SEE ALSO child protection; female genital cutting; injury; power; risk factors; upstream and downstream; women’s health
Violence is the intentional use of physical force or power, threatened or actual, against oneself, another person or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation (World Health Organization, 2002a).
Any act that is injurious, damaging or destructive or presents risk accordingly, by, and against, a person can be described as violence and can be divided into three broad categories: self-directed violence; interpersonal violence; and collective violence. Violence can be physical, sexual and psychological in nature as well as involving deprivation or neglect. Globally, violence is estimated to take the lives of more than 1.6 million people annually. Approximately, 50% is due to suicide, 35% due to homicide and 12% as a direct result of war or some other form of conflict. However, for each single death due to violence there are many more injuries that can have lifelong consequences for both physical and mental health (World Health Organization, 2002a).
Gender-based violence is directed against a person on the basis of his or her gender and reinforces inequalities between men and women, although it is mostly inflicted by men on women and girls. Gender-based violence includes domestic violence, sexual harassment, rape, sexual violence during conflict and harmful customary or traditional practices such as female genital cutting. Violence against women is sometimes used interchangeably with gender-based violence and refers to violent acts that are primarily or exclusively committed against women, with the victim’s gender as a primary motive. Domestic violence is a pattern of abusive behaviour performed by one partner towards another in an intimate relationship and a common form of violence against women. Violence against women, for example, is often performed by a husband or male partner and is one of the most common forms of violence but one in which cultural norms sometimes do not treat this act as a crime but rather as a family matter or as a normal part of life (World Health Organization, 2002a).
Violence-prevention strategies can be broadly classified into three types (World Health Organization, 2009):
•Primary prevention: approaches that aim to prevent violence before it occurs;
•Secondary prevention: approaches that focus on the more immediate responses to violence, such as pre-hospital care, emergency services or treatment for sexually transmitted infections following a rape;
•Tertiary prevention: approaches that focus on long-term care in the wake of violence, such as rehabilitation and reintegration, and attempts to lessen trauma or reduce long-term disability associated with violence.
Public health emphasizes the primary prevention of violence to stop these acts from occurring in the first place. However, the most critical element of a public health approach is the ability to identify underlying causes (upstream) rather than focusing upon more visible symptoms (downstream). This allows for the development and testing of effective approaches to address the underlying causes of violence to improve health (World Health Organization, 2009). Violence is often preventable and the evidence shows a relationship between levels of violence and potentially modifiable factors such as income and gender inequality and alcohol abuse (World Health Organization, 2009). Violence-prevention strategies that are considered to be most effective address these types of underlying causes, including (1) developing safe, stable and nurturing relationships between children and their parents and caregivers; (2) developing life skills in children and adolescents; (3) reducing the availability and harmful use of alcohol; (4) reducing access to guns, knives and pesticides; (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 (World Health Organization, 2004b).
Reliable data on violence is vital for understanding and advocating for effective changes to address the problem. Many acts of violence are never recorded because they do not come to the attention of authorities or because of the way in which forms of abuse are defined. There is therefore the need to expand the evidence, to intensify and expand violence-prevention awareness and to increase financial resources and technical support for violence prevention. These interventions should be evidence-based with an emphasis on prevention, especially in low-income and middle-income countries, and from a research perspective, with a view to expanding the number of outcome evaluation studies (World Health Organization, 2009).
KEY TEXTS
•World Health Organization (2002a) World Report on Violence and Health (Geneva: World Health Organization)
•World Health Organization (2004b) Preventing Violence: A Guide to Implementing the Recommendations of the World Report on Violence and Health (Geneva: World Health Organization)
•World Health Organization (2009) Violence Prevention: The Evidence (Geneva: World Health Organization)
SEE ALSO community; later life; participation; peer education; social movements
Volunteerism is an activity that involves spending time doing something for free to benefit the environment or other people (Volunteering England, 2012).
Volunteerism is an important aspect of working with others in regard to public health and is an activity that can increase skills development and socialization. An important distinction is between the participation of individual volunteers and the voluntary sector which provides an infrastructure for citizen involvement across the third sector. The ‘third sector’ is a term used to cover all not-for-profit organizations, voluntary, community, charities and social associations. There is a wide array of terms that can be used to describe lay roles including community health advocates and educators, link workers, peer coaches and counsellors, community champions, popular opinion leaders and lay health workers (South, White and Gamsu, 2013).
Volunteers are sometimes trained in the areas they work, such as education and counselling, whilst others provide services on an as-needed basis, such as outreach, culturally sensitive care, home visiting and in community kitchens. The Cardiovascular Health Awareness Programme (CHAP) in Ontario, Canada, for example, recruits local volunteers to help carry out health checks such as measuring blood pressure. People at risk can then be referred to their doctor helping other health professionals who would normally have to undertake this type of routine work (South, White and Gamsu, 2013).
Lay health workers are members of the communities where they work, selected by their communities, answerable to their communities for their activities, supported by the health system but are not necessarily part of its organization (WHO, 2007). Lay health workers are without clinical training and undertake basic health care and preventive work. They have been an effective means to engage communities in public health programmes by actively involving them in organizing, peer education, peer support, as opinion leaders and to act as a bridge between communities and health services (South, White and Gamsu, 2012). For example, the ‘Altogether Better’ project in the United Kingdom, launched in 2008, was a five-year, regional-local programme designed to deliver innovative techniques to empower communities to improve their health and well-being. The programme focuses on exceptional local volunteers who were identified as leaders to provide a focal point around which partnerships could later develop. Other participants were then drawn into the process and with increased confidence and capacity they also became advocates for their own communities (Altogether Better, 2011).
Volunteering often plays a pivotal role in community interventions supported by non-government and government agencies. Volunteers can provide a valuable network of local contacts and many community-based organizations depend on the efforts of volunteers who, behind the scenes, strive tirelessly doing day-to day-activities (Winfield, 2013). Volunteers usually receive no pay although their role can be fulfilling and can bring many benefits to the volunteer such as improving self-confidence along with gaining valuable skills. Volunteering should not cost the volunteer, that is to say that volunteers should be reimbursed financially for costs incurred, for example, due to travel, accommodation and food. One of the most critical problems for volunteerism is the high rate of attrition that can lead to a lack of programme continuity, volunteer burn-out and an increase in costs and time in training new volunteers. Volunteers can become dissatisfied with not receiving any incentives for the services that they provide and lose their motivation to work. If this situation continues it can have a negative effect on the programme outcomes and on the role of other volunteers in the programme (Bhattacharya et al., 2001).
An international review (Bhattacharya et al., 2001) of community workers found that successful projects had multiple incentives overtime to provide more job satisfaction. Incentives do not have to be monetary but could be in-kind, such as clothing or an appreciation of their role through greater professional support. The review concluded that the sustainability of voluntary inputs into health programmes depends on several key factors including:
•Volunteers should maintain a transparent relationship with the community such that they remain accountable to its members for their activities;
•The programme should plan for a high turnover of volunteers, for example, by having shorter but more regular training;
•Volunteers should continue to be made to feel valued by the health system and to collaborate with other health professionals, for example, in outreach activities;
•The spirit of volunteerism should be maintained for as long as possible and when incentives are introduced these should be multiple and matched to duties and responsibilities;
•Regular monitoring of duties and provide feedback to the volunteers.
The social ties that volunteerism can provide are a key determinant of health (South, White and Gamsu, 2013) and play an important role in supporting social relationships through a strong sense of identity and solidarity. However, high attrition rates and the need for regular intensive training, multiple incentives and the regular monitoring of duties means that volunteerism is not necessarily a cheap or easy option for public health programmes.
KEY TEXTS
•South, J., White, J. and Gamsu, M. (2013) People-Centred Public Health (UK: Policy Press)
•Volunteering England (2012) What Is Volunteering? Available at www.volunteering.org.uk. Accessed 5 January 2014
•Winfield, M. (2013) The Essential Volunteer Handbook (Victoria, BC, Canada: Friesen Press)