Interpersonal violence is often approached from different facets such as criminal, economic and health yet rarely are the actual health implications looked into, other than the immediate physical damage caused by violence. Yet, as the Global Status Report on Violence Prevention 2014 has found, the non-fatal consequences of violence are the greatest part of the social and health burden arising from violence and this burden is generally carried by women, elderly people and children throughout the world. This can include negative behavioural, cognitive, mental health, sexual and reproductive health problems, chronic diseases and social effects that all outweigh the physical injuries sustained from the violence.
It has been found that violence against women and children contributes disproportionately to the health burden, particularly child maltreatment and women who have experienced intimate partner and sexual violence have more health problems, incur considerably higher healthcare costs, make more visits to healthcare providers over their lives and have more hospital stays (including longer durations) than those who have not experienced violence.
This violence has also been linked to other adverse health reactions such as afflictions of the brain and nervous system, gastrointestinal and genitourinary systems, and immune and endocrine function. For the women going through or having survived intimate partner violence and other forms for violence associated with that, there are also sexual health implications, as chances for HIV and other sexually transmitted infections (such as syphilis), unwanted pregnancies and other reproductive problems skyrocket with experience of violence. This can include having low birth weight babies (16% higher risk) and chances twice as high of an induced abortion.
Evidently this violence also affects the behaviours of the victims and thus being exposed to violence is linked to high-risk behaviours such as alcohol and drug abuse, as well as smoking, which all increase the risks of several leading causes of death (i.e., cancer, chronic lung disease, liver disease, etc.). This can affect young victims as well, either as a learned behaviour or as backlash to their suffering, which becomes very dangerous.
There are also repercussions on victims’ mental health. The risk for anxiety, depression, post-traumatic stress disorder and suicidal behaviour is also heightened, not to mention that exposure to violence and men’s perpetration of violence against women have been shown to be associated with high-risk sexual behaviours. This can tie in with the aforementioned sexual health risks.
Unmistakably, with all of the health menaces associated with violence there are also a wide range of indirect costs, such as spells of unemployment, absenteeism and other health problems that can affect the victim’s job performance. There are also indirect costs that relate to lost productivity because of things such as premature death, long-term disability, the provision of places of safety for children and women, and disruptions to daily life for fear regarding personal safety. Obviously these indirect costs affect people at varying degrees and those with a less stable income to begin with, from poorer social economic classes are disproportionally affected. Those without proper social support (i.e. family/friends) can also be disproportionately affected.
Relatedly and just as importantly, there is the issue of other violent crimes like homicide and non-domestic assault, both of which can have long-term implications on health. The hazards associated with being victimized by violent crime also include engaging in negative coping mechanisms, such as substance abuse and said victims are at a much higher risk to turn to such behaviour versus the general public. Anxiety, depression and post-traumatic stress disorder also pose as huge perils. Furthermore, all of the aforementioned health risks have an impact and contribute to problems in regards to unemployment, loss of productivity and disruptions to normal, daily life.
Sadly, Canada does not take a public health stance towards victimization as a result of interpersonal violence or other forms of violent crime. We have chosen to instead focus on the causes of violence, over the impacts. Research done on restorative justice programs shows the positive impact RJ seems to have on the improvement of the psychiatric and physical health of victims. This is possibly because such programs focus on the harm (caused and suffered) versus justice processes. In Canada, many of the short and long-term health needs of victims and survivors alike go untreated as a result of this focus on justice. With violent crime being sudden and unpredictable, victims and survivors are at the highest risk for severe impacts from victimization, yet they have very few low-cost or free mental health supports or other healthcare services at their disposal. The CRCVC believes we must move toward a healthcare response to violence, without linking the services offered to offenders or perpetrators, in order to more fully address the impacts of violence on survivors.
In 1999, Peggy-Jo Barkley-Dube, 27, was repeatedly stabbed in her home in Sault Ste. Marie and died on the kitchen floor. The man who attacked her was later convicted of second-degree murder. He is still serving a life sentence and has been denied parole.
For Peggy-Jo’s sister, Jennifer Barkley, then 21, the story did not end with the sentencing. It will never end, she says.
“Throughout my life, I will be revisiting that day in 1999. I will have to tell a parole board why I am in pain for the rest of my life,” says Barkley, who asked that her sister’s killer not be named.
“When it happened, I thought I had experienced the worst. When it went to the parole board hearing, it came back to me.”
That day in 1999 shaped Barkely’s life choices. In 2001, she came to Ottawa to study criminology at Carleton University. “To me, knowledge was power. I was trying to explore why this happened to my family. My criminology degree was my therapy. I got the answers I needed. That degree did everything it needed to do for me.”
She later took a post-graduate course in victimology at Algonquin College, which offered Canada’s first program in the study of the victims of crime and the psychological effects crime has had on them.
“For a long time, I was angry,” says Barkley. “I couldn’t see other people’s pain. The program allowed me to see other people’s pain. People have experienced something equally painful to them.”
Today, Barkley is a researcher in an Algonquin-led study that is looking at resilience and victims of crime, asking how unspeakable events can lead to “post-traumatic growth” — positive change that occurs as the result of adversity.
Resilience is a hot topic. And while it suggests bounce or elasticity, resilience means something different for every victim of violence, says Benjamin Roebuck, professor and co-ordinator of Algonquin’s graduate victimology program who is leading the study, which won a $207,000 grant from the Social Sciences and Humanities Research Council of Canada.
The researchers aim to recruit between 300 and 500 people, 18 years and older, who have been victims of violence or are family survivors of a homicide, to take an online questionnaire. About 150 have signed on so far. Those who qualify range from those who have been in a collision with a drunk driver to those who have been stalked, or sexually assaulted, as well as those who have been assaulted by a partner, male or female. The incident may date back to childhood, as long as it it not currently the subject of a criminal trial.
There’s something in common with all of these forms of violence: there is some degree of intent behind it, says Roebuck. And while every experience of violence is different, it is very common for those who have experienced it to reflect deeply on it.
People do all kinds of things to cope with grief in the wake of a violent crime, he says. The same crime can affect members of the same family differently, says Roebuck. Some avoid the media, the court house, or any reference to the crime. Others attend every court appearance and advocate for the harshest penalty possible for the perpetrator. Some embrace spirituality with fervor. Others reject it completely. Some don’t see themselves as victims, but rather as “survivors” or even “thrivers.”
“You can’t ever go back to a time before it happened. It’s a new life, a different life,” says Roebuck, who has done previous research on resilience and homeless youth. “We’re trying to understand people’s experiences and pathways to feeling well. To be able to have the conversation, we have to see all the harms that are there. But we can experience both harms and growth.”
The study will look at the path to recovery and interactions with the criminal justice system and social services, with an eye to identifying what can be done to help victims of violence and improving training for those who work with victims. The results will likely benefit advocacy organizations and the prison system — people who have caused harm have likely also experienced harm, says Roebuck.
The research team includes representatives from a number of victims’ groups including Victim Justice Network, the Office of Victims of Crime, the Canadian Resource Centre for Victims of Crime, and Victims of Violence.
For Barkley, resilience has meant accepting help from experienced, trained people. She says her service providers gave her the strength to go to court, to go to parole hearings, and to write victim impact statements. She also recognized that her story is a powerful teaching tool.
“I still live day-to-day and appreciate every day as it unfolds. I can be going along day-to-day and I can get a call from victim services and see that the offender has put in an application for release,” she says. “Everyone is so unique — where is strength and how we find strength. For me resilience is hope. It’s these little pieces of hope and recognizing what gives you strength.”
By the numbers
Every five years, Statistics Canada conducts its general social survey on victimization, which asks Canadians to self-report victimization for eight offence types, including incidents that were not brought to the attention of police.
1 in 5: Proportion of Canadians 15 years and older in 2014 who reported being a victim of one of these eight crimes in the previous year
5.6 million: Number of Canadians 15 years and older in 2014 who reported being a victim of one of these eight crimes in the previous year
1 in 4: Proportion of Canadians who reported being a victim of crime in 2004
65 Percentage of crimes reported in the 2014 survey that were non-violent.
34 Percentage of all reported incidents that were about theft of property
22 Percentage of respondents who reported physical assault
12 Percentage who reported theft of household property
10 Percentage who reported sexual assault
9 Percentage who reported vandalism
7 Percentage who reported break and enter
4 Percentage who reported a theft of a motor vehicle or parts
3 Percentage who reported robbery