Reflections from the 2026 Annual David Sanders Lecture in Public Health and Social Justice

The Systems Behind Violence: Power, Profit and Prevention in Cape Town

written by:  Dr Takunda Satumba

The 2026 Annual David Sanders Lecture in Public Health and Social Justice brought together critical perspectives on one of Cape Town’s most pressing public health challenges: violence. Held under the theme “The Systems Behind Violence: Power, Profit and Prevention in Cape Town,” the lecture invited participants to look beyond individual acts of violence and consider the wider systems, social conditions and power structures that shape violence and society’s responses to it.

Prof. Asha George chaired the session, with opening remarks acknowledging and recognising the work of David, received from Prof. Matete Madiba (Deputy Vice Chancellor – Student Development and Support) and Prof. Sue Fawcus, on behalf of David’s family.

The panel discussion was moderated by Crystal Orderson, an executive producer and journalist, and featured panellists Nadia Degrass; Dr Sisanda Mguzulwa; Dr Heidi Sauls; and Prof Fiona Anciano.

The Annual David Sanders Lecture honours the legacy of Emeritus Professor David Sanders, founding director of the School of Public Health, and his enduring contribution to public health and social justice. The 2026 discussion reflected this legacy by placing violence within a broader public health and social justice framework.

Moving beyond individual explanations of violence

A central message emerging from the discussion was that violence cannot be understood simply as the result of individual behaviour. While individual choices and actions matter, violence occurs within communities and systems that are shaped by historical, political, economic and social conditions.

This requires asking more difficult questions: What are the systems that make violence possible? Who has power within those systems? Who benefits from them? Who is excluded from decision-making? And how do these systems shape the choices available to people, particularly young people?

The discussion highlighted the importance of understanding Cape Town within both its historical and contemporary context. The effects of historical spatial and socioeconomic inequalities continue to shape how communities experience opportunity, exclusion, insecurity and access to essential services.

At the same time, the discussion cautioned against overly simplistic explanations of violence. Poverty, for example, should not always be treated as a direct cause of violence. Rather, poverty and inequality interact with unemployment, limited opportunities, social exclusion, community conditions and other factors that can shape vulnerability and the choices available to individuals and communities.

Young people and the conditions surrounding violence

Young people featured prominently in reflections on violence, particularly in relation to gangs, territorial conflict and access to weapons.

An important question was raised: What happens before violence becomes visible?

By the time a young person becomes involved in violence or criminal activity, there may already have been a long history of social and institutional vulnerabilities. This points to the importance of prevention and early intervention, including the role of schools, education, social support and meaningful opportunities for young people.

Rather than waiting until violence becomes a crisis, prevention requires attention to the environments in which young people grow, learn and make decisions. It also requires understanding the social and institutional conditions that shape their opportunities and choices.

A question was also asked by the audience: what is the role of social media in shaping young people’s experiences and perceptions of violence?

Violence is a public health issue

The discussion also reinforced the idea that healthcare is a community issue.

Violence affects individuals, families and communities, but its consequences also extend into health systems. Health services may be required to respond to injuries, trauma and other consequences of violence, while communities experiencing persistent insecurity may experience broader effects on health and wellbeing.

This means that violence cannot be left to the health sector alone. Effective prevention requires collaboration across sectors, including health, education, food security, social services, local government, civil society and community organisations.

Yet an important challenge remains: different departments and organisations often work within separate mandates and systems, even when the problems they are addressing are deeply interconnected.

The question, therefore, is not simply whether sectors are working, but whether they are working together effectively.

Power matters: Systems for whom and designed by whom?

Another important thread running through the discussion was the question of power.

Understanding violence requires us to ask:

Who has power, where does that power come from, and how is it exercised?

The discussion also considered the role of communities themselves. Communities should not be understood only as recipients of interventions. They possess knowledge, relationships, networks and forms of collective power that can contribute to violence prevention.

Working with influential community members, activists, civil society organisations, schools and other local actors can therefore be an important part of developing locally appropriate responses.

The principle is simple but powerful: there is greater potential for change when people and organisations work collectively rather than in isolation.

From responding to violence to preventing it

The discussion questioned approaches that rely primarily on responding to violence after it has occurred. It also challenged the assumption that violence can simply be addressed through more violence or punitive responses.

Prevention requires a broader approach that considers the conditions in which violence emerges. This includes:

• Creating meaningful opportunities for young people;
• Strengthening education and community support;
• Addressing social and economic inequalities;
• Improving access to essential services;
• Strengthening collaboration between government departments;
• Supporting civil society and community organisations; and
• Understanding and engaging with local power structures.

Regarding social media, rather than treating social media as a simple cause of violence, the discussion points towards the need to better understand whether and how digital platforms may amplify, normalise or contribute to existing forms of violence.

A systems approach to violence prevention

The discussion returned to a fundamental public health question:

If violence is a symptom of wider systemic problems, should our focus only be on stopping violence, or should we also examine what is happening within society that makes violence possible?

A systems approach does not remove individual responsibility. Rather, it recognises that individual actions occur within wider environments that influence opportunities, choices, relationships and risks.

For public health, this means moving beyond treating the consequences of violence and engaging with the social, economic, political and institutional conditions that shape it.

The 2026 Annual David Sanders Lecture therefore provided an important reminder that violence prevention is not the responsibility of one profession, department or institution. It requires collaboration, community engagement and a willingness to examine how power, inequality, institutions and social conditions interact.

In keeping with Professor David Sanders’ enduring commitment to health and social justice, the discussion ultimately invited us to ask not only how we respond to violence, but also how we can transform the systems and conditions that allow violence to persist.

Watch the full lecture

The full recording of the 2026 Annual David Sanders Lecture is available on the School of Public Health’s YouTube channel.

Acknowledgements

The lecture was supported through the National Research Foundation (NRF/DST/UWC) Research Chair in Health Systems, Complexity and Social Change, held by Prof. Asha George.