1. Violence Prevention A CARICOM Developmental Imperative Izben C Williams, MD MPH

2. Report of Caribbean Commission Caribbean Commission on Health and Caribbean Commission on Health and Development (2005) identified three health issues with significant ramifications for development if not specifically addressed Development (2005) identified three health issues with significant ramifications for development if not specifically addressed HIV / AIDS HIV / AIDS Chronic Non-communicable Diseases (NCD) Chronic Non-communicable Diseases (NCD) Violence and Injuries Violence and Injuries

3. Actions consequent from report 1. Pan Caribbean Partnership against HIV and AIDS (PANCAP) 1. Pan Caribbean Partnership against HIV and AIDS (PANCAP) 2.UN Resolution April 2010 and Global Summit October 2011 on NCDs 2.UN Resolution April 2010 and Global Summit October 2011 on NCDs 3.On Violence Prevention Regional coordinated action lagging (needs impetus) 3.On Violence Prevention Regional coordinated action lagging (needs impetus)

4. The Situation (WB/UNODC 2007)

5. The Situation in seven selected

6. The Situation Canada (Hemispheric Low: 1.8 X 10 4 ) Canada (Hemispheric Low: 1.8 X 10 4 )

7. The Situation I Barbados (Caribbean low: 7.5 / 10 4 ) Barbados (Caribbean low: 7.5 / 10 4 )

8. The Situation II Guyana (15.3 / 10 4 ) Guyana (15.3 / 10 4 )

9. The Situation III St. Lucia (23.0 X 10 4 ) St. Lucia (23.0 X 10 4 )

10. The Situation IV St. Vincent and the Grenadines (54.8 X 10 4 ) St. Vincent and the Grenadines (54.8 X 10 4 )

11. The Situation - V Trinidad & Tobago (38 X 10 4 ) Trinidad & Tobago (38 X 10 4 )

12. The Situation - VI St. Kitts and Nevis (54.8 X 10 4 ) St. Kitts and Nevis (54.8 X 10 4 )

13. The Situation VII Jamaica (62.4 X 10 4 ) Jamaica (62.4 X 10 4 )

14. Youth Violence 75% of homicides committed by youth under 30 years of age - Jamaica) 75% of homicides committed by youth under 30 years of age - Jamaica)

15. Hemispheric Rankings I Homicide rate <10/100,000 Homicide rate <10/100,000 Canada 1.8 United States 5.2 Argentina 5.3 Uruguay* 5.8 Chile 8.1 Costa Rica 8.3 Grenada 8.4 Barbados 10.0

16. Hemispheric Rankings I Homicide rate 10-20/100,000 Homicide rate 10-20/100,000 Peru 10.2 Paraguay 12.3 Bolivia 12.5 Panama 12.9 Nicaragua 13.0 Ecuador 13.8 Mexico 14.7 Guyana 15.3 Ant & Bar 16.4 Dominica 17.8 Dom Rep 18.4 Haiti* (2002) 19.0

17. Hemispheric Rankings I Homicide rate 20-30/100,000 Homicide rate 20-30/100,000 Suriname 20.5 St. Lucia 22.9 St. Vinc & Gre 24.0 Bahamas 25.4 Brazil 25.8 Belize 29.1

18. Hemispheric Rankings I Homicide rate >30/100,000 Homicide rate >30/100,000 Colombia 34.6 Venezuela* 37.0 Trin & Tob 37.8 Honduras 42. 9 Guatamala 46.3 St. Kit & Nev 54.9 Jamaica 62.5 El Salvador 70.6

19. Homicides - fraction of the tip Homicides are symptomatic of a larger problem – an epidemic of violent behavior Homicides are symptomatic of a larger problem – an epidemic of violent behavior For every homicide there are 20-40 violence- related injuries requiring emergency medical care For every homicide there are 20-40 violence- related injuries requiring emergency medical care For every emergency medical intervention there substantial unreported or hidden incidents (particularly among vulnerable populations) For every emergency medical intervention there substantial unreported or hidden incidents (particularly among vulnerable populations)

20. The costs of violence and crime Violence exacts human and economic toll on nations Violence exacts human and economic toll on nations Personal health and insecurity (physical, psychological and social) Personal health and insecurity (physical, psychological and social) Economic: Economic: GDP per capita 5.4% due to homicides (Jamaica, Haiti) [UNODC] GDP per capita 5.4% due to homicides (Jamaica, Haiti) [UNODC] Direct prevention costs (police, justice, prison etc) Direct prevention costs (police, justice, prison etc) Non-monetary costs (mortality, morbidity etc) Non-monetary costs (mortality, morbidity etc) Economic and social multiplier effects Economic and social multiplier effects

21. VIOLENCE IS PREVENTABLE (THE PUBLIC HEALTH MODEL) Defining and monitoring the extent of the problem Defining and monitoring the extent of the problem Identifying the causes of the problem Identifying the causes of the problem Formulating and testing ways of dealing with the problem Formulating and testing ways of dealing with the problem Applying widely the measures that are found to work Applying widely the measures that are found to work Evaluating interventions Evaluating interventions

22. Benefits of inter-sectoral action Collective impact of inter-linkages Collective impact of inter-linkages Improving effectiveness of interventions Improving effectiveness of interventions Avoiding duplication of efforts Avoiding duplication of efforts Increasing available resources through pooling Increasing available resources through pooling Collaboration on and coordination of research Collaboration on and coordination of research

23. ROLE OF OAS-SMS Currently secretariat for IACPV Currently secretariat for IACPV SMS particularly Dept of Public Security providing leadership (Observatory etc) SMS particularly Dept of Public Security providing leadership (Observatory etc) Other Secretariats and Departments addressing one or more risk factors Other Secretariats and Departments addressing one or more risk factors Many mandates, resolutions, new impetus Many mandates, resolutions, new impetus Member States strong interest (themes of GA) Member States strong interest (themes of GA)

24. TEN RECOMMENDATIONS FOR ACTION Create National Violence-Prevention Action Plans Create National Violence-Prevention Action Plans Enhance data-collecting capacity Enhance data-collecting capacity Support prevention research (prioritizing) Support prevention research (prioritizing) Promote primary prevention responses Promote primary prevention responses Strengthen responses for victims of violence Strengthen responses for victims of violence

25. TEN RECOMMENDATIONS FOR ACTION Integrate violence prevention into social and educational policies Integrate violence prevention into social and educational policies Increase collaboration and information exchange Increase collaboration and information exchange Promote and protect human rights Promote and protect human rights Develop practical drug and arms policy Develop practical drug and arms policy Establish effective regional and national coordination Establish effective regional and national coordination WHO Report

26. VIOLENCE IS PREVENTABLE BY: BY: Developing safe stable and nuturing relationships between children and their parents Developing safe stable and nuturing relationships between children and their parents Developing life skills, in children and adolescents Developing life skills, in children and adolescents Reducing the availability and harmful use of alcohol Reducing the availability and harmful use of alcohol

27. VIOLENCE ISSPREVENTABLE BY: BY: Reducing access to guns, knives and pesticides (or other self harm agents) Reducing access to guns, knives and pesticides (or other self harm agents) Promoting gender equality to prevent violence against women Promoting gender equality to prevent violence against women Changing social and cultural norms that support violence Changing social and cultural norms that support violence Victim identification, care and support programs Victim identification, care and support programs

28. Colombia – evidence in results A 30% serial decline in homicide rates over six years with an integrated, multi-sectoral approach (and Plan Colombia) A 30% serial decline in homicide rates over six years with an integrated, multi-sectoral approach (and Plan Colombia)