Violence in society: a public health perspective
In 1990, CPHA members approved a resolution that recognized violence as a pervasive and destructive force in society and pledged to advocate strongly for its elimination. This issue paper has been prepared to provide background information on the scope and nature of the problem, to present a public health perspective on violence in society and to make recommendations for action.
The issue paper, Violence in Society: A Public Health Perspective was approved by CPHA's Board of Directors in June 1994 and released in November 1994.
Violence in Society
Violence in society is of increasing concern to all Canadians. Our growing knowledge of the nature of violence requires us to expand our ideas of who are the perpetrators of violence, and who are affected. We are coming to realize that violence takes many more forms than physical blows or wounds. It includes sexual assault, neglect, verbal attacks, insults, threats, harassment and other psychological abuses. Violence occurs in homes, workplaces, public institutions, schools, health care facilities and the street. Women and children are as often the victims of violence as are men, and most often the violence is committed by someone known to the victim. Current violence includes acts that are random and spontaneous as in a lashing out in rage, as well as systematic, planned acts calculated to overpower and control. Violence affects its direct victims, those who witness violence, family members, co-workers, service providers and all members of society.
All forms of violence have damaging short- and long-term effects on mental, physical and spiritual well-being. Living with violence, or in fear of violence, is clearly in opposition to the fundamental conditions and resources for health. In Canada, violence has not yet been clearly identified as a priority health issue nor addressed in the design and delivery of community health services or health promotion efforts.
A Health Promotion Approach
To understand the complexity of violence and to reduce its occurrence, it is critical to take a health promotion approach to this problem. A thorough understanding of violence requires information on its epidemiology, the social values underlying human relationships and effective strategies used to prevent violence and reduce its effects.
In 1986, the Canadian Public Health Association, along with Health and Welfare Canada and the World Health Organization, adopted the Ottawa Charter for Health Promotion. Three of the strategies for achieving health outlined in the Charter have particular significance with respect to violence.
Building Healthy Public Policy
Healthy public policy to reduce violence will require policy reform in all disciplines and all sectors. Such policies must be enacted at the national, provincial and local community levels. For example, legislation and justice reform are required to protect all members of society and hold perpetrators of violence accountable for their actions; fiscal and social reform are required to reduce economic inequities and address the conditions that lead to violence; and, health policies are needed to improve prevention, early intervention and treatment of violence.
Reorienting Health Services
Health reform must include a shift in our conception of health care from a curative, technologically and professionally driven system, to a preventive, community-based and consumer-driven one. Within such a system, violence could be more readily identified as a major health issue; one that is influenced by all of the broad determinants of health and, in turn, impacts the health of the community at large as well as its individual members.
Strengthening Community Action
The achievement of a violence-free society requires a proactive process which originates in the community. The basis of this process is the empowerment of community members to set priorities, make decisions, and plan and implement strategies to address violence. Community action must ensure the full participation of community members regardless of their socio-economic status, gender, race, culture, age or sexual orientation.
The Canadian Public Health Association proposes the following recommendations intended for policy and decision makers who have the ability to change our approach to violence as a public health issue.
Acknowledgement of Violence as a Priority Issue in the Health Sector
- Health organizations at all levels acknowledge the scope of violence in society as a priority health issue.
- Governmental and non-governmental organizations concerned about violence work collaboratively to address the societal basis of violence; that is, our tolerance for violence and the social and economic conditions that allow violence to flourish.
- The Canadian Public Health Association seek support to develop a health promotion framework on violence.
National Health Goal on Violence
- The federal and provincial governments along with the voluntary sector establish a national, priority health goal to eliminate violence in Canada.
New Programs to Address Social and Economic Inequality
- The federal government consider pooling some of its existing transfers to the provinces and individuals to establish new programs which would more effectively reduce social and economic inequality and improve health status. This new funding structure should involve enhancement of disease prevention, community health and health promotion activities. (Canadian Public Health Association, Caring About Health, 1992, p. 17)
- Community health programs take a population-based, community-wide health promotion approach to addressing violence.
Healthy, Violence-Free Communities
- Communities be encouraged and supported in their efforts to define their own needs and to design appropriate programs and services to become violence-free.
- Communities apply the knowledge and expertise developed in the Healthy Communities movement to the creation of healthy, violence-free communities.
- Models and approaches to primary and secondary prevention be supported and replicated.
- Health organizations substantially increase the identification of victims and perpetrators of violence.
- Health care providers identify new approaches to client-centred care of victims and perpetrators of violence.
- Governments and health organizations develop new methods of providing integrated health, social and justice services to victims of violence.
- Educators of health professionals develop and implement mandatory core training for all new and existing health professionals.
Education and training programs for public health professionals, health promoters and community developers include a thorough understanding of violence and effective community-building strategies that address violence.
Primary and secondary education of children address such issues as gender roles, valuing of individual rights and responsibilities, skills for non-violent resolution of conflict and for the building of healthy relationships with others. Adults who work with children should also be better prepared to provide guidance in non-violent interaction.
Documentation of the Extent and Effects of Violence
- Data-gathering methods be developed to more accurately document the extent of violence in our society.
- Research be done to more accurately describe the human and financial costs of violence to society and the potential cost savings to the health care sector in preventing violence.
- Indicators to measure the impact of intervention and prevention programs and support for qualitative, quantitative and evaluative research on community approaches to decrease violence be developed.