More than 1.6 million people worldwide lost their lives to violence in 2000, says the first comprehensive review of the global impact of violence, published by the World Health Organization this week.
The report was developed to raise awareness of the impact of violence and to encourage a much wider role for public health in the response to violence. The report analysed data on morbidity and mortality associated with violence submitted by different countries to the WHO but acknowledges that the data represent only the tip of the iceberg. Data were also gathered from an extensive literature review of the impact of violence on health. The report took more than three years to develop, and 160 experts from around the world participated.
The report analyses violence in categories according to the person who committed the act, who the victims were, and what kind of violence they were subjected to. Around half the deaths in 2000 that were due to violence were suicides (815000 deaths), nearly a third were homicides (520000), and about a fifth were casualties of armed conflict (310000). The results show who the principal victims of violence were and where they lived. Male victims accounted for three quarters of all victims of homicide and had rates more than three times the rates among female victims.
The highest homicide rates were in men aged 15-29 years. Rates in men tended to decline with age, but the rate for women was around 4 per 100000 across all ages. Suicide rates, in contrast, tended to increase with age for both sexes. The highest rate of suicide—44.9 per 100000—was found in men aged 60 years or more, more than double the rate among women of the same age.
Rates of violent death varied according to countries' income levels, with the rate in low to middle income countries (32.1 per 100000) more than twice the rate in middle income countries (14.4 per 100000). There were large variations between the WHO regions. In the African region and the region of the Americas, for example, the homicide rate was nearly triple the suicide rate.
The report points out that most violence resulted in non-fatal injuries, mental health problems and reproductive health problems, sexually transmitted diseases, and other problems.
Domestic violence seems to be a common problem. Results from 48 population based surveys from around the world showed that between 10% and 69% of women reported being physically assaulted by an intimate male partner at some point in their lives.
An estimated 57000 children were killed in 2000 as a result of child abuse, with children aged four years or less at greatest risk. About 20% of women and 5-10% of men were sexually abused as children. The report also recognises abuse of old people as a growing problem, with 4-6% of old people, defined variously according to country, experiencing some form of abuse in their home.
Dr Etienne Krug, director of the WHO's Department for Injury and Violence Prevention, Geneva, considered that violence was clearly a major issue for public health. He said, “The physical effects of violence are obvious—with millions of deaths and injuries each year. There are also major psychological effects. In some countries up to 5% of the gross domestic product is spent on treating the effects of violence.”
He considered that taking a public health perspective on violence could improve the situation. “Public health has a strong advocacy role. People listen to public health professionals when they point out that something is a problem in a way that they may not listen to other sectors. Public health can play an important part as a convenor, bringing together the different parties needed to address violence.”
One reason why violence has largely been ignored as a public health issue has been the lack of a clear definition of the problem. The report acknowledges that notions of acceptable behaviour were culturally influenced but tries to find a definition that is not limited to just one culture. It defines violence as: “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.”
The report argues that violence is often predictable and preventable. It recommends that countries should create, implement, and monitor national action plans for violence prevention. “The most important step is to gain political commitment to work on the prevention of violence,” said Dr Krug.
The authors considered that primary prevention was important and recommend measures to reduce child abuse and neglect, such as improving prenatal and perinatal health care for mothers and training for good parenting.
The report also outlines measures to reduce violence among adults and teenagers, including improvements to urban infrastructure, measures to reduce firearm injuries, and media campaigns to change attitudes, behaviour, and social norms. (See p 726.)
An estimated 57000 children were killed in 2000 as a result of child abuse
Footnotes
Copies of the World Report on Violence and Health are available from Marketing and Dissemination, World Health Organization, CH-1211 Geneva 27, Switzerland, and a summary of the report is accessible at www.who.org