Number 2 [2008]  
November, 2008

Conflict, Violence and Illegal Trade
from an International Health Perspective

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INTRODUCTION

The Leaders in International Health Program (LIHP) 2008 of the Pan American Health Organization commenced with the development of a conceptual model of international health that was designed to respond to the need to better explain the growing complexity of the processes of health and illness within a context of geopolitical transformation and globalization. This model is part of a dynamic and continuous process of the conceptual development of international health to which the LIHP has contributed for over two decades.

This conceptual model, which is still in the process of development, takes into consideration the international manifestations of four key forces: conflicts, trade, migration and models of development. Although the model does not rule out the existence of other forces, it’s deemed that the analysis of these four will provide a glimpse into some of the existing connections and tensions between the various determinants of health and development. This, in turn, will lead to a greater understanding of international health and strengthen the capacity of countries to attain regional and national goals, within a framework of human rights and social protection.

In coherence with this concept, the 2008 Program included the development of three thematic modules, each of which addressed a different problem or area of interest from an international health perspective. Each module addressed its respective topic through the analysis of one or more of the forces in the conceptual model and by emphasizing the strengthening of the following competencies considered essential for an international health professional: Analysis of global risks and international determinants of health; policy formulation and decision-making in international health; negotiation and advocacy in international health; management of projects and cooperation in international health; production and dissemination of knowledge in the field of international health; and communication . The thematic modules undertaken in 2008 were: Conflicts, Violence and Illegal Trade from an International Health Perspective; Nutrition, Food Trade and Development; and Access to Medicines and other Technology, Trade and International Agreements.

The development of the module on Conflicts, Violence and Illegal Trade from an International Health Perspective responds to the international dimensions of one of the forces – conflicts – which have been defined within the Program as situations that generate or reduce tensions, and which, depending on how they are resolved, can exert a positive or negative impact on the health and quality of life of different population groups. In this manner, the conceptual model allows one to address the structural prevention of conflicts and the contribution of inter-country agreements and consensus to the same. In such a scenario, international relations should contribute to the reduction of risks and the roots of the conflict. The module thereby allows participants to develop a conceptual basis for the analysis of different conflicts, and a critical and proactive perspective to address these situations as international health professionals.

This edition of the International Health Bulletin will explore conflict as a topic in international health, with particular emphasis to the approach utilized in the module Conflicts, Violence and Illegal Trade from an International Health Perspective, as well as its importance as the central theme of the country topic selected by the LIHP teams from Colombia and Ecuador. In addition, the bulletin will include information on the International Health Seminar on Conflicts, Violence and Illegal Trade that took place on 30 July, 2008 and which included expert panelists in the area of conflicts from these two countries.


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MODULE ON CONFLICTS, VIOLENCE AND ILLEGAL TRADE FROM AN INTERNATIONAL HEALTH PERSPECTIVE
Development of the Module on Conflicts, Violence and Illegal Trade from an International Health Perspective

The main objective of the module on Conflicts, Violence and Illegal Trade from an International Health Perspective was to develop competencies in analysis and debate among participants so that they might better understand and develop violence prevention strategies within an international context. The module was structured in three thematic components: “From the theoretical to the conceptual”; “From understanding the problem to critical analysis”; and “From critical analysis to proposals for intervention”, utilizing the logical process of “step by step”, in the collective development of knowledge based on problems. A “Road towards learning” was established that guided and oriented the development of the module.

The module progressed from general to specific and from conceptual to methodological, using the conceptual model of international health as a reference. The module began with the consideration of general concerns about human security and human rights that, together with the ecological model for understanding the causality of aggression, provided participants with a solid conceptual base from which to advance in their understanding of conflict, violence and illegal trade as international health issues. These conceptual bases were complemented with information, research and communication tools that could be utilized to analyze the situation of conflict and violence in each country.

The social, political, economic and cultural determinants were subsequently analyzed and used to develop a critical position regarding real problematic situations in the region. Through a case analysis of conflicts and territorial tensions on the Ecuador-Colombia border, the module delved more deeply into the effects of the illegal trade of arms and drugs, migration and models of development on the conflict. As a final exercise, each country group, based on existing norms and regulations, proposed and debated specific prevention strategies from an international health perspective that were related to the negotiation and advocacy of treaties or agreement, national or regional policies and the intersectoral management of cooperation projects.

It is worth noting the importance of the collective construction by the group through the discussion forum available in the virtual classroom of the Leaders in International Health Program in the development of the module. Using the discussion forum, each participant shared with the rest of the group his or her own conceptual thinking regarding the contributions of human security and the ecological model to the understanding of conflict and violence. The participants affirmed how human security refers to the guarantee of human rights, thereby implying a guarantee to the right to freedom and to the inexistence of inequality. They also evaluated the usefulness of the ecological model for the analysis of conflict in relation to its corresponding levels (individual, relational, community and social), recognizing, at the same time, its limitations for analysis from an international health perspective, and the need to consider other theoretical models.

An important product of the module was a summary document regarding the situation of conflict and violence in each of the participating countries. Each country produced a document, the majority with information through the year 2007, that includes various indicators (homicide rates, migration rates, interpersonal injuries, high-impact crimes, perceptions of violence and victimization, etc.) and which integrates validated data from official national sources, research conducted by various institutions including the United Nations, and information compiled by other means. Each document also includes an analysis and presentation of the country’s position regarding the situation of conflict and violence, using the levels proposed in the ecological model. These documents are intended for publication and availability to other actors. In this bulletin, you can access the following documents that are in the process of publication:

Summary document regarding the situation of conflict and violence in Colombia
Summary document regarding the situation of conflict and violence in Ecuador
Summary document regarding the situation of conflict and violence in Guatemala
Summary document regarding the situation of conflict and violence in Peru

The coordination of the module, from its conceptualization to its development, was done jointly by the National Faculty of Public Health of the University of Antioquia and the CISALVA Institute of the University of Valle, who worked with the Leaders in International Health Program Coordination and with the PAHO/WHO regional advisor in violence prevention, thereby ensuring that it responded to the required lines of action of the Pan American Health Organization/World Health Organization.

Development of a Country Topic: “Health: Harmonizing the Colombia-Ecuador Border”

An important component of the Leaders in International Health Program is the development of a country topic, which is defined and developed in coordination with the PAHO/WHO Country Office, the government and other authorities. In this first cohort, the LIHP participants from Colombia and Ecuador decided to work on the same topic, approaching the same from the perspective of the situation in their respective countries. The title for their chosen topic is “Health: Harmonizing the Colombia-Ecuador Border”, and it has as its objective to describe from an international health perspective the effects of the conflict on governance, community participation mechanisms and access to health services in the Colombia-Ecuador integrated border zone in 2008. The team hopes to utilize this information to propose some lines of action for conflict prevention projects in the zone. Conflict has been considered the primary point of analysis for the topic; other forces such as violence, migration, and illegal trade on the border are considered generators of tension and therefore also have an effect on governance, community participation and access to services. More information about the country topic, including the initial proposal, specific objectives, description of the site visit, preliminary results and interactions with the community of practice, can be found through the International Health Situation Rooms of both countries.

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INTERVIEW
Interview with Dr. Rodrigo Guerrero

An interview was conducted with Dr. Rodrigo Guerrero, former mayor of Cali, Colombia, with the purpose of documenting “the role of governments in the prevention of conflicts, violence and illegal trade”. Dr. Guerrero describes the interventions developed during his administration for the prevention of conflict and violence, interventions that afterwards were implemented in other capital city administrations in the country. According to the information reported, the interinstitutional and intersectoral approach, the systematic collection of data through information surveillance systems, and the monitoring and evaluation of the different actions implemented are aspects to consider in designing programs or projects to prevent conflict and violence.  Interview

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SEMINARS AND WORKSHOPS
International Health Seminar on Conflicts, Violence and Illegal Trade

The first International Health Seminar of the Leaders in International Health Program was held on 30 July, 2008, the purpose of which was to “identify the international alignments and approaches to conflict, violence and illegal trade that impact citizens’ human development”. The seminar was organized by the LIHP participants from the Colombia and Ecuador teams: Martha Idalí Saboyá, Martha Patricia Velandía, and Isabel Cristina Posada, and Victor Arauz and Alex Camacho, respectively.

The seminar panel included: Dr. Alberto Concha, Regional Advisor, Violence Prevention and Road Safety, PAHO/WHO; Mr. Fernando Carrión, Coordinator of the City Studies Program, FLACSO-Ecuador; Dr. Michael Brown, Advisor for Peace and Development, Office of the Resident Coordinator for the United Nations in Ecuador; and Dr. Vilma Restrepo, Professor, University of Antioquia, Colombia. Topics included PAHO/WHO’s proposed framework on violence; conflict and violence in urban areas; development and peace through the perspective of conflict; and the illegal trade of drugs and international health.

It is important to note that, in addition to the LIHP participants and the PAHO/WHO Country Offices of each participating country, other governmental and non-governmental organizations and academia were also invited, thereby broadening discussion of the topic. The recording of the seminar and presentations are available through the attached link.  Seminar


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Workshop “Towards a New Construction of the Conceptual Model of International Health”

A workshop for the construction of the conceptual model of International Health was held from 8-10 October, 2008 in Medellín, Colombia. Participants included experts in the areas of conflict, trade, migration and models of development, as well as four LIHP participants who are using one of these forces as a point of analysis for their country topic: Isabel Cristina Posada from Colombia, Silvia Faraone from Argentina, Luis Lopez from Guatemala and Claudia Carrasco from Chile. The objective of the workshop was to contribute to the development of a more solid conceptual model of international health that would better reflect the growing complexity of the health-illness processes within a context of geopolitical transformation and globalization in the region. The first documents that have been developed to support the conceptual model are available for review on the Regional International Health Situation Room. These documents will serve as input into further discussions and, eventually, a publication. We invite you to visit the Regional International Health Situation Room at the following link and contribute to the development of the model. Link

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Leaders in International Health Program 2008 Closing-Transition Activity

The Leaders in International Health Program 2008 will hold its closing-transition event from 1-4 December in Brasilia, Brazil. The experience of this first group of “pioneers” in the LIHP has been demanding, yet, at the same time, filled with important learning, reflections and developments for the participants as well as for the tutors, coordinators, and other national, regional and international actors who have accompanied the process, in which all parties contributed to a deeper conceptual understanding of international health and its components. Participants will have the opportunity to present their country topics, the development of the virtual International Health Situation Rooms in their country and their interactions with their communities of practice. An evaluation of the 2008 Program will be conducted, taking into account the various actors involved and plans for the 2009 Program. The PAHO/WHO Country Office and Ministry of Health of Brazil have contributed significantly to this important event and have shared their valuable experience in technical cooperation and global health. The LIHP closing-transition ceremony will coincide with important activities of the Specialization Course in Global Health and Health Diplomacy of the Oswaldo Cruz Foundation (FIOCRUZ) and there will be opportunity during the meeting for both programs to share ideas, visions and experiences. Link

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OTHER ITEMS OF INTEREST
  • LIHP 2009 Call for Applications: The call for applications for the 2009 Leaders in International Health Program is now open. For more information visit PLSI 2009


  • Future editions of the International Health Bulletin: Volumes 3 and 4 of the International Health Bulletin will be available soon and will explore the topics of nutrition and medicines, respectively.

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WE INVITE YOU TO PARTICIPATE!
  • Invitation to contribute to the collective development of “Towards a new Construction of the Conceptual Model of International Health”. The first documents that have been developed to support the conceptual model are available for review on the Regional International Health Situation Room. We invite you to visit the Regional International Health Situation Room at the following link and contribute to the development of the model. Link



  • International Health Situation Rooms: We recommend that you visit the International Health Situation Rooms, which will allow you to see the progress made on the country topics. There you will find the proposal and progress made by each of the teams from Argentina, Belize, Bolivia, Colombia, Chile, Ecuador, Guatemala and Peru, in collaboration with the PAHO/WHO Country Offices, technical areas, national authorities and other actors. Space has been provided on the Situation Rooms to interact with the country teams through a series of questions that have been posed for discussion and analysis. We await your active participation. Link

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