1. Violence Prevention: the evidence Alessandra C. Guedes, MA, MSc Regional Advisor, Intra-family Violence Pan American Health Organization 2 nd Special Meeting on Criminal Gangs OAS – March 2, 2010

2. Structure of this presentation 1.Public health model for prevention 2.Socio ecological model for understanding violence 3.7 strategies for violence prevention with a sound evidence base 4.Conclusions

3. 3 1. Surveillance Defining and understanding the problem 2. Research Identifying causes and risk factors 3.Monitoring and evaluation 4. Implementation Innovative and effective strategies Achieving results and sharing findings The public health model for prevention

4. Socio-ecological model for understanding violence

5. Choice of 7 strategies for which there is substantial evidence 1.Developing safe, stable & nurturing relationships between children & their parents / caregivers 2.Developing life skills in children and adolescents 3.Reducing availability and harmful use of alcohol 4.Reducing access to guns and knives: the means of lethal violence 5.Promoting gender equality to prevent violence against women 6.Changing cultural and social norms that support violence 7.Victim identification, care and support programmes

6. Nucleo de Estudos da Violencia (NEV), Brazil Home visitation programs by health care professionals Low-income first time adolescent mothers Parenting skills Emotional bonding Health behaviours Personal development Parenting programmes Information & support for parents Parent & child programmes Preschool education, family support, child/health services etc. Social support groups e.g. peer support for parents Media interventions e.g. raise awareness & knowledge of child maltreatment Developing safe, stable & nurturing relationships between children & their parents & caregivers Early, primary prevention to avoid the development of violence such as child abuse and childhood aggression 1 Some strong evidence that parenting programmes and parent and child programmes can reduce child maltreatment and problem/aggressive behaviours in youth

7. Preschool enrichment Child skills, parent programmes Social development training Empathy, relationships, conflict resolution, anger management.. Academic enrichment Study & recreation out of school Educational incentives E.g. finance for completing school Vocational Training Providing skills to find work ¡Preparados, Listos, Ya! A synthesis of effective interventions for the prevention of violence amongst youth and adolescents – PAHO, 2008 Developing life skills in children and adolescents Cognitive, emotional, interpersonal & social skills to enable youth to deal with the challenges of everyday life 2 Some strong evidence that preschool enrichment and social development programmes can reduce aggression and improve social skills, particularly in at-risk youth

8. Reduced alcohol hours Diadema, Brazil Sales banned after 11pm Municipal law Information campaign Strict enforcement Three year impacts Reduced homicides Reducing availability and harmful use of alcohol Addressing the strong links between alcohol and violence 3 Evidence promising, suggesting that alcohol-focused interventions can reduce violence. However, barriers to intervening and few available studies Regulating alcohol availability Sales times, outlet density Raising alcohol prices E.g taxation, minimum price Reducing alcohol use in problem drinkers E.g. brief interventions, treatment for alcohol dependence ; Improving drinking environments Community partnerships, responsible retailing, strict enforcement, physical design…

9. Studies in Colombia and El Salvador indicate that enforced bans on carrying firearms in public may reduce homicide rates Reducing access to lethal means Reducing access to guns, knives; the means of lethal violence 4 Some evidence of success, mainly for firearms legislation. Elsewhere evidence base poorly developed. More research needed, particularly in developing countries Legislative measures E.g. bans and licensing schemes Increased enforcement E.g. test purchasing, stop and search Weapons amnesties

10. Program H / PROMUNDO (Bolivia, Brazil, Colombia, Jamaica, Mexico, Peru) Works with boys and young men; Interactive group education; Creates alternative non-violence peer groups; Puts young men in contact with non-violent role-models; Makes it cool to be non-violent by tapping into popular youth culture. Promotes male-friendly health services Promoting gender equality to prevent violence against women 5 Challenging ideas that one sex has more power and control over another; a reason for violence against women Good evidence for school-based programmes. Some evidence for community-based interventions, although further research is needed School-based interventions Addressing gender norms and attitudes, e.g. safer dating Community interventions Microfinance programmes, combined with gender equity training Life skills programmes educate about gender-based violence and develop relationship skills

11. Puntos de Encuentro, Nicaragua Edutainment: Soap opera (Sexto Sentido), radio, information booklets Addressed social issues, including IPV Longitudinal cohort study with 4,000 youth showed that: Sexto Sentido significantly changed views on gender, stigma, sexuality and violence Changing cultural and social norms that support violence Challenging rules or expectations of behaviour within a social or cultural group that tolerate violent behaviour 6 Limited evidence for mass media campaigns, including edutainment initiatives. However, further rigorous evaluations are needed. Campaigns for dating and sexual violence Challenges harmful beliefs about dating and encourages healthy relationships Campaigns for youth violence Challenges violence as a method of resolving conflict and promotes non- violent conflict resolution Laws and policies Implementing laws that make violent behaviour an offence.

12. Brief support & counselling Targeted at IPV victims in US Safety plan Details of local support services Nurse-led discussion offering support, guidance and referrals Following intervention: Reductions in violence Better behavioural functioning of victims children victim identification, care and support programmes Providing effective care and support to victims of violence to protect against further violence and minimise harm 7 Good evidence for the use of advocacy support programmes. Promising evidence for screening and referral, psychosocial interventions and protection orders Screening and referral Identifying and supporting victims of violence Advocacy support Support and guidance to victims, e.g. counselling, education, legal aid. Psychosocial interventions Treat emotional & behavioural problems linked to victimisation. Protection orders Prohibit perpetrators from further abusing their victims

13. Conclusions Sufficient evidence to take action now and implement interventions Intensify and expand violence prevention awareness –among decision makers in low-income and middle-income countries –leaders of high-income countries and international donor agencies Enhance investment in research on violence and violence prevention –especially in low-income and middle-income countries –expanding the number of outcome evaluation studies Increase the flow to low-income and middle- income countries of –financial resources –technical support for violence prevention. Strengthen evidence-based, prevention-oriented collaborative work between public health and criminal justice agencies

14. Thank you, gracias, obrigada, merci… Alessandra Guedes guedesal@paho.org Violence prevention: the evidence is available at: www.who.int