SOCIETAL VIOLENCE – A PUBLIC HEALTH ISSUEITS PREVENTION – A CARICOM DEVELOPMENTAL IMPERATIVE

Remarks by H.E Dr. IzBen C. Williams to National and Regional Leaders and other high-level officials of the Caribbean Community of Nations, attending the Regional Symposium on Violence Prevention as a Public Health Issue, and its related Crime Challenge, at Trinidad’s Hyatt Regency, 17-18 April 2023

Good day to all the participants in this important meeting, which brings together CARICOM leaders at the highest National and Regional levels, to discuss and find solutions to our epidemic of Societal Violence and Crime, having regard for their implications not just for citizen security, but also for national and regional development. I am grateful for the opportunity to share some thoughts on this issue with you. I regret, however, not being able to attend in person as my current circumstances, albeit temporary, dictate otherwise.

For his foresight in mounting this initiative, I am sure you all join me in thanking the convenor of this sorely needed Symposium, CARICOM’s Lead Head on Security – Trinidad and Tobago’s Prime Minister, the Hon Dr Keith Rowley.

Permit me also to adopt the order of acknowledgements which preceded, save for acknowledging the presence and participation of:
Current Chair of the CARICOM Conference of Heads, the Hon. Phillip Davis KC, Prime Minister of the Bahamas.

CARICOM’S Lead Head on Health, Prime Minister the Hon. Dr. Terrence Drew of St. Kitts and Nevis (my Prime Minister).

Secretary General of the Caribbean Community of Nations, Her Excellency Dr Clara Barnett CBE.
……………

Distinguished ladies and gentlemen.
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In the time allotted me, I invite you to position your thinking (or perhaps to reposition your thinking) for a while on the issue of violence prevention and to envision it as a developmental imperative – a critical dimension of development for the global community – but particularly for regions such as the Caribbean States, which have not had great success at remedying this situation.

Violence has become one of the most preeminent developmental issues facing policymakers and one of the most persistent challenges in today’s global agenda. Its negative impact on social and economic development in many countries has been well documented.

Violence takes many forms and has many faces. Its various manifestations all converge to erode the well-being of us all, and to stymie development efforts. It is undeniable that anxieties and hypervigilance caused by the possibility of violence being perpetrated against any right- thinking one of us, all too frequently pervade our thoughts. For, how can we escape such anxieties, triggered as they are by being bombarded daily and relentlessly on many fronts with reports of violent occurrences happening around us. We have all come to appreciate the risk to our personal security and to experience some measure of unsafety.

For many of us, staying out of harm’s way may be a matter of locking our doors and windows and avoiding dangerous places. For others, escape is not possible – the threat of violence is behind those same closed doors, well hidden from public view; and for those living amidst external threat or conflict, the risk of violence may permeate every aspect of life – thoughts, feelings and actions. Many who live with repeated violence, in whatever form over an extended period, may have difficulty disabusing their minds of the faulty notion that violence is an intrinsic part of our human condition to which we should adapt. Not so. Violence can be prevented. We now have the knowledge, we have developed tools, and we must now harness the courage to face up to it and reverse its trend.

Violence is now clearly recognized as a public health problem, but just 40 years ago the words “violence” and “health” rarely shared a common context nor were they even remotely connected. But several serendipitous
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occurrences and observed trends contributed to a growing recognition and acceptance that violence could and should be addressed from a public health vantage.

Firstly, as the Western World became more successful at preventing and treating many infectious diseases, it was observed that homicide and suicide rose in the rankings of ‘causes of death’. Tuberculosis and pneumonia were the two leading causes of death at the turn of the 20th century. By mid-century, the incidence and mortality from these infectious diseases along with others such as yellow fever, typhoid, poliomyelitis measles and diphtheria, were dramatically reduced
through public health measures – by sanitary control of the environment, isolation of contagious disease cases, immunization and, as a result of medical advances and the application in updated therapeutic techniques.

Violence became a phenomenon of greater focus by the US-Centers for Disease Control and Prevention (CDC), and in public health, because in the USA the risk of homicide and suicide reached epidemic proportions during the 1980s among specific segments of the population including youth and minority groups. Suicide rates among adolescents and young adults 15 to 24 years of age almost tripled between 1950 and 1990. Similarly, from 1985 to 1991 homicide rates among 15 to 19-year-old males increased 154 percent, a dramatic departure from rates of the previous 20 years for this age group. This increase was particularly acute among young African American males. These trends raised concerns and provoked calls and epidemiologic enquiry for new solutions.

Another important development was the increasing acceptance within the public health community of the importance of behavioral factors in the etiology and prevention of disease. It is now generally accepted
that prevention of three of the leading causes of death in the United States — heart disease, cancer, and stroke — rests largely on behavioral modifications such as exercise, changes in diet, and smoking cessation. Successes in these areas encouraged public health professionals to believe that they could likewise overcome the same behavioral challenges underlying interpersonal violence and suicidal behavior.
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Thirdly, the emergence of child maltreatment and intimate partner violence as recognized social problems in the 1960s and 1970s demonstrated the need to move beyond sole reliance on the criminal- justice sector in solving these problems.

This is the public health foundation upon which the proven steps in violence-prevention, rests:
i. Surveillance
ii. Identifying risk and protective factors
iii. Developing and evaluating interventions
iv. Implementing programs, born of sound policy
As public health efforts to understand and prevent violence gained momentum in the United States, they also garnered attention abroad. Violence was placed on the international agenda in 1996 when the World Health Assembly (WHA) adopted a resolution (WHA49.25), which declared violence “a leading worldwide public health problem.” The resolution requested the WHO to initiate public health activities to:
1) document and characterize the burden of violence,
2) assess the effectiveness of programs, with particular attention to women and children, and community-based initiatives, and
3) promote activities to tackle the problem at the international and country level.

In 2000, the WHO created the Department of Violence and Injuries Prevention to increase the global visibility of intentional injury and violence and to facilitate public health action. The organization’s “World Report on Violence and Health,” published in 2002, is now used throughout the world as a platform for increased public health action toward preventing violence.
Moving Forward in a Global Context

Despite How does the Caribbean fit into this now global violence prevention scenario?

[Well] globally, homicide rates have been a gauge for the incidence of societal violence. It is couched as “number of murders per 100.000 of population”.

The Global Homicide Rate for 2019 was 6.1 per 100,000.

Homicide rates have been consistently high in the Americas for at least
three decades and have remained high in the Americas even as they plummeted elsewhere. The region’s average rate remained at the same level between 1990 and 2016, fluctuating slightly from a low of 14.5 to a high of 16.7 per 100,000 people – compared with a global average that varied between 6.0 and 7.4 over the same period. The rate in the Americas jumped to 17.2 in 2017, reaching the highest level since at least 1990. On the Global chart for 2017 Africa came in a distant second with a homicide rate of 13.0 /100,000. In Europe and Asia, at the same time, the rates were 3.0 and 2.3 /100,000 respectively.

The Caribbean sub-region of the Americas has also consistently led mainland America in homicide rates. According to a joint UNODC/World Bank Report of 2002, the Caribbean had attained a level of 30 per 100,000 in the first decade of the new century. These rates must give us at least cause for pause. Yet, as the Caribbean Community of Nations reels and quivers from the acute on chronic ecological impact of Violence in its varied manifestations, I am heartened and proud to realize that our leaders are prepared and emboldened at this time to seize the moment in reversing this trend.
Public Health professionals having contributed to the
understanding of violence using epidemiologic methods to characterize
the problem and identify modifiable risk factors, enlightened methods of
violence prevention remained adrift in too many global jurisdictions, and
adapting to the new paradigm shift has been somewhat of a hard sell.
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Violence constitutes a common enough occurrence in our daily Caribbean lives, even if not necessarily impacting most of us directly or personally. Nonetheless, we should guard against ever bringing ourselves to regard it as an inevitable part of our social and human condition; an immutable characteristic of our daily lives, to which we must find ways of adjusting or responding to the extent we find possible. Rather we must regard it as a phenomenon that can in fact be curtailed or prevented.

Violent cultures can be turned around and cultures of non-violence vigorously promoted. There are many remarkable shining examples of how violence has been countered, and not primarily with a law-and-order approach nor repressive pushback or coercion. Because of the multifaceted character of violence, it has been shown that what is required to abate its progression is broad engagement of all societal sectors – government, civic and corporate sectors, academia, the citizenry and partners at all levels – local, national, regional and international, with a key role being played by International Development Agencies.

Even with the increased awareness that violence can be prevented, a commensurate level of appreciation among policymakers and program developers is still necessary. And even such understanding by itself is insufficient unless there is the unfettered will for essential next steps to be taken in shaping appropriate data-driven responses.

Hence, I entreat you to arm yourselves and those you entrust with taking over the rudder after this symposium is done. Gird yourselves with evidence of what is known to have worked to curtail the impact of this scourge of societal violence and to apply this knowledge to all our benefit; for as is well known, the essence of knowledge, is having it to apply it.

Defining the nature and extent of violence is a necessary first step toward fully comprehending the phenomenon of violence. Homicide rate is not the only indicator of societal violence. Homicide rate is the measure that is used most often to determine overall levels of violence in a city or country because homicide constitutes the most serious and publicly visible
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of all violent acts and it is usually reported more accurately in statistics on violent crime.

It is estimated however, that for every young person killed 20-40 receive non-fatal injuries that may require hospital treatment, and a preponderance of victims of violence never access needed medical care, particularly for the types of interpersonal violence that are stigmatized. Homicide rates represent therefore but a fraction of the tip of the societal violence iceberg.

In 2005 the Heads of Government of the Caribbean Community commissioned a report on the health situation of the region. Among the findings of the Caribbean Commission on Health and Development (CCHD), chaired by Sir George Alleyne, was that there were three health issues looming large, which had the potential to stymie growth and development in the Community of Nations, and which needed to be addressed as priorities. These were:
HIV/AIDS

Chronic non-communicable diseases • Violence and intentional Injuries
Progress in addressing HIV/AIDS has been significant. The Pan- Caribbean Partnership Against HIV and AIDS (PANCAP), which is dedicated to this health issue, had been established in February 2001. It has provided a unified vision and direction among all partners in reducing the spread and mitigating the impact of HIV in the Caribbean. PANCAP is now recognized by UNAIDS as a global best-practice model.

Commendable strides have also been made more recently regarding chronic non-communicable diseases (NCDs). In fact, it is the CARICOM States that were instrumental in placing this issue on the Agenda of the
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United Nations General Assembly in September 2011 when World Leaders convened at UN Headquarters, a High-Level Meeting on NCDs.

Violence and Injuries was the third issue identified by the CCHD as needing immediate redress. Although as much a health-and- development-issue as the other two, it straddles the purview of many other sectors including public security, governance, law enforcement, and education among others. Perhaps because of its complexity as an issue, and the many sectors to be engaged, it has not yet gained the traction it deserves. You, the participants in this high-level symposium, have the capacity to change that. I entreat you to do so, if only having regard for it’s being a critical dimension of development.

I have heard the opinion expressed that after the deliberations of this high-level symposium and its planned follow-up actions, nothing short of an agency, partnership or alliance (an organization akin to PANCAP), capable of developing and implementing policy for preventing violence and reducing its impact, and reducing the rate of homicide in which we are front runners, would justify our efforts. Perhaps so. I have faith that our Heads, being at the end of this exercise better seized of the problem, would at this juncture make sound decision in taking this challenge forward.

Violence is often not only preventable but also predictable. Many of the factors that increase the risk of violence are shared across different types of violence and are modifiable. Hence while Public Health does not offer all the answers to this complex problem, we must be determined to play our role in shaping responses peculiar to our ecologic and socio- cultural realities, for better outcome, and thereby make the Caribbean, the Americas and our world a safer and healthier place for all.
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I thank you for your attention and I trust that your deliberations would be very fruitful.
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