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Collective violence, especially in the form of armed conflict, accounts for more death and disability than many major diseases worldwide. Collective violence destroys families, communities, and sometimes entire cultures. It directs scarce resources away from promotion and protection of health, medical care, and other health and social services. It destroys that health-supporting infrastructure of society. It limits human rights and contributes to social injustice. It leads individuals and nations to believe that violence is the only way to resolve conflicts. It contributes to destruction of the physical environment and the overuse of nonrenewable resources. In sum, collective violence threatens much of the fabric of our civilization (see Appendix C, Sidel and Levy, 2007). Self-directed violence, interpersonal violence, and collective violence in some ways overlap. Those involved in collective violence may engage in self-directed violence as a symptom of posttraumatic stress syndrome or as a result of self-hatred because of acts committed in war. Collective violence may also be associated with interpersonal violence. For example, individuals and groups engaged in collective violence may commit interpersonal violence, sometimes fueled by ethnic tensions or by conflict with superior officers or with fellow service members in the midst of war. Soldiers may return from war with a battlefield mind-set in which they commit violence to address interpersonal conflicts that could have been addressed in nonviolent ways. Children raised in the midst of war may come to believe that violence is an appropriate way to settle interpersonal conflicts (see Appendix C, Sidel and Levy, 2007).

Richard Garfield opened his presentation by providing a common operational definition of conflict, which was that at least 1,000 deaths would occur in a period of conflict, which is usually a multiyear period. The good news, he noted, is that the trend has been a long-term decline in global conflict as he defined it since the end of World War II, a short-term increase at the end of the Cold War, followed by a continued decline. Since fewer people are engaged in conflict, the resultant deaths are the lowest at any time during the last 150 years. For the first time, the prevalence of organized political violence between states or in a military fashion within states is so low that it is has become almost an exception to the political engagement between groups—a message that seldom gets out to the media or to those who work in violence prevention. These data may be indicative of two of the strategic primary prevention foci outlined by Mercy (see Appendix C, Mercy et al., 2007)—the importance of changing social norms to promote nonviolence for conflict resolution and possibly reducing the social distance between conflicting groups. The exception, Garfield noted, is Africa where most conflicts are concentrated, are often within borders, and do not come to international attention. Even here, research findings indicate

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