Kofi Annan, Secretary-General, United Nations, Nobel Peace

54 Pages·2002·0.57 MB·English

Violence cuts short the lives of millions of people across the world each year, and damages the
lives of millions more. It knows no boundaries of geography, race, age or income. It strikes at children,
young people, women and the elderly. It finds its way into homes, schools and the workplace. Men and
women everywhere have the right to live their lives and raise their children free from the fear of violence.
We must help them enjoy that right by making it clearly understood that violence is preventable, and by
working together to identify and address its underlying causes.
Kofi Annan, Secretary-General, United Nations,
Nobel Peace Laureate, 2001
World report
Massacres, forced displacement of populations, discriminatory access to health care – in the contexts in which
MSF works, violence, particularly political violence, is often one of the main causes of mortality. The absence
of this category in epidemiological registers often reflects the ambiguity of doctors and experts to authorities
in power. This report is a welcome break in this wall of silence.
on violence
Morten Rostrup, President, Médecins Sans Frontières (MSF) International Council,
Nobel Peace Laureate, 1999
A stronger commitment to increase global violence prevention efforts is desperately needed. Therefore, and health
I welcome this report very much. For the first time all of the available knowledge has been assembled into one
publication. Civil society, United Nations agencies and governments need to work hand in hand on the
implementation of the recommendations of this report.
Jody Williams, International Campaign to Ban Landmines,
Nobel Peace Laureate, 1997
As long as humanity continues to rely on violence to resolve conflicts, the world will enjoy neither peace S U M M A R Y
nor security, and our health will continue to suffer. This report is an important resource for opening our eyes
to the reality of violence as a public health problem, and for providing a source of hope for the future.
Perhaps only when we realize that violence is destroying both our bodies and our souls will we begin to
collectively address its roots and consequences. This report is an important step in that direction.
Oscar Arias, Former President of Costa Rica,
Nobel Peace Laureate, 1987
WHO has made a substantial contribution by providing a global perspective on all forms of violence. The
colossal human and social cost of violence hitherto has been inadequately addressed as a public health issue.
This report will raise the struggle against violence to a new level of engagement by health workers and others.
Over 20 years we in IPPNW have maintained that nuclear weapons and war are the ultimate expressions of
violence that must be eliminated if we are to bequeath a liveable planet to generations yet unborn.
Anton Chazov and Bernard Lown, International Physicians for the Prevention
of Nuclear War (IPPNW), Nobel Peace Laureates, 1985
ISBN 92 4 154562 3
World Health Organization
Geneva
World report on
violence and health:
summary
WorldHealthOrganization
Geneva
2002
WHOLibraryCataloguing-in-PublicationData
Worldreportonviolenceandhealth:summary
1.Violence2.Domesticviolence3.Suicide4.Sexoffenses5.War
6.Publichealth7.Riskfactors
ISBN9241545623 (NLMclassification:HV6625)
Suggestedcitation:Worldreportonviolenceandhealth:summary.Geneva,WorldHealthOrganization,2002.
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onthepartoftheSecretariatoftheWorldHealthOrganizationconcerningthelegalstatusofanycountry,territory,cityorareaorofits
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Contents
Foreword v
Preface vii
Violence–auniversalchallenge 1
Thepublichealthapproachtoviolence 3
Definingviolence 4
Typologyofviolence 4
Measuringviolence 5
Theimpactofviolence–liveslostandhealthharmed 6
Therootsofviolence–anecologicalmodel 9
Fromanalysistoaction 10
Theformsandcontextsofviolence 13
Interpersonalviolence 13
Youngpeopleandviolence 13
Violenceagainstintimatepartners 15
Childabuseandneglectbyparentsandothercaregivers 16
Abuseoftheelderly 17
Sexualviolence 17
Thedynamicsofinterpersonalviolence 18
Self-directedviolence 19
Magnitudeoftheproblem 19
Thedynamicsofsuicide 20
Collectiveviolence 21
Magnitudeoftheproblem 21
Consequencesofcollectiveviolence 22
Thedynamicsofviolentconflict 23
Whatcanbedonetopreventviolence? 25
Individualapproaches 25
Relationshipapproaches 26
Community-basedefforts 27
Societalapproaches 28
Someimportantgaps 28
Recommendationsforaction 31
Conclusion 35
References 37

Foreword
Thetwentiethcenturywillberememberedasacenturymarkedbyviolence.It
burdensuswithitslegacyofmassdestruction,ofviolenceinflictedonascale
neverseenandneverpossiblebeforeinhumanhistory.Butthislegacy–the
resultofnewtechnologyintheserviceofideologiesofhate–isnottheonly
onewecarry,northatwemustfaceupto.
Less visible, but even more widespread, is the legacy of day-to-day,
individualsuffering.Itisthepainofchildrenwhoareabusedbypeoplewho
shouldprotectthem,womeninjuredorhumiliatedbyviolentpartners,elderly
persons maltreated by their caregivers, youths who are bullied by other
youths,andpeopleofallageswhoinflictviolenceonthemselves.Thissuffering–andtherearemanymore
examplesthatIcouldgive–isalegacythatreproducesitself,asnewgenerationslearnfromtheviolenceof
generations past, as victims learn from victimizers, and as the social conditions that nurture violence are
allowedtocontinue.Nocountry,nocity,nocommunityisimmune.Butneitherarewepowerlessagainstit.
Violencethrivesintheabsenceofdemocracy,respectforhumanrightsandgoodgovernance.Weoften
talkabouthowa‘‘cultureofviolence’’cantakeroot.Thisisindeedtrue–asaSouthAfricanwhohaslived
through apartheid and is living through its aftermath, I have seen and experienced it. It is also true that
patternsofviolencearemorepervasiveandwidespreadinsocietieswheretheauthoritiesendorsetheuseof
violence through their own actions. In many societies, violence is so dominant that it thwarts hopes of
economicandsocialdevelopment.Wecannotletthatcontinue.
Manywholivewithviolencedayinanddayoutassumethatitisanintrinsicpartofthehumancondition.
Butthisisnotso.Violencecanbeprevented.Violentculturescanbeturnedaround.Inmyowncountryand
around the world, we have shining examples of how violence has been countered. Governments,
communitiesandindividualscanmakeadifference.
IwelcomethisfirstWorldreportonviolenceandhealth.Thisreportmakesamajorcontributiontoour
understandingofviolenceanditsimpactonsocieties.Itilluminatesthedifferentfacesofviolence,fromthe
‘‘invisible’’suffering ofsociety’s most vulnerable individuals tothe all-too-visible tragedyofsocietiesin
conflict.Itadvancesouranalysisofthefactorsthatleadtoviolence,andthepossibleresponsesofdifferent
sectorsofsociety.Andindoingso,itremindsusthatsafetyandsecuritydon’tjusthappen:theyaretheresult
ofcollectiveconsensusandpublicinvestment.
Thereportdescribesandmakesrecommendationsforactionatthelocal,nationalandinternationallevels.
It will thus be an invaluable tool for policy-makers, researchers, practitioners, advocates and volunteers
involvedinviolenceprevention.Whileviolencetraditionallyhasbeenthedomainofthecriminaljustice
system,thereportstronglymakesthecaseforinvolvingallsectorsofsocietyinpreventionefforts.
Weoweourchildren–themostvulnerablecitizensinanysociety–alifefreefromviolenceandfear.In
ordertoensurethis,wemustbetirelessinoureffortsnotonlytoattainpeace,justiceandprosperityfor
countries,butalsoforcommunitiesandmembersofthesamefamily.Wemustaddresstherootsofviolence.
Onlythenwillwetransformthepastcentury’slegacyfromacrushingburdenintoacautionarylesson.
NelsonMandela

Preface
Violencepervadesthelivesofmanypeoplearoundtheworld,andtouchesall
ofusinsomeway.Tomanypeople,stayingoutofharm’swayisamatterof
lockingdoorsandwindowsandavoidingdangerousplaces.Toothers,escape
isnotpossible.Thethreatofviolenceisbehindthosedoors–wellhiddenfrom
public view. And for those living in the midst of war and conflict, violence
permeateseveryaspectoflife.
Thisreport,thefirstcomprehensive summaryoftheproblemonaglobal
scale,showsnotonlythehumantollofviolence–over1.6millionliveslost
eachyearandcountlessmoredamagedinwaysthatarenotalwaysapparent–butexposesthemanyfacesof
interpersonal,collectiveandself-directedviolence,aswellasthesettingsinwhichviolenceoccurs.Itshows
thatwhereviolencepersists,healthisseriouslycompromised.
The report also challenges us in many respects. It forces us to reach beyond our notions of what is
acceptableandcomfortable–tochallengenotionsthatactsofviolencearesimplymattersoffamilyprivacy,
individualchoice,orinevitablefacetsoflife.Violenceisacomplexproblemrelatedtopatternsofthought
andbehaviourthatareshapedbyamultitudeofforceswithinourfamiliesandcommunities,forcesthatcan
also transcend national borders. The report urges us to work with a range of partners and to adopt an
approachthatisproactive,scientificandcomprehensive.
Wehavesomeofthetoolsandknowledgetomakeadifference–thesametoolsthathavesuccessfully
beenusedtotackleotherhealthproblems.Thisisevidentthroughoutthereport.Andwehaveasenseof
wheretoapplyourknowledge.Violenceisoftenpredictableandpreventable.Likeotherhealthproblems,it
isnotdistributedevenlyacrosspopulationgroupsorsettings.Manyofthefactorsthatincreasetheriskof
violencearesharedacrossthedifferenttypesofviolenceandaremodifiable.
Onetheme thatisechoed throughout this report istheimportanceofprimary prevention. Evensmall
investmentsherecanhavelargeandlong-lastingbenefits,butnotwithouttheresolveofleadersandsupport
forpreventioneffortsfromabroadarrayofpartnersinboththepublicandprivatespheres,andfromboth
industrializedanddevelopingcountries.
Public health has made some remarkable achievements in recent decades, particularly with regard to
reducingratesofmany childhooddiseases. However,savingourchildrenfrom these diseasesonly tolet
themfallvictimtoviolenceorlosethemlatertoactsofviolencebetweenintimatepartners,tothesavagery
ofwarandconflict,ortoself-inflictedinjuriesorsuicide,wouldbeafailureofpublichealth.
Whilepublichealthdoesnotofferalloftheanswerstothiscomplexproblem,wearedeterminedtoplay
ourroleinthepreventionofviolenceworldwide.Thisreportwillcontributetoshapingtheglobalresponse
to violence and to making the world a safer and healthier place for all. I invite you to read the report
carefully, and to join me and the many violence prevention experts from around the world who have
contributedtoitinimplementingitsvitalcallforaction.
GroHarlemBrundtland
Director-General
WorldHealthOrganization

Violence --- a universal challenge
No country or community is untouched by tospellthisoutclearly,in1979,inareportentitled
violence.Imagesandaccountsofviolencepervade Healthypeople (3). The report stated that the
themedia;itisonourstreets,inourhomes,schools, consequences of violent behaviour could not be
workplacesandinstitutions.Violenceisauniversal ignoredintheefforttoimprovethenation’shealth,
scourgethattearsatthefabricofcommunitiesand and made tackling the roots of violence a top
threatensthelife,healthandhappinessofusall.Each priorityforthehealthcommunity.
year,morethan1.6millionpeopleworldwidelose Since then, a wide range of public health
their lives to violence. For everyone who diesas a practitioners and researchers in the United States
resultofviolence,manymoreareinjuredandsuffer andaroundtheworldhavesetthemselvesthetask
fromarangeofphysical,sexual,reproductiveand of understanding violence and finding ways to
mental health problems. Violence is among the prevent it (4). The issue was put on the interna-
leadingcausesofdeathforpeopleaged15–44years tionalagendawhentheWorldHealthAssembly,at
worldwide, accounting for about 14% of deaths itsmeetinginGenevain1996,adoptedaresolution
amongmalesand7%ofdeathsamongfemales(1). declaring violence a leading worldwide public
Becauseitissopervasive,violenceisoftenseen healthproblem(seeBox1).
asaninevitablepartofthehumancondition–afact Raisingawarenessofthefactthatviolencecanbe
of life to respond to, rather than to prevent. preventedis,however,onlythefirststepinshaping
Moreover it is commonly considered a ‘‘law and theresponsetoit.Violenceisanextremelysensitive
order’’ issue, in which the role of health profes- issue.Manypeoplehavedifficultyconfrontingitin
sionalsislimitedtodealingwiththeconsequences. theirprofessionallivesbecauseitraisesuncomfor-
Buttheseassumptionsarechanging,encouragedby table questions about their personal lives. Talking
the success of public health approaches to other about violence means touching upon complex
environmental and behaviour-related health pro- mattersofmorality,ideologyandculture.Thereis,
blems such as heart disease, smoking and human
thus,often resistanceatofficialaswellaspersonal
immunodeficiency virus/acquired immunodefi-
levelstoopendiscussionofthetopic.
ciencysyndrome(HIV/AIDS).Thefocusisbroad-
The purpose of the first World report on
ening,withincreasingemphasisonpreventionand violenceandhealth1 is to challenge the secrecy,
addressingtherootcausesofviolence.Atthesame
taboos and feelings of inevitability that surround
time, the efforts of the police, courts and
violent behaviour, and to encourage debate that
criminologists are being augmented by the con-
will increase our understanding of this hugely
tributions of other institutions and disciplines,
complex phenomenon. While individual initiative
fromchildpsychologiststoepidemiologists.
andleadershipareinvaluableinovercomingapathy
Asubstantialproportionofthecostsofviolence
and resistance, a key requirement for tackling
result from its impact on victims’ health and the
violence in acomprehensive manner is for people
burden it places on health institutions (2). This
gives the health sector both a special interest in
prevention and a key role to play. The Surgeon
1 KrugEGetal.,eds.Worldreportonviolenceandhealth.Geneva,
GeneraloftheUnitedStatesofAmericawasthefirst WorldHealthOrganization,2002.