Domestic violence or abuse is any behavior, not just physical violence, that aims to gain power and control over a spouse, partner or  family member. Like many  behaviors in life, abuse is a learned behavior and not caused by common excuses such as anger, mental problems, drugs and alcohol. Major categories of abuse include Physical, Sexual, Emotional, Verbal and Economic Abuse. Domestic violence, like other manifestations of abuse,  can be classified under, or take the form of any of the above listed categories of abuse.

The major purpose of the abuser is to gain and maintain total control over the abused by instilling negative emotions such as fear, guilt, shame and intimidation. Threats, blackmail, blame, dominance, isolation, humiliation, emotional and physical violence are often used to achieve these means. Sometimes, abusers hurt people or things that are dear to the abused in order to keep them in the constant state of depression, pain and powerlessness. Clearly, these injuries and emotions that result from domestic violence affect health negatively.

Domestic violence and abuse do not happen in only certain groups of people, it occurs irrespective of people‘s characteristics such as age, gender, race, social class, and level of education. Also, it happens both in heterosexual and homosexual relationships and is not specific to any gender in particular. Hence, while women are more commonly victimized and physically harmed because men may be stronger, men are also abused—especially verbally and emotionally. The fact is, abuse or violence is never acceptable for whatever reason, whether it’s coming from a man, a woman, a teenager, or an older adult- everyone deserves to be safe and respected.

Most often, domestic abuse often begins with threats, emotional blackmail and verbal abuse, and then escalates to violence, which is the most obvious act. Despite not being as obvious as violence or physical injury, emotional and psychological forms of domestic abuse are as severe and damaging. Emotionally abusive relationships can destroy an individual’s self-worth, lead to anxiety and depression, and make one feel helpless and alone. No one should have to endure the pain and worthlessness that comes with such manipulation.

The first step to breaking free from an abuser is recognizing that there is a problem- that a relationship is abusive or has abusive potentials. Once the reality of the abusive situation is acknowledged, it then becomes easier for the abused individual to get the much needed help, which is usually available through many NGOs, government funded, community -based and charitable organizations.

There are several characteristics of an abusive relationship, the major one being the fear of one’s partner. Once an individual feels like there’s need to be overly cautious around their partner, either by constantly watching what they say or do, it is likely  the relationship is unhealthy and potentially abusive. Other signs of an abusive or potentially abusive relationship include: being belittled or controlled, humiliation, hyper-criticism, refusal to communicate, being ignored or excluded, extramarital affairs, use of sarcasm and unpleasant tone of voice, unreasonable jealousy, withdrawal of affection or money and guilt trips.

Before we talk about gender inequality, let’s first take a look at what gender is…

World Health Organization defines gender as the socially constructed qualities of women and men- such as norms, roles and relationships with people. These qualities vary from society to society and may depend on location, age, religion and other social or economic factors. Gender is different from sex; which is our anatomy as female, male, or intersex based on internal and external bodies including sexual and reproductive organs, genetic makeup, and hormones. When people are born into a certain society or community, they observe and are taught gender norms and behaviours peculiar to that group including standards on how to interact with people of the same or opposite sex, within households and work places.

Given that gender roles are set ‘standard observed in communities, individuals or groups that do not “fit” these established gender norms often face stigma, discriminatory practices or social exclusion, all of which negatively impact health. Most times, the roles of men and women are already “defined” in many societies. These gender norms, roles and relations can influence people’s susceptibility to different health conditions and diseases and potentially affect their mental and physical health and wellbeing. They also influence health outcomes and the likelihood of accessing health services due to fear of being judged.

In many societies, not just Africa, these gender roles put women at a disadvantage, creating wealth and consequently, health gaps between men and women. In Canada, the Center for Social Justice records that this gender gap is much wider than most people know, despite many years of trying and several efforts to close the gap. A few general facts and examples to buttress this point include:

• In many countries, while husbands can divorce their wives with much ease, wives’ access to divorce is often extremely limited.
• Women are poorer in may countries. For example: In Canada, poverty rates for women in general is as high as 20%; for women of colour and aboriginal women, it is 37% and 43% respectively. The percentages for men are lower.
• Women’s low income would constitute high risk of poverty in retirement and this can limit access to health care. Due to poverty, many female seniors may also not afford quality health care since retirement income is a function of lifetime earnings.
• Many countries still deny women the opportunity of going to school. We all know that education is a social determinant of health
• Many countries do not have laws to punish domestic violence, of which women are usually vulnerable to and victims of
• In countries like Egypt, Bahrain, Syria, Iraq, Libya, Jordan, Morocco, Oman, Yemen, and Saudi Arabia, decision to travel for women is completely at the mercy of the men.

In conclusion, gender inequality affects health like many other social determinants of health.

Engagement is a two-way process which involves any interaction and communication, with the goal of generating mutual benefit. It is a planned process where identified groups of people who are connected by geographic location, common interest, affiliation or identity, work together to address issues affecting their well-being. Depending on the situation, engagement is  used to broadly describe various interactions between people and may represent both one-way or two-way interactions including consultation, communication, education, public participation, participative democracy, partnership, information delivery, involvement and collaboration. These interactions lead to decision-making through empowered action in either informal groups or formal partnerships. Community is also used broadly to define various groups of people who may be stakeholders, interest groups, citizens, union members or colleagues. The term community may represent a geographic location (community of place), a community of similar interest (community of practice), or a community of affiliation or identity (such as industry or sporting club).

What is Community Engagement? Community Engagement is a means by which community members plan, work and learn as a united group on behalf of their communities in order to conceive and achieve present and future goals that are common to, and benefit the community at large. As Community Engagement increases, citizens progress from being just passive consumers of information to taking active leadership and decision making roles. Engaging as much members in a community as possible is a critical component of any work that will greatly impact that community in any way. It involves listening to the community’s needs through needs assessment, interviews, focus groups or surveys and then responding to address those needs using their feasible recommendations. Engagement increases unity and allows for the community to be responsible and have ownership over the outcomes of their decisions.

The major aim of engagement in any community is to foster inclusiveness, sustainability and ensure considerations and decisions are reflective of the diversity that exists within the community. These in-turn promote the quality of life, wellbeing and improve the health of the engaged and empowered citizens and enable them to take control of their health.

In the academic environment, community engagement describes the numerous ways in which the activities and benefits of research are shared with the public and community. It is a process that involves informing, engaging, partnering with, and empowering citizens about initiatives designed for them, in a collaborative manner so as to generate solutions and reach desired outcomes together. In politics and policy making, community engagement specifically relates to the role of government which involves mutual communication and deliberation that occurs between government and citizens. It is a bottom-up approach, rather than a dictated top-down approach, where the government ensures decisions are reflective of the input of citizens. Generally, community engagement takes different forms and covers a broad range of activities including:

• Informing the community of policy directions from government or intending partners
• Consulting the community as part of a process to develop policies, or build community awareness and understanding.
• Involving the community through a range of mechanisms to ensure that issues and concerns are understood and considered as part of the decision-making process.
• Collaborating with the community by developing partnerships to formulate options and provide recommendations.
• Empowering the community to make decisions and to implement, manage and sustain change.

Recession is defined as any significant continuing decline in activities across the economy of a country, industry or trade. Technically, recession is a normal part of the business cycle, despite being a major challenge. Many events precede a recession including one or more of the following: high interest rate, stock market crash, wage price controls, war, falling housing prices and sales, a slow down in manufacturing orders, deregulation, credit crunch, asset bubbles and deflation. The 2007-2009 global recession emphasized the precarious nature of investment strategies used by large financial institutions as well as the global nature of financial systems. The recession caused a significant setback for economies of virtually all the world’s developed and developing nations.

Within a country, a negative economic growth persisting in two consecutive quarters signifies the occurrence of an economic recession. A country’s economic growth is measured by it’s gross domestic product (GDP) which is the current market value of all goods and services produced within the country in a particular time period. Economic recession is therefore defined as a consecutive decline in a country’s gross domestic product (GDP) for two or more quarters. During an economic recession, everyone is impacted in various areas of life due to the many uncertainties that come with it. The most impacted group during this period remains the unemployed who are often impaired psychologically due to feelings of hopelessness.

The economy of a country shapes the cost of living and budget allocation including how much is assigned to healthcare and services. These factors can directly impact the health of the population by influencing the income value of the residents. Income, a socio-economic factor which is a social determinant of health, in turn influences the health and quality of life of these residents. Several studies across the globe have shown that recession influences health and health outcomes negatively.  Firstly, a study on the economic recession in Japan titled “Economic recession and health inequalities in Japan: analysis with a national sample, 1986–2001” found that self- reported health improved in absolute terms for all classes of residents after the economic recession. Another study in the United States recorded an increase in suicide rates in an estimated excess of 4,750 suicide deaths during the economic recession in 2012. Finally, a 2010 study in Spain showed that recession significantly increased the frequency of mental health disorders and alcohol abuse, particularly among families experiencing unemployment and difficulties in paying mortgage. It is notable that poor populations in all countries are usually the first and hardest to be impacted by any recession or downturn since recession is accompanied by increased cost of living.

In countries affected by an economic downturn the total health expenditure, public spending and private out-of-pocket expenses tends to decline. This reduction in total expenditure causes an increase in the cost of care, medicines and medical equipment. It also results in a negative impact on population health since reducing operating costs related to surveillance or supervision are likely to have immediate damaging effect on service delivery. Every recession would likely affect health directly or indirectly, depending on the cause, type, magnitude and how long it lasts. However, to limit the potential impact of economic recession on health, it is important to maintain the following:

• Active labour market programmes that support the unemployed as well as keep and reintegrate workers in jobs
• Increased family, parenting and social support programmes
• Control of alcohol price and availability
• Debt relief programmes
• Increased strength of social capital
• Accelerated mental health care reforms