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Edited by E G Krug, L L Dahlberg, J A Mercy, A Zwi, R Lozano. (Pp 340; $US 27; Swiss francs 30, developing countries Swiss francs 15.) Geneva: World Health Organization, 2002. ISBN 92-4-154561-5.
The World Report on Violence and Health is a watershed publication, marking a turning point in violence prevention efforts. It offers a framework to stimulate coordinated preventive action and research across types of violence; to address social, economic, and policy factors that transcend national boundaries; and to pursue violence prevention efforts on a regional or global scale.
The report presents violence as a growing, yet preventable public health problem at a time when the problem of violence is among the priority agenda items of many nations. At the United Nations (UN) meeting on UN Collaboration for the Prevention of Interpersonal Violence held in November 2001, the UN recognized the global and widespread impact of interpersonal violence on health, development, human rights, human security, and peace and acknowledged that the multiple and complex causes of interpersonal violence require a multidisciplinary, multicultural response. In the Americas, the Plan of Action issued at the April 2001 Quebec Summit of the Americas of the Organization of American States identified violence prevention as a prerequisite in regional efforts to strengthen democracy, create prosperity, and realize human potential (www.summit-americas.org).
In 2000, an estimated 1.6 million people worldwide died due to violence. Yet the toll of violent death offers only a partial picture of the suffering and costs to the individual and society. For every death, many more were injured and suffer from a range of physical, sexual, reproductive, and mental health problems. Violence undermines the health and wellbeing of many millions of people, it costs nations vast sums in health care, legal and criminal justice costs, absenteeism from work, and lost productivity. Violence aggravates existing inequities.
In the report violence is defined as the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community, that either results in, or has a high likelihood of resulting in, injury, death, psychological harm, maldevelopment, or deprivation.1 The report describes the magnitude and impact of violence throughout the world. It outlines the key risk factors for violence, summarizing the types of intervention and policy responses that have been tried and what is known about their effectiveness. The analysis highlights the crucial part that public health has to play in addressing its causes and consequences.
The typology advanced characterizes the different types of violence and the links between them. It divides violence into three broad categories according to the characteristics of those committing the violent acts: self directed violence, interpersonal violence, and collective violence. These categories are further broken down, and a chapter is devoted to each of seven topics: child abuse and neglect by caregivers, youth violence, violence by intimate partners, sexual violence, elder abuse, suicide, and collective violence. Physical, sexual, and psychological violence and acts involving deprivation or neglect are included in the typology.
Employing an ecological model, the report views violence as the result of the complex interplay of individual, relationship, social, cultural, and environmental factors. The analysis highlights the fact that the various types of violence commonly share a number of risk factors and the links between different types of violence. These links and the interaction between individual factors and the larger social, cultural, and economic contexts have important implications for practice and policy. They suggest that addressing risk factors may contribute to decreases in more than one form of violence.
The report findings challenge injury professionals to look beyond the fragmentation that has characterized the field of violence prevention, in which research and prevention efforts for the various types of violence have often evolved separately from one another. They argue for broader partnerships between groups with an interest in primary and secondary prevention, whatever specific field they are working in and whether they work at a local, national, or global level. In sum, the report charges injury professionals and their constituent and allied groups to think globally even as they act locally. The launching of the report signifies the beginning of a year long global campaign on violence prevention, involving discussions and debates about violence and concrete and practical ways to implement the recommendations of the report. It behooves us all to get involved.
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