Reducing Sexual Violence Using Public Health

There are many multilevel models of health for solving health problems. One of the simplest is Dahlgren and Whitehead (1991) which shows the progression from non controllable factors and personal choices to broader spheres of social networks and socioeconomic, cultural, and environmental conditions. The Canadian Council on Social Determinants of Health’s report (2015) describes the types of frameworks as explanatory, interactive, and action-oriented, and reviews seven frameworks.

Sexual Violence is a complex construct with deep, widespread roots through generations of our culture making it difficult to pinpoint the causes. Victims often experience long-term gynecological, gastrointestinal, mental, and sexual health problems (CDC, 2016, Vivolo et al., 2010). For all these reasons, it is important to address the issue on multiple levels so that sexual violence stops.

The determinants of heath focus on causes so that problems can be prevented. Thus, focusing on causes of sexualized violence should help create strategies to prevent it. There are many spheres of influence in our culture that we should use to prevent violence.

Many current programs (CDC, 2016) teach strategies to prevent being sexually assaulted, thus focussing on the micro or individual level, and the potential victim’s choices. Some focus on empowering women and minorities to make better choices. Considering that many key risk factors are exposure to violence or sexual violence at a young age, and exposure to traditional gender role norms and hyper-masculinity, these types of programs make sense. However, the lack of programs focussing on males, who are the majority of perpetrators, shows our culture of victim-blaming when it comes to sexual violence. Two programs examined gender norms, such as encouraging bystanders to speak up and one was focussed on males. Basile et al., (2022) notes that those programs that focus on the Mesa-level spheres such as challenging gender norms, work well. Culyba et al., (2023) issued caution because their program showed an increase in sexual violence in one cohort after a boys intervention program. It could be iatrogenic--the boys ‘learned’ what to do during the program discussions, or it could be that following education the boys could identify their behaviours as sexual violence, therefore scoring higher.

In the broader Macro-level sphere, programs addressing the creation of workplace violence and sexual harassment policy are noted. However, most of the institutional programs were social and medico-legal services related to aftercare for victims of sexual violence, not prevention.

The WHO model from 2007 (CCSDH, 2015) involves all three categories of frameworks, focuses on the broader determinants of health, and may be a good one to address the gaps from most current programs which focus solely on individuals or treatment and not broader initiatives. I am excited to delve into more on this topic next week.

References

Basile, K. C., Smith, S. G., Kresnow, M.-J., Khatiwada, S., & Leemis, R. W. (2022). The National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Sexual Violence. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. https://www.cdc.gov/violenceprevention/pdf/nisvs/nisvsReportonSexualViolence.pdf

Canadian Council on Social Determinants of Health. (2015). A Review of Frameworks on the Determinants of Health. 76. https://nccdh.ca/images/uploads/comments/CCSDH_A-review-of-frameworks-on-the-determinants-of-health_EN.pdf

CDC. (2023, July 23). Prevention Strategies: Sexual Violence Prevention. Center for Disease Control. https://www.cdc.gov/violenceprevention/sexualviolence/prevention.html

Culyba, A. J., Fuhrman, B., Barker, G., Abebe, K. Z., & Miller, E. (2023). Primary Versus Secondary Prevention Effects of a Gender-Transformative Sexual Violence Prevention Program Among Male Youth: A Planned Secondary Analysis of a Randomized Clinical Trial. Journal of Interpersonal Violence, 38(19–20), 11220–11242. https://doi.org/10.1177/08862605231179717

Dahlgren, G., & Whitehead, M. (n.d.). Policies and strategies to promote social equity in health.

ValorUS. (2019, January 30). Applying a public health approach to preventing sexual and domestic violence. https://www.youtube.com/watch?v=vDsbsOZMP9I

Vivolo, A. M., Holland, K. M., Teten, A. L., & Holt, M. K. (2010). Developing Sexual Violence Prevention Strategies by Bridging Spheres of Public Health. Journal of Women’s Health (15409996), 19(10), 1811–1814. https://doi.org/10.1089/jwh.2010.2311