Violence and injuries are the second leading cause of death and lost disability-adjusted life years in SA. The overall injury death rate of 157·8 per 100 000 population is nearly twice the global average, and the rate of homicide of women by intimate partners is six times the global average, The issues are explored in paper five of the Series, written by Dr Ashley Van Nierkerk, Crime, Violence and Injury Programme, Medical Research Council-University of South Africa, Cape Town, SA, and colleagues.
The authors say: "The high injury death rate is driven mainly by interpersonal and gender-based violence, followed by traffic injuries, self-inflicted injuries, and other unintentional injuries arising from fires, drowning, and falls. Violence is profoundly gendered, with young men (aged 15 years) disproportionately engaged in violence both as victims and perpetrators. Half the female victims of homicide are killed by their intimate male partners and the country has an especially high rate of rape of women and girls."
The social dynamics that support violence are widespread poverty, unemployment, and income inequality; patriarchal notions of masculinity that valourise toughness, risk-taking, and defence of honour; exposure to abuse in childhood and weak parenting; access to firearms; widespread alcohol misuse; and weaknesses in the mechanisms of law enforcement. Although there have been advances in development of services for victims of violence, innovation from non-governmental organisations, and evidence from research, the authors say that there has been a conspicuous absence of government stewardship and leadership.
The authors conclude: "The government should identify reduction in violence and injuries as a key goal and to develop and implement a comprehensive, national intersectoral, evidence-based action plan."
Dr Ashley Van Nierkerk, Crime, Violence and Injury Programme, Medical Research Council-University of South Africa, Cape Town, SA T) +27 (0) 21 938 0399 E) Ashley.van.Niekerk@mrc.ac.za
Prof Mohammed Seedat, Institute for Social and Health Sciences, University of South Africa, Johannesburg, SA T) +27 (0) 11 857 1142 E) seedama@unisa.ac.za
Full paper 5: http://press.thelancet.com/saser5.pdf
Journal
The Lancet