By Amy VanderZanden, special to Humanosphere
With wars taking place in several regions of the world right now, and regular news accounts of violent deaths in the United States, it seems like it would be easy to tally up the countries where people face the highest likelihood of dying from interpersonal violence.
By looking at a map of findings from the Global Burden of Disease one can see probabilities of death globally from different causes, ranging from cancers to car accidents. What might be surprising to some is that young adults in El Salvador have the highest probability of death from interpersonal violence in the world – and that Central Latin America, more than any other region, is the place where people are most at risk of being killed violently.
Probability of death from interpersonal violence among 15- to 49-year-olds, 2013
Source: Global Burden of Disease Study 2013. To explore the data visualization online, go to http://ihmeuw.org/30v6.
In El Salvador in 2013, the rate of deaths from interpersonal violence for adults ages 15 to 49 was 110 per 100,000 people. By comparison, among adults in the United States there were fewer than 10 deaths per 100,000, or about 12,605 deaths total, from interpersonal violence in 2013. This difference is enormous. If the United States had the same rates of violent deaths as El Salvador, more than 130,000 adults would have died from violence in 2013.
When we break down the major causes of death for Salvadorans, we see that, overall, men have a much greater likelihood of dying prematurely than women – and that violence (darkest green) outranks any other cause by a substantial margin.
Men in El Salvador are nearly four times more likely to die from violence than from transport injuries, and more than five times more likely to die a violent death than one due to mental and substance use disorders. By comparison, while violence is also a leading cause of death in Mexico, it only slightly outranks transport injuries and cirrhosis as the top three contributors to early death. As the graph below shows, tiny El Salvador experiences violence for men at a scale much greater (forest green bar) than even DR Congo. (Click on image to enlarge)
Probability of death among 15- to 49-year-olds in El Salvador, Mexico, U.S., DR Congo and elsewhere, 2013
This has not always been the case. In 1990, diarrheal diseases were the most significant contributor to El Salvador’s loss of health, causing over 200,000 healthy years of life lost that year. By 2013, diarrheal diseases, along with most other major infectious diseases, had dropped considerably in their contribution to the country’s disease burden – many to a fraction of their earlier size. The health loss from interpersonal violence, on the other hand, rose by over 50 percent during the same period.
We generally expect to see declines in the burden of infectious diseases in developing regions during the 1990s and early 2000s, and correspondingly, increases in the burden of chronic diseases, such as diabetes, cancer, or heart disease. But global health models don’t typically anticipate the pattern of growing interpersonal violence that we see in El Salvador. As steadily as the country has made progress against childhood diseases like diarrhea and lower respiratory infections, the burden of interpersonal violence has expanded to fill the space.
The burden of interpersonal violence in El Salvador, and Central Latin America generally, is worrying to many. It is thought that gangs and organized crime are major drivers of this kind of violence, and that drug trafficking is a major motivator. As the Global Burden of Disease collaboration provides more frequent updates to global estimates, we will be able to see whether policies to control violence have been followed by improvements in the health of people in El Salvador and elsewhere.