Transcript Epidemiological Study - McMaster Faculty of Humanities

Small
Arms
El
Salvador
El Salvador (The Saviour)
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Central America
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6.9 Million People
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Most densely Populated Nation
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Most industrialized
History
Coffee Staple Export
 Oligarchy of several hundred families
 Revolt in 1932, Military Dictatorship
implemented
 In 60s, land reform was encouraged
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Build of Civil conflict
Reform opposed by military elite
 Opposition arose (politically and
military)
 Death squads introduced to quell
insurrections
 Demonstrators were fired upon
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Guerrillas
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Guerrillas gained more power in 70s
Government controlled elections were
biased
United States, fearing Cuba 2, funded El
Salvadoran Govt.
Cuba, Nicaragua and Soviet Union funded
Guerrillas
Civil War
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Archbishop Romero, rural priest,
proponent of social change
Assassination, sparking civil war
Guerrillas united, FMLN (Farabundo Marti
National Liberation Front)
FMLN vs. Govt. + Vigilante Death Squads
War’s effects
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Hundreds of thousands wounded
(mentally and physically)
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70,000 killed
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Economy crumbled
Peace Talks
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6 Jesuit priests, housekeeper and her
daughter murdered- International Attn.
US Congress sent in Task Force
Found that Priests were murdered by
Govt., some American Govt. members
knew
UN brought in and sponsored Peace
Accords, signed by both sides
Peace Accords and after
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FMLN and Govt. to dissolve several units
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The introduction of social reform
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International Supervision
After the War
Bad News
 Many El Salvadorans are still unemployed
 High homicide rates
 Only 2 percent control nations wealth
Good News
 FMLN won majority seats in 2000
 US involvement still apparent- built
military base
President Elias Antonio Saca
El Salvador
What Happened next?
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United Nations Observer Mission in El Salvador
(ONUSAL) successful in addressing politically-motivated
human rights violations BUT:
New threat post-war - VIOLENCE - fear and insecurity
95% of violent acts documented committed by military,
government security forces and death squads
Intimidation, death threats, executions and
disappearances common tools used against opposition
Judicial system found to be “incapable of fairly assessing
and carrying out punishment”
Long history of youth violence – 80% government troops
and 20% FMLN recruits under 18 years of age
What About Today?
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Today, crime is the major concern of most
Salvadorans.
Fighting between government forces and
revolutionary FMLN left 75,000 dead, over a
million displaced and, 7,000 "disappeared".
Most of the survivors continue to suffer the
psychological effects.
The root causes and inequalities of the war still
exist today
El Salvador's pain  Murder
Rate Highest in Latin America
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El Salvador’s murder rate is:
54 murders per 100,000 (the highest in
Latin America)
No other country has a rate higher than
40 per 100,000
The World average for death by murder is
10 per 100,000
El Salvador's Murder Rate 5.5
Times World Average, but Falling
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2005: 3,812 murders were committed or
10 murders/day
Estimate for 2006: 3,430 or 9.4
murders/day
Majority of the killings were of people
between the ages of 15 and 49 (46%
between 20 and 29 years)
Guns as a Public Health Issue
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78.5 % of murders carried out with
firearms, 13.6 % with knives and 3.5 %
with blunt instruments.
An even greater number of people are
injured (non-fatal) by firearms every hour
Handguns are relatively affordable
Why?
The causes are many but include:
 Gangs
 Poverty
 The proliferation of guns
 An ineffective court system
 Organized crime
 Family violence
Elusive Solutions?
o
The only thing which is clear is that this
tragic situation requires efforts at all levels
of society from the government, to the
churches, to the schools, to the media, to
business and community leaders
Prevention Model
Drawing upon the public
health field, violence
prevention and intervention
strategies can be categorized
into three levels
Primary Prevention:
Creating Safe Environments
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Looks are the root cause, conditions and
environment: ways to proactively
eliminate the possibility of violence and
injury
Aim to prevent violence before it occurs
Examples- youth engagement and activity
programs and community help groups on
conflict resolution
Secondary Prevention:
Reducing Risk
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Address attitudes and behaviors, focusing
on early identification and intervention to
reverse or reduce the impacts of violence
Focus more on the immediate responses
to violence
Examples- pre-hospital care, emergency
services, education
Tertiary Prevention:
Managing the Crisis Situations
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Reactive efforts and intervention that
correct or treat a problem
Focus on the long-term care in the wake
of violence
Examples- rehabilitation, reintegration,
and attempts to lesson trauma or reduce
the long term disability associated with
violence
Epidemiological Study
Wounds and Firearms
El Salvador
2003-2004
PtH Student Driven Project
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Maria Emperatriz Crespin Najera*
Overall objective – actively participate, public
health perspective, construction of program to
control small arms violence
One specific objective – research on small arms
injuries
Published in Conflict and Survival volume 21(3),
2005
*working with Salvadoran Physicians for Social Responsibility (MESARES) and Salvadoran Medical Students for
Social Responsibility (E-MESARES) - affiliated with International Physicians for the Prevention of Nuclear War
(IPPNW)
Gun Violence Statistics
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El Salvador – 150/100,000
70% of homicides
USA – 10.6/100,000*
Britain – 0.3/100,000*
Perspective
US murder rate with handguns is 15x greater
than in Canada*
*Ref: Arya, N, British Medical Journal, (Editorial), volume 324, 2002
Information from UN development
program (2003)
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Three important factors driving violence in
culture:
1) youth culture and gangs
2) availability of drugs and alcohol
3) lack of (or ineffective) social controls
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12% of GDP spent on violence issues
including fall-out in health care spending
Study Components
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Review of governmental statistics on
homicide from WFA (wounds from
firearms)
Retrospective study of WFA in children
(33 cases/year compared to 3 cases/year
in Mexico – 20% permanently disabled)
Prospective study on 100 WFA hospital
admissions (tertiary care hospital in San
Salvador)
Method
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Six researchers, random selection of participants
>13 years based on consent and availability of
researchers (June 2003-May 2004)
Data collected via survey:
-socioeconomic status
-age, sex
-family status
-event history
-cost of healthcare
Data collected
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789 visits for WFA (623 admitted – 133
deaths)
92% male (60% <25 years old)
62% single, living in San Salvador
50% stable backgrounds
Larger than average family size
90% in families with minimal income
(50% <$100 US/month)
Data collected
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27% completed high school
>50% involved in sports
12% gang members
50% knew offender
86% attacked on the street
25% hit with >3 bullets
Common injury - limbs
Healthcare costs
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1500 patient bed days
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$300,000 US
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$1.8M/year (10% of hospital budget)
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Estimated $34M US cost to economy
Victim Profile
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Young man
Urban centre
Unemployed/underemployed
Contributing to support of large family
Some education
Drugs, alcohol and firearms part of daily
life (increase in WFA on Saturday nights
and holidays)
Recommendations
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Control access to firearms
- lobby for arms regulation – met with President
- Society without violence planning team
Increase public awareness and educational
programs
- radio, television, public events, conferences,
journal articles, involve student medical
community, presented research to WHO, local
government
Paniagua,I., Crespin, E., Guardado, A., Mauricio, A., Medicine Conflict and Survival. Wounds
caused by firearms in El Salvador, 2003-2004: Epidemiological Issues, vol 21 (3), 2005.
National Commission for Gun
Law Review
Image from iansa website www.iansa.org (downloaded Feb 26, 2005)
Goods for Guns: A Case Study
Who?
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Local business leaders alarmed by impact
of armed violence
In 1995, these business leaders form the
Patriotic Movement Against Crime
(Movimento Patriotico Contra la
Delincuencia-MPCD).
In 1996, MPDC decides to conduct
weapons collection program
Why?
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Association of Distributors (consumer
goods) of El Salvador (ADES) member’s
delivery trucks were regularly assaulted by
armed men
ADES worried about security of employees
ADES wanted to help address this growing
violence in El Salvador
Goals
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Stated Goals
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Raise awareness and encourage citizens to
help combat crime
Cut the flow of weapons into the black market
Publicize it’s goals of providing incentives for
civilians to exchange firearms and explosives
Hidden Goals
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Create a safer climate in which to maximize
the private sector economy in El Salvador, or
more specifically, San Salvador
How?
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The MPCD garnered support from the
PNC, MoD, Rotary Club, and Catholic
Church. They also received funding from
various foreign governments, including
Canada, although most funding came from
national private sector.
They designed the program around highly
publicized collection weekends
How?
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Local churches acted as collection sites,
staffed by members of the PNC, MoD, and
civil society.
Any citizen could anonymously exchange
any weapon for vouchers for
supermarkets, drug stores, or clothing
stores
How?
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Weapons were documented individually,
with forms signed by the MPCD, PNC,
MoD and the Rotary Club; this paper trail
ensured the program’s transparency and
legitimacy. Weapons were then destroyed
by the MoD.
What types of Weapons were
Exchanged?
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Among the citizens exchanging weapons
were….
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A middle aged woman with a shoulder bag
containing five rocket launchers
A young soccer player with 35 40 mm
grenade launcher projectiles in his backpack
A peasant man who arrived with wife and
children to exchange two .22 caliber rifles for
medication for his infant daughter
Goods for Guns: A Success Story?
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The program had many positive outcomes
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Removal of thousands of weapons and hundreds of thousands of
rounds of ammunition from circulation
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Fostered relationships between private sector, civil society,
media, government, police, etc
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Provided a model that could be further developed in other
countries
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Demonstrated the high potential for media to contribute to
public good
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Raised awareness and encouraged new programs
But also many Shortcomings…
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The program primarily focused on the impact of small
arms on upper and middle class, and therefore neglected
many rural areas
The program was not linked to policies designed to limit
supply of new weapons (During the period of the
program, almost 50 000 new firearms were legally
imported into El Salvador. This caused many donor
states to withdraw support.)
Program failed to examine many of the reasons behind
the gun violence (i.e.. No attempt was made to interview
citizens about their experiences, motives, etc…)
Evaluation
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Evaluation is difficult due to lack of reliable
statistics on firearm related injury and death
BUT
Over the 3 Year period 9,500 weapons were
collected along with over 100,000 rounds of
ammunition
represents thousands of injuries that did not
occur → OUTCOME: healthcare funds available
for other health services.
GROUP 6:
Our thoughts
on possible
interventions
Sports and Education
From the research:
 educated population (80% literacy rate)
 common interest in sports
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Bring interventions to:
sports clubs – strict rules for association re: drug
use, guns (team pledges)
early school programs aimed a peace initiatives
Gun Violence and Disability:
Wheels of Change
Image Downloaded from iansa website ww.iansa.org Feb 26, 2005
Government involvement
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Lobby for sponsorship for school and sport
programs
Small business investment and loan
programs
President – former sportscaster (special
Presidential program for athletics)
Community Leaders and
International Support
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Religious leaders
Sport Celebrities
Monetary support for programs from
countries involved in export of arms to El
Salvador – helped create problem NOW
help fix it!