Applying upstream interventions for interpersonal violence prevention: An uphill struggle in low- to middle-income contexts
Section snippets
Background
Violence claims an estimated 1.6 million lives worldwide annually and 90% of these deaths occur in low- to middle-income countries [1]. However, this only reflects a fraction of the overall impact of violence on global health and development [2]. South Africa's rates of fatal violence are five and eight times higher than the global average for females and males, respectively [3]. Official police statistics estimate that there were 40% fewer homicides, but comparable data from other countries
Biological risk factors
Young males are more likely to be perpetrators and victims of violence worldwide. In the Western Cape province, males were disproportionately affected by fatal violence and in 2000 there were 5.2 male deaths due to interpersonal violence for every female death [6]. This ratio was marginally higher than the average in other provinces, but 60% higher than the world average of 3.2 male deaths for every female death [13]. In South Africa, males also account for a greater proportion of non-fatal
Proven and promising interventions
Having provided a brief profile of the Western Cape's risk factors for violence across the ecological model, we draw on internationally reviewed, proven and promising interventions as they relate to these data, in order to provide the range of intervention possibilities that might be considered to address the burden of violence in the Western Cape province and other similar contexts.
Butchart et al. [54] maintain that violence prevention requires comprehensive intervention strategies involving
Prioritising interventions in the Western Cape
South Africa, seemingly at the forefront of progressive legislation and policy, needs to ensure that political will translates into the provision of the human resources, management capacity and moral leadership required to drive the social changes that new policies might impose on an unsupportive public still steeped in dysfunctional cultural norms and values. A cursory review of current national violence prevention strategies reveals an over-reliance on downstream interventions to reduce the
Conclusion
It is clear that efforts to address the burden of violence in the Western Cape require a multi-sectoral approach that spans the criminal justice, health and infrastructural domains. There is also a need to balance achievable short-term targets and the long-term nature of many of the strategies most needed to affect fundamental shifts in socio-cultural attitudes and propensities towards aggressive and violent behaviour. Thus, if the typical perpetrator in the Western Cape is a young male
Funding
This work was supported by the Burden of Disease Reduction Project of the Department of Health of the Western Cape Provincial Government. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Richard Matzopoulos is a Specialist Scientist at the Burden of Disease Research Unit of the Medical Research Council of South Africa and an Honorary Research Associate at the School of Public Health and Family Medicine of the University of Cape Town.
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Richard Matzopoulos is a Specialist Scientist at the Burden of Disease Research Unit of the Medical Research Council of South Africa and an Honorary Research Associate at the School of Public Health and Family Medicine of the University of Cape Town.
Brett Bowman is a Senior Researcher in the Discipline of Psychology at the School of Human and Community Development of the University of the Witwatersrand, Johannesburg, South Africa.
Shanaaz Mathews is a Senior Scientist in the Gender and Health Research Unit of the Medical Research Council of South Africa.
Jonny Myers is the Director of the Occupational and Environmental Health Research Unit, and Professor in the School of Public Health and Family Medicine of the University of Cape Town.