Pursuing my foray along my bookshelves led me, as I wrote last week, to some interesting ‘discoveries’ which often bring some powerful memories to the surface. Somerset Maugham, the English novelist who gave up medical practice to become a full-time writer, stated ruefully in his ‘The Summing-up’ that the tragedy about old age is that you only have the past to look to.
Sob sob… But no, I haven’t reached that stage yet, so I felt quite comfortable going back a few years – to the last century though! – and refreshing my mind with material that I had read before. I feel that much of what was said then is still, perhaps even more relevant to our times and to the future, and I thought that it would be worth sharing with readers these valuable opinions and insights. So here goes.
Violence – and Health
I came across a World Health Organisation report on the topic of violence and health, published in 2002. There was also a book titled ‘Bearing Witness’, subtitled Violence and Collective Responsibility, authored by a medical doctor and a psychologist on behalf of the ‘Philadelphia Physicians for Social Responsibility’ (PSR) and published in 1998.
They begin their preface by pointing out that in every crisis there is an opportunity and that the social crisis engendered by escalating levels of social violence had forced them to ‘make the startling realization that conventional wisdom does not help us to understand why people treat each other so badly,’ and ‘provides the impetus to broaden our search for answers.’
This led to the setting up of a Task Force on Psychosocial Causes of Violence by the PSR, made up essentially of clinicians (doctors who deal directly with patients) who shared the ‘experience of working with perpetrators and victims of violence.’ Most doctors have at some stage during their training had to deal with these two groups, mainly the latter, and some have to treat the victims on a more regular basis during their career.
So it is not surprising that PSR took the lead to address the problem, examining it in its manifold aspects and proposing what they called a Public Health (PH) approach to a possible solution. They first considered what they termed the ‘traumatogenic’ (NB: trauma = injury) forces in society to then look at the settings where violence occurs (family, workplace, school, church), and next the usual response to violence, finally positing that we live in a ‘Trauma-Organised system.’
They develop a Trauma Theory before proposing the Public Health Approach in three parts: 1. Tertiary Prevention – Fixing what is already broken; 2. Secondary Prevention – Containing the traumatic infection; and 3. Primary Prevention – Ending the cycles of violence.
I was not surprised that the WHO report, four years later, was based on the Public Health approach already adopted in 1996 (see later) – after all PH is WHO’s forte. There is a foreword by Nelson Mandela which begins by indicating that ‘The twentieth century will be remembered as a century marked by violence’ and ends on a hopeful note, ‘We must address the roots of violence. Only then will we transform the past century’s legacy from a crushing burden into a cautionary lesson.’
WHO at its 49th World Health Assembly in 1996 adopted Resolution WHA49.25 – Preventing Violence: a Public Health Priority. There followed a plan of action which is in various stages of implementation by member states.
On the back cover of that report is a message from Kofi Annan, then eral, United Nations, to the effect that men, women and children everywhere had the right to live their lives free from the fear of violence: ‘We must help them enjoy that right by making it clearly understood that violence is preventable, and by working together to identify and address its underlying causes.’
As I read these wise words, I could not help reflecting on the irony that Kofi Annan’s efforts in Syria were tragically thwarted by the escalating violence there, especially against children of late, and that Mandela’s hope for the 21st century were belied as it opened with the destruction of the twin towers in New York on 9/11, leaving almost 3000 innocent people dead.
Stephen Pinker, a leading psychologist at Harvard University, has published a book some time back in which he argues, with supporting facts and figures, that mankind is living at the most peaceful time in its history, and that violence is on the wane globally.
That may well be so, but for those who have to endure it daily, especially the large-scale variety that is endemic in chronic zones of conflict, that larger picture is of no comfort. Still, man lives on hope, and because we have no other choice, we must perforce share with Nelson Mandela and Kofi Annan their sincere hope for a world with less violence and better ways to cope with it.
Physicians have a great responsibility in this endeavour, and national authorities must provide them with all the means to face this scourge. Let this not be a mere wish.