Saúl Franco Agudelo

Violencia y salud en Colombia

La violencia en Colombia parece incontenible. A las masacres y asesinatos colectivos, de una crueldad desconcertante, se suman los secuestros y desapariciones, el maltrato de ninos y ancianos y las violaciones de adolescentes. Cada dia, sin tregua, los colombianos son espectadores o victimas de atracos callejeros y de discriminacion racial, sexual y socioeconomica. Sin quererlo, se convierten en agentes de agresiones en el transporte urbano, el hogar, la escuela y el trabajo. Colombia tiene las tasas de mortalidad por homicidio mas altas del mundo. Independientemente de la enorme sobrecarga institucional que impone a los servicios de salud y medicina legal, la violencia constituye actualmente en Colombia el principal problema de salud publica. Para hacerle frente, el sector de la salud debe elaborar politicas y financiar acciones; crear nuevos procesos de formacion de personal, poner en marcha procesos de educacion publica, y dedicar mayor esfuerzo y creatividad al campo de la investigacion, que hasta ahora ha dado respuestas importantes pero aun insuficientes. Al reflexionar sobre la violencia, que es la sustitucion de toda argumentacion por la fuerza, es necesario ubicarla en el contexto de la vida y la salud. No se pretende solo racionalizarla, y menos aun sustituir la accion por la palabra o por las reflexiones, sino tratar de comprenderla a fondo con el objeto de buscarle alternativas. En el presente articulo se analiza, con esta finalidad, el tema de la violencia en Colombia, principalmente desde el punto de vista de su efecto en la salud de los colombianos y de sus implicaciones para el sector sanitario. El autor expone sus puntos de vista con plena conciencia de su subjetividad y limitaciones.

Violence and health in Colombia

In Colombia, violence seems uncontrollable. Along with massacres and group killings of astonishing cruelty, there are also kidnappings and disappearances, abuse of children and the elderly, and rape of young adolescents. Every day, without respite, Colombians are witnesses or victims of street crimes as well as racial, sexual, and socioeconomic discrimination. Unwillingly, they become agents of aggression in public transport, at home, at school, and at work. Colombia has the highest rates of mortality from homicide in the world. Apart from the enormous institutional burden that violence imposes on the health services and forensic medicine, it now constitutes the principal public health problem in the country. To confront it, the health sector must develop policies and finance actions, develop innovative ways to train personnel, implement public education processes, and devote more effort and greater creativity to research, which up to now has provided some important, albeit insufficient, responses. Violence, which is the substitution of force for any type of dialogue, must be considered within the context of life and health. Doing so is not an attempt to rationalize violence, much less to substitute words or reflection for action, but rather an attempt to understand it in depth in order to search for alternatives. With that goal, this article analyzes the subject of violence in Colombia, principally from the perspective of its effect on the health of the citizens and its implications for the health sector. The author fully recognizes the subjectivity and limitations of the views he expresses herein.

Caracterización sociodemográfica de los suicidas adultos mayores de 60 años: Bogotá 2003-2007

OBJECTIVE To identify the major epidemiological and sociodemographic characteristics of suicidal adults over 60 years old in Bogotá between the years 2003 and 2007. METHODOLOGY A descriptive-retrospective study was performed, mainly using information obtained from necropsy reports (n=98), taking into account selected epidemiological variables. The data were systematized using Epi-Info 6.04 software, and were analyzed using contingency tables. RESULTS Suicide victims of this population group are primarily male, having one of the highest suicide rates with respect to the whole population. The presence of chronic and disabling diseases was reported among the main motivations for suicide in males, while for women it was the presence of a mental disorder and/or loss of a loved one. Having family support did not affect suicide rates. The locality that had the highest suicide rates was the district of Los Mártires, and there was no direct relationship between poverty rates or health insurance and the presence of the phenomenon. CONCLUSIONS Although there has been a decrease in suicide rates for the population over 60 years old since 2003, suicide in elderly people remains a predominantly male phenomenon and an important public health problem. Due to its complexity in terms of multiple causes and multidimensionality, the protective and risk factors are just aspects to consider in terms of understanding the phenomenon and its prevention.

Artículo originalCaracterización sociodemográfica de los suicidas adultos mayores de 60 años: Bogotá 2003-2007Sociodemographic Characterization of Suicidal Adults Over 60 Years Old: Bogotá 2003-2007?

OBJECTIVE To identify the major epidemiological and sociodemographic characteristics of suicidal adults over 60 years old in Bogotá between the years 2003 and 2007. METHODOLOGY A descriptive-retrospective study was performed, mainly using information obtained from necropsy reports (n=98), taking into account selected epidemiological variables. The data were systematized using Epi-Info 6.04 software, and were analyzed using contingency tables. RESULTS Suicide victims of this population group are primarily male, having one of the highest suicide rates with respect to the whole population. The presence of chronic and disabling diseases was reported among the main motivations for suicide in males, while for women it was the presence of a mental disorder and/or loss of a loved one. Having family support did not affect suicide rates. The locality that had the highest suicide rates was the district of Los Mártires, and there was no direct relationship between poverty rates or health insurance and the presence of the phenomenon. CONCLUSIONS Although there has been a decrease in suicide rates for the population over 60 years old since 2003, suicide in elderly people remains a predominantly male phenomenon and an important public health problem. Due to its complexity in terms of multiple causes and multidimensionality, the protective and risk factors are just aspects to consider in terms of understanding the phenomenon and its prevention.