Abstract
El Salvador, Guatemala, and Honduras rank among the top 10 countries experiencing violence in the world, despite not being at war. Although there is abundant literature on generalized violence in this “northern triangle” of Central America as a driver of out-migration to the United States, very little is known about the perspectives and experiences of youth who do not migrate. This study aimed to elicit the emic perspectives of youth residing in the region on how the day-to-day generalized violence produces a pervasive threat to the overall health and human security of youth as well as the key protective factors and resiliencies at work. We conducted two separate waves of qualitative research in 2015 and 2018 over a 6-month period, which included 60 in-depth interviews and six focus groups among Salvadoran, Guatemalan and Honduran youth living in urban areas. Qualitative thematic analysis revealed two meta-themes: (1) ‘Lack of health,’ defined as not experiencing peace within the family, the community, and the country’ and (2) ‘Resilience.’ Thematic clusters that reflect the first meta-theme are: (1) violence as a common occurrence; (2) living in fear and insecurity; (3) victimization; and (4) lack of state protection and services. Thematic clusters for the second meta-theme are: (1) a positive future outlook and a commitment to education; (2) transnational and local family network support; and (3) engagement in community-based youth groups. To interpret the findings, we adopt the Latin American Social Medicine and Collective Health (LASM-CH) approach that prioritizes perspectives from the region. Generalized violence is conceptualized as a systemic phenomenon that is generated and reproduced through the complex interactions of structural inequities and unequal power relations. The findings of this study provide new insights into the implementation of a different approach to address the generalized violence, insights that may guide multi-sectoral health policies and interventions both in the region and transnationally.
Highlights
The “northern triangle” of Central America, comprised of El Salvador, Guatemala, and Honduras, historically, has historically undergone political instability, state repression, and sustained violence due to civil war
We recognize that the sample is not generalizable to all youth in the “northern triangle’ of Central America, we provide a rationale for the eligibility criteria in the Methods section
The inclusion and empowerment of local youth, community actors, and leaders is essential for health interventions to successfully and sustainably address the generalized violence
Summary
The “northern triangle” of Central America, comprised of El Salvador, Guatemala, and Honduras, historically, has historically undergone political instability, state repression, and sustained violence due to civil war (in Guatemala from 1960–1996 and in El Salvador from 1979–1992). Central America is experiencing an epidemic of generalized violence—defined as widespread and large-scale violence that is affecting the civilian population at large. El Salvador, Guatemala, and Honduras consistently rank among the top 10 countries experiencing violence in the world, despite not being at war [1]. In El. Salvador alone, 20,000 individuals were killed from 2014 to 2017 [2]. 20,000 individuals were killed from 2014 to 2017 [2] Res. Public Health 2019, 16, 3465; doi:10.3390/ijerph16183465 www.mdpi.com/journal/ijerph
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