/IPS DEVELOPMENT BULLETIN/ LATIN AMERICA: Violence as a Health Problem

By Humberto Márquez Reprint | | Print |

Humberto Marquez

CARACAS, Oct 12 1996 (IPS) - Latin American sociologists, attempting to place the wave of violence raging across the continent within a broader social context, have characterised the scourge as one of four “enemies” of the health sector.

Violence is among the ‘gang of four’ major enemies of health in countries like Venezuela, a conference held here last week to discuss the relationship between the social sciences and health was told. These four “enemies” were listed as poverty, lifestyle, the environment and violence.

In Venezuela, a country of 22 million people, violence is the third biggest cause of death coming behind only cardio-vascular diseases and cancer, said sociologist Roberto Bricena-Leon.

Latin America is the “most violent continent, with an average rate of 19 homicides per 100,000 inhabitants,” said Ecuadorean expert Fernando Carrion. “We have the most violent country, Colombia, with a rate of 77, and the most violent city, Medellin, where there have been up to 350 violent deaths per 100,000 inhabitants in one year.”

If account was taken of other violent acts, such as traffic accidents and suicides, the rate of deaths in the region reached 44 per 100,000, said Brazilian Maria Cecilia Minayo of the Latin American Center for the Study of Violence.

That compares with a world average of 7 per 100,000, said Minayo, who also provided another figure: 35 percent of the violent acts committed in Latin America are associated with the consumption of alcohol.

“Violence provides a profile of a society. It is linked closely to social inequality, youth unemployment and the weakness of state institutions like the police, schools and the health system,” said Minayo.

In Venezuela, which has about 2.5 million vehicles, “there is one death by traffic accident every hour and a half,” said Bricena-Leon.

Violence is the main cause of the lowering of life expectancy. “If in a country with a life expectancy of 70 years, a 60 year- old dies of a cardio-vascular problem, 10 years are lost. But if a 20-year-old dies of a gunshot wound, 50 years are lost,” explained the sociologist.

To this, one must add all those who are “wounded as a result of violence, who create serious problems of overcrowding at hospitals, because they fill up emergency rooms, occupy beds for patients who need operations, and turn them into true war-zone hospitals,” he added.

In the middle of 1996, many of the larger hospitals in Caracas closed their doors temporarily, one after another, because in addition to emergency room congestion, there were many problems of administrative backlog.

“This demonstrates that we have been following policies and practices for years, in which we have developed systems for medical and hospital services, but not for health” in a preventive sense, said Bricena-Leon.

In countries like Venezuela, there have been “large investments in the last four decades, to buy hospital equipment, instead of designing policies for prevention.”

For that reason, the conference organized by Bricena-Leon, of the Central University of Venezuela, emphasized violence as a novel public health problem. At the head of the list of the “four ills” is poverty, which affects 40 percent of the population in Latin America.

Second on the list are the “lifestyle” problems. Latin America is becoming increasingly urban, and faces problems of “marginality, overcrowding, sedentary life styles, and bad eating habits,” said the expert.

Poor nutrition, he said, causes obesity among poor people, “a product of a division between those who eat little and poorly, and those who eat a lot, but poorly.”

In third place are “environmental problems, air pollution, lack of drinking water, inadequate facilities for garbage disposal, and a combination of poverty and lifestyles that breed disease.”

Violence is the fourth ill, according to Bricena-Leon, who also points out that in Latin America “there has been a shift in perspective, that can be observed in national and regional health plans, like the incorporation of social issues.”

Another positive factor is the “incorporation of a gender perspective in health studies and programs,” says Carol Vlasoff, of the World Health Organization.

One study with a gender perspective on the transmission of leishmaniasis in Colombia revealed that the disease, which was though to affect mostly men, was found to affect both men and women, said Vlasoff.

She argued that a perspective on gender allows for the better detection in groups that are not registered, better knowledge on the risk factors by age and sex, more appropriate treatment, and better intervention for the entire population.