Number 2 [2008] |
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November, 2008
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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
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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
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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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