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Regional Symposium to address Crime and Violence as a Public Health Issue
Theme- “Violence as a Public Health Issue – The Crime Challenge”
PORT-of-Spain, Trinidad and Tobago

17- 18 April 2023
Day # 1 (April 17, 2023)
1:30 pm

Remarks

Hon. Dr. Terrance Drew, Prime Minister of  St. Kitts and Nevis
CARICOM Lead – Health & Human Development
 Colleague Heads of Government, Ladies and Gentlemen, Greetings

I am grateful for the opportunity to speak on the challenge of youth violence. 

At the outset, it is clear that much work has been done to document the risk factors; the characteristics of victims and perpetrators; and the impacts on the individual, family, country, and region.

Solutions have also come to the fore.  So, there is reason to be optimistic.    

In 1996, the World Health Organization was correct to declare violence as a major public health. 

Then, in 2002, WHO’s Report on Violence said this: “Gangs and a local supply of guns and drugs are a potent mixture, increasing the likelihood of youth violence”.    

St. Kitts and Nevis accepts this formula “Gangs + Guns + Drugs” as a key driver of our gang violence issue. 

By the early 1990’s, we witnessed young adults then high school students organized in the transnational traffic of drugs.  The groups of brothers and sisters became deadly territorial as they protected their turfs with imported guns. 

Such is the influence, that by 2018, primary school children were gang members rather than being constructively engaged in organized arts, culture, and sports. 

What push-pull factors cause some children to be ensnared by a sub-culture of mental and physical violence? 

Why are they not be aspiring to be CARIFTA Games participants?  Why the seemingly overpowering appeal of: “Get rich quick or die trying”?      

I am advised that the “Habits of Thought” model is operative.  It speaks to chronic, toxic early childhood experiences that erode mental resilience.  So much so that by or before mid-adolescence, violent behaviour spills out of homes onto the streets as a disease.

In November 1937, Marcus Garvey came to St. Kitts and Nevis to speak to my grandparents.  Among the pearls of wisdom, he said: “Man is a product of his mind”.  In other words, “Violence is learned behaviour”. 

I am a medical doctor.  What is learned can be unlearned provided that there is definition of the issue and early application of best-practice interventions. 

Speaking of definition:  For two decades, Caribbean public health experts have known that, like Measles, Dengue Fever, and HIV-AIDS, Violence is characterized by the “Epidemiological Triad of Disease Causation”.  The triad elements being Agent, Host, and Environment. 

For example, COVID’s agent is a virus.  The hosts are animals and humans.  An environment dominated by Structural, Social and Commercial Determinants of Injustice, Inequity and Ill-health facilitates transmission and virulence.

In youth violence, the agent is chronic exposure to family-based toxicity.  The primary hosts are children.  Enablers are the determinants of injustice, inequity, and ill-health, including easy access to guns we do not produce. 

My information is that public health and security experts can produce maps of violence hotspots.  They know the demographics and geographics of clusters.  There are graphs of incidence versus time which depict a series of Epidemiological Curves. 

Therefore, the violence challenge in the Caribbean appears to be well-characterized as a public health issue with ominous social and economic implications. 

Neither good health nor development are possible in a climate of violence. 

We need violence climate change. The pressing leadership task is to resource and apply best-practice interventions. 

In that regard, the work of Dr. Gary Slutkin, WHO and others is instructive. Three (3) primary intervention fronts are recommended.  Namely:

1. Interrupt Transmission
2. Prevent further spread among the exposed
3. Change societal behaviour norms

If they sound familiar, they should.  They were part of the public health toolkit to mitigate COVID. 

I regard this regional symposium as a coalition of the willing.  Notwithstanding the delays, there is a window of opportunity to move the needle to solutions.  Our people must see and feel solutions, now. 

I came convinced and I want to leave seize with a commitment to train people with street credibility to function as violence interrupters. 

We can track and trace young people experiencing toxic exposure or who are high risk for the same. We can find them then offer a suite of targeted interventions.

We can rollout a campaign of culturally appropriate public messaging using the talents of known social influencers. 

Several experts will follow me to the microphone. I expect them to be factual and forthright about the required resources.

Let me tease them by saying how struck I was with data produced in 1992 by the U.S. Government Accounting Office.  Specifically, that violence prevention programs save $6 to $8 for every $1 invested.  (Data found in the presentation: “Violence Prevention – Creating a New Scientific Discipline” by Ron Slaby, PhD, Boston Childrens Hospital, May 2021).  

The US GAO conclusion that violence prevention funding is “Smart Money” is accepted and, to my mind, a political imperative.   

Therefore, gathering research evidence on violence is not the rate-limiting step of Caribbean action.  Political will is.  

I end with a quote from Martti Ahtisaari, 10^th President of Finland and Nobel Laureate: “If the political will is there, we can solve anything”.

The Caribbean has a proud track record of solving or mitigating major public health issues through robust, evidence-guided intervention programs. 

St. Kitts and Nevis is ready and willing to move forward from research and experience to robust and sustained action. 

Thank you for your attention.