Elsevier

Health Policy

Volume 97, Issue 1, September 2010, Pages 62-70
Health Policy

Applying upstream interventions for interpersonal violence prevention: An uphill struggle in low- to middle-income contexts

https://doi.org/10.1016/j.healthpol.2010.03.003Get rights and content

Abstract

In South Africa's Western Cape province, interpersonal violence was identified among the key prevention priorities in the provincial government's Burden of Disease (BoD) Reduction project. To date, there are no adequate systematic reviews of the full range of potential intervention strategies. In response, available data and the literature on risk factors and prevention strategies for interpersonal violence were reviewed with a view to providing policy makers with an inventory of interventions for application. Given the predominance of upstream factors in driving the province's rates of interpersonal violence, efforts to address its burden require an intersectoral approach. Achievable short-term targets are also required to offset the long-term nature of the strategies most likely to affect fundamental shifts. Documentation and evaluation will be important to drive long-term investment, ensure effectiveness and enable replication of successful programmes and should be considered imperative by interpersonal violence prevention policymakers in other 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.

REFERENCES (92)

  • S.F. Messner

    Research on cultural and socioeconomic factors in criminal violence

    Psychiatric Clinics of North America

    (1988)
  • C. Kapp

    South Africa failing people displaced by xenophobia riots

    Lancet

    (2008)
  • C.D. Mathers et al.

    Statistical annex

  • R. Matzopoulos et al.

    Violence, health, and development

    Violence prevention in low- and middle-income countries: finding a place on the global agenda, workshop summary, by the Institute of Medicine

    (2008)
  • R. Norman et al.

    The high burden of injuries in South Africa

    WHO Bulletin

    (2007)
  • United Nations Office on Drugs and Crime [UNODC]. International Homicide Statistics;...
  • R. Norman et al.

    Estimating the burden of disease attributable to interpersonal violence in South Africa in 2000

    South African Medical Journal

    (2007)
  • Bradshaw D, Nannan N, Laubscher R, Groenewald P, Joubert J, Nojilana B, et al. South African National Burden of Disease...
  • Myers JE, Naledi NT. Western Cape burden of disease reduction project: overview of the report;...
  • World Health Organization. Global consultation on violence and health. Violence: a public health priority;...
  • C. Groenewald

    Western Cape: an overview

  • L.L. Dahlberg et al.

    Violence—a global public health problem

  • Ottawa Charter for Health Promotion. First international conference on health promotion; 21 November...
  • Commission on Social Determinants of Health. Achieving health equity: from root causes to fair outcomes. Interim...
  • World Health Organisation. Age-standardized mortality rates by cause (per 100,000 population); 2008, available at:...
  • Violence and Injury Surveillance Consortium. National non-fatal injury surveillance system: pilot study report;...
  • Norman R. Estimates of Injury mortality and disability based on the Cape Metropole Study;...
  • Prinsloo M
  • Mathews S, Abrahams N, Martin LJ, Vetten L, Van der Merwe L, Jewkes R. Every six hours a woman is killed by her...
  • R.G. Matzopoulos et al.

    Violence and children in South Africa

  • South African Police Services. Annual report of the South African police services for 2004/2005;...
  • D. Runyan et al.

    Child abuse and neglect by parents and other caregivers

  • A. Raine

    The psychopathology of crime: criminal behavior as a clinical disorder

    (1993)
  • J. Kagan

    Temperamental contributions to social behavior

    American Psychologist

    (1989)
  • J.A. Mercy et al.

    Youth violence

  • A. Raine

    Biosocial studies of antisocial and violent behavior in children and adults: a review

    Journal of Abnormal Child Psychology

    (2002)
  • A. Caspi et al.

    Role of genotype in the cycle of violence in maltreated children

    Science

    (2002)
  • S. Schoenthaler et al.

    The effect of randomized vitamin-mineral supplementation

    Journal of Nutritional & Environmental Medicine

    (1997)
  • C.B. Gesch et al.

    Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial

    British Journal of Psychiatry

    (2002)
  • C.D.H. Parry et al.

    A public health approach to addressing alcohol related crime in South Africa

    African Journal of Drug & Alcohol Studies

    (2006)
  • M. Strauss et al.

    Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys

    Journal of Marriage and the Family

    (1986)
  • J.M. Golding

    Sexual assault history and limitations in physical functioning in two general population samples

    Research in Nursing & Health

    (1996)
  • K. Rodgers

    Wife assault: the findings of a national survey

    Juristat

    (1994)
  • H. Johnson

    Dangerous domains: violence against women in Canada

    (1996)
  • K.E. Leonard

    Alcohol and intimate partner violence: when can we say that heavy drinking is a contributing cause of violence?

    Addiction

    (2005)
  • S. Mathews et al.

    Alcohol use and its role in female homicides in the Western Cape, South Africa

    Journal of Studies on Alcohol and Drugs

    (2009)
  • Cited by (37)

    • Incidence and factors associated with being a victim of community assault; retrospective review of medical records in an Emergency Centre

      2022, African Journal of Emergency Medicine
      Citation Excerpt :

      Interventions to improve the employment status of those at risk are likely to have an indirect impact on number of community assault cases [10]. Intervening at community, societal, structural and policy levels might have greater sustained success, despite being more difficult to measure compared with interventions aimed at addressing individual-level behaviours [17]. Routine community surveillance may identify unemployed young males at risk of community assault.

    • Trauma patients at the Helderberg District Hospital emergency centre, South Africa: A descriptive study

      2021, African Journal of Emergency Medicine
      Citation Excerpt :

      The recent alcohol ban as part of the national lockdown for the Corona virus pandemic resulted in an almost 60% reduction in assaults, accidents and other injuries and a 90% reduction in sexual assaults [31]. Violence is a complex problem and needs to be addressed in a comprehensive and holistic manner addressing infrastructure, healthcare and justice systems [32,33]. The WHO World Report on Violence and Health has made public health initiatives a priority to address the problem of violence [34].

    • Urban upgrading and levels of interpersonal violence in Cape Town, South Africa: The violence prevention through urban upgrading programme

      2020, Social Science and Medicine
      Citation Excerpt :

      Potential confounders included deprivation, which we considered at both household and area-level, access to alcohol, and social cohesion. Each of these factors is known to be associated positively or negatively with interpersonal violence in some contexts (Matzopoulos et al., 2010) and we considered that they might be distributed differently within the VPUU exposed areas than in the rest of Khayelitsha. In South Africa's low-income communities, even ostensibly formal areas are prone to the erection of informal structures attached to formal serviced sites.

    • The burden of trauma at a district hospital in the Western Cape Province of South Africa

      2019, African Journal of Emergency Medicine
      Citation Excerpt :

      The high volume of trauma cases, particularly among young males, is similar to other African data and concerning. Public health experts suggest rates of interpersonal violence in South Africa, and much of sub-Saharan Africa, may be reduced by increasing employment, reducing income inequality, limiting access to weapons, and reducing alcohol and drug abuse [61]. A prior study at a Cape Town hospital found that approximately 47% of trauma patients were under the influence of alcohol, of which 87% had some form of interpersonal violence ensuing [46].

    View all citing articles on Scopus

    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.

    View full text