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VIOLENCE PREVENTION IN LOW- AND MIDDLE-INCOME COUNTRIES

Finding a Place on the Global Agenda

WORKSHOP SUMMARY

Kimberly A. Scott, Rapporteur

Board on Global Health

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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VIOLENCE PREVENTION IN LOW- AND MIDDLE- INCOME COUNTRIES Finding a Place on the Global Agenda WORKSHOP SUMMARY Kimberly A. Scott, Rapporteur Board on Global Health

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. This study was supported by a grant from the F. Felix Foundation to the National Academy of Sciences. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number-13: 978-0-309-11205-5 International Standard Book Number-10: 0-309-11205-2 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2008 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: Institute of Medicine (IOM). 2008. Violence prevention in low- and middle-income countries: Finding a place on the global agenda. Washington, DC: The National Academies Press. Cover design by Van Nguyen. Photos by Fran Henry (copyright 2007).

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general wel- fare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Insti- tute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sci- ences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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PLANNING COMMITTEE FOR A WORKSHOP ON VIOLENCE PREVENTION IN LOW- AND MIDDLE-INCOME COUNTRIES Mark L. Rosenberg (Chair), Executive Director, The Task Force for Child Survival and Development, Decatur, Georgia James A. Mercy (Vice-Chair), Special Advisor for Strategic Directions, Division of Violence Prevention, National Center for Injury Control and Prevention at the Centers for Disease Control and Prevention, Atlanta, Georgia Sir George Alleyne, Director Emeritus, Pan American Health Organization, Washington, D.C. Alexander Butchart, Coordinator, Prevention of Violence in the Department of Injuries and Violence Prevention, World Health Organisation, Geneva, Switzerland Jacquelyn Campbell, Anna D. Wolf Chair and Professor, The Johns Hopkins University School of Nursing, Baltimore, Maryland Darnell Hawkins, Professor Emeritus, Departments of African-American Studies and Department of Sociology, University of Illinois, Chicago IOM Staff Kimberly Scott, Senior Program Officer and Rapporteur Allison Brantley, Senior Program Assistant Megan Ginivan, Intern Julie Wiltshire, Financial Associate Patrick Kelley, Board Director v

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Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Stephen W. Hargarten, Department of Emergency Medicine, Medical College of Wisconsin Adetokunbo O. Lucas, Harvard University James A. Mercy, Division of Violence Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention Susan C. Scrimshaw, Simmons College, Boston, Massachusetts Although the reviewers listed above have provided many construc- tive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was over- seen by Dr. Elena Nightingale, Scholar-in-Residence, Institute of Medicine. Appointed by the Institute of Medicine, she was responsible for making vii

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viii REVIEWERS certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the author and the institution.

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Contents PREFACE xiii SUMMARY 1 1 INTRODUCTION 7 Organization of the Report, 12 2 SETTING THE STAGE 14 Welcoming Remarks, 14 The Public Health Approach to Violence Prevention, 15 Keynote Address by Stephen Lewis, 18 3 WHY THE WORLD SHOULD CARE ABOUT VIOLENCE PREVENTION 22 Health Perspective, 23 Criminal Justice Perspective, 26 Economic Development Perspective, 29 Human Development Perspective, 33 Questions and Answers, 35 4 THE INTERSECTION OF VIOLENCE AND HEALTH 36 Collective Violence, 37 Self-Directed Violence, 40 Child Maltreatment and Its Health Consequences, 43 ix

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x CONTENTS Violence Against Women and Women’s Health, 48 Questions and Answers, 52 5 WHAT IS WORKING AROUND THE WORLD IN VIOLENCE PREVENTION? 53 Advances in the Identification of Effective Policies and Interventions, 55 Evidence for Effective and Ineffective Prevention Interventions, 56 Intervention with Microfinance for AIDS and Gender Equity (IMAGE) Study, 58 The Importance of Epidemiological Data for Guiding Prevention, 61 The Caribbean, 62 Characteristics of Effective Interventions, 63 Challenges for Effective Programming and Research, 64 Questions and Answers, 65 6 WORDS OF WISDOM: WORKING WITH THE MEDIA AND NONGOVERNMENTAL ORGANIZATIONS 66 Relationships with the Media, 66 Relationships with Nongovernmental Organizations, 68 7 SCALING UP INTERNATIONAL SUPPORT FOR VIOLENCE PREVENTION 72 International Development Assistance and Violence Prevention, 73 Lesson Learned from Long-Term Funding Commitments, 75 The United Kingdom’s Efforts in Armed Violence Prevention, 78 UNICEF and Prevention of Violence Against Children, 81 Gender-Based Violence in the Caribbean, 83 National and International Perspectives of Scaling Up Prevention Programs, 86 Questions and Answers, 88 8 OPPORTUNITIES AND CHALLENGES FOR U.S. AGENCIES AND ORGANIZATIONS TO FOCUS ON VIOLENCE PREVENTION IN DEVELOPING COUNTRIES 89 Organizational Profiles of Violence Prevention Activities, 89 Round-Robin Questions with the Panelists, 95 Questions from Participants, 100

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xi CONTENTS 9 TAKING GLOBAL VIOLENCE PREVENTION TO THE NEXT STEP: QUESTIONS FOR THE WORKSHOP PARTICIPANTS 102 Making the Case for the U.S. Interest in Preventing Global Violence, 103 Garnering Sustained Commitment and Support from U.S Agencies and Organizations, 104 Identifying Research and Programmatic Priorities, 105 Encouraging Collaborative Efforts, 106 Next Steps for U.S. Agencies to Implement the Public Health Approach, 106 Concluding Observations, 107 REFERENCES 109 APPENDIXES A Workshop Agenda 113 B Participant List 121 C Background Papers for June 2007 Workshop 123 Preventing Violence in Developing Countries: A Framework for Action, 125 Mercy et al., 2007 The Intersection of Violence Against Women and HIV/AIDS, 149 Campbell et al., 2007 A Logical Framework for Preventing Interpersonal and Self-Directed Violence in Low- and Middle-Income Countries, 167 Zaro et al., 2007 Collective Violence: Health Impact and Prevention, 171 Sidel and Levy, 2007 Violence, Health, and Development, 201 Matzopoulos et al., 2007 D Biographies of Planning Committee Members and Workshop Speakers 247

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Preface This report summarizes a two-day workshop convened in June 2007 that reviewed the state of the science related to the application of a pub- lic health approach to violence prevention in low- and middle-income countries—with an emphasis on what is known to be effective to prevent interpersonal violence. It highlights some of the views expressed by work- shop speakers and participants. Although the time frame for the workshop did not allow a comprehensive review of this topic (e.g., violence in video games; the use of the Internet for sexually predatory behavior against young people, or gang violence), the workshop itself provided a unique and timely opportunity for researchers, practitioners, and advocates from different disciplines and areas to come together for scientific discourse. Participants were also asked to make suggestions about how to elevate the issue of vio- lence prevention on the global public health agenda based on the evidence presented, as well as their own policy, research, programmatic, and clinical experiences; but these should not be construed as recommendations from the Institute of Medicine. This report does not contain a comprehensive review of the literature that exists on this topic but rather, like the work- shop, is intended to spur further action by others who can play a pivotal role in increasing human, technical, and fiscal resources for global violence prevention. The report appendixes do, however, contain papers commis- sioned for this report that have reviewed the existing literature for different aspects of violence and its consequences (see Appendix C). The content and views expressed in the papers do not necessarily represent the views of the Institute of Medicine (IOM). xiii

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xiv PREFACE As occurs for many other topics of interest in public health, vio- lence prevention has historically been approached in an insular way with researchers from a variety of fields working in “silos.” In these silos, researchers and practitioners are often without the benefit of major find- ings or funding from other disciplines that are truly necessary for an inter- disciplinary approach to address the commonalities among not only the risk factors for different types of violence, but also the consequences for its victims and communities. Thus the workshop was intended and structured as a forum for researchers and practitioners addressing the seven types of violence (child maltreatment and other violence directed at children; youth violence; intimate partner violence; sexual violence; abuse of the elderly; self-directed violence; and collective violence) to come together to discuss cross-cutting risk factors and synergistic approaches to violence prevention (see Appendix A for the workshop agenda). Additionally, these synergistic approaches and linkages among disciplines and types of violence could be another step to help facilitate the translation of emerging and innova- tive research findings into domestic and international policy and practice. Other participants in the workshop included those with a wide array of expertise in fields related to health, criminal justice, and economic devel- opment, as well as representatives from U.S. government agencies, private philanthropic foundations, nonprofit organizations in the private sector, the Department of State, and bilateral and multilateral organizations (see Appendix B for participant list). The overarching goals of the workshop were to illuminate the issue of global violence prevention and to identify and mobilize specific actions for the U.S. government and other leaders with resources to more effectively support programming for prevention of the many forms of violence. We greatly appreciate the support of the F Felix Foundation, as well as the collaboration with Global Violence Prevention Advocacy, in convening this workshop. Special appreciation is extended to Rosemary Chalk, direc- tor of the Board on Children, Youth, and Families, for her expertise and guidance during the organization of this meeting. We are also grateful for the contributions of our expert presenters and moderators, as well as the participants who contributed to the discussions. Many were eager to see and be a part of additional activities that might result from the meeting, and all of their contributions enriched the process of open dialogue that may result in new research, programmatic, and advocacy collaborations beyond the traditional confines of the silo approach. Several members of the planning committee met once in person, with the rest connected by teleconference, and 13 international teleconferences were held over three months to plan and convene the workshop. Deep appreciation goes to the committee members for the amount of time they volunteered to this project. The workshop rapporteur and IOM Senior

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xv PREFACE Program Officer, Kimberly Scott, deserves special recognition for coordi- nating the entire effort over a rather short time frame. Her dedication and responsiveness were notable. Special appreciation also goes to members of the project staff including Allison Brantley, senior program assistant; Megan Ginivan, student intern; and Julie Wiltshire, financial associate, for their able assistance in the organization of this meeting. Additional thanks go to Sarah Bronko for research and logistic support during the meeting, as well as to Tia Carter, Angela Mensah, and Rachel Passman for support during the meeting. Patrick Kelley Board on Global Health

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