Violence and health

Authors: Leonardo Brasil Bueno (FIOCRUZ); Djefferson Ferreira (FIOCRUZ); Elenice Pessoa (FIOCRUZ).

Translated by: Lidiele Nogueira

Review: Marlon Coutinho da Silva and André Broseghini

Health is not only about the “absence of disease” or “fighting diseases”, just like violence is not restricted to the analysis of the fight against “crime or contravention”. To employ these concepts in such a reductionist way is like walking into the the trap of delegating to the superficial moment and restricted part of the social process the condition of totality or center of explanation. As Brasil et alii (2013, p. 44) state, it´s simplistic an explanation when “crime is seen as a whole and not the 'tip of the iceberg', just as it is an analytical reduction to restrict health only to its relation to diseases, thus disregarding the complexity of physical and social processes that constitute the historical process of the dialectical production of health and disease.” Among the various associations made due to the occurrence of gun-violent deaths in the cities, Yunes (1993) identifies inequality of wealth distribution , easy access to guns, police violence, and drug trafficking. Minayo (2014) mentions public security, its policies, and its actions as a matter of public health; and also explains that armed confrontations, especially in hefavelas, produce violations of rights, such as the closing of schools, health centers, and stores, the invasion of houses, and the infringement of the residents’ right to come and go . It is worth mentioning a significant number of people injured and killed in armed clashes with organized crime and militias, or in police operations that heavily make use of guns. The author reinforces that police operations and the shootings in the conflict between drug trafficking factions produce psychological suffering, affecting the lives of people who suffer from various types of illnesses as a consequence. For Minayo (1998), violence is, fundamentally, a social problem that follows the entire history and the transformations of humanity. Violence affects health a lot: it causes death, injuries, and physical traumas, plus countless mental and emotional harms ; it decreases the quality of life of people and communities, shows the inadequacy of the traditional organization of health services, and it highlights the need for a much more specific, interdisciplinary, multi-professional, intersectoral and engaged performance of the department, aiming the needs of citizens.

For the author, to some extent every social violence has a revealing character of structures of domination (between social classes, groups, individuals, ethnicities, age groups, genders, nations), and it appears as an expression of contradictions between those who seek privileges and those who rebel against them. Even delinquency, or especially delinquency, can be interpreted under these conflicting social relations. Social inequalities, and economic and cultural expropriation are important ingredients to understand the basis of criminality [...] (Minayo, 1998, p. 522). In research conducted by Bueno(2018) for Ippur/Ufrj, in collaboration with Djefferson Amadeus and Elenice Pessoa, both researchers from the Oswaldo Cruz Foundation, where eighty-eight residents of the favelas of Manguinhos, Maré and Jacarezinho were interviewed, 80% of them stated that violence with the use of guns affects their health and/or their family members health and/or people close to them. The research identified and systematized, from the narratives of the residents of the favelas, eleven (11) categories about the impact of armed violence on health, from the most to theleast mentioned: 1) Psychic suffering, mental and emotional injuries; 2) Fatal victims of firearms ; 3) Significant worsening in blood pressure; 4) Deprivation of access to culture, education and leisure activities; 5) Physical aggression; 6) Non-fatal firearm injury ; 7) Verbal threat by an armed person; 8) Deprivation of access to health service; (9) Worsening of cardiac conditions and heart attacks; 10) Worsening of respiratory crises; 11) Physical torture. The impacts of armed violence on the health and daily life of the favelas residents are not obvious, nor largely supported by formal notifications through schools and public health facilities - let alone by public safety agencies. Above the different forms of armed violence, there is also in the sub-notification a reality that has not been overcome yet in regards to favelas’ territories, mainly in the notifications made by public security agencies, but also in gaps in the few notifications made by schools and health equipment. Compulsory notification about violence, although legally provided for education and healthy public spaces is still rarely carried out in the favelas’ territories due to the fear of retaliation workers have in relation to armed groups , but also because of the lack of training of these same professionals to deal with different forms of violence, followed by a long-lasting understanding that violence supposedly needs to be solved exclusively by the police. The multiple impacts and drastic consequences of armed violence on the health of the favelas residents are still underreported, underpublicized, and underanalyzed in their complexity, while the imagination of the need to increase violent practices by public security authorities remains a dominant ideas and common sense of most of society on this issue. In a city bewildered by the permanent sense of a fear that is oversized by mainstream media, and the security and guns market, containing the favelas territory to “not let violent crime spread” beyond the favelas produces an illusory or false sense of comfort, where "isolation, support for tough police action, and permissiveness, disrespect for civil rights…” are accepted. “It is a frightened population, often in a state of panic, that often sees no other way to fight violence than violently" (ENDO, 2005, p. 287).