develop our community health model to work with marginalised communities in the urban global South. Through this work committed to social justice in marginalised urban communities, we seek to support women’s health needs through harm reduction in historically marginalised communities in urban settings. Our results expose how multi-level gender-based violence affects women’s health in their living spaces in the urban margins. Drawing from women’s voices and narratives of urban violence, we call for a feminist alternative to traditionally masculinist and public-space oriented harm reduction practice for health empowerment in the urban margins.     

Linking health promotion and social justice: a rationale and two case stories

Although health promotion and social justice come from distincttraditions, their integration can strengthen the field of healtheducation. This paper explores the complexities and ethicaldilemmas of incorporating social justice into health promotion,including differing agendas among agencies, communities andhealth educators; role conflicts; ideologic differences in thefield; and lack of willingness of health educators to take risks.Two case studies, a transitional program to assist incarceratedwomen and youth to return to communities, and a statewide youthpolicy initiative, illustrate these issues and argue for thevalue of linking social justice and health promotion strategiesto create a powerful health education agenda for the next century.     

The ecology of urban violence: its relationship to health promotion behaviors in low-income black and Latino communities

PURPOSE: The purpose of this review is to identify and examine relationships between exposure to violence and health promotion behaviors in low-income black and Latino groups. DESIGN: Based on computer surveys of the psychologic, public health, medical, and sociologic literature, approximately 90 previous studies of the impact of exposure to violence on psychologic functioning, perceptions of health and well-being, and health decisions and behavior were identified. This article reviews those studies that examine the relationships between experiences of violence and subsequent feelings of alienation, powerlessness, and hopelessness, and perceptions of health and well-being and studies that examine relationships between alienation, hopelessness, and powerlessness and health promotion behaviors. Studies of health promotion behavior that did not examine or address the impact of exposure to violence are not reviewed in this article. RESULTS: Violence affects low-income communities directly by contributing to rates of mortality, and indirectly by affecting health promotion behaviors. Exposure to violence can result in feelings of powerlessness, hopelessness, and alienation that significantly limit motivation, the extent of involvement, and persistence in overcoming barriers to health promotion behavior. CONCLUSIONS: Future researchers must consider the confounding effects of exposure to violence when investigating differences in health promotion behaviors for low-income black and Latino groups. Community empowerment programs that address the impact of violence and focus on developing control over life and health outcomes may be needed to successfully address the effect of violence on health promotion behavior in low-income, black and Latino communities.     

Environmental justice: building a unified vision of health and the environment

The assorted and multidimensional concerns that give rise to the issue of environmental justice have proved to be intellectually daunting and highly resistant to positive change. Low-income, people of color, and tribal communities confronting environmental stressors are beset by stressors in both the physical and social environments. For this reason, while the bifurcation of the public health and environmental fields taking place over the past several decades has yielded generally negative impacts in areas of public health, environment, and planning, the consequences for low-income and disadvantaged communities have been especially grievous. This commentary builds on the recent Institute of Medicine workshop titled "Rebuilding the Unity of Health and the Environment: A New Vision of Environmental Health for the 21st Century." The workshop organizers posited that only by thinking about environmental health on multiple levels will it be possible to merge various strategies to protect both the environment and health. In this commentary we examine how such a new vision of uniting public health and the environment can contribute to attaining environmental justice for all populations.     

Trauma Exposure and PTSD in Justice-Involved Youth

This special issue of Child and Youth Care Forum includes four original research reports that build on the field’s knowledge of trauma stress exposure and PTSD in justice-involved youth. Utilizing diverse methodologies, study authors report unique results investigating important questions related to screening and assessment of justice-involved populations, the potential linkage between violence exposure and violence perpetration, and the complex relationships between trauma exposure in childhood and specific problematic offending behaviors. Each article includes specific clinical implications and recommendations for future research to provide useful information to juvenile justice administrators, mental health professionals, and researchers involved in the care and management of trauma exposed youth within the juvenile justice system. This introduction provides an overview of how empirical studies of the nature and sequelae of traumatic stress exposure are currently a focus for research and services in the juvenile justice field, highlighting how the articles in the Special Issue exemplify the progress to date, and promise for the future, of several lines of research involving psychometrics, health and correctional services, and clinical epidemiology.     

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.     

DEVELOPMENT OF HEALTHY PUBLIC POLICY: FEMINIST ANALYSIS OF CONFLICT,COLLABORATION AND SOCIAL CHANGE

In the past two decades, the need for economic restructuring has served as a rationale for dismantling social programs in Canada. As it has been enacted, such social restructuring has disproportionately affected marginalized people, particularly women. In this article we explore the schism between the principles that underlie the development of healthy public policy and those that are driving current social policy development. Through this analysis we discuss the implications of policy development that is based upon principles of inequity, and we suggest that implementation of healthy public policy requires transformational change in the underlying principles of the social system. A policy shift based upon principles of equity and social justice has been espoused throughout the health promotion literature. We suggest that such a shift will be facilitated by strengthening collaborative relations among points of conflict within society and among policy makers and women's organizations.     

The poor have become rich, and the rich have become poor: collective trauma in the Guinean Languette

This paper uses Kai Erikson's (Everything in its path: the disaster at Buffalo Creek. Simon & Schuster, New York, 1978) definition of collective trauma to interrogate the symptom reports and narrative accounts of six Guinean communities attacked by Sierra Leonean and Liberian RUF forces in 2000-2001. These data, collected in 2003, found high rates of fear, physical anxiety, emotional anxiety, depression, physical distress, sadness, and post-traumatic stress disorder-related symptoms across all communities, but found lower rates of distress among communities that had developed collective narratives of resistance to violence, or had concertedly resisted post-conflict social change. Communities with higher rates of distress tended to report community narratives of violence and post-conflict social life, which emphasized abandonment, isolation, disregard of community rituals and social supports, and the dislocation of local moral worlds. This study argues that the physical and emotional symptoms of trauma-related mental illness are articulations of collective trauma and represent the physical and emotional manifestations of the destruction of local moral worlds. It illuminates the processes by which violence inverts social experience, and argues that the social dimensions of trauma have long-term consequences for post-conflict reconstruction.     

Exposure to community violence and depressive symptoms: Examining community,family, and peer effects among public housing youth

Exposure to community violence is an epidemic problem that causes debilitating effects on youth mental health. However, the relationships between violence exposure and youth mental health remain unclear when examining co-occurring socioecological risk and protective factors. The purpose of this study is to clarify the observed gaps in knowledge by utilizing structural equation modeling (SEM) to examine the mediating role of community violence exposure on the relationship between perceived neighborhood risk factors, parental behaviors, and peers on depressive symptoms in a sample of urban youth in low-income public housing communities (n = 320). Results indicate that community violence exposure and exposure to delinquent peers mediates the effects of perceived neighborhood risk and parenting behaviors on depressive symptoms. These findings suggest that while interventions that limit exposure to community violence and delinquent peers could reduce depressive symptoms, interventions that reduce community violence are essential to improve youth mental health.     

Social capital, disorganized communities, and the third way: understanding the retreat from structural inequalities in epidemiology and public health.

The construct of social capital has recently captured the interest of researchers in social epidemiology and public health. The authors review current hypotheses on the social capital and health link, and examine the empirical evidence and its implications for health policy. The construct of social capital employed in the public health literature lacks depth compared with its uses in social science. It presents itself as an alternative to materialist structural inequalities (class, gender, and race) and invokes a romanticized view of communities without social conflict that favors an idealist psychology over a psychology connected to material resources and social structure. The evidence on social capital as a determinant of better health is scant or ambiguous. Even if confirmed, such hypotheses call for attention to social determinants beyond the proximal realm of individualized sociopsychological infrastructure. Social capital is used in public health as an alternative to both state-centered economic redistribution and party politics, and represents a potential privatization of both economics and politics. Such uses of social capital mirror recent "third way" policies in Germany, the United Kingdom, and United States. If third way policies lose support in Europe, the prominence of social capital there might be short lived. In the United States, where the working class is less likely to influence social policy, interest in social capital could be longer lived or could drift into academic limbo like other psychosocial constructs once heralded as the next big idea.     

Development of healthy public policy: feminist analysis of conflict,collaboration and social change

In the past two decades, the need for economic restructuring has served as a rationale for dismantling social programs in Canada. As it has been enacted, such social restructuring has disproportionately affected marginalized people, particularly women. In this article we explore the schism between the principles that underlie the development of healthy public policy and those that are driving current social policy development. Through this analysis we discuss the implications of policy development that is based upon principles of inequity, and we suggest that implementation of healthy public policy requires transformational change in the underlying principles of the social system. A policy shift based upon principles of equity and social justice has been espoused throughout the health promotion literature. We suggest that such a shift will be facilitated by strengthening collaborative relations among points of conflict within society and among policy makers and women's organizations.     

Rethinking gender-based violence during war: Is violence against civilian men a problem worth addressing?

Gender-based violence during conflict and post-conflict situations has received increased attention in research and in the work of development agencies. Viewed primarily as a form of violence against women, this commentary questions whether male civilians have also been victims of gender-based violence during conflict, invisible due to stereotypes surrounding masculinity and a culturally permissive approach towards violence perpetrated against men, especially at times of war. The experience of civilian males of violence, including sexual violence, during the war in Bosnia and Herzegovina and other contemporary wars, suggests that the discourse on gender-based violence and public health research should begin exploring the specific needs of men. Drawing on Nancy Krieger's (Krieger, N. (2003). Genders, sexes, and health: what are the connections—and why does it matter? International Journal of Epidemiology, 32, 652–657) analysis on the differential role of ‘sex’ and ‘gender’ on a given exposure-outcome association, this commentary suggests that the impact of gender-based violence on health during conflict may be different for men and women and may require distinct therapeutic approaches. Given that perpetrators are often male, an extra level of stigma is added when heterosexual men are sexually violated, which may lead to underreporting and reduced health-service seeking behavior. Further public health research is needed to guide the work of humanitarian agencies working with survivors of gender-based violence in conflict and post-conflict settings to ensure equal access to appropriate health services for men and women.     

Childhood sexual abuse and adult binge drinking among Kanak women in New Caledonia

The long-term consequences of violence against women are poorly documented within the context of political domination, economic inequalities and rapid social change of indigenous communities. Using data from the first population study on violence against women and their consequences on health in New Caledonia, South Pacific, this article investigates the association between childhood sexual abuse and binge drinking among 441 adult Kanak women. Face-to-face standardised interviews were conducted in 2002–2003, among women aged 18–54 years drawn from the electoral rolls. Childhood sexual abuse before 15 years of age was reported by 11.6% of respondents. Nearly all the perpetrators (96%) were known to the victims (63% being a close relative). The rate of frequent binge drinking amongst the women within the last 12 months was 34%. After controlling for social and demographic factors, an independent association was found between childhood sexual abuse and current binge drinking. This study is the first to analyse the contribution of childhood sexual abuse to the likelihood of later heavy alcohol use in an indigenous population in the South Pacific. The findings call for improving and giving priority to care for children who are victims of violence to prevent long-term health consequences and to develop prevention programs aimed at alcohol-related behaviour in women, while taking into account simultaneous individual and collective factors.     

The sequelae of political violence: assessing trauma, suffering and dislocation in the Peruvian highlands

In this article, we begin with a qualitative mapping of the multiple ways indigenous peoples in the Peruvian highlands construct their emotions, symptoms and specific disorders when confronted with an adverse environment of sustained political violence, multiple stressors and massive exposure to traumatic experiences. Second, we address the issue of magnitude (point prevalence) and distribution of mental health problems such as depression and anxiety, and sequelae of exposure to violence-related stressors as reported in the selected populations, by reviewing the quantitative results of a cross-sectional survey. Third, we examine the pathways and linkages between the social context (drawn from ethnography and secondary sources) and the collective experience, such as massive exodus, forced displacement, resilience and accommodation strategies for coping and survival. When assessing the overall mental health impact of exposure to protracted forms of extreme violence in civilian populations, we argue for the need to move beyond the limited notion of post-traumatic stress disorder, which is a useful but restrictive medical category failing to encompass the myriad of signals of distress, suffering and affliction, as well as other culture bound trauma-related disorders and long-term sequelae of traumatic experiences. Lastly, following the concluding remarks, we discuss some implications the results of the study may have at various levels, not only for the victims and survivors of massive exposure to traumatic events, but also their families and communities, as well as for interventions carried out by humanitarian and emergency relief organizations, and specialised agencies engaged in the promotion of social justice, prevention of human rights abuses, and mental health rehabilitation programs at both national and international levels.     

Political violence,ethnic conflict,and contemporary wars: broad implications for health and social well-being

Ethnic conflict, political violence and wars that presently shape many parts of world have deep-seated structural causes. In poor and highly indebted countries, economic and environmental decline, asset depletion, and erosion of the subsistence base lead to further impoverishment and food insecurity for vast sectors of the population. Growing ethnic and religious tensions over a shrinking resource base often escort the emergence of predatory practices, rivalry, political violence, and internal wars. The nature of armed conflict has changed substantially over time and most strategic analysts agree that in the second half of the 20th century, contemporary wars are less of a problem of relations between states than a problem within states. Despite the growing number of armed conflicts and wars throughout the world, not enough attention has been paid to the local patterns of distress being experienced and the long-term health impact and psychosocial consequences of the various forms of political violence against individuals, communities, or specific ethnic groups. The short or long-term impact assessment on civilian populations of poor countries affected by war have been scarce, and studies focussing on experiences of collective suffering and trauma-related disorders among survivors are beginning to emerge in the scientific literature. The medicalization of collective suffering and trauma reflects a poor understanding of the relationships among critically important social determinants and the range of possible health outcomes of political violence.     

Umweltgerechtigkeit als Thema für Public-Health-Ethik

Environmental justice is a topic at the interface of social, environmental, and health policy. It is concerned with unequal socio-spatial distributions of environmental exposures, the effects of such unequal distributions (e.g., on health), and approaches to their prevention, clean-up or compensation. Environmental justice has some overlap with public health, which is still little recognized. Environmental justice is relevant for the new discussion on public health ethics, as ethical conclusions differ, to some degree, between public health and environmental justice, despite similar topics and often identical effect variables.