A Model for Acting of Peace through Health

McMaster

Feb. 27, 2006

Goals

• Present the Model

• View Anti-nuclear activities of IPPNW and PGS through the Model

• Present development of project on El Salvador

• How do we evaluate such projects?

Redefinition of the Situation

Teaching : Communication of knowledge

Primordial Primary Secondary TertiaryPre-conflict Conflict Post-conflict

Skills

Values and Qualities

Knowledge

Public Health - Epidemiology, Prevention, Promotion

Altruism - Evocation and Broadening

Sensitizing : Putting a human face on suffering

Solidarity - Extension of

Dissent and Non-cooperation

Each of the above

Healing of communities: Physical, Psychological, Social, Spiritual

Maintaining structural integrity for society

Diplomacy

Psychological - cycles of violence, post traumatic stress, concepts eg. psychic numbing,

Principles and Practice: Lessons from General Systems

Personification of “Enemy”

Stage of Prevention

Figure 1 Peace through Health Working Model

Medical Ethics

Superordinate Goals - Construction of

Peace Accords

Post-Conflict Reconstruction

Breaking the Chain of War: Medical Peace Action in a Framework of Prevention

Incidence of Violence

WarRoot Causes

i

i

i

Primordial Prevention

Primary Prevention

i

i

i

i iSecondary Prevention

i Ceasefire

Tertiary Prevention

Peace Accords

Post-Conflict Reconstruction

Figure 2 Breaking the Chain of War: Medical Peace Action in a Framework of Prevention

Incidence of Violence

WarRoot Causes

i

i

iEnvironmental and

Human RightsAmnesty

Physicians for Human Rights ISDE

MSF

Domestic Gun Control

HELP Network CGC

IPPNW

Coalitions Against Weapons Systems

IANSA ICBL

Primordial Prevention

Primary Prevention

i

i

i

i i

International HealthICRC

WHO HPB UNICEFSecondary

Prevention

i Ceasefire

Tertiary Prevention

McMaster Centre for Peace Studies

Relief

Organisations

OXFAM

IPPNW Mission

• “IPPNW is a non-partisan, global federation of national medical organizations in 58 countries dedicated to research, education, and advocacy relevant to the prevention of nuclear war. To this end, IPPNW seeks to prevent all wars, to promote non-violent conflict resolution, and to minimize the effects of war and preparations for war on health, development, and the environment.”

Deterrence TIME September 23,2002• Reasons to Be Fearful

• Charles Krauthammer's argument for invading Iraq in "The Terrible Logic of Nukes" [Essay, Sept. 2] is just that: terrible logic. Iraq wants nuclear weapons to balance Israel's, which built them to balance Arab conventional superiority. Pakistan wanted to balance India, which had to balance China, which had to balance Russia, which had to balance the U.S. and its allies, which had to balance Russia's presumed European-theater superiority. Throughout this balancing act, the world has been no more than 30 minutes away from Armageddon. The only logical way to keep nuclear weapons out of the hands of madmen is to renounce them ourselves. NEIL ARYA, M.D.International Physicians for the Prevention of Nuclear War Waterloo, Ont.

EL SALVADOR

SMALL ARMS PEACE THROUGH HEALTH TRAINING

DECLARATION OF ALMA-ATA •

• I

The Conference strongly reaffirms that health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the

attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector.

• II

The existing gross inequality in the health status of the people particularly between

developed and developing countries as well as within countries is politically, socially and economically unacceptable and is, therefore, of common concern to all countries.

• International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978

Ottawa Charter for Health Promotion (1986)

Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment.

Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing. http://www.who.dk/AboutWHO/Policy/20010827_2

OTTAWA CHARTER• Prerequisites for Health• The fundamental conditions and resources for health are:• a peace,• b shelter,• c education,• d food,• e income,• f a stable eco-system,• g sustainable resources,• h social justice, and equity.• CHARTER ADOPTED AT AN INTERNATIONAL CONFERENCE ON HEALTH PROMOTION*• The move towards a new public health, November 17-21, 1986 Ottawa, Ontario, Canada• * Co-sponsored by the Canadian Public Health Association,Health and Welfare• Canada, and the World Health Organization

From Wendy Cukier

CENTRAL AMERICA

• El Salvador (Cruz, Beltran)

• murder rate similar to Colombia about 90/100,000

• over 75% of these are caused by firearms

• over 60% of violent deaths in total are caused by firearms or explosives.

• 7% of 13-19 year old admitted carrying a gun to school

• vast majority of weapons in the country remain pistols and revolvers.

PREVENTABLE DEATHS?• WHO estimates homicide rates

• Japan at 0.6 per 100,000

• United States 7 per 100,000

• Brazil 25 per 100,000

PUBLIC HEALTH PRIORITY?• estimated 200,000 people non-conflict situations Cukier

• 500,000 deaths=one death for every minute tuberculosis (2.9 million), HIV/AIDS (2.3 million) and malaria (1.5-2.7 million). youngest and healthiest of society

• Represent c. one quarter of the 2.3 million deaths due to violence[i],[ii], 42% are suicides, 38% are homicides and 26% are war-related[iii],[iv]

• i] Krug, E.E., ed. World Report on Violence and HealthGeneva: WHO, 2002:• http://www5.who.int/violence_injury_prevention/main.cfm?p=0000000675#Appendix%204.

• [ii] United Nations Development Programme (UNDP). UNDP Human Development Report 2000. New York: Oxford, 2000: p. 36: http://hdr.undp.org/reports/view_reports.cfm?year=2000.

• [iii] Reza, A., J.A. Mercy, and E.E. Krug. “Epidemiology of Violent Deaths in the World”, Injury Prevention (7), 2001: 104-111: www.injuryprevention.com.

• [iv] WHO. “Small Arms and Global Health”, paper prepared for SALW talks. Geneva: July 2001: http://www5.who.int/violence_injury_prevention/download.cfm?id=0000000158.

Homicides rates El Salvador

0

20

40

60

80

100

120

140

1960-1970

1994-1995

1999 2000 2001 2002 2003 2004 Jul-05

Evaluation Activities • Needs Assessment

– Conditions program is intended to address

• Assessment of Program Theory

– Conceptualization & design

• Assessment of Program Process

– Operations, implementation & delivery

• Impact Assessment

– Outcomes & impact

• Efficiency Assessment

– Cost & cost effectiveness

Source: CDC. Framework for Program Evaluation in Public Health. MMWR 1999;48(No.RR-11)

Long-term Outcomes

Intermediate Outcomes

Initial

Outcomes

Outputs

Activities

Inputs

End Conflict / Build sustainable, just structures

impact evaluation of PTH

Ken Bush PhD Pol. Sci.“A Measure of Peace: Peace and

Conflict Impact Assessment (PCIA) of Development Projects in Conflict Zones,” IDRC, Ottawa1998.

PCIA “A means of anticipating and evaluating the impacts of proposed and completed development interventions on the structures and processes that strengthen the prospects for peaceful coexistence and decrease the likelihood of the outbreak, recurrence or continuation of violent conflict; and the structures and processes that increase the likelihood that conflict be dealt with through violent means.”

Do No HarmCategories of Negative Impacts

1 Worsening divisions between conflicting groups

2 Increasing danger for participants in peace activities

3 Reinforcing structural or overt violence

4 Diverting resources from productive peace activities

5 Increasing cynicism

6 Disempowering local people