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Violence can affect anyone

Dr Etienne Krug, Director, Management of NCDs, Disability, Violence and Injury Prevention

10 December 2014

While working as a medical doctor in El Salvador, Mozambique, Nicaragua and Sudan, I saw first-hand the devastating impact of violence and its destruction on families and communities.

Dr Etienne Krug, Director, Management of NCDs, Disability, Violence and Injury Prevention.

Although war was raging in these countries at the time, many patients I treated in rural hospitals were children who were victims of abuse, women beaten by their partners, young boys injured in fights, or older people abandoned by their families. I also saw first-hand examples of the enormous impact such violence has on the health sector which devoted a significant amount of time and resources responding to its consequences.

Lifelong ill health

Violence ripples well beyond physical harm. It causes depression, anxiety and other mental health disorders. It also contributes to cancer, heart disease, stroke and HIV/AIDS because victims of violence often try to cope with their traumatic experiences by adopting risky behaviours such as using tobacco, alcohol and drugs, as well as engaging in unsafe sex. In this regard too, violence can be a driver of early death and lifelong ill health.

When we put these health consequences into perspective taking into account the large number of people affected, we start lifting the veil on the enormity of the issue. For example, one fifth of girls have been sexually abused; one quarter of children have suffered physical abuse; and one third of women have experienced, at some point in their lifetimes, physical and/or sexual violence by a partner.

Violence is predictable and preventable

"Violence can be effectively tackled by public health efforts quite similar to those used to control disease."

Dr Etienne Krug, Director, Management of NCDs, Disability, Violence and Injury Prevention.

We need not, however, be fatalistic about violence: it is both predictable and preventable. While working for the United States Centers for Disease Control and Prevention, it became clear to me that violence can be effectively tackled by public health efforts quite similar to those used to control disease.

In 2002 WHO issued the first ever "World report on violence and health", which even today remains among WHO’s “best sellers”. More recently we embarked on assessing how the recommendations of this report have been implemented around the world, an effort which has led to the "Global status report on violence prevention 2014". The report describes the current state of interpersonal violence prevention related to child maltreatment, youth violence, intimate partner and sexual violence, and elder abuse. Data from 133 countries (88% of the world population) were collected and analysed.

Homicides are decreasing globally

I am encouraged by the report’s findings: for instance, violence is now talked about in many countries as a public health problem. Violence prevention programmes, laws and services for victims are being developed and implemented in an increasing number of countries. The statistics are moving in the right direction. Although the annual global number of homicides at 475 000 is still unacceptably high, this represents a reduction of 16% since 2000; in high-income countries this decrease is even greater at 39%.

No country can rest on its laurels

Still, much more needs to be done. The Global status report reviewed implementation of 18 “best buy” violence prevention programmes, a dozen laws that are relevant for violence prevention, and a number of services for victims of violence that every country should have in place. It found, for example, that only a third of countries are implementing each of the 18 prevention programmes, such as life skills development to prevent youth violence, education for parents to prevent child maltreatment, and support to caregivers to prevent elder abuse.

The report also found that while most countries have violence prevention legislation in place, only half of countries report that these laws – against, for example, rape, domestic violence, weapons in schools, elder abuse – are fully enforced.

Finally, while it is widely recognized that mental health services for victims of violence are essential to reduce the long-term consequences of violence – including the risk of becoming a perpetrator of violence – less than half of the countries have such services in place.

WHO has played a role in supporting countries to strengthen their response to violence. We have come a long way since the late 1990s. I hope that this new report, adoption of the recent World Health Assembly resolution, current efforts toward developing a global action plan, and ongoing discussion around the post-2015 Sustainable Development Goals will help boost national and international violence prevention efforts to a new level.