Scripta Consulting LLC

1600 S. Federal Hwy, Suite 500

Pompano Beach, FL 33067

AFFIDAVIT - TRANSLATION

This is to certify that I, Isadora Falcão Quadros da Silva, enrolled at the Ordem dos
Advogados do Brasil - Seccional Rio de Janeiro (OAB/RJ) under the number 201.504,
am fluent in the English and Portuguese languages and competent to do translations
from and to these languages. I also declare that, to the best of my knowledge and belief,
the following English language translation, Book Chapter - Homicides and Aggressions
is a true, accurate, and complete translation of the attached copy of the Portuguese
language document, Capítulo de Livro - Homicídios e Agressões.

Translated by:

Isadora Falcão Quadros da Silva

Rio de Janeiro, April 15, 2021

 Maria Cecília de Souza Minayo
Simone Gonçalves de Assis
Organizers

NEW AND OLD

FACES OF VIOLENCE
ON THE 21st CENTURY
A view of Brazilian literature in the health field
 3
Homicides and Aggressions
the most evident faces of violence

Ednilsa Ramos de Souza, Adalgisa Peixoto Ribeiro,

Tiago Oliveira de Souza, Carlos Augusto Moreira de Sousa,
Francisca Letícia Gadelha Cardoso and Tauanne do Nascimento Santos

This chapter encompasses the analysis of Brazilian production on homicides/aggressions

within the health field, published in the form of articles, dissertations and theses between 2001 and
2013.
The phenomena discussed here are socio-historical and take place within interpersonal
relations through an intentional aggression which employs different means to inflict injuries and cause
the death of other people. They are characterized as an expression of violence and and emerge in
health indicators as specific morbidity and mortality causes (Minayo & Souza, 1993; Franco, 1999;
Minayo, 2006a). Therefore, based on those events, the gravity of the violent situation in a specific
context can be understood.
In this chapter, fatal intentional injuries are denominated as homicides and the non-fatal
injuries, aggressions or attempted homicides. They account for a serious public health issue in Brazil
and the world, especially in medium and low-income countries, where the death rates are high and
growing. As it is a phenomenon that occurs particularly among the young population, homicides have
an effect in the structure of the demographic pyramid and in the direct and indirect costs to several
sectors of society (Vermelho, Costa & Kale, 2009; Peres, 2014).
Nowadays, homicides are the third major cause of death among men between 15 and 44
years old in the entire world. In Brazil, it takes the first place in young people’s deaths. And the
aggressions, when not fatal, result in fractures, hemorragies, neurological damages, physical and
psychological traumas which encumber health services throughout different levels of attention (Peres,
2014; OMS, 2015).
In 2012, the number of homicide victims worldwide was 474,837 and the medium and
low-income area of the Americas presented the highest rates by 100,000 people, when compared to
the other regions in the world (OMS, 2015). In Brazil, in 2013, there were 56,804 deaths by homicide
and a total of 51,744 hospitalizations for aggression. In 2015, the cost of hospitalizations was higher
than 61 million reais (approximately 15 million dollars) at the public health service (Datasus, 2016).
The damages, lesions, traumas and deaths caused by aggression/homicide also affect those
indirectly involved, like family, friends, acquaintances - with harms to individual and collective health.
They also generate economic losses, such as lost years of productive life, absenteeism at work and
feelings of fear and insecurity among society (Brasil, 2005d; Minayo, 2006a). That way, homicides
and aggression are considered to be universal indicators of the quality of social ties and life conditions
in contemporary societies (Franco, 1997).
As the health sector must treat the direct and indirect victims, including the perpetrators of the
aggressions/homicides, its professionals need to be properly trained to work in an articulated manner
within an inter-sectorial network aiming full assistance, prevention of future harm and the promotion of
environment favorable to the quality of life.
Bibliographic review studies on the subject of the effects of violence in health were performed
in two moments by researchers at Claves (Department of Studies on Violence and Health Jorge
Careli). The first, non-exhaustive, was developed by Minayo (1990); and the second, much more
complete, encompassed research within several databases and public health libraries all over the
country, organized by Minayo and Souza (2003). On the first review, the object of the analysis was the
production up to the year 1990, having been observed that most works had been published during the
1980s (86%). The studies which have composed that analysis discussed mostly violence, accidents
and death at work (35 texts) as well as suicide attempts, ideations and actual deaths (32 documents).
On that occasion, the authors have pointed out that homicides, despite emerging as a notable issue to
be researched due to the growing trend of its indexes, had been the object of one single study,
although several papers simultaneously discussed all of its so-called external causes.
The second assessment, on its turn - published in 2003 and conducted by Minayo and Souza
- found 46 texts on homicides and their attempts, of which 13 were published in national periodicals
and 33 international magazines, always on the Brazilian situation. Most of the texts in Portuguese
were from the collective health area, bringing epidemiologic and sociological analyses based on
secondary data through the application of georeferencing techniques and spatial distribution of the
events. The authors comment that only one of the studies discussed the issue of the perpetrator, and
even so, through a psychopathy perspective; few of them discussed homicide in an articulated and
inter-sectoral manner, and almost none proposed suggestions of preventive actions. Some articles,
however, pointed out the need for actions to protect young and low-income people.
As for what has been published in international magazines, Minayo and Souza (2003)
identified 14 (42.4%) articles on mortality by homicide, 17 (51.5%) on morbidity by aggression and two
(6.1%) simultaneously on deaths and attempts. Over the group of documents, 17 were classified as
descriptive and 15 as analytical. Many of those papers discussed the aggressions and attempted
homicides in school and family environments. As for the latter, with emphasis on women’s
victimization. In studies that discussed domestic violence, it is noticeable the association between
harms and drug and alcohol consumption. A subject barely discussed in the texts was the violence
against the elderly, as opposed to the emphasis on young male people living in peripheral areas,
identified as the main victims of homicide.
In the present analysis, we seek to verify the advancements, trends in the studies and the
gaps in relation to the previous papers in the health field, through a review of the years 2001 to 2013.

METHOD

We performed a bibliographic review of the Brazilian scientific production in the health field on
the subject homicide/attempted homicide/aggression. In order to obtain the articles, we used the
following databases: BVS, Lilacs, Scopus, Pubmed and Web of Science. For theses and dissertations
we used the Digital Brazilian Library of Theses and Dissertations (BDTD) and the Public Health
Theses Portal. As for Scopus, Web of Science and BDTD - multidisciplinary bases - the results were
filtered for the health field. The investigated timeframe was the period between 2001 and 2013. The
search was performed according to Portuguese labels and their English equivalents, considering the
title, abstract and keywords.
Using the labels homicide, murder and massacre, we performed our first search, crossed with
the terms violence, attack behavior, aggressiveness, aggression and atrocities, which returned 222
documents. On that stage, we observed the existence of many documents concerning other subjects
and the lack of studies known by the authors of this review. For that reason, we performed a second
search adding new labels: homicidal, killing, violent death, mortality, intentional death, intentional
death by violence, slaughter, sharp object, cold weapon, fire arm, negligence, abandonment, edged
object, blunt object, sexual aggression, physical strength, strangling, beating, homophobic crime,
homophobia, LGBT, criminal violence, drug trafficking, drugs, legal intervention, bullying,
cyberbulyying, violent crime, infanticide, feminicide, rape, parricide, racism, racist, social violence,
discrimination, racial discrimination, prejudice, racial prejudice. Those new labels assessed were also
crossed with: violence, attack behavior, aggression, aggressiveness and atrocities. This second
search returned 1,005 works. In the end, after cleaning the data, the documents left were the 297
analyzed here. We included the articles published by Brazilian authors in specific national and
international scientific periodicals of the health field or those which made it explicit in their scope that
they accepted this kind of paper. Through a double check, duplicated documents were excluded, as
well as those which employed the term injury without referring to any violent events, articles in
periodicals outside the health field, reference works such as manuals and informatives and
dissertations and theses presented in graduate programs in other fields. In order to enforce the
inclusion and exclusion criteria it was necessary, in several moments, to verify the full text and
analyze the variables of interest for this study not informed in the abstracts.
In order to classify the 297 documents, we organized a list with the title of the paper, author
name, abstract, keyword, title of the periodical, country and year of publication. For dissertations and
theses we also collected information on the language, level of the degree, if a master’s or a Ph.D, the
institution and year of presentation, using the bibliographic management software EndNote. The list of
documents organized within the software has been exported to a Word 2007 format text file and the
entire collection was classified according to variables of interest for the present analysis, with the
creation of an Excel database. Within this categorization were taken into account the type of
production, year of publication or presentation of theses and dissertations, morbidity or mortality, the
lesion or death described as the conclusion or consequence of other events, the area encompassed
by the study, the area of knowledge of the article/periodical/graduate program, the research type and
design, the analysis methodology, the nature of the violence, the focus group, the condition of the
group or person in study and the subject axis of the paper.
In order to identify the inclusion of some important variables in the study of homicides, we
analyzed sex/gender, race/color/ethnic group, social class/layer, mental health and inter-sectoriality,
public policies and human rights, denominating those terms as transversal variables.
Aiming to assemble the papers in larger subjects, we defined thematic axes: 1) historical,
political, social and legal landmarks; 2) social inequalities and territorial analyses (employability
situation; social and economic differences; vulnerabilities; and peripheral areas); 3) race/color; 4)
descriptive analyses (description of the absolute and relative frequency of medical records, medical
care and information system data); 5) epidemiological analyses (time-series studies on morbidity and
mortality rates; on trends; on georeferencing and spatial analyses); 6) violence perceptions; 7) health
issues, traumas and sequelae resulting from aggressions; 8) trafficking/use of alcohol and other
drugs, substance abuse, drug dealing with homicide as an outcome; 9) crimes of passion between
intimate partners; 10) crimes among relatives; 11) homophobic and transphobic crimes; 12) reports of
resistance with death by legal intervention (homicides or attempted homicides perpetrated by
representatives of the State, such as police officers, city guards and others); 13) violence in the media
(analysis of cases, pieces and stories); 14) mental disorders (disorders, illnesses and issues triggered
by traumatic events) and; 15) bibliographic review, systematic or not, on the subjects in focus.
It is important to mention that some papers might be classified within more than one axis.
However, they were fit into the category in which they stood out the most and were considered to be
the most relevant by the authors of this review. The data were tabbed with the software Statistical
Package for Social Science (spss) version 19.0 for Windows and analyzed through absolute numbers
and relative frequencies, as they are presented throughout the written text and in the tables.

CHARACTERIZATION OF PRODUCTION

Out of the 297 documents analyzed here, 206 (69.4%) are articles, 59 (19.8%) are
dissertations and 32 (10.8%) are theses. The scientific production has grown especially from 2005 on;
45.1% of the texts were produced between 2005 and 2009; 40.8%, between 2010 and 2013. These
two intervals encompass almost the entirety of the productions, since between 2001 and 2004 the
published documents stand for a 14.1% proportion (Table 1).

Table 1. Distribution of Brazilian scientific production on homicide, published between 2001-2013,

according to the period of publication
 Year of Publication Number Percentage

2001-2004 42 14.1

2005-2009 134 45.1

2010-2013 121 40.8

Total 297 100.0

Out of a total 291 documents, 61.5% focused on mortality, 20.6% on morbidity - that is,
attempted homicide - and 17.9% discuss both events. There is no information about those variables in
four texts and that point does not apply to two of them.
Out of the 179 papers which focus on mortality by homicide, 72.6% are quantitative studies,
52.6% are from the public health field, 20.1% in epidemiology and 12.3% in medicine. Over half of the
studies contemplate the general population (52%) and a small percentage focus solely on the young
population (11.2%).
Out of the 60 papers on morbidity by aggressions, 78.3% are quantitative. The areas of
knowledge in which most studies are focused are medicine (38.3%) dentistry, (23.3%) and public
health (18.3%). A great part of the texts focus on the general population (63.3%), followed by studies
about children and adolescents (18.3%).
Out of the total, in 245 texts it is possible to identify in which form lethal aggressions and
non-lethal lesions and traumas resulting from them are considered. That way, 135 (55.1%) studies
have discussed it as an outcome of other problems taken as the object of the study, that is, the
lesion/death as an outcome, for example, of discrimination, homophobia; 110 (44.9%) papers have
examined aggression/homicide as a central object of the study, that is, the independent variable or
previous to the lesion, trauma or death. In 14 documents it was not possible to obtain such
information and in 38 it did not apply.
Out of 268 documents in which there was information on the area covered by the study,
77.3% refer to local data or information, 11.6% have a countrywide focus, 7.8% analyze regions and
3.3% are the result of multinational research. In 10 documents there is no such information and in 23,
the exploration of this variable did not apply.
According to table 2, public health, medicine, epidemiology and psychology are the areas of
knowledge which focus the most on the subject of homicide. Together they assemble 88.9% of the
papers. Dentistry and nursing have a smaller number of productions, followed by occupational therapy
and pharmacy.

Table 2. Distribution of Brazilian scientific production on homicide, published between 2001-2013,

according to the area of knowledge of the article, periodical and graduate program

Area of Knowledge Number Percentage

Public Health 123 41.5

Medicine 64 21.5

Epidemiology 41 13.8

Psychology 36 12.1
 Dentistry 15 5.1

Nursing 7 2.4

Occupational Therapy 1 0.3

Pharmacy 1 0.3

Others 9 3.0

Total 297 100.0

Out of the 273 documents in which it was possible to obtain information on the type of study,
77.3% (211) use a quantitative approach, 17.2%, a qualitative methodology and 15 (5.5%) have
triangled the methods. In seven documents this variable is not informed and in 17 it does not apply,
since those consist in reviews, editorials, brief discussions, essays, amongst others.
Within the 280 works in which it was possible to identify the analysis methodology, a
significant share (83.6%) uses a descriptive method and only 16.4% apply analytical techniques. In
nine texts there is no information available on this variable and in eight cases it does not apply.
The subject axes which guided the studies were analyzed and are presented on Table 3. The
studies by descriptive and epidemiological analyses of homicide data account for half of the papers.
The texts on health issues and sequelae resulting from aggressions, those focusing on social
inequalities throughout specific territories, as well as those analyzing violence perceptions appear with
relative frequency. All of the other axes present themselves in proportions lower than 5%, even
though they constitute a very wide range of subjects.

Table 3. Distribution of Brazilian scientific production on homicide, published between 2001-2013,

according to subject axes

Subject Axes Number Percentage

Descriptive data analyses 89 29.9

Epidemiologic data analyses 62 20.8

Health problems/Sequels resulting from aggressions 32 10.8

Social inequalities/Territorial Analyses 23 7.7

Violence perception 21 7.1

Trafficking/Use of alcohol and other drugs 13 4.4

Violence in the media 13 4.4

Bibliographic Review 9 3.0

Passion crimes between intimate partners 7 2.4

Race/Color 7 2.4

Mental disorders 8 2.7

 Reports of resistance/Deaths by legal intervention 5 1.7

Crimes among relatives 3 1.0

Historical, political, social and legal landmarks 3 1.0

Homophobic Crimes 2 0.7

Total 297 100.0

With regard to the nature of the violence in study, it can be seen in Table 4 that, out of the 286
documents in which this information was available, almost all of them (97%) focus on physical
violence. Psychological, sexual and institutional aggressions are still scarcely discussed by
academics. This finding shows how much it still predominates in the field the definition of violence
associated with physical damages and traumas and the lack of knowledge of their psychosocial
consequences, which is a result of the biomedical view of health. Two papers do not inform the nature
of the violence investigated and in nine this variable does not apply.

Table 4. Distribution of Brazilian scientific production on homicide, published between 2001-2013,

according to the nature of the violence

Nature of violence Number Percentage

Physical 277 97.0

Psychological 5 1.7

Sexual 3 1.0

Institutional 1 0.3

Subtotal 286 96.3

Not informed 2 0.7

Does not apply 9 3.0

Total 297 100.0

The analysis of the material collected according to the focus group showed that almost 60%
of the studies concern the general population, as it can be seen on Table 5. Other agents like
child/adolescent, woman, young person and young man had much lower frequencies.
The analysis of the production, according to the life cycle, shows that 32 papers focus on men
and women regardless of age range: 30 of them focused on young people; nine, the adult group and
two, elderly people. Considering the texts which evidence one sex or the other, there were 28 studies
taking the woman as a target-group and 23 focusing on the male situation.
It is important to point out that, among the studies which focus on women’s homicides, only
one refers to young women, while 12 discuss young men. The adult woman is the focus of five papers
and only one discusses the adult man. However, the elder woman is not the object of any texts. It is
noticeable the small participation of papers that analyze the situation of adult and elderly men, as well
as the elderly in general. Ten documents do not detail their focus group and for 25 of them this
information does not apply.
Table 5. Distribution of Brazilian scientific production on homicide, published between 2001-2013,
according to the focus group

Focus Group Number Percentage

General Population 156 59.5

Child/Adolescent 33 12.6

Young Person 17 6.5

Young Man 12 4.6

Young Woman 1 0.4

Adult Person 3 1.1

Adult Woman 5 1.9

Adult Man 1 0.4

Elder Person 1 0.4

Elder Man 1 0.4

Woman 22 8.4

Man 10 3.8

Subtotal 262 88.2

Not informed 10 3.4

Does not apply 25 8.4

Total 297 100.0

Out of the 280 texts in which it was possible to analyze the condition of the studied group or
person, the great majority (87.1%) identifies them as victims. Only in 12.9% the person studied
appears as the perpetrator of the violence. In four papers, this information is not described and in 13 it
does not apply.
The fact that the issue of violence perpetrators has been discussed in 37 articles is a step
forward in homicide studies, since on a previous assessment, Minayo and Souza (2003) identified
only one text on the subject.
Transversal matters were also analyzed in order to verify if the Brazilian scientific production
in the health field has been including them. That way, we have investigated in what measure the
variables sex and gender are contemplated. Out of the 296 papers containing sex information, 60.8%
take this variable into account in their analyses. The analyses that integrate the relational concept of
gender are much less frequent. Out of the group of texts, only 13.9% make the concept explicit in the
title, abstract or as keywords (Table 6).

Table 6. Distribution of Brazilian scientific production on homicide, published between 2001-2013,

according to sex and gender
 Sex Gender
Sex/Gender
Number Percentage Number Percentage

No 116 39.2 255 86.1

Yes 180 60.8 41 13.9

Subtotal 296 99.7 296 99.7

Not informed 1 0.3 1 0.3

Total 297 100.0 297 100.0

The concept of gender appears more frequently in the studies on domestic violence against
women (Blay, 2003; Reichenheim et al., 2011a; Labronici, 2012; Rodrigues et al., 2012) and in
quantitative studies on mortality focused exclusively on women or men (Souza, 2005; Santos,
Guimarães & Araújo, 2007; Dualibi et al., 2007; Silva, L.S., et al., 2011). Few papers discuss
feminicide or murders resulting from the exercise of power by men over women (Campos et al., 2011;
Meneghel & Hirakata, 2011; Meneghel et al., 2013); the influences of patriarchal culture over ways of
dying, usually marked by symbols and power positions that characterize sexism (Sant’anna & Lopes,
2002; Endo, 2009; Santiago & Coelho, 2010); and homicides within LGBT population (Rolim &
Rodrigues, 2013; Fernandes, F.B.M., 2013). One of the studies discusses the variable sex as a
synonym for gender (Sobreira et al., 2002).
We also seeked to investigate, within the scientific production on aggression and homicide,
studies that included classifications by race/color/ethnic group. Out of the 282 documents
contemplating this variable, only 36 (12.8%) take it into consideration when analyzing the data. In 15
documents there is no such information.
Other transversal subjects considered in the analysis of the collection researched are mental
health, social class/layer, inter-sectoriality and public policies, of which results can be seen on Table 7.
It can be noticed that health or mental disorders appear as a transversal subject in 46 (15.5%)
out of the 296 documents, with valid information for such a variable. The diversity of approaches on
the subject is detailed as follows:
● Studies that focus on the perpetrators of homicide, showing an association between violence
and mental disorders (Andreoli et al., 2009); the experience of a multidisciplinary psychiatric
team when supervising an infanticide suspect, admitted to a psychiatry infirmary (Scherer &
Scherer, 2007); analysis of the psychological impacts over the perpetrator of a homicide who
survived the subsequent suicide attempt and of the features of perpetrators of this type of
crime, as it is the case of depression and the use of psychoactive substances (Sá & Werlang,
2007; Bins, Döler & Teitelbaum, 2009); differences between crimes, including homicide and
aggressive and rage constructs in inmates (Ferreira & Capitão, 2006); profile of the inmates
at a judicial psychiatric hospital according to psychiatric diagnoses, previous treatments and
type of crime perpetrated (Garbayo & Argolo, 2008); presentation of a semistructured
interview model directed to inmate populations used at forensis psychiatry (Jozef & Silva,
2002); features of the several disorders, such as the anti-social personality and psychopathy,
with emphasis on serial killings, filicide, matricide and parricide (Morana, Stone and
Abdalla-Filho, 2006; Rigonatti et al., 2006; Schmitt et at., 2006; Valença et al., 2009, 2001;
Gomide et al., 2013); and mental flexibility in the solution of problems in individuals who are
doing time for second-degree murder in a correction facility (Del Pino & Werlang, 2008).
● Studies on victims of lethal violence: use of psychoactive substances, treatment experiences
and mortality of crack users (Ribeiro et al., 2007; Dias, A.C. et al., 2008, 2011).
 ● Studies on indirect victims of homicide: following families and close people who experience
grief generated by the loss of a relative/friend (Domingos & Maluf, 2003; Pascoal, 2012); and
transformations in feelings, social relations and the support social network of families who lost
young people by violent deaths (Domingues & Dessen, 2013).
● Violence as a psychosocial factor interfering in the development of psychiatric issues
(Vasconcelos et al., 2005).
The variable social layer or class appears in 62 (21.6%) out of the 287 documents, ten of
which were excluded due to their lack of information. Such concepts are present in the studies that
analyze the spatial distribution of young people mortality indicating that the high rate of homicides in
some regions is influenced by the social condition of poverty (Gawryszewski & Costa, 2005; Kilsztajn
.et al., 2005; Costa, Ludermir & Silva, 2009; Andrade, L. et al., 2012; Duarte et al., 2012; Mansano et
al., 2013). Several papers reaffirm that people of black ethnicity and low socioeconomic level have
higher chances of dying by homicide (Bastos et al., 2009; Belon, Barros & Marín-León, 2012) and this
risk is increased for groups without material life conditions (Viana et al., 2011).
On this subject, a rather particular argument by Briceño-León (2012) stands out, that
institutionality has a greater explanatory power in the reduction or increasement of mortality by
homicide than poverty or inequality, which was also found on a paper by Minayo and Constantino
(2012), showing the weight of informality (in all of its aspects) for the production of such a
phenomenon. Ruotti and contributors (2009), on their turn, point out that the serious human right
violations, such as victimization by the police, lynching and summary executions are more bluntly
directed to the population with worse life conditions. Zunino, Souza and Lauritzen (2008) conclude
that the profile homicides perpetrated with firearms in Brazil is a result not only of social violence and
high levels of inequality but also the emergence, expansion and strengthening of several armed
groups in the Country.
Lettiere (2010) discusses that the context and the social condition of women in violent
situations has a significant influence over the confront of the problem. For this author, each
individual’s interpretation for the possible ways to alleviate their suffering is related to their social
condition in a specific context.
Inter-sectoriality, crucial in the discussion of such a complex problem as homicide and its
attempts, has been mentioned in 84 (28.4%) out of the 296 texts analyzed (one document which did
not bring such information has been excluded). We distinguished the papers which analyze data from
different sources and sectors and reaffirm the need to understand contemporary forms of violence as
a transversal subject for public policies, since their discussion implicates several agents, such as
those in the health and public safety fields (Bonamigo et al., 2011). Some investigations simply point
out that their results reinforce the need for integrated policies for the control of such violence (Campos
et al., 2011; Belon, Barros & Marín-León, 2012); others emphasize that the object of the study
requires an analysis that brings together several fields of knowledge in order for prevention and
intervention propositions to be formulated (Estevam, 2011) (Table 7).

Table 7. Distribution of Brazilian scientific production on homicide, published between 2001-2013,

according to some transversal variables analyzed

Transversal variables Number Percentage

Mental Health

No 250 84.5

Yes 46 15.5

Subtotal 296 99.7

 Does not apply 1 0.3

Total 297 100.0

Social class/layer

No 225 78.4

Yes 62 21.6

Subtotal 287 96.7

Not informed 10 3.3

Total 297 100.0

Inter-sectoriality

No 212 71.6

Yes 84 28.4

Subtotal 296 99.7

Not informed 1 0.3

Total 297 100.0

Public policies

No 232 78.4

Yes 64 21.6

Subtotal 296 99.7

Not informed 1 0.3

Total 297 100.0

Finally, public policies and human rights are discussed in 64 (21.6%) of the papers. Some of
them analyze female mortality by aggression after the enactment of the Maria da Penha Act (Amaral,
Amaral & Amaral, 2013). Others mention public policies that focus on violence against women (Blay,
2003).
Some studies mention, generically, that their findings are able to subsidize policies in the
public health field (Gawryszewski, Mello Jorge & Koizumi, 2004; Andreoli et al., 2009). Others, within
their conclusions, highlight the importance of the knowledge produced as a support for preventive
policies (Santos, S.M. et al., 2001; Viana et al., 2011; Malta et al., 2012b). Few of them, however,
analyze the legislation and policies dedicated to violence reduction and gun control (Macinko &
Souza, 2007; Souza, E.R. et al., 2007).
Social and public safety policies are made clear in a study which analyzes the decline in
homicide rates in the city of São Paulo. The authors conclude that demographic alterations, economic
acceleration, investments in social policies and changes to the public safety policies have had
significant influence over the reduction in the mortality rates by violence in the city (Peres et al.,
2011a). Special attention is paid to several authors to the need to prioritize young people through
violence prevention public policies, aiming to consolidate democracy and in inclusion in human rights
(Souza, E.R. et al., 2012a). The assessment of the implementation of policies is a scarcely discussed
matter within the collection of transversal-type papers: the meeting of the goals of the Dry Law (Lei
Seca) is analyzed by T.A. Martins and contributors (2013) in relation to the aggressions involving the
use of alcoholic beverages.
The publications around the subject of human rights understand public safety as a
fundamental right that must be enforced within the many different management instances (Bonamigo
et al., 2011). They also highlight the mismatch between the growing complexity around the
circumstances of the homicides and the legal practices and procedures established for their
investigation (Zilli & Vargas, 2013).
Even though the National Policy for the Reduction of Morbimortality by Accidents and
Violence has the homicide as a priority subject in its guidelines, none of the papers mentions this
policy within the health area as a compass for actions of attention and prevention to these events.

FINAL COMMENTS

By comparing the present research to the two previous reviews, a notorious growth in the
production on the subject of homicides and aggressions can be observed. That is expressed through
the increase in the amount of published papers (46 studies between 1990 and 200 and 302 between
2001 and 2013) and the refinement in the methodological approaches. However, it is important to
point out that most studies are still the result of secondary data and descriptive quantitative
approaches. Some authors just mention, without going deeper on transversal subjects crucial for
understanding the phenomenon, such as race/color/ethnic group, inter-sectoriality and public policies
for homicide prevention and reduction as well as the high level of social exacerbation existing in the
Country.
The six-time growth in the analyzed production can be partially explained by the inclusion of
works that do not have homicides as their main focus, but somehow discuss them as an outcome or
consequence. However, the exclusion criterion for studies published in fields other than the health one
indicates that there are much more papers on aggressions and homicides than the ones here
analyzed.
Public health, medicine, epidemiology and psychology are the areas of knowledge that most
discuss the subject, being responsible for the greatest part of the scientific production studied here.
Nevertheless, when compared with the previous reviews, the present analysis shows greater diversity,
since it also encompasses papers from the dentistry, nursing, occupational therapy and pharmacy
fields, even if in smaller proportions.
The low frequency of texts focusing on young people is surprising, since homicides constitute
the main cause of death for this socio-age group throughout the entire reviewed period. Out of the
thirty documents which have this demographic as their focus, most of them are composed by
quantitative studies that analyze data by information systems on mortality and place young people as
the main target group of homicides (Minamisava et al., 2009; Silva L.S. et al., 2011; Andrade L., et al.,
2012; Souza, E.R. et al., 2012b; Mansano et al., 2013). Others focus on the general population, but
emphasize the excessive mortality of young people (Lima et al., 2002, 2005; Arnold et al., 2007;
Lozada et al., 2009). Others, on their turn, mention the high lethality rates among young people only
in the introduction to their papers, without focusing on this group as an object of their study or
mentioning them in the results, as it is the case for Zilli and Vargas (2013). One of the articles
specifically discusses risk factors for violent confrontations between young people (Câmara, Sarriera
& Carlotto, 2007).
In a qualitative study, Martins and Pillon (2008) point out that they have not found a
connection between the use of drugs and homicides. And an ethnographic work has shown the
repercussions of the deaths of young people in their families, colleagues of the same community and
the perpetrator (Santos, J.E.F., 2007). The thesis by Lico (2009), who studied youth and ways of
preventing violence in two vulnerable areas in the city of São Paulo ponders that young people do not
have the role of protagonists in public policies. Those who dropped out of school have no access to
other government actions, usually fragmented and unarticulated. Also, the protection network for such
a vulnerable group is diffuse, schools do not usually handle violence situations properly and other
entities which work with them prefer assistential practices.
Something new in the agenda of health researchers is the subject of homophobic crimes,
even if the literature on them is scarce, present in only two documents. In that regard, J.M. Oliveira
(2012) points out that, identified in the association or use of drugs and passion crimes, homophobia is
one of the main reasons for murders of the LGBT population. Aggressions perpetrated against trans
people often result in death with cruelty features and punctuated by the impunity of its perpetrators
(Guimarães et al., 2013). The paper by Rolim and Rodrigues (2013) shows the criminalization of
homossexuals through the analysis of how a homicide charge has been conducted in court. And
Castro (2008) points out the dynamics of violence manifestations within homoerotic relationships and
the meaning of those actions for the individuals involved (Castro, 2008).
Within some points there are still significant gaps in the production of knowledge. There is a
need for refinement in the characterization of youth; for proposing programs for the prevention of
interpersonal violence; for investment in the assessment of public policies aimed to young people; for
studies on families who suffer the impact of the violent loss of a child; and for improving the analysis
on health actions for preventing homicides. There is also a significant gap in the knowledge about the
involvement of young people with the illegal trade of drugs and weapons. This is the main focus of
crime reports and common sense as an important cause for homicides. However, it is a scarcely
discussed subject in scientific investigations.
It is true that the texts which mention the variable race/skin color estimate its relative
contribution to mortality by homicide (Marchese, Scatena & Ignotti, 2008; Pereira, M.D. et al., 2008;
Hennington et al., 2008; Bastos et al., 2009; Costa, Ludermir & Silva, 2009; Lamoglia & Minayo, 2009;
Araújo et al., 2010; Luz et al., 2011; Malta et al., 2012b). Nevertheless, this is still an insufficiently
discussed matter within the papers included in the collection, which leads to the conclusion that the
discussion of the subject falls behind the magnitude of the fatal violence which victimizes black and
brown people. In Brazil, in 2003, the mortality rate by homicide of black and brown men was almost
twice that of white men: 155.1/100,000 vs 83.5/100.000 inhabitants (Soares Filho et al., 2007).
Few of the documents make the race/color issue their object of study or explicit in the results
of the quantitative works. Only one of them describes racial inequalities in the mortality of women
(Santos, Guimarães & Araújo, 2007). As for the qualitative-type texts, the subject arises through the
description of the demographic group in study (Meneghel et al., 2013); through the discussion of
criminal recidivism (Mariño, 2002); the discussion about the connection between race and lethal
violence against the LGBT population (Fernandes, F.B.M., 2013); and the analysis of the production of
information on race/color in statements of death. In the latter, some inaccuracies that favor the
culpabilizations of the victim and the justification of the violent death could be observed (Santos,
Coelho & Araújo, 2013).
In the theses (2) and dissertations (8) that include the subject race/skin color, a pattern similar
to the articles can also be noticed, in which most authors discuss such a variable as just another one
in the composition of the profile of mortality by homicide. Even within the few more analytic studies,
race/color appears as a tangential variable to the objects of research. Therefore, based on the several
aspects examined in this review, it can be concluded that the variable race/color has been much less
researched than other also important issues, as it is the case of social inequalities associated with
homicide: in the first case, there are 36 documents of reference, and in the latter, 62.
Another significant gap can be seen through the small number of documents (10) on crimes
of passion, between intimate partners and family members. Few studies discuss issues like homicide
followed by attempted suicide and the forensic and psychological aspects of the perpetrators of such
crimes (Bins, Döler & Teitelbaum, 2009). Among those who do it, we can mention: Azevedo (2013),
on the meanings of the experience of homicide followed by suicide, based on women who survived
the act; Santiago and Coelho (2010), who discuss the emotional aspects associated with crimes of
passion and the experience of their perpetrators as inmates; Pereira (2013), which focus on the profile
of women and the perpetrators of domestic violence identified in forensics reports; Ramos (2010),
which analyzes how, during the trials of women’s murders the prerogative of the legitimate defense of
honor has been used by the defendant as a means to reverse the aggravated homicide conviction;
and Lettiere (2010), which tries to understand the support required and obtained within the relational
and institutional environments by women who suffer domestic violence. The latter highlights that the
aggravations the aggressions pose for health and quality of life are simply alluded to by the
researchers.
The three documents that examine homicide within the family realm originate from
psychological and psychiatric analyses. Ribeiro (2001) takes as an example a family crime in which a
young man perpetrated a quintuple homicide in order to study the police, legal, psychiatric and
journalistic discourses concerning the perpetrator of such a crime and how those analysis lack
criticism over the social influences over him. Valença and contributors (2009) report the case of a
woman suffering from bipolar disorder who murdered her mother and, according to psychiatric
forensics in order to assess criminal liability, she was considered criminally incapable due to her
mental illness which affected her understanding and determination about the crime perpetrated.
Gomide and contributors (2013) have investigated the occurrence of parricide in Brazil, between 2005
and 2011 and observe that, out of the 246 cases, 86% were perpetrated by male sons, the great
majority committed the crime on their own (88%) and those who were aided in perpetrating the
homicide relied on people from inside the family.
As identified by previous studies (Minayo, 2003; Minayo, Souza & Paula, 2010), homicides
against the elderly remain as outcasts of scientific investment. Only one paper focusing on this group
analyzes mortality by accidents and violence and identifies the rate of 9.5/100,000 homicides in the
year 2000 (Gawryszewski, Mello Jorge and Koizumi, 2004).
The violence against men and women in the realm of intimate relations becomes the focus
only when it reaches its most serious outcome: mortality. Interpersonal violence as a generator of
serious health damages is scarcely mentioned within the analyzed collection. And some emerging
subjects concerning gender violence appear very discreetly, as it is the case with that against LGBT
groups, pregnant women and women victim of sexual violence. A possible explanation for such a
scarce production on those subjects can be the difficulty in obtaining information on the reports within
the official systems. In this sense, some effort has been made to access data on morbidity caused by
aggressions, as it is the case with the creation of the Surveillance System for Violence and Accidents
(Viva) and the addition of specific fields for the report of crimes motivated by homophobia within the
notification forms in the health and public safety areas. However, the compliance with the initiatives for
the proper filling of the registration instruments are still an obstacle for the obtention of accurate
information.
At the end of this analysis, it is important to highlight the limits and difficulties found due to the
lack of standardization in document indexing. In this sense, it should be commented that the names of
the authors and periodicals can be found with different spellings depending on the database where
those papers are obtained, which generates duplicity of documents. Another difficulty worth
mentioning concerns the quality of some abstracts, which fail to make it explicit some important
information such as the purpose, method and results of the studies performed.