A Global Overview of Intimate Partner Violence

by ihsection, posted in APHA IH Section, Guest Blog, Human Rights, Women's Health

This is a guest blog post by Evangeline Wang, a public health student at Arcadia University and Dr. Heather F. de Vries McClintock PhD MSPH MSW, IH Section Member and Assistant Professor in the Department of Public Health in the College of Health Sciences at Arcadia University. It is the first in a three-part series the IH Blog will feature this summer called Intimate Partner Violence: Global Burden, Risk Factors and Outcomes.

Part I: A Global Overview of Intimate Partner Violence

Intimate partner violence, or IPV, as defined by the Centers for Disease Control (CDC), is violence that manifests as physical, sexual, or psychological harm inflicted by a current or former partner/spouse (CDC, 2018).

For my friend, it was psychological abuse. Last fall, my friend, a headstrong, independent woman, had just gotten out of an emotionally abusive relationship. As we were discussing it, she stated that although she knew some aspects were bad at the time, she found it difficult to leave the relationship. In this relationship, her partner would text her repeatedly, asking where she was, who she was with, and accusing her of unfaithfulness when she did not respond. She justified this behavior because she thought the constant text messages meant he was in love with her and was showing commitment toward her. One day during a fight he followed her home and despite her protests, entered her home spewing hurtful language. It was at this point she realized how harmful the relationship was and that she could not be in the relationship anymore. She decided to end it. When talking to me about it she expressed how challenging it was to leave and her thankfulness for having done so. She related to other victims and their challenges in ending an abusive relationship with a manipulative partner.  Unfortunately, like many others, my friend fell victim to intimate partner violence, a pervasive global public health issue.

Globally, in 2016, the World Health Organization (WHO) reported that 30% of women are physically and/or sexually abused by their partner as the global lifetime prevalence. This means that nearly 1 in 3 women will experience intimate partner violence during their lifetime. In the United States, the median prevalence of physical abuse is 30% (Violence Info, 2018). The prevalence of physical abuse is much higher in countries like Ethiopia (45%), Jordan (43%), and Bosnia and Herzegovina (76%).

Regional estimates range from 24.6% in the WHO Western Pacific region to 37.7% in the WHO South East Asia region. A more nuanced assessment by sub regions shows that the highest prevalence of lifetime intimate partner violence is found in central sub-Saharan Africa, with a prevalence of 65.6%. All regions in sub-Saharan Africa have lifetime prevalence estimates that are greater than the global average (WHO Global and Regional Estimates, 2013).  

The consequences of intimate partner violence are severe with research showing that exposure to intimate partner violence ultimately increases risk for disability and death. Persons exposed to intimate partner violence are more likely to experience physical and psychological trauma and stress. Such experiences are often characterized by musculoskeletal injuries, genital trauma, mental health problems, substance abuse, non-communicable diseases, somatoform disorders and/or many other adverse consequences. Concurrently, victims may have compromised access to health care due to a lack of autonomy as well as limited decision making power regarding their sexual and reproductive health. Intergenerational effects are common with victims experiencing greater risk for having premature and low birth weight babies as well as pregnancy loss (WHO Global and Regional Estimates, 2013).

Intimate partner violence is a pervasive public health problem that discriminates against no one. From underdeveloped countries to developing countries, this is a major public health issue that cannot be ignored. However, many people lack knowledge about the basic components of intimate partner violence. Furthermore, professionals seeking research on this topic have struggled to compile and access comprehensive information. Greater accessibility of knowledge can enhance global prevention, management and treatment efforts.

The World Health Organization developed an interactive app in response to these needs. This app allows for the public to access online violence studies by country and type of violence (e.g. physical abuse, sexual abuse, and psychological abuse). The purpose of the app is to consolidate and centralize academic journals and various reports about violence in order to make this information more accessible and easier for the public to understand. Not only does it allow journal article access, but it provides important information like prevalence, risk factors, consequences as well as prevention and response strategies. The prevention tab is especially helpful because it allows the user to see the effectiveness of given prevention initiatives based on prior research. Additionally, there are multiple graphs and other visuals that users can click on for more information making this an interactive and user-friendly app. This app can be accessed here: WHO Violence Info App.

Please stay tuned for Part II in this series: Risk Factors for Global Intimate Partner Violence

mcclintock-picture.jpg

Dr. Heather F. de Vries McClintock, is an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life and Integrating Management for Depression and Type 2 Diabetes Mellitus Studies.

evangeline wang

Evangeline Wang is a public health major at Arcadia University. She is the president of the Public Health Society and has volunteered and interned with various public health agencies such as Prevention Point Philadelphia and HIPS in Washington D.C. After graduation, Evangeline hopes to attend graduate school and continue her studies in global public health.

The G20 Makes Early Childhood Development a Priority

by Eighmey Zeeck, posted in APHA IH Section, Health Equity, Maternal and Child Health, MDGs / SDGs, News, Policy and Advocacy

World wide roughly 200 million children under the age of five, in low and middle income countries, will fail to meet basic developmental milestones. Such deficits affect health across the lifespan, the ability to contribute to the national economy, and the ability to stop the cycle of poverty. With this knowledge in mind the United Nations made a point of linking their sustainable development goals to children’s issues, specifically early childhood development (ECD). Recently the G20, with Argentina as the new chair, have placed an emphasis on ECD in the international community by adding it to their own sustainability goals. The G20 has recognized that ECD must be incorporated into all programs, not just within child centric programs and that an emphasis must be placed on children under five years of age.

Programmatic areas have remained siloed focusing on nutrition and ensuring school aged children receive an education. While these initiatives play a role in ECD they only focus on topical areas and do not formally integrate ECD, newborn to age five, into programmatic work. The G20 has created a case for cross collaboration within programmatic and policy level work, even laying out funding streams for such work. This puts the G20 in line with World Health Organization guidelines, including guidelines around integration of ECD in emergency situations. When you are already servicing families and their children, especially in low income programmatic settings, it is easy to add in basic ECD education. For example, when providing breastfeeding support to mothers this is a wonderful opportunity to briefly discuss the need to talk and sing to the child in order to develop language acquisition. Another example is to provide pamphlets, that match the health literacy level of the community, around positive parenting and age appropriate milestones at an immunization drive.  

ECD doesn’t just apply to children – it applies directly to the child’s environment: families, caregivers, and national leadership. ECD focuses a lot on positive parenting to encourage positive brain development and language acquisition. The World Health Organization just released a guideline that discusses nurturing care within ECD, highlighting strategies and policies focusing on the environment that impacts ECD. A really interesting piece that the G20 highlights is the need for better trained child care providers. The G20 ties it back to economics – if a family, mothers in particular, feels comfortable leaving their child in the care of someone else they are able to contribute to their local and national economy in a greater way. There is also the money saving aspect for countries who invest in programs that promote ECD in children under the age of five. As discussed in the literature, children’s brains are rapidly developing arguably from in the womb through the first 1,000 days of life, and programs that focus on this age group provide a larger cost saving than programs that focus on children over five. This is because potential developmental delays are prevented, thus not as much money is needed to get a child back on their developmental track. Also, at such a young age with the focus predominantly being on environmental factors the cost is solely around training and educating front line staff, not actual school aged interventions.

Again – it is great news to have a group like G20 make ECD a priority, especially for children under five. It brings the topic back to the front of the global health stage and proves that it can be easily incorporated into programmatic work.

Separating parents and children at US border is inhumane and sets the stage for a public health crisis

by ihsection, posted in APHA IH Section, Section Announcements

Statement from the American Public Health Association and Trust for America’s Health

Washington, D.C., June 15, 2018

“The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.

“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.

“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.

“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.

“There is no law requiring the separation of parents and children at the border. This policy violates fundamental human rights. We urge the administration to immediately stop the practice of separating immigrant children and parents and ensure those who have been separated are rapidly reunited, to ensure the health and well-being of these children.”

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Global News Round Up

by abbhirami, posted in APHA IH Section, News

Politics & Policies

Within the space of a few short weeks, the reputation of Peter Sands, incoming Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, has gone from respected to reckless according to some critics.

A report from the WHO’s Independent High-level Commission on Noncommunicable Diseases (NCDs) has called for urgent action, high-level political commitment and immediate scaling of actions to address NCDs.

“Winning the fight against tuberculosis (TB)  requires that ‘social drivers’ of the disease – especially poverty and inequality – are tackled head on, the United Nations Secretary General said [Monday], urging greater efforts to provide universal health coverage and combat the growing threat of anti-microbial resistance…”

Being active is critical for health. But in our modern world, this is becoming more and more of a challenge, largely because our cities and communities aren’t designed in the right ways,” said Tedros Adhanom Ghebreyesus, WHO Director-General on Monday, launching the WHO Global action plan on physical activity and health 2018-2030: More active people for a healthier world, alongside Portuguese Prime Minister, António Costa.

Programs, Grants & Awards

The World Health Organization has certified Paraguay a malaria-free country. An independent panel concluded earlier this year that Paraguay interrupted indigenous malaria transmission for the requisite 3-year period and that it can prevent re-establishment of transmission.

Research

In a new study, scientists suggest that your beloved furry companion could trigger a flu pandemic among people in the future. Why? Researchers found that flu strains can jump from pigs to dogs, and that flu is becoming increasingly diverse in dogs.

In a day long mock pandemic exercise organized by Johns Hopkins Center for Health Security, an unreal mystery virus, Clade X, brought the world to its knees before eventually burning out.

A large-scale clinical trial, called HOPE (HIV Organ Policy Equity Act) in Action, a multicenter kidney study, assessing the risks of transplanting kidneys from HIV- positive donors into patients living with the virus, is set to begin soon.

Travellers carrying standby antibiotics take them more often than those traveling without such drugs.  Having antibiotics packed in the bags allows their use – against recommendations – also for mild and moderate diarrhoea, i.e. cases not requiring medication.

Diseases, Disasters & Wars

Haider Hammoud often goes tent-to-tent at the refugee camps near the Syrian border asking families whether they’ve enjoyed their iftar meal.  It’s the Muslim holy month of Ramadan and the Syrian 32-year-old wants to ensure that when the sun goes down, displaced families break their fasts with a taste of home-cooked food.

First case of Polio (since 1989) has been reported in Venezuela as it falls deeper into crisis that has crippled its healthcare system.

In 2015, a dermatologist in Russia’s fourth largest city, Yekaterinburg, diagnosed Katia with herpes. “I had no idea what it was,” says Katia, who asked that her last name not be used. But because she had suffered repeated illnesses over the preceding 2 years and had an alcoholic ex-boyfriend who simultaneously had other girlfriends, she suspected that something more serious might be wrong.

Technology

Bausch + Lomb, a leading global eye health company and wholly owned subsidiary of Valeant Pharmaceuticals International (NYSE/TSX: VRX), today announced the introduction of Ocuvite® Blue Light eye vitamins, a nutritional supplement formulated with lutein and zeaxanthin, the two carotenoid pigments naturally found in the eye. This formulation of eye nutrients includes high levels of lutein and helps protect eyes from the blue light that reaches the macula, which is responsible for our central vision.

Mobile health technology has the potential to transform the way we prevent and manage heart disease, but there are unanswered questions about how to optimize this technology and maintain engagement with patients, according to a recent review.

A new study by Waldemar Gorski, professor and chair of the UTSA Department of Chemistry, and Stanton McHardy, associate professor of research in chemistry and director of the UTSA Center for Innovative Drug Discovery, describes a method that could show quickly and accurately whether a person has been infected with harmful bacteria or other pathogens.

Environmental Health

Plastic and chemical pollution has been detected in most samples of snow and seawater taken by researchers in Antarctica, said the non-governmental environmental group Greenpeace.

Equity & Disparities

An estimated 239,000 excess deaths occur among girls under 5 years of age each year in India. The study highlights the significant effects of gender bias on mortality.

For urban planners, data and technology are valuable tools in the drive to improve administration and services. But while these innovations are making urban environments more livable, they come with a hidden cost: the potential to deepen inequality among digitally marginalized groups.

Women, Maternal, Neonatal & Children’s Health

Childhood deaths from pneumonia and meningitis decreased significantly between 2000 and 2015. This sharp decline could be attributed to the introduction of vaccines against these bacteria in high-burden countries.

The unique composition of a mother’s breast milk may reduce food sensitization in her infant, report researchers at the University Of California San Diego School of Medicine with colleagues in Canada.  The findings, publishing in the June 15 issue of Allergy, further highlight the health role of human milk oligosaccharides (HMOs), which are not found in infant formula, and underscore their potential for therapeutic interventions.

Challenges Accessing PrEP for HIV Prevention in England

by kimberly levitt, posted in APHA IH Section

The successful integration of HIV prevention programs that increase testing and offer early treatment for infected individuals is contributing to reductions in new HIV infections. By 2016, the 5,164 HIV diagnoses in gay and bisexual men living in England represented an 18% decline compared to the 6,286 diagnosis in 2015.  Secure integration of pre-exposure prophylaxis (PrEP) will continue to reduce infections. HIV prevention programs need to address persistent barriers and doubts however, including limited access of PrEP in England. Continue reading “Challenges Accessing PrEP for HIV Prevention in England” →