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First ever Global Report on Violence and Health released

New WHO report presents more complete picture of global violence

Cover of World Report on Violence and Health

The World Report on Violence and Health is the first comprehensive report of its kind to address violence as a global public health problem. Violence kills more than 1.6 million people every year. Public health experts say these statistics are just the tip of the iceberg with the majority of violent acts being committed behind closed doors and going largely unreported. This report aims to shed light on these acts. In addition to the deaths, millions of people are left injured as a result of violence and suffer from physical, sexual, reproductive and mental health problems, says the first comprehensive World report on violence and health released today by the World Health Organization (WHO).

The death and disability caused by violence make it one of the leading public health issues of our time, says the report. Violence is among the leading causes of death for people aged 15-44 years of age, accounting for 14% of deaths among males and 7% of deaths among females. On an average day, 1424 people are killed in acts of homicide almost one person every minute. Roughly one person commits suicide every 40 seconds. About 35 people are killed every hour as a direct result of armed conflict. In the 20th century, an estimated 191 million people lost their lives directly or indirectly as a result of conflict, and well over half of them were civilians. Studies have shown that in some countries, health care expenditures due to violence account for up to 5% of GDP.

The report challenges us in many respects. It forces us to reach beyond our notions of what is acceptable and comfortable to challenge notions that acts of violence are simply matters of family privacy, individual choice, or inevitable facets of life, said Dr Gro Harlem Brundtland, Director-General of WHO on releasing the report. Violence is a complex problem related to patterns of thought and behaviour that are shaped by a multitude of forces within our families and communities, forces that can also transcend national borders, she added.

The World report on violence and health is the first comprehensive review of the problem of violence at a global level. It focuses not only on the scale of the problem, but also covers issues related to the causes of violence and the methods for preventing violence and reducing its adverse health and social consequences. In addition to the familiar issues of collective violence such as war or conflict, the report examines equally significant yet frequently overlooked issues such as youth violence, child abuse, elderly abuse, intimate partner violence, sexual violence, and self-inflicted violence or suicides.

The data on youth violence show that youth homicide rates have increased in many parts of the world. For every young person killed by violence, an estimated 20-40 receive injuries that require treatment. Research shows that fighting and bullying are common among young people and that drunkenness is one of the situational factors found to precipitate violence. As far as child abuse is concerned, data from selected countries suggest that about 20% of women and 5-10% of men suffered sexual abuse as children.

Women often face the greatest risk at home and in familiar settings, says the report. Almost half the women who die due to homicide are killed by their current or former husbands or boyfriends, while in some countries it can be as high as 70%. While exact numbers are hard to come by due to lack of reporting, available data suggest that nearly one in four women will experience sexual violence by an intimate partner in their lifetime. Most victims of physical aggression are subjected to multiple acts of violence over extended periods of time. A third to over half of these cases are accompanied by sexual violence. In some countries, up to one-third of adolescent girls report forced sexual initiation.

Abuse of the elderly is one of the most hidden faces of violence according to the report, and one that is likely to grow given the rapidly aging populations in many countries. Up to 6% of the elderly report having been abused. As for suicide or self-inflicted violence, it is recognised as one of the leading causes of death in the world. Among those aged 15-44 years, suicide is the fourth leading cause of death and the sixth leading cause of disability and ill-health.

The statistics are chilling but the situation is far from hopeless, say the experts. There is nothing inevitable about violence, nor is it an intrinsic part of the human condition, said Dr Etienne Krug, Director, Department of Injuries and Violence Prevention. Evidence from around the world suggests that violence can be prevented by a variety of measures aimed at individuals, families and communities, he added. As a complement to the law and order approach to violence, the report promotes a public health understanding of the complex social, psychological, economic and community underpinnings of violence. While recent research suggests that biological and other individual factors may explain some of the predisposition to aggression, these factors more often interact with family, community, cultural and other external factors to create a situation where violence is likely to occur. Understanding these situations and these causes creates opportunities to intervene before violent acts occur, providing policy-makers with a variety of concrete options to prevent violence.

Among the recommendations for prevention made by the report are primary prevention responses such as preschool and social development programmes for children and adolescents, parent training and support programmes and measures to reduce firearm injuries and improve firearm safety. Other recommendations include strengthening responses for victims of violence, promoting adherence to international treaties and laws, and improving data collection on violence.

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