Is Violence a Public Health Problem?

Oscar Echeverri, MD, ScD

Yes, violence is a public health problem. But, how can it be controlled or reduced to “acceptable
levels”? The recurrent answer usually is “multisectoral policies, strategies and interventions based
on sound epidemiological assessments”. But I would propose a different approach on such
assessments. Social determinants result from human behavior driving to equitable or inequitable
situations. Thus, human behavior assessments and inequality measurements can be a better focus
for understanding and controlling violence.

Tracing back interpersonal violence, the bible narrates that, because of his envy, Cain killed his
brother Abel; also, the God of most religions is punitive, denying heaven and threatening with hell
to those who do not follow his (her?) mandates. Since then, the history of humankind has been
marked by continuous interpersonal violence, and recurring collective violence – gang violence,
violent social conflicts, wars-. Skipping some monotonous periods, it is worthwhile to briefly
examine how human behavior and inequality remain linked to violence through history.

During the golden Greek era, Herodotus wrote that in a democracy, equality before law is the
most splendid of virtues, but at the same time, Aristoteles argued that the law is deficient when it
does not consider unequal conditions among citizens, and it requires equity to correct injustice – a
form of violence. Some centuries after, during renaissance, Machiavelli endorsed evil and immoral
behavior by rulers (the Prince) driving to governance under violence and inequality. Few centuries
after, the philosophers of “enlightenment” addressed inequality as the source of interpersonal
violence. Hobbes, in his Leviathan stated that all humans are by nature equal in faculties of body
and mind, and from this equality and other causes in human nature, everyone is naturally willing
to fight one another leading to a life "solitary, poor, nasty, brutish, and short". Rousseau, on his
part, affirmed in his outstanding “Discourse on inequality” that at the beginning, the untamed man
did not know each other enough to come into conflict, but later, society and the environment
changed him more for bad than for good. Inequality was established “from the moment one man
began to stand in need of the help of another; from the moment it appeared advantageous to any
one man to have enough provisions for two, equality disappeared, (and) property was
introduced…” Since then, human beings aware of inequality and property, began to feel “the thirst
of raising their respective fortunes, not so much from real want as from the desire to surpass
others,(and) inspired all men with a vile propensity to injure one another”.

Wilkinson and Pickett in a remarkable book “The spirit level: Why greater equality makes societies
stronger”, reveal that violence is most common in more unequal societies, and that one of the
most common causes of violence is degradation and humiliation people feel when they are
despised and disrespected. Precisely, by middle XX century, a growing trend in the western culture
has been the loss of interpersonal respect and loss of respect for others (not present) in daily life.
Lucinda Holdforth in her lucid book “Why manners matter” calls for a civilized world in a
barbarous world. Richard Senet addressthe relation between respect and inequality, in his book
"Respect in a World of Inequality" and pointed out that modern society lacks positive expressions
of respect and recognition for others to the point that a scarcity of respect has been established.

Tony Blair, in his inaugural speech of the Respect Action Plan said: … “But there are still intractable
problems with the behavior of some individuals and families, behavior which can make life a
misery for others, particularly in the most disadvantaged communities. What lies at the heart of
this behavior is a lack of respect for values that almost everyone in this country shares…”

It is true that homicide is the gravest outcome of interpersonal violence, but it is far less frequent
than other manifestations of violence caused by interpersonal disrespect which make life
miserable and prone to much non-lethal violent behavior, thus becoming more important than
homicide in daily life. For instance, interpersonal disrespect is at the root of many violent
manifestations: at home, as domestic violence – violence against women, child abuse, disregard
for elders, etc.-; at school, as bullying; at work, as “boss harassment”; at public spaces, as
antisocial behavior by gangs such as Keeling’s "broken windows", destruction of city equipment,
etc. This is why life today has become "solitary, poor, nasty, brutish, and short" for many people.
Our present way of life has been characterized by less interpersonal respect than ever before, and
with it, marked for more interpersonal violence and collective violence. Perhaps, the increased
world population density in cities is reaching critical levels, making us more disrespectful and
aggressive as we become closer to each other.

Much more can be said about violence as a public health problem, but I should stop here and
propose: Let us work, as John Rawls tells us, for a more equitable society where Justice should
protect the more disadvantaged from unfair inequality. And let us work for recovering
interpersonal respect and respect for others as a signal of a more civilized world as I propose in my
book El respeto, clave en la solución (Oscar Echeverri, 2012).

Oscar Echeverri, World Bank retiree