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Modern Marvels Carbon Worksheet Answers – Violence Prevention in Low- and Middle-Income Countries: Finding a Place on the Global Agenda: Workshop Summary (2008) Chapter: Mass Violence: Health Impacts and Prevention – Victor W. Seidel, Barry S.

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« Previous: A Logical Framework for Preventing Interpersonal and Self-Directed Violence in Low- and Middle-Income Countries – Susan Zarrow, Mark L. Rosenberg, James A. Compassion

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Appendix C 171 Mass Violence: Health Implications and Prevention Victor W. Sidell, MD1 Barry S. Levy, MD, MPH2 Introduction Collective violence, especially in the form of armed conflict, causes more death and disability worldwide than many serious diseases taken together. Massive violence destroys families, communities, and sometimes entire cultures. This diverts scarce resources from health promotion and protection, medical care and other health and social services. It destroys the structure that maintains the health of society. This limits human rights and contributes to social injustice. This leads people and countries to believe that violence is the only way to resolve conflict. And it contributes to the destruction of the physical environment and the overuse of non-renewable resources. In general, mass violence threatens much of our culture. Definition of “mass violence” In 1996, the World Health Assembly, the governing body of the World Health Organization (WHO), adopted resolution WHA49.25, which declared violence to be a serious and growing public health problem worldwide. (World Health Assembly, 1996). The Assembly requested WHO 1, Distinguished University Professor of Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, The Bronx, New York; Associate Professor of Public Health, Cornell University Weil College of Medicine, New York, NY. 2 Associate Professor of Public Health, Tufts University School of Medicine, Boston, Massachusetts.

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172 Annex C Director-General to develop public health measures to address this problem. The resulting World Report on Violence and Health, published by WHO in 2002, was the first comprehensive WHO report on violence as a public health problem (Krug et al., 2002). The WHO report presents a typology of “violence” that defines three broad categories based on the characteristics of the perpetrators: self-directed violence, interpersonal violence, and collective violence. This article discusses the elements of the third category, mass violence, with a focus on mass violence, which includes “armed conflict”. People who engage in collective violence may resort to self-violence as a symptom of PTSD or as a result of self-hatred due to acts committed in war. Collective violence can also be associated with interpersonal violence. For example, individuals and groups involved in armed conflict may engage in interpersonal violence, sometimes due to ethnic tensions or conflicts with military superiors or fellow soldiers in the midst of war. Soldiers may return from war with a military mentality where they resort to interpersonal violence to resolve interpersonal conflicts that could have been resolved nonviolently. And children who grew up in the midst of war believe that violence is the right way to resolve interpersonal conflicts. Collective violence is classified as the instrumental use of violence by people who identify themselves as members of a group (regardless of whether this group is a temporary or more permanent identity) against another group or group of individuals to achieve political, economic, ideological goals. or social goals (Zwi et al., 2002). The WHO report gives examples of mass violence, violent conflicts between countries and groups, state and group terrorism, rape as a means of warfare, mass expulsion of people from their homes and gang warfare. As the report notes, “all this happens every day in many parts of the world” and “the damage to health, physical illness, disability and mental suffering from these various types of events is enormous. This paper includes a detailed discussion of war and other warfare, as well as a brief discussion of “terrorism” and the “war on terror” (Levy and Seidel, 2008a). “Defining Armed Conflict” Conflict is commonplace in most societies, but rarely escalates into the use of physical force and even more rarely into the use of weapons. When a weapon is used in “mass violence”, it is often referred to as a “weapon”. â This is a variety of weapons

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Appendix C 173 from knives, bayonets and machetes to nuclear weapons. In this article, we are mainly concerned with “small arms and light weapons” as these weapons are most commonly used in armed conflicts in low- and middle-income countries, but we will also include a discussion of bombs (air and ground-based). such as “improvised explosive devices”), landmines and artillery shells. Nuclear, chemical and biological weapons, sometimes referred to as WMD of Mass Destruction) �� is also mentioned because this weapon poses a risk of chaos. – Pure and widespread destruction, damage and death. Definition of “Low and Middle Income Countries” The World Bank classifies countries into economic groups based primarily on a country’s gross national income (GNI) per capita (World Bank, 2007). Based on its GNI per capita, each economy is classified as a low-income, middle-income (divided into lower-middle and upper-middle) or high-income country. World Bank tables classify all 185 member countries and all other countries with populations over 30,000 (208 in total). The Bank notes that low- and middle-income countries are sometimes referred to as “developing countries,” the term we use in this background paper. The use of this term is convenient; This does not mean that all countries in the group have experienced the same development or that other countries have reached certain stages of development. Income classification does not reflect development status. The World Bank currently classifies countries by GNI per capita for 2006, calculated using the World Bank Atlas method. The groups are: low income, $905 or less; below average income: $906 to $3,595; above average income: $3,596 to $11,115; and high income, $11,116 or more. Low income, lower middle income and upper middle income countries can be found on the World Bank website. Examples of low-income countries include the Democratic Republic of the Congo (DRC), Haiti, India, Nigeria, Pakistan, Viet Nam and Zimbabwe. Examples of lower middle income countries include China, Cuba, Egypt, Iran, Iraq, Philippines, Thailand and Ukraine. Examples of upper middle income countries include Argentina, Brazil, Hungary, Mexico, Poland, South Africa and Turkey. World Bank data show a striking correlation between a country’s wealth and the likelihood of civil war. For example, in a country with a gross domestic product (GDP) per capita of $250, the probability of going to war in the next 5 years is 15 percent, while for a country with a GDP per capita of $600, this probability is almost halved. . By contrast, countries with a per capita income above $5,000 are less than 1 percent likely to have civil conflict.

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174 Appendix C Other things being equal. In addition to poverty, risk factors for armed conflict can be associated with poor health and poor access to quality medical care, the low status of women, a large gap between rich and poor, and a poorly developed civil society in the country. their lives, limited opportunities for education and employment, increased access to small arms and light weapons, and the right to vote or otherwise participate in decision-making that does not meet the basic needs of citizens (deSoysa and Neumayer, 2005). Health consequences of mass violence There are significant direct and indirect health consequences of armed conflict (Levy and Seidel, 2008a, b, c). This is described below. Direct Consequences of Wars and Military Operations Armed conflicts in the 21st century consist primarily of interstate conflicts (conflicts within countries where other countries sometimes contribute troops) that continue to rage in many parts of the world. For example, as recently as 2007, 15 serious armed conflicts (1,000 or more dead) and 21 more “hot spots” that could flare up or re-emerge were reported (Smith, 2007). In the period after the end of the Cold War 1990-2001. there were 57 major armed conflicts in 45 locations, all but three of which were civil wars (Stockholm International Peace Research Institute, 2002). Other

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