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A Model for Acting of Peace through Health McMaster Feb. 27, 2006.

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1 A Model for Acting of Peace through Health McMaster Feb. 27, 2006

2 Goals Present the Model View Anti-nuclear activities of IPPNW and PGS through the Model Present development of project on El Salvador How do we evaluate such projects?

3 Redefinition of the Situation Teaching : Communication of knowledge PrimordialPrimary SecondaryTertiary Pre-conflictConflictPost-conflict Skills Values and Qualities Knowledge Public Health - Epidemiology, Prevention, Promotion Altruism - Evocation and Broadening Sensitizing : Putting a human face on suffering Solidarity - Extension of Dissent and Non-cooperation Each of the above Healing of communities: Physical, Psychological, Social, Spiritual Maintaining structural integrity for society Diplomacy Psychological - cycles of violence, post traumatic stress, concepts eg. psychic numbing, Principles and Practice: Lessons from General Systems Personification of “Enemy” Stage of Prevention Figure 1 Peace through Health Working Model Medical Ethics Superordinate Goals - Construction of

4 Adapted from Yusuf et al. and Santa Barbara


6 IPPNW Mission “IPPNW is a non-partisan, global federation of national medical organizations in 58 countries dedicated to research, education, and advocacy relevant to the prevention of nuclear war. To this end, IPPNW seeks to prevent all wars, to promote non-violent conflict resolution, and to minimize the effects of war and preparations for war on health, development, and the environment.”



9 Deterrence TIME September 23,2002 Reasons to Be Fearful Charles Krauthammer's argument for invading Iraq in "The Terrible Logic of Nukes" [Essay, Sept. 2] is just that: terrible logic. Iraq wants nuclear weapons to balance Israel's, which built them to balance Arab conventional superiority. Pakistan wanted to balance India, which had to balance China, which had to balance Russia, which had to balance the U.S. and its allies, which had to balance Russia's presumed European-theater superiority. Throughout this balancing act, the world has been no more than 30 minutes away from Armageddon. The only logical way to keep nuclear weapons out of the hands of madmen is to renounce them ourselves. NEIL ARYA, M.D. International Physicians for the Prevention of Nuclear War Waterloo, Ont.


11 DECLARATION OF ALMA- ATA I The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector. II The existing gross inequality in the health status of the people particularly between developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

12 Ottawa Charter for Health Promotion (1986) Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing.

13 OTTAWA CHARTER Prerequisites for Health The fundamental conditions and resources for health are: a peace, b shelter, c education, d food, e income, f a stable eco-system, g sustainable resources, h social justice, and equity. CHARTER ADOPTED AT AN INTERNATIONAL CONFERENCE ON HEALTH PROMOTION* The move towards a new public health, November 17-21, 1986 Ottawa, Ontario, Canada * Co-sponsored by the Canadian Public Health Association,Health and Welfare Canada, and the World Health Organization



16 From Wendy Cukier

17 “Small children have big dreams. Small arms cause big tragedies. Clearly, the two do not mix.” And yet, from war zones to inner city streets to suburban classrooms, this combustible blend is wreaking havoc and ruining lives[i]. [i] Frechette, Louise. Speech quoted in United Nations Daily Highlights, “Deputy Secretary-General opens exhibit highlighting impact of small arms proliferation on children”, 20 July 1999: [i] CHILDREN

18 CENTRAL AMERICA El Salvador (Cruz, Beltran) murder rate similar to Colombia about 90/100,000 over 75% of these are caused by firearms over 60% of violent deaths in total are caused by firearms or explosives. 7% of 13-19 year old admitted carrying a gun to school vast majority of weapons in the country remain pistols and revolvers.

19 CANADA/US COMPARISONS Table 1: US/CANADA COMPARISONS Canada US US/CAN Population (1995) 29.5 m 263 m 8.9x Estimated Number of All Firearms (1993)7 m223 m31.9x Estimated Number of Handguns (1993)1 m77 m77x Firearms Per Capita (1995).24.843.5X 1995 Firearms Death and Crime Statistics (per 100,000) Accidental deaths with Firearms (ER-codes) Homicides with Firearms (ER-codes).56.012x Suicides with Firearms (ER-codes) Total Deaths from Firearms(ER-codes)3.813.73.6X Murder (UCR) Murder with Firearms (UCR) Murder with Handguns (UCR)0.34.615x Murder without Firearms (UCR) – W. Cukier, Firearms Regulation: Canada in International Context, Chronic Diseases in Canada, April, 1998. J. Chronic Diseases in Canada Cukier Vol 19 p25-33 table 1 From Wendy Cukier

20 PREVENTABLE DEATHS? WHO estimates homicide rates Japan at 0.6 per 100,000 United States 7 per 100,000 Brazil 25 per 100,000

21 PUBLIC HEALTH PRIORITY? estimated 200,000 people non-conflict situations Cukier 500,000 deaths=one death for every minute tuberculosis (2.9 million), HIV/AIDS (2.3 million) and malaria (1.5-2.7 million). youngest and healthiest of society Represent c. one quarter of the 2.3 million deaths due to violence [i],[ii], 42% are suicides, 38% are homicides and 26% are war-related [iii],[iv] [i][ii] [iii][iv] i] Krug, E.E., ed. World Report on Violence and HealthGeneva : WHO, 2002 :i] [ii] United Nations Development Programme (UNDP). UNDP Human Development Report 2000. New York: Oxford, 2000: p. 36:[ii] [iii] Reza, A., J.A. Mercy, and E.E. Krug. “Epidemiology of Violent Deaths in the World”, Injury Prevention (7), 2001: 104-111:[iii] [iv] WHO. “Small Arms and Global Health”, paper prepared for SALW talks. Geneva: July 2001:[iv]

22 A PUBLIC HEALTH APPROACH TO SMALL ARMS Based on evidence and science and involve various disciplines of expertise, including epidemiology, but also psychology, sociology, criminology, economics, education and medicine.1 A harm-reduction approach begins with the premise that the weapons, by their very nature, are designed to kill, harm or threaten other beings in a particular context. Given the accepted utility of legal firearms in society, the goal is not typically a ban, as was the case with antipersonnel mines, but regulation or “harm reduction”. 1.Wendy Cukier

23 Homicides rates El Salvador



26 Evaluation Activities Needs Assessment – Conditions program is intended to address Assessment of Program Theory – Conceptualization & design Assessment of Program Process – Operations, implementation & delivery Impact Assessment – Outcomes & impact Efficiency Assessment – Cost & cost effectiveness

27 Source: CDC. Framework for Program Evaluation in Public Health. MMWR 1999;48(No.RR-11)

28 Long-term Outcomes Intermediate Outcomes Initial Outcomes Outputs Activities Inputs End Conflict / Build sustainable, just structures

29 impact evaluation of PTH Ken Bush PhD Pol. Sci. “ A Measure of Peace: Peace and Conflict Impact Assessment (PCIA) of Development Projects in Conflict Zones, ” IDRC, Ottawa1998. PCIA “ A means of anticipating and evaluating the impacts of proposed and completed development interventions on the structures and processes that strengthen the prospects for peaceful coexistence and decrease the likelihood of the outbreak, recurrence or continuation of violent conflict; and the structures and processes that increase the likelihood that conflict be dealt with through violent means. ”

30 Do No Harm Categories of Negative Impacts 1 Worsening divisions between conflicting groups 2 Increasing danger for participants in peace activities 3 Reinforcing structural or overt violence 4 Diverting resources from productive peace activities 5 Increasing cynicism 6 Disempowering local people



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