jech-2019-213712 1..2 Commentary in response to ‘characterising the risk of homicide in a population-based cohort’ (O’Neill et al, 2019) Susitha Wanigaratne ,1,2,3 Farah N Mawani ,3,4 Patricia O’Campo,3,5 Donald C Cole,5 Sureya Ibrahim,6 Carles Muntaner5,7,8 We are social epidemiologists and commu- nity advocates focused on addressing social determinants of health inequities. While we appreciate O’Neill et al’s effort to link multiple provincial-level adminis- trative data sets to examine homicide vic- timisation by immigration status in Ontario, Canada, we have concerns about the framing and interpretation of findings and their potential impact on immigrants and refugees.1 FRAMING AND APPROACH While O’Neill et al’s data and sample size are strengths, the attention to the context of being an immigrant to Canada, theore- tical framework and motivation for exam- ining immigrants in relation to homicide victimisation are not fully developed. O’Neill et al do not acknowledge having done any community engagement which is critical and ethical2 given the long history of exclusion, exploitation, racism and dis- crimination, and the current global climate of increasing criminalisation of migrants. Meaningful community engagement offers important context; helps shape the research purpose, questions, approach, interpretation and recommendations; and can reduce the potential for harm. Though criminalisation of migration under security pretexts is an infringement of international law,3 and contradicts evi- dence that immigration is related to a reduction in crime,4 many high-income countries, including Canada, are framing harmful immigration policy (eg, restricting entry, detaining immigrants) as an urgent need to protect against threats of safety and security,4 5 disproportionately target- ing racialised and Muslim immigrants and refugees. Within this policy context, along with political rhetoric to generate support for it, hate crimes are at record highs in Canada, with approximately 85% of these crimes motivated by racism and ethnic or religious discrimination.6 Not only does this paper fail to consider this context, the statements that immi- grant communities are ‘predisposed to violence’ without evidence to support this claim; the conflation of perpetrating and dying by homicide, by alternating between the use of ‘homicide’ and ‘homi- cide victimisation’; and the suggestion that ‘cultural views on gender’ increase risk of violence and homicide victimisa- tion against immigrant women, are parti- cularly harmful. RESULTS AND INTERPRETATION The authors’ emphasis on the increased risk of homicide victimisation of female and male refugees compared to long-term resi- dents is misleading given that these results are not statistically significant. The authors argue that the findings are important regard- less of significance, because of large effect sizes. But for many researchers, effect sizes of 1.31 and 1.23, respectively, would be considered small to medium and would lead to a much more cautious interpretation. The authors’ interpretation that non- refugee immigrants have a lower risk of homicide victimisation because Canada’s immigration policies select for highly edu- cated and healthy immigrants reflects pro- blems with the theory informing this research, since homicide victimisation is not within the control of an individual. Social epidemiology was founded on the need to theorise political, economic and cul- tural context over and above individual characteristics.7 A concerning omission is that there is no mention of the potential for hate crimes6 to be at least partially respon- sible for homicide victimisation among refu- gees and immigrants. Additionally, in the text, it is left unclear how a refugee’s history of ‘violence, trauma and torture’ and ‘depression and psychosocial illness’ are linked to homicide victimisation. Such unsupported statements omit essential con- sideration that Canadian neighbourhoods are heterogeneous combinations of refugees, non-refugees and long-term residents and that violence occurs within a social context which includes racism, xenophobia and Islamophobia.8 With the study’s low counts of homi- cide victimisations among refugees (31 among females and 89 among males over 20 years), 90% of all homicide victi- misations in the same time period occur- ring among long-term residents (table 1 of paper), and no clear data pointing to specific factors to intervene upon, we argue that this potential in excess homi- cide victimisation does not warrant tar- geted homicide prevention strategies, as the authors suggest. Broader prevention strategies targeting the entire population (eg, a national ban on handguns and assault weapons,9 10 implementing Canada’s Anti-Racism Strategy8) may be more beneficial in reducing homicide victimisation. POTENTIAL IMPACT We are concerned that the paper’s framing, approach and interpretation could nega- tively impact immigrant and refugee com- munities targeted by significant racism, anti-immigrant sentiment and Islamophobia at policy, practice, commu- nity and individual levels.6 11 Community engagement from the start, and compre- hensive multi-level, multistage social deter- minants of immigrant health framework,11 could have prevented misinterpretations of the findings and this potential for harm. It could have also shifted the approach from a deficit- to an asset-based one that recog- nises the leadership and impacts of women who founded groups such as Mothers for Peace12 and Mending a Crack in the Sky.13 These groups combat the stigmatisation of mothers and families that have lost children to violence; support mothers and families 1Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Canada 2Institute for Clinical Evaluative Sciences, Toronto, Canada 3MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada 4Faculty of Environmental Studies, York University, Toronto, Canada 5Dalla Lana School of Public Health, University of Toronto, Toronto, Canada 6Mothers for Peace, TD Centre of Learning & Development Regent Park, Toronto, Canada 7Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada 8Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA Correspondence to Susitha Wanigaratne, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada; susitha.wanigaratne@ sickkids.ca and Farah Mawani, MAP Centre for Urban Health Solutions, Toronto, Canada; farah.mawani@unityhealth.to SW and FNM are co-principal authors. Wanigaratne S, et al. J Epidemiol Community Health August 2020 Vol 0 No 00 1 Commentary o n A p ril 5 , 2 0 2 1 b y g u e st. P ro te cte d b y co p yrig h t. h ttp ://je ch .b m j.co m / J E p id e m io l C o m m u n ity H e a lth : first p u b lish e d a s 1 0 .1 1 3 6 /je ch -2 0 1 9 -2 1 3 7 1 2 o n 9 S e p te m b e r 2 0 2 0 . D o w n lo a d e d fro m http://orcid.org/0000-0003-0840-9006 http://orcid.org/0000-0003-4817-5099 mailto:susitha.wanigaratne@sickkids.ca mailto:susitha.wanigaratne@sickkids.ca mailto:susitha.wanigaratne@sickkids.ca http://jech.bmj.com/ experiencing ongoing trauma due to vio- lence; and advocate for policy and pro- gramme change to reduce poverty, violence and homicide for all people in Canada, a more inclusive public health approach. Twitter Farah Mawani @farah_way. Contributors SW and FNM conceived the commentary and contributed equally to the development of the initial draft. SW, FNM, PO, DCC, SI and CM edited, critically reviewed and approved the final content of the commentary. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; internally peer reviewed. Open access This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non- commercial. See: http://creativecommons.org/licenses/ by-nc/4.0/. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. To cite Wanigaratne S, et al. J Epidemiol Community Health 2020;0:1–2. ► http://dx.doi.org/10.1136/jech-2019-213249 J Epidemiol Community Health 2020;0:1–2. doi:10.1136/jech-2019-213712 ORCID iDs Susitha Wanigaratne http://orcid.org/0000-0003-0840- 9006 Farah N Mawani http://orcid.org/0000-0003-4817- 5099 REFERENCES 1 O’Neill M, Buajitti E, Donnelly PD, et al. Characterising risk of homicide in a population-based cohort. J Epidemiol Community Health 2019. 2 Flicker S, Travers R, Guta A, et al. Ethical dilemmas in community-based participatory research: recommen- dations for institutional review boards. J Urban Health 2007;84:478–93. 3 Ammar W. Migration and health: human rights in the era of populism. Lancet 2018;392:2526–8. 4 Ousey GC, Kubrin CE. Immigration and crime: assessing a contentious issue. Annu Rev Criminol 2018;1:63–84. 5 The Guardian. Sri Lankan Tamil refugees spark racism row in Canada. 2010. 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