By Richard Matzopoulos, Sarah Truen, and Ian Neethling,

Violence as a health priority impacts low- to middle-income countries (LMICs) disproportionately, which experience mortality rates almost 2.5 times greater than in high-income countries.

South Africa is among the LMICs most affected by violence with homicide rates six times global averages and among the world’s highest rates of gender-based violence, including rape and intimate partner violence. Several historical drivers have contributed, including colonialism, apartheid race-based social control policies, civil unrest and armed struggle, and the violent oppression of social justice movements. Some social drivers have endured, and income inequality—which still largely follows the apartheid-era race profiles and geography—has continued to be entrenched within society.

Within this milieu, certain progressive policies such as the 1996 National Crime Prevention Strategy and the 2020 National Strategic Plan on Gender-Based Violence and Femicide have sought to holistically address South Africa’s problem. However, uptake has been sub-optimal and violence has become so normalized that the extent of its harm to society is no longer fully recognized.

The authors in this study present evidence for the prevention of violence including examples from South Africa, and document the enormous toll of violence in terms of both its health impact on mortality and morbidity and its economic cost. In doing so, the study illustrates the costs of prevention are not prohibitive and emphasizes the urgent need to implement effective policies and interventions.

Recommendations in this study include highlighting the urgent need to provide financial and technical support for intersectoral collaboration, multilateral research cooperation, and research capacity to address violence, which in South Africa imposes a significant threat to development. Key aspects to support this agenda include: an integrated violence prevention approach to prevent violence at a societal level; and research to improve the evidence base for violence prevention and the quality of future costing studies.

New York: Center on International Cooperation, New York University, 2023. 54p.

By Li Li, Anke Hoeffler, and Teresa Artho

Background: Switzerland is a high-income country with low rates of fatal and nonfatal violence. Possibly due to these low prevalence rates, the costs of violence to Swiss society have received relatively little attention. Objective: This report aims to establish the prevalence rates of homicide and assaults (both physical and sexual) in Switzerland and assess their related tangible and intangible costs. Furthermore, it aims to estimate the economic cost of violence in Switzerland while specifically delving into the economic impact of domestic violence and intimate partner violence (IPV). Methods: We employ a comprehensive approach to categorize violence-related costs into three categories: (1) tangible direct costs; (2) tangible indirect costs; and (3) intangible costs. Within each category, we further classify costs based on the outcome of injuries, distinguishing between fatal and nonfatal violence. To estimate these costs, we use official crime data from the Federal Statistical Office for homicide and assaults. Recognizing the issue of underreporting in physical and sexual assault offenses, victimization surveys are employed to estimate the number of unreported cases. In the absence of Swiss data on the cost of injuries, the Centers for Disease Control and Prevention (CDC) provides estimates on medical costs, work loss costs, and the value of a statistical life (VSL)/quality of life loss costs. To ensure comparability, violence types are mapped, and costs are adjusted for purchasing power parity between the US and Switzerland. We also make adjustments to reflect the relative size of medical spending between the two countries. For comparison, we use prevalence rates of physical assault from Gallup. Using the same methodology, we also estimate the costs of domestic violence and IPV. Results: Our estimates suggest that the economic cost of violence in Switzerland is about USD 66.3 billion, equivalent to 8.3 percent of the country’s GDP, according to Swiss data. However, the costs could be as high as USD 73.4 billion, representing 9.2 percent of GDP, based on the Gallup World Poll data. Further, domestic violence alone accounts for at least 4.4 percent of Swiss GDP, while IPV accounts for at least 3.2 percent. Conclusions: Despite low Swiss prevalence rates of violence, the estimated costs of said violence are high. However, there is considerable uncertainty regarding our estimates due to missing Swiss data on medical and criminal justice costs, as well as the severity of injuries due to assault.

New York: NYU Center on International Cooperation, 2023. 36p

By Andrés Fernández Arauz , and Camelie Ilie

Costa Rica faces an unprecedented challenge in the form of escalating violence concentrated within specific regions of the country. This report delves into the country's administrative divisions, shedding light on its eighty-two cantons, where critical security data is localized. Recent statistics up to September 2023 underline a concerning situation. While violence in Costa Rica remains lower than the regional average for Latin America, it is the country in the region where violence has grown the most since 1995. Levels of intentional homicide have surpassed the threshold of 10 per 100,000 people, which makes it an epidemic in the country according to the World Health Organization’s classification. Moreover, while violence remains a localized issue, the number of cantons surpassing ten homicides per 100,000 inhabitants has increased, especially in coastal and border regions Much of this increase can be attributed to organized crime and the proliferation of illegal weapons, which is made clear by the fact that the cantons that saw the most increase in violence are territories through which the entry and transit of drugs occur in the region. Beyond homicide, non-lethal assault and intimate partner violence are issues that have their own effects in society. While official statistics put the rate of assault at less than one percent, survey data shows the number to be close to 4 percent, and evenly spread between men and women. Intimate partner violence affects 7 percent of adult women, and has increased over the last few years. These statistics add to a diminishing perception of safety, with 65 percent of the population reporting feeling that the country is not safe. For women, the feeling of unsafety is even higher, with 73 percent of female respondents expressing that they feel a high likelihood of being assaulted, compared to 57 percent of male respondents. Specific recommendations are delineated to counter these challenges. First, a thorough reevaluation and update of previous social programs is imperative. This evaluation should delve deep into identifying flaws in the existing programs. Such scrutiny enables timely corrections and reveals valuable lessons to be gleaned from previous work. Second, a regional focus for targeted interventions is proposed. By channeling efforts into the six cantons witnessing the steepest rise in homicides, particularly those strategically located along coasts and borders, Costa Rica can address the problems at their source. These areas often serve as primary entry points for drug trafficking, requiring concentrated and specialized interventions. Finally, an integrated strategy involving local, national, and international stakeholders is emphasized. Present programs often lack alignment and coordination to address recent violence patterns, emphasizing the need for cohesive collaboration. This strategy should foster a cooperative spirit between local governments, ensuring harmonized and effective efforts. These joint initiatives can significantly curb violence in specific cantons by integrating local insights with national expertise

New York: NYU Center on International Cooperation, 2023. 46p.

By Lester Ramirez Irias

This report seeks to understand how communities in El Salvador, Guatemala and Honduras build and sustain their resilience to extortion, especially in light of state-led anti-extortion measures under emergency regimes in El Salvador and Honduras. It examines how community resilience manifests in environments plagued by violence and organized crime, particularly where gangs operate alongside public security forces under emergency regimes or mano dura (‘iron fist’) policies. Through six case studies, the report explores the varying contexts of community resilience, the factors contributing to its development and long-term sustainability, and the communities' capacity to absorb the impacts of criminal governance, adapt, and transform their environments. The findings reveal a shifting risk landscape for communities. Under emergency regimes, while the incidence of extortion and homicides has decreased, there has been an increase in restrictions on fundamental rights and freedoms. These restrictions complicate community resilience, as the state – expected to provide public security and protect human rights – has become an enabler of impunity. The case studies highlight different forms of resilience, driven by diverse actors such as women victims of extortion, private sector organizations, and foundations promoting sports and community development. While not fully representative of each country, these case studies offer valuable insights into community resilience in high-violence and emergency contexts. Main findings § Emergency regimes have negatively impacted community resilience in El Salvador and Honduras. Each country has unique characteristics in how emergency regimes or ‘iron fist’ measures are implemented, driven by their respective governments. In El Salvador, community resilience is undermined by an emergency regime that has become entrenched as state policy, weakening communities' ability to resist and recover from threats. In Honduras, community resilience faces a dual challenge: criminal networks that once profited from extortion now operate legitimate businesses within communities, making it difficult to identify and manage threats. § Private sector-led initiatives are proving effective. Activities organized by the private sector, such as those by sugar associations in El Salvador and traders in Guatemala, have been effective in building and maintaining community resilience. The private sector’s ability to provide financial resources, along with its organization, leadership and influence over governments, has been crucial in reducing the risks posed by organized crime and transforming environments. However, as seen in the Honduras case study below, mistrust, fragmented initiatives and a highly uncertain context have hindered sustained collaboration between organized entrepreneurs and the police. § Organized sports contribute positively to community resilience. Participation in organized sports has been a key strategy for building resilience in the communities of La Bethania in Guatemala and Chamelecón in Honduras. Sports foster social cohesion by involving not only young people but also parents, coaches and other adults who serve as positive role models. It also offers young people a safe space and instils life values that extend beyond the playing field. § Corruption within the state significantly hampers resilience efforts. Corruption has a detrimental impact on the sustainability and effectiveness of community resilience initiatives. In El Salvador, for example, as extortion by gangs has decreased, police corruption has emerged as a new form of extortion. Unchecked corruption erodes public trust in institutions, allows organized crime to infiltrate state structures and excludes vulnerable groups such as women. § Sexual extortion and impunity obstruct the development of resilience. Under emergency regimes, sexual violence by state actors often receives institutional backing, with arbitrary detention threats becoming commonplace. Victims face severe psychological and social consequences, including stigma and revictimization. The normalization of sexual violence within communities exacerbates these issues, leaving women feeling unprotected and isolated. Mistrust of authorities and fear of reprisals further hinder the community’s ability to organize and respond collectively to such abuses.

Geneva, SWIT: Global Initiative Against Transnational Organized Crime , 2024. 25p.