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INFORME ALTERNATIVO SOBRE LA SALUD EN AMERICA LATINA5Social and Political Violence in Colombia:A Social-Medical ApproachSaúl Franco A.IntroductionViolence is not only a political, sociological and military problem; it isalso a public health issue. In Colombia, violence is in fact the main threat topublic health.The high rates of homicide and kidnapping, the significant reductionin the quality of life of the country’s citizens and the systematic violationof international humanitarian law and the medical mission are evidence of theenormous impact of violence on health in Colombia. Different theoreticalapproaches have been proposed to study the violence. They have emergedmainly from the social sciences.Within the health sector, epidemiology, withits different trends and different approaches, has been the discipline mostactively involved in the study of the problem. This article presents the conceptualbases, the main findings, and the conclusions of the author’s researchon this topic over the past 15 years from a social medicine perspective.Conceptual and methodological basesAcknowledgements:This articlewas translated from Spanish by Drs.Luis Franco and Paola Pinto.The concept of violence. There is no accurate and universally accepteddefinition of violence. Each of the many proposed definitions highlights specificaspects, usually related to the author’s area of expertise. The WorldHealth Organization, for instance, defines violence as "The intentional use of48
Observatorio Latinoamericano de Salud.physical force or power, threatened or actual, againstoneself, another person, or against a group or community,that either results in or has a high likelihood ofresulting in injury, death, psychological harm, maldevelopment,or deprivation" [World Health Organization,2002]. Of course this definition includes the mostessential elements of the concept. In my opinion, however,it excludes important aspects and includes particularitiesthat are not necessary in a definition. Idefine violence, more concisely, as a specific form ofhuman interaction in which, in order to achieve a givenpurpose, force is used to cause harm or injury to others.Given its implications, it is necessary to discuss thecontents of this definition: the human character of violenceimplies that it is an intelligent activity.Violence asa form of human interaction is a learned behavior.Although violent acts may initially appear to be irrational,they have an intrinsic logic and a context. Themost specific characteristic of violence is that it is arelationship based on the use of force. Force can bephysical or psychological. Violence always producesharm or injury.Without damage, there is no violence.Damage can be physical or psychological and it mayalso occur in different levels of intensity. Purpose is themost controversial characteristic of violence and itrefers to the intention of achieving a particular goal.Violence is not a random event. Power is one of violence’smost common purposes and the two are closelyrelated [Arendt, 1970]. However, they are very differentconcepts: while power is a goal, violence is aninstrument. Analysts of violence often refer to poweras the instrumental nature of violence [Arendt, 1970;Benjamin, 1995; Cortina, 1998]. As a consequence ofthe above, it is clear that violence is a process and thatit has a historical context. Violence is not a singleaction: it involves different steps, activities and consequencesfor both the victim and the agent, and itaffects not only individuals but also their surroundings.Violence changes: its intensity and modalities varyamong different countries and among different times.This implies that violence can be reduced and modified;thereby, some types of violence are preventable.Homicide as an indicator of violence. Homicide haslong been recognized as one of the most importantindicators of violence because of its serious consequencesand greater reporting reliability. In the caseof Colombia’s current cycle of violence, homicide isundoubtedly the indicator that most clearly portraysthe magnitude and severity of the situation.With certainlimitations, especially in those regions of thecountry that are under the control by illegally armedgroups, homicide is the most documented form ofviolence in Colombia. Research on Colombian violenceinvolves the analysis and comparison of diverseand often variable sources of information.Structural conditions and transitional situations.Methodologically, in the study of Colombian violencewithin the framework of social medicine its useful todifferentiate between structural conditions and transitionalsituations. Structural conditions are processesof longer duration that are related to the fundamentalcomponents of the phenomenon under study.Transitional situations, on the other hand, are processesof shorter duration that exert an important butcomplementary influence over the fundamental components.In the case of violence, this differentiation isuseful when attempting to explain the phenomenonand when seeking possible solutions. The study ofColombian violence has involved a long debatebetween "structuralist" and "transitionalist" views.Thisconflict of views has had a clear impact on the country’spolicies and strategies towards violence. Thesocial-medical approach attempts to study the ways inwhich structural and transitional elements interact.This discipline avoids exclusions that initially appear tosimplify the task and emphasizes the need for a strategicsolution that integrates both doctrines for longterm effectiveness.49
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