WHO | Violence Prevention Alliance (VPA)

Table of Contents

Building global commitment to violence prevention

Reproduced from: https://www.who.int/violenceprevention/en/

The Violence Prevention Alliance (VPA) is a network of WHO Member States, international agencies and civil society organizations working to prevent violence. VPA participants share an evidence-based public health approach that targets the risk factors leading to violence and promotes multi-sectoral cooperation. Participants are committed to implement the recommendations of the World report on violence and health.

Please find the full report here


General Information about the World report on violence and health

Reproduced from: https://www.who.int/violence_injury_prevention/violence/world_report/en/

Objectives

  • To describe the magnitude and impact of violence throughout the world
  • To describe the key risk factors for violence
  • To summarize the types of intervention and policy responses that have been tried and what is known about their effectiveness
  • To make recommendations for action at local, national and international levels

Content

The Report examines a broad spectrum of violence including child abuse and neglect by caregivers, youth violence, violence by intimate partners, sexual violence, elder abuse, suicide, and collective violence. One chapter is devoted to each of these seven topics. The Report also includes a statistical annex with country and regional data derived from the WHO Mortality and Morbidity Database and a list of resources for violence prevention.

Main messages

  • Violence is a major public health problem worldwide. Each year, millions of people die as the result of injuries due to violence. Many more survive their injuries, but live with a permanent disability. Violence is among the leading causes of death among people aged 15-44 years worldwide, accounting for 14% of deaths among males and 7% of deaths among females.
  • In addition to death and disability, violence contributes to a variety of other health consequences. These include depression, alcohol and substance abuse, smoking, eating and sleeping disorders, and HIV and other sexually transmitted diseases.
  • Violence, however, is preventable – it is not an intractable social problem or an inevitable part of the human condition. The wide variation in violence among and within nations over time suggests that violence is the product of complex, yet modifiable social and environmental factors.
  • Violence results from interplay of individual, relationship, community, and societal factors. Some of the factors associated with violence include a history of early aggression, impulsiveness, harsh punitive discipline, poor monitoring and supervision of children, associating with delinquent peers, witnessing violence, drug trafficking, access to firearms, gender and income inequality, and norms that support violence as a way to resolve conflict.
  • Creating safe and healthy communities around the globe requires commitment on the part of multiple sectors at the international, national and community levels to document the problem; build the knowledge base; promote the design and testing of prevention programmes; and promote the dissemination of lessons learned.
  • A science-based public health approach focused on prevention may contribute to reducing violence. Public health officials have a very important role to play in this process. Through their vision and leadership, much can be done to establish national plans and policies for violence prevention, to help facilitate the collection of data to document and respond to the problem, to build important partnerships with other sectors, and to ensure an adequate commitment of resources to prevention efforts.

The VPA approach

Reproduced from: https://www.who.int/violenceprevention/approach/en/

The perspective that VPA promotes revolves around three theoretical models: the typology of violence, the public health approach and the ecological framework. These models guide understanding, research and action for violence prevention. The typology is a tool to help organize thinking about the types of violence and the ways in which violence occurs. The public health approach offers practitioners, policy-makers and researchers a step-wise guide that can be applied to planning programmes, policies, and investigation. Finally, the ecological framework bridges these two models, giving a structure to understanding the contexts within which violence occurs and the interactions between risk factors in each of these contexts and between them. The ecological framework shows where and how to apply the public health approach and is useful for categorizing planned or existing interventions to help understand the mechanisms by which they might be working.


Definition and typology of violence

Reproduced from: https://www.who.int/violenceprevention/approach/definition/en/

VPA addresses the problem of violence as defined in the World report on violence and health (WRVH), namely:

“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 WRVH also presents a typology of violence that, while not uniformly accepted, can be a useful way to understand the contexts in which violence occurs and the interactions between types of violence. This typology distinguishes four modes in which violence may be inflicted: physical; sexual; and psychological attack; and deprivation. It further divides the general definition of violence into three sub-types according to the victim-perpetrator relationship.

  • Self-directed violence refers to violence in which the perpetrator and the victim are the same individual and is subdivided into self-abuse and suicide.
  • Interpersonal violence refers to violence between individuals, and is subdivided into family and intimate partner violence and community violence. The former category includes child maltreatment; intimate partner violence; and elder abuse, while the latter is broken down into acquaintance and stranger violence and includes youth violence; assault by strangers; violence related to property crimes; and violence in workplaces and other institutions.
  • Collective violence refers to violence committed by larger groups of individuals and can be subdivided into social, political and economic violence.
Typology of interpersonal violence

Source: World report on violence and health p.7
 https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf

The public health approach

Reproduced from: https://www.who.int/violenceprevention/approach/public_health/en/

The principles of public health provide a useful framework for both continuing to investigate and understand the causes and consequences of violence and for preventing violence from occurring through primary prevention programmes, policy interventions and advocacy. The activities of VPA are guided by the scientifically-tested and proven principles and recommendations described in the World report on violence and health. This public health approach to violence prevention seeks to improve the health and safety of all individuals by addressing underlying risk factors that increase the likelihood that an individual will become a victim or a perpetrator of violence.

The approach consists of four steps:

  1. To define the problem through the systematic collection of information about the magnitude, scope, characteristics and consequences of violence.
  2. To establish why violence occurs using research to determine the causes and correlates of violence, the factors that increase or decrease the risk for violence, and the factors that could be modified through interventions.
  3. To find out what works to prevent violence by designing, implementing and evaluating interventions.
  4. To implement effective and promising interventions in a wide range of settings. The effects of these interventions on risk factors and the target outcome should be monitored, and their impact and cost-effectiveness should be evaluated.

By definition, public health aims to provide the maximum benefit for the largest number of people. Programmes for the primary prevention of violence based on the public health approach are designed to expose a broad segment of a population to prevention measures and to reduce and prevent violence at a population-level.

The steps of the public health approach

The ecological framework

Reproduced from: https://www.who.int/violenceprevention/approach/ecology/en/

The ecological framework is based on evidence that no single factor can explain why some people or groups are at higher risk of interpersonal violence, while others are more protected from it. This framework views interpersonal violence as the outcome of interaction among many factors at four levels—the individual, the relationship, the community, and the societal.

  1. At the individual level, personal history and biological factors influence how individuals behave and increase their likelihood of becoming a victim or a perpetrator of violence. Among these factors are being a victim of child maltreatment, psychological or personality disorders, alcohol and/or substance abuse and a history of behaving aggressively or having experienced abuse.
  2. Personal relationships such as family, friends, intimate partners and peers may influence the risks of becoming a victim or perpetrator of violence. For example, having violent friends may influence whether a young person engages in or becomes a victim of violence.
  3. Community contexts in which social relationships occur, such as schools, neighbourhoods and workplaces, also influence violence. Risk factors here may include the level of unemployment, population density, mobility and the existence of a local drug or gun trade.
  4. Societal factors influence whether violence is encouraged or inhibited. These include economic and social policies that maintain socioeconomic inequalities between people, the availability of weapons, and social and cultural norms such as those around male dominance over women, parental dominance over children and cultural norms that endorse violence as an acceptable method to resolve conflicts.

The ecological framework treats the interaction between factors at the different levels with equal importance to the influence of factors within a single level. For example, longitudinal studies suggest that complications associated with pregnancy and delivery, perhaps because they lead to neurological damage and psychological or personality disorder, seem to predict violence in youth and young adulthood mainly when they occur in combination with other problems within the family, such as poor parenting practices. The ecological framework helps explain the result—violence later in life—as the interaction of an individual risk factor, the consequences of complications during birth, and a relationship risk factor, the experience of poor parenting. This framework is also useful to identify and cluster intervention strategies based on the ecological level in which they act. For example, home visitation interventions act in the relationship level to strengthen the bond between parent and child by supporting positive parenting practices.

The ecological framework: examples of risk factors at each level

Preventing violence: a guide to implementing the recommendations of the World report on violence and health

Reproduced from: https://www.who.int/violence_injury_prevention/media/news/08_09_2004/en/

Preventing violence: a guide to implementing the recommendations of the World report on violence and health was published with the generous support of the Government of Belgium, and thanks to input from violence prevention practitioners worldwide. The document focuses upon the first six recommendations, namely:

  1. Increasing the capacity for collecting data on violence.
  2. Researching violence – its causes, consequences and prevention.
  3. Promoting the primary prevention of violence.
  4. Promoting gender and social equality and equity to prevent violence.
  5. Strengthening care and support services for victims.
  6. Bringing it all together – developing a national action plan of action.

The document provides conceptual, policy and practical suggestions on how to implement each of the six country-level activities, and promotes a multi-sectoral, data-driven and evidence-based approach. Should the resources for achieving certain aspects of the recommendations be lacking, the information contained in the guide will still be useful for planning purposes. Since plans usually precede actions (and are often used to generate the resources needed to implement actions), the guide will therefore be of use even in areas where violence prevention resources are currently scarce.


Selected Excerpts from the Reports

A profile of gangs

Source: World report on violence and health
Box 2.1 p.35
https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf

Youth gangs are found in all regions of the world. Although their size and nature may vary greatly — from mainly social grouping to organized criminal network — they all seem to answer a basic need to belong to a group and create a self-identity.

In the Western Cape region of South Africa, there are about 90 000 members of gangs, while in Guam, some 110 permanent gangs were recorded in 1993, around 30 of them hard-core gangs. In Port Moresby, Papua New Guinea, four large criminal associations with numerous subgroups have been reported. There are an estimated 30 000–35 000 gang members in El Salvador and a similar number in Honduras, while in the United States, some 31 000 gangs were operating in 1996 in about 4800 cities and towns. In Europe, gangs exist to varying extents across the continent, and are particularly strong in those countries in economic transition such as the Russian Federation.

Gangs are primarily a male phenomenon, though in countries such as the United States, girls are forming their own gangs. Gang members can range in age from 7 to 35 years, but typically are in their teens or early twenties. They tend to come from economically deprived areas, and from low-income and working-class urban and suburban environments. Often, gang members may have dropped out of school and hold low-skilled or low-paying jobs. Many gangs in high-income and middle-income countries consist of people from ethnic or racial minorities who may be socially very marginalized.

Gangs are associated with violent behaviour. Studies have shown that as youths enter gangs they become more violent and engage in riskier, often illegal activities. In Guam, over 60% of all violent crime reported to the police is committed by young people, much of it related to activities of the island’s hard-core gangs. In Bremen, Germany, violence by gang members accounts for almost half of reported violent offences. In a longitudinal study of nearly 1000 youths in Rochester, NY, United States, some 30% of the sample were gang members, but they accounted for around 70% of self-reported violent crimes and 70% of drug dealing.

A complex interaction of factors leads young people to opt for gang life. Gangs seem to proliferate in places where the established social order has broken down and where alternative forms of shared cultural behaviour are lacking. Other socioeconomic, community and interpersonal factors that encourage young people to join gangs include:

— a lack of opportunity for social or economic mobility, within a society that aggressively promotes consumption;
— a decline locally in the enforcement of law and order;
— interrupted schooling, combined with low rates of pay for unskilled labour;
— a lack of guidance, supervision and support from parents and other family members;
— harsh physical punishment or victimization in the home;
— having peers who are already involved in a gang.

Actively addressing these underlying factors that encourage youth gangs to flourish, and providing safer, alternative cultural outlets for their prospective members, can help eliminate a significant proportion of violent crime committed by gangs or otherwise involving young people.


Policing and correctional approaches: expensive solutions to interpersonal violence

Source: Preventing violence: a guide to implementing the recommendations of the World report on violence and health.
Box 2. p. 7
https://apps.who.int/iris/bitstream/handle/10665/43014/9241592079.pdf

Policing will not reduce rates of victimization by:

  • Increasing budgets, even by large amounts. Instead, this will divert scarce financial resources away from public health and educational programmes that have been shown to significantly reduce crime and victimization;
  • Continuing the current policing models based upon patrols, response to calls for service, and investigation – all of which become less and less effective in reducing crime as fewer victims report to the police;
  • Using popular programmes such as neighbourhood watch, boot camps and drug resistance education, all of which have been shown to be ineffective in reducing crime and interpersonal violence (see Part 3, TABLE THREE).

Policing will reduce rates of victimization by:

  • Deploying police officers strategically and holding them accountable to target specific problems;
  • Adopting models for policing such as the Strategic Approaches to Community Safety, where joint police and university teams analyse the causes of violence, particularly for youth homicides;
  • Providing data and collaborating in multi-sectoral partnerships (for example, with schools, welfare and housing) that aim to tackle persistent offending by men who are high-risk because of dropping out of school or having dysfunctional families;
  • Targeting repeat victimization – where the same person or address is victimized more than once – through a combination of enforcement, situational crime prevention and social prevention;
  • Empowering victims to protect themselves, for instance by creating police stations where female victims of violence know they can talk to female police officers;
  • Holding young first offenders accountable through reparation to victims and ensuring they get assistance with life goals through counselling and school participation.

Correctional approaches will contribute to reduced crime and victimization through:

  • Investment in programmes that divert offenders from prison to community programmes that are adequately resourced and known to tackle successfully the causes of interpersonal violence and alcohol use;
  • Massive increases in the number of persons incarcerated, which can achieve decreases in crime rates for a very high cost – in the USA, increasing the incarceration rate by 250% from 1974 to 2004 is estimated to have decreased the crime rate by 35%, but at costs exceeding US$ 20 billion (enough to provide a job to every unemployed youth or child care for the poor, both of which have been shown to have a much larger impact on crime rates);
  • Investment in correctional programme models that have been shown to reduce recidivism. However, these models are few and reduce recidivism by only small proportions.

Collective Violence

Source: https://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/collectiveviolfacts.pdf

Collective violence receives a high degree of public attention. Violent conflicts between nations and groups, state and group terrorism, rape as a weapon of war, the movement of large numbers of people displaced from their homes, and gang warfare – all these occur on a daily basis in many parts of the world. The effects of these different types of event on health in terms of deaths, physical illness, disabilities and mental anguish are vast.

Collective violence may be defined as:
the instrumental use of violence by people who identify themselves as members of a group –whether this group is transitory or has a more permanent identity – against another group or set of individuals, in order to achieve political, economic or social objectives.

THE EXTENT OF THE PROBLEM

  • The 20th century was one of the most violent periods in human history. An estimated 191 million people lost their lives directly or indirectly as a result of conflict, and well over half of them were civilians.
  • In 2000, over 300 000 people died as a direct result of violent conflicts. Rates varied from less than 1 per 100 000 population in high-income countries to 6.2 per 100 000 in low and middle-income countries.
  • Worldwide, the highest rates of conflict-related deaths are found in Africa (32.0 per 100 000).
  • Besides the many thousands killed each year in violent conflicts, there are huge numbers who are physically injured as a result – including some who are permanently disabled or mutilated.
  • Torture and rape are also used to terrorize and undermine communities, although exact numbers of people subjected to these abuses are difficult to determine. Many people hide the trauma they have suffered and parties to a conflict often try to manipulate or conceal evidence of torture and rape.

THE CONSEQUENCES OF COLLECTIVE VIOLENCE

The impact of violent conflicts on health can be very great in terms of mortality, morbidity and disability.

Increased mortality rates of civilians during violent conflicts are usually due to:

  • injuries
  • decreased access to food, leading to poor nutrition
  • increased risk of communicable diseases
  • diminished access to health services
  • reduced public health programmes
  • poor environmental conditions
  • psychosocial distress.

Infants and refugees are among the groups most vulnerable to disease and death in times of conflict. Increases in morbidity and mortality rates among these two groups can be dramatic.

The violence and cruelty of conflicts are associated with a range of psychological and behavioural problems, including depression and anxiety, suicidal behaviour, alcohol abuse and post-traumatic stress disorder.

Conflicts disrupt trade and other business activities, and divert resources to defence from other vital services and sectors. They also have an impact on food production or distribution and displace thousands of people from their homes. Famine related to war, other armed conflicts or genocide is estimated to have killed 40 million people in the 20th century.

EXAMPLES OF THE DIRECT IMPACT ON HEALTH OF COLLECTIVE VIOLENCE

Health impactCauses
Increased mortality• Deaths due to external causes, mainly related to weapons
• Deaths due to infectious diseases (such as measles, poliomyelitis, tetanus and malaria)
• Deaths due to noncommunicable diseases, as well as deaths otherwise avoidable through medical care (including asthma, diabetes and emergency surgery)
Increased morbidity• Injuries from external causes, such as those from weapons, mutilation, anti-personnel landmines, burns and poisoning
• Morbidity associated with other external causes, including sexual violence
• Infectious diseases:
– water-related (such as cholera, typhoid, dysentery due to Shigella spp.)
– vecor-borne (such as malaria and onchocerciasis)
– other communicable diseases (such as tuberculosis, acute repiratory infections, HIV infection and other sexually transmitted diseases)
• Reproductive health:
– a greater number of stillbirths and premature births, more cases of low birth weight and more delivery complications
– longer-term generic impact of exposure to chemicals and radiation
• Nutrition:
– acute and chronic malnutrition and a variety of deficiency disorders
• Mental health:
– anxiety
– depression
– post-traumatic stress disorder
– suicidal behaviour
Increased disability• Physical
• Psychological
• Social

WHAT ARE THE RISK FACTORS FOR COLLECTIVE VIOLENCE?

The roots of violent conflict are generally deep and may be the result of long-standing tensions between groups. There are a number of factors that put states at risk of violent conflict. They include:

  • A lack of democratic processes and unequal access to power. The risk is especially high when power stems from ethnic or religious identity, and when leadership is repressive and disposed to the abuse of human rights.
  • Social inequality marked by grossly unequal distribution of, and access to, resources. Conflict is most likely in situations where the economy is in decline, thus exacerbating social inequalities and intensifying competition for resources.
  • Control by a single group of valuable natural resources, such as diamonds, oil, timber and drugs.
  • Rapid demographic change that outstrips the capacity of the state to provide essential services and job opportunities.

Many of these risk factors can be identified before overt collective violence takes place.

WHAT CAN BE DONE TO PREVENT COLLECTIVE VIOLENCE?

There are a number of measures that can be taken to prevent collective violence and – where it occurs – to lessen its impact.

Some of the general policies needed to reduce the potential for violent conflicts include:

  • Reducing poverty, both in absolute and relative terms, and ensuring that development assistance is targeted so as to make the greatest possible impact on poverty.
  • Reducing inequality between groups in society.
  • Reducing access to biological, chemical, nuclear and other weapons.
  • Ensuring the promotion and application of internationally agreed treaties, including those relating to human rights.

National governments can help prevent conflicts by upholding the spirit of the United Nations Chapter, which calls for the prevention of aggression and the promotion of peace and security. At a more detailed level, this involves adhering to international legal instruments, including the 1949 Geneva Conventions and their 1977 Protocols.

Investing in health development can contribute to the prevention of violent conflict. A strong emphasis on social services can help maintain social cohesion and stability.

Early manifestations of situations that can lead to conflicts can often be detected in the health sector. Health care workers have a significant role to play in drawing attention to these signs and in calling for appropriate social and health interventions.

For more information, please visit: http://www.who.int/violence_injury_prevention, or e-mail: violenceprevention@who.int ©World Health Organization 2002. All rights reserved.


Indicators of states at risk of collapse and internal conflict

Source: World report on violence and health
Table 8.1 p.220
https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf

IndicatorSigns
Inequality. Widening social and economic inequalities --- especially those between, rather than within, distinct population groups
Rapidly changing demographic characteristics. High rates of infant mortality
. Rapid changes in population structure, including large-scale movements of refugees
. Excessively high population densities
. High levels of unemployment, particularly among large numbers of young people
. An insufficient supply of food or access to safe water
. Disputes over territory or environmental resources that are claimed by distinct ethnic groups
Lack of democratic processes. Violations of human rights
. Criminal behaviour by the state
. Corrupt governments
Political instability. Rapid changes in regimes
Ethnic composition of the ruling group sharply different from that of the population at large. Political and economic power exercised --- and differentially applied --- according to ethnic or religious identity
. Desecration of ethnic or religious symbols
Deterioration in public services. A significant decline in the scope and effectiveness of social safety nets designed to ensure minimum universal standards of service
Severe economic decline. Uneven economic development
. Grossly unequal gains or losses between different population groups or geographical areas resulting from large economic changes
. Massive economic transfers or losses over short periods of time
Cycles of violent revenge. A continued cycle of violence between rival groups

Possible linkages between globalization, inequalities and conflict

Source: World report on violence and health
Figure 8.1 p.221
https://apps.who.int/iris/bitstream/handle/10665/42495/9241545615_eng.pdf


R E C O M M E N D A T I O N S
from the World report on violence and health

Reproduced from: https://www.who.int/violence_injury_prevention/violence/world_report/en/wrvhrecommendations.pdf

Given the huge, and often hidden, complexity behind violence it will take a wide range of actors to successfully implement violence-prevention programmes. From health professionals to community workers, from law enforcement officials to school authorities, from urban planners to media campaigners – violence prevention has to form many alliances and take various forms. Most important of all, tackling violence prevention requires political and financial commitment. The engagement of governments and other stakeholders at all levels of decision-making – local, national and international is also crucial to the success of any programme to prevent violence. Recognising violence and its effects may require a great deal of courage and fortitude as the many faces of violence go deep into the roots of families, societies and cultures. The message of the World report on violence and health is that this political commitment must be made and that change is possible. The following recommendations for preventing violence reflect the need for multi-sectoral and collaborative approaches:

1. Create, implement and monitor a national action plan for violence prevention

National planning to prevent violence should be based on a consensus developed by a wide range of governmental and nongovernmental actors. It should include a timetable and evaluation mechanism, and enable collaboration between sectors that might contribute to preventing violence, such as the criminal justice, human rights, education, labour, health, and social welfare sectors. Many countries currently do not have a national plan nor a coordinating agency or department that deals with violence comprehensively. To date, for example, in many countries the response if mostly focused on law and order, with only limited strategic cooperation with other authorities to help reduce violence. Formulating and implementing a coherent and multidisciplinary national plan is the first critical step towards violence prevention.

2. Enhance capacity for collecting data on violence

Most acts and consequences of violence remain hidden and unreported. Consequently, there is insufficient data on which to form coherent policy responses. Reliable data on violence are crucial not only for setting priorities, guiding programme design and monitoring progress, but also for advocacy to help raise awareness about the issue. Without information, there is little pressure on anyone to acknowledge or respond to the problem. Data needs to be collected at various settings such as hospitals, police stations, community centres and other places where authorities come into contact with victims and perpetuators of violence. It is also equally important that this information be shared across agencies and that internationally accepted standards for data collection be adopted to enhance the comparability of data across these agencies and even between nations and cultures.

3. Define priorities for, and support research on, the causes, consequences, costs and prevention of violence

Al though there has been great progress in the understanding of violence and violence prevention, questions still remain. At the national and local level, research can be advanced by government policy, by direct involvement of government institutions, and by funding to academic institutions and independent researchers. Among many research priorities, there is a pressing need to develop or adapt, test and evaluate many more prevention programmes in both developing and developed countries. At the global level, issues calling for cross-national research include the relationship between violence and various aspects of globalization; risk and protective factors common to different cultures and societies; and promising prevention approaches applicable in a variety of contexts. Resources for conducting and evaluating this research are needed.

4. Promote primary prevention responses

  • prenatal and perinatal health care for mothers, as well as preschool enrichment and social development programmes for children and adolescents;
  • training for good parenting practices and improved family functioning;
  • improvements to urban infrastructure, both physical and socioeconomic;
  • measures to reduce firearm injuries and improve firearm-related safety;
  • media campaigns to change attitudes, behaviour and social norms.

The first two interventions are important for reducing child abuse and neglect as well as violence perpetrated during adolescence and adulthood. The latter three can have significant impacts on several types of violence such as youth and collective violence or suicide.

5. Strengthen responses for victims of violence

National health systems as a whole should aim to provide high-quality care to victims of all types of violence, as well as the rehabilitation and support services needed to prevent further complications. Priorities include:

  • improvements to emergency response systems and the ability of the health care sector to treat and rehabilitate victims;
  • recognition of signs of violent incidents or ongoing violent situations, and referral of victims to appropriate agencies for follow-up and support;
  • ensuring that health, judicial, policing and social services avoid a renewed victimization of earlier victims, and that these services effectively deter perpetrators from reoffending;
  • social support, prevention programmes, and other services to protect families at risk of violence and reduce stress on caregivers;
  • incorporation of modules on violence prevention into the curricula for medical and nursing students.

Each of these responses can help minimize the impact of violence on individuals and families and the cost to health and social systems.

6. Integrate violence prevention into social and educational policies, and thereby promote gender and social equality

Much of violence has links with gender and social inequalities that place large sections of the population at increased risk. In many parts of the world, social protection policies and programmes are under considerable strain. Many countries have seen real wages fall, basic infrastructure deteriorate, and steady reductions in the quality and quantity of health, education and social services. Since such conditions are linked with increased risks for violence, governments should do their utmost to maintain social protection services, if necessary reordering the priorities in their national budgets.

7. Increase collaboration and exchange of information on violence prevention

Better working relations between international agencies, governments, researchers, networks and non-governmental organizations engaged in violence prevention are needed to achieve better sharing of knowledge, agreement on prevention goals and coordination of action. The contributions of advocacy groups – such as those concerned with violence against women or children, human rights abuses, abuse of the elderly and suicide – should also be recognized and encouraged through practical measures such as offering these groups official status at key international conferences and including them in official working groups.

8. Promote and monitor adherence to international treaties, laws and other mechanisms to protect human rights

Over the past half-century, national governments have signed a variety of international legal agreements that have direct relevance to violence and its prevention. They include the Convention on the Rights of the Child, the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, the Convention on the Elimination of All Forms of Racial Discrimination and many others. While many countries have made progress in harmonizing national legislation with their international obligations and commitments, others have not. Where the obstacle is the scarcity of resources or information, the international community should do more to assist.

9. Seek practical, internationally agreed responses to the global drug trade and the global arms trade

The global drug trade and the global arms trade are risk factors for different types of violence such as youth violence, suicide and collective violence, and are integral to violence in both developing and industrialized countries. A supply of gangs, guns and drugs in a locality is a potent mixture that strongly increases the likelihood of violence. Studies have shown particularly high rates of homicide and violence among youthful gang members involved in the trafficking of drugs and guns. Even modest progress on either front will contribute to reducing the amount and degree of violence suffered by millions of people.

Conclusion

Violence is not an intractable social problem or an inevitable part of the human condition. We can do much to address and prevent it. The world has not yet fully measured the size of the task and does not yet have all the tools to carry it out. But the global knowledge base is growing and much useful experience has already been gained which needs to be implemented.

For more information, please visit: http://www.who.int/violence_injury_prevention, or e-mail: violenceprevention@who.int ©World Health Organization 2002. All rights reserved.