Impact of violence on chronic and infectious diseases

 

Dr Martin Luther King once said “Hate begets hate, violence begets violence, and toughness begets a greater toughness” Thus, a violent behavior promotes another violent behavior, in return. In the Bible Jesus is reported to have once said “ ….for all who draw the sword will die by the sword”. Welcome to this week’s installment of The Public Health Corner, where we tackle the issue of violence and its impact on public health. Violence is defined by WHO as “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 harms, disability or depravation”. They say injure one injure all. Globally, violence resulted in deaths of an estimated 1.28 million people in 2013 up from 1.13 million in 1990. Of the deaths in 2013, roughly 842 000 were attributed to suicide, 405 000 to interpersonal violence, 31 000 to collective violence (war) and legal intervention. The economic costs due to violence are estimated at US$ 151 billion. Namibians have regularly fallen victim to street crime and incidence of violent cases usually occur more frequently after dark than during daytime hours. Many are affected as victims and witnesses. The magnitude of the problem extends far beyond the physical and emotional aspects. Impact goes far beyond the direct costs of physical injury and death. Emerging evidence suggest that exposure to violence in childhood in form of maltreatment or witnessing is a risk factor for many chronic and infectious diseases through its influence on risk behaviors such as substance abuse, depression, obesity, smoking, teenage pregnancy and high risk-sexual behaviors. In my culture we say “a simple fire can spread and burn big logs at a great distance”.
Childhood violence and adult health
Violence against women and children is one of Namibian’s most severe human rights problems. How much domestic violence occurs in Namibia? The answer is unknown since there is no specific crime of domestic violence; most cases which are reports to the police are hidden within larger crime categories such as rape and assault. Interestingly, most of the medical care personnel concur that half of all women and children whom they treat often show signs of domestic violence. Childhood experiences of abuse (physical, sexual, emotional) and neglect (physical and emotional) and house dysfunction ( mother treated violently, substance abuse, mental illness, parental separation/divorce, incarcerated household member) often manifest negatively in adult life.
Developing safe, stable & nurturing relationships
Children are at greater risk of being abused when: parents have little understanding of child development, are less affectionate and responsive, use harsh or inconsistent punishment. Early relationships are central to a child’s development as they: affect brain development; affect social, emotional and intellectual development. Lack of safe, stable and nurturing relationships in childhood can have long-lasting effects leading to: anxiety, low self-esteem, difficulty forming relationships, increased risks of violence and low performance at school.
Early, primary prevention to teach parenting skills and support healthy child development:
•    Parenting programmes: Information & support for parents
•    Parent & child programmes: Preschool education, edutainment, family support, child/health services etc.
•    Social support groups:  e.g. peer support for parents, street theatre, community forums
•    Media interventions: e.g. raise awareness & knowledge of child maltreatment
In Namibia, the following organizations can be helpful in early, primary prevention to teach parenting skills and support health child development: Aids Care Trust of Namibia, Dutch Reformed Church Benevolence Board-Social Service Council, Helping Hand Welfare Organization, Helpline, Legal Assistance Centre (LAC), Lifeline/Childline, Ministry of Safety and Security (MOSS), Ministry of National Youth Services, Namibian Institute of Democracy and Namibian Planned Parenthood Association.
These organizations are instrumental in teaching parents abilities for adaptive and positive behaviour that enable individuals to deal effectively with the demands and challenges of everyday life for example: self-awareness (e.g. self-esteem), self-management (e.g. coping skills), social awareness (e.g. empathy), relationships (e.g. conflict management) and decision making (e.g. critical thinking). These social development interventions to develop life skills can: improve social and emotional competence, improve school participation & performance and increase prospects for employment. The skills are also essential in addressing risk factors for violence such as poor social competence and low academic achievement and truancy.
Reducing availability & harmful use of alcohol
There is a strong link between alcohol and violence as the former affects physical and cognitive function. There is also a wide spread belief that alcohol causes aggression and some people use it to prepare for/excuse violent acts. In 1996, Namibia’s Mental Health Program conducted a needs assessment and reported alcohol abuse, dependency on tobacco and other drugs as the causes of mental illness and violent acts. Reduction in violence and other alcohol related harms can be achieved through counseling service, psychos-social support and support groups like Namibia Men for Change, PEACE, Michelle McLean Children’s Trust and Namibia’s woman Association.
Reducing access to lethal means
Lethality of violence can depend on means used. Three lethal means account for a significant proportion of homicide and suicide
Guns
Globally, there are 360,000 firearm homicides in non-conflict situations each year and a further 52,000 deaths directly through armed conflict. In Namibia the police recorded 338 murder cases involving fire-arms between January 2011 and January 2016. Statistics also indicate that at least 1 050 attempted murder cases, 1 641 armed robbery cases and 1 997 threatening by fire-arm cases were reported in the country over the same period.  
Knives
Some of the homicides in Namibia are due to knives and sharp implements
Pesticides
Worldwide, pesticide ingestion accounts for 370,000 suicides each year over a third of all suicides
Removal of lethal means to violence
Legislative measures (e.g. bans and licensing schemes), increased enforcement (e.g. test purchasing, stop and search), weapons amnesties and safer storage (e.g. provision of pesticide storage facilities) are essential for the removal of lethal means to violence.  
Promoting gender equality
Relationships between gender and violence are complex. Different roles and behaviours of males and females are shaped and reinforced by gender norms in society. Differences in these roles and behaviours can create gender inequalities which can: increase the risk of violence by men against women and hinder victims’ ability to remove themselves from violence and seek support. Gender based violence can be addressed though challenging ideas that one sex has more power and control over another; a reason for violence against women.
•    School-based interventions: Addressing gender norms and attitudes, e.g. safer dating
•    Community interventions: Microfinance programmes, combined with gender equity training
•    Life skills programmes: educate about gender-based violence and develop relationship skills
Currently there are many workshops being done across the length and breadth of Namibia to address the issues of gender based violence.
Changing cultural and societal norms that characterise violence
Cultural and social norms strongly influence individual behaviour. Cultural acceptance of violence is a risk factor for many violence types. Social tolerance of violence likely learned in childhood, e.g. use of corporal punishment, witnessing violence in the family and violence in the media. Interventions challenge rules or behaviour expectations that tolerate violent behaviour
•    Mass media campaigns: Providing messages on health behaviour to a wide audience and edutainment. The Villager Newspaper is also assisting in this area
•    Social norms / marketing targeting specific groups and correcting misperceptions of cultural norms
In Namibia, the National Domestic Violence and Sexual Abuse Directory has all the services available country wide to support the victims of violence. Let’s encourage each other and read it.
Till we meet again in the next issue, be blessed and stay free from violence. The writer can be contacted on: phcnamibia@gmail.com