1

Introduction 1

The past 25 years have seen a major paradigm shift in the field of violence prevention, from the assumption that violence is inevitable to the recognition that violence is preventable. Part of this shift has occurred in thinking about why violence occurs, and where intervention points might lie. In exploring the occurrence of violence, researchers have recognized the tendency for violent acts to cluster, to spread from place to place, and to mutate from one type to another. Furthermore, violent acts are often preceded or followed by other violent acts. Contextual and social factors play a role in increasing or reducing the risk of violence; such factors might exist at community or individual levels.

In the field of public health, such a process has also been seen in the infectious disease model, in which an agent or vector initiates a specific biological pathway leading to symptoms of disease and infectivity. The agent transmits from individual to individual, and levels of the disease in the population above the expected rate constitute an epidemic. Although violence does not have a readily observable biological agent as an initiator, it can follow similar epidemiological pathways. Just as with those infected by microbial agents, those exposed to violence have varying levels of resilience

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1 The planning committee’s role was limited to planning the workshop. The workshop summary was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Forum, the Institute of Medicine, or the National Research Council, and they should not be construed as reflecting any group consensus.



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1 Introduction1 T he past 25 years have seen a major paradigm shift in the field of violence prevention, from the assumption that violence is inevitable to the recognition that violence is preventable. Part of this shift has occurred in thinking about why violence occurs, and where intervention points might lie. In exploring the occurrence of violence, researchers have recognized the tendency for violent acts to cluster, to spread from place to place, and to mutate from one type to another. Furthermore, violent acts are often preceded or followed by other violent acts. Contextual and social factors play a role in increasing or reducing the risk of violence; such factors might exist at community or individual levels. In the field of public health, such a process has also been seen in the infectious disease model, in which an agent or vector initiates a specific bio- logical pathway leading to symptoms of disease and infectivity. The agent transmits from individual to individual, and levels of the disease in the population above the expected rate constitute an epidemic. Although vio- lence does not have a readily observable biological agent as an initiator, it can follow similar epidemiological pathways. Just as with those infected by microbial agents, those exposed to violence have varying levels of resilience 1  The planning committee’s role was limited to planning the workshop. The workshop sum- mary was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Forum, the Institute of Medicine, or the National Research Council, and they should not be construed as reflecting any group consensus. 1

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2 CONTAGION OF VIOLENCE and susceptibility. In addition, the influence of the environment can play a major role not only in symptomology, but also in transmission. On April 30-May 1, 2012, the Institute of Medicine (IOM) Forum on Global Violence Prevention convened a workshop to explore the contagious nature of violence (see Box 1-1 for the Statement of Task). Part of the Forum’s mandate is to engage in multisectoral, multidirectional dialogue that explores crosscutting, evidence-based approaches to violence preven- tion, and the Forum has convened four workshops to this point exploring various elements of violence prevention. The workshops are designed to examine such approaches from multiple perspectives and at multiple levels of society. In particular, the workshop on the contagion of violence focused on exploring the epidemiology of the contagion, describing possible pro- cesses and mechanisms by which violence is transmitted, examining how contextual factors mitigate or exacerbate the issue, and illuminating ways in which the contagion of violence might be interrupted. Speakers were invited to share the progress and outcomes of their work and to engage in a dialogue exploring the gaps and opportunities in the field. It should be noted that, while the infectious disease model was utilized as a framework for common language, not all speakers approached the issue of contagion literally. These differing approaches allowed for an emerging exploration of this issue, and one that might benefit from future exploration and research. BOX 1-1 Statement of Task The contagion of violence is a universal phenomenon, occurring at all levels of society and affecting a broad spectrum of individuals. It occurs globally, within all societies, and is transmitted through interpersonal relationships, families, peer groups, neighborhoods, and cultures. The Institute of Medicine will convene a 2-day workshop to explore the contagion of violence and how it can be prevented and eventually ended. The workshop will emphasize the challenge in low- and middle-income countries, where the burden of violence is the greatest. The public workshop will be organized and conducted by an ad hoc commit- tee to examine (1) the contagious nature of violence, (2) the relationship between the contagion of violence and epidemics of violence, and (3) how contagions of violence can be prevented or ended. The committee will develop the workshop agenda, select and invite speak- ers and discussants, and moderate the discussions. Experts will be drawn from the public and private sectors as well as from academic organizations to allow for multilateral, evidence-based discussions. Following the conclusion of the workshop, an individually authored summary of the event will be prepared by a designated rapporteur.

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INTRODUCTION 3 The World Health Organization (WHO) defines violence as “the inten- tional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation” (WHO, 2002). WHO further categorizes violence into seven types: child abuse, elder abuse, sexual violence, inti- mate partner violence, youth violence, collective violence, and self-directed violence. The workshop was planned by a formally appointed committee of the IOM, whose members created an agenda and identified relevant speakers. Because the topic is large and the field is broad, presentations at this event represent only a sample of the research currently being undertaken. Speak- ers were chosen to present a global, balanced perspective, but by no means a comprehensive one. Working within the limitations imposed by its time and resource constraints, the planning committee members chose speakers who could provide diverse perspectives on which further discussion could occur. The agenda for this workshop can be found in Appendix A. The speakers’ presentations and the audio recordings of the workshop can also be found on the website for the workshop: http://iom.edu/contagionofviolence. ORGANIZATION OF THE REPORT This summary provides an account of the presentations given at the workshop. Opinions expressed within this summary are not those of the IOM, the National Research Council, the Forum on Global Violence Pre- vention, or their agents, but rather of the presenters themselves. Such statements are the views of the speakers and do not reflect conclusions or recommendations of a formally appointed committee. This summary was authored by designated rapporteurs based on the workshop presentations and discussions and does not represent the views of the institution, nor does it constitute a full or exhaustive overview of the field. The workshop summary covers the major topics that arose during the 2-day workshop. It is organized by important elements of the infectious dis- ease model so as to present the contagion of violence in a larger context and in a more compelling and comprehensive way. The topics and key points presented in this summary were the most frequent, crosscutting, and es- sential elements that arose from the various presentations of the workshop, but the choice of these topics does not represent the views of the IOM or a formal consensus process. The first part of this report consists of four chapters that provide a summary of the workshop: Patterns of Transmission of Violence (Chap- ter 2), Processes and Mechanisms of the Contagion of Violence (Chapter 3), The Role of Contextual Factors in the Contagion of Violence (Chapter 4),

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4 CONTAGION OF VIOLENCE and Contagion and Interruption in Practice (Chapter 5). The second part consists of submitted papers and commentary from speakers regarding the substance of the work they presented at the workshop. These papers were solicited from speakers in order to offer further information about their work and this field; not all speakers contributed papers. Finally, the appen- dixes contain the workshop agenda (Appendix A), a glossary (Appendix B), and the speakers’ biographies (Appendix C). REFERENCE WHO (World Health Organization). 2002. World report on violence and health. Geneva, Switzerland: WHO.