Violence Posed as Public Health Threat

The impact of violence on public health and the urgent need to use public health methods to reduce it were the focus of a series of recent events surrounding the launch in the Americas of the World Health Organization's World Report on Violence and Health and the Pan American Health Organization's Violence against Women: the Health Sector Responds.

Both reports were presented at a June 11 meeting at PAHO headquarters of the Inter-American Coalition for the Prevention of Violence, whose members include PAHO, the Inter-American Development Bank, the Organization of American States, the Centers for Disease Control and Prevention, the World Bank, USAID and UNESCO. The WHO report was also presented at a July 10 forum organized by PAHO's country office in Mexico City and at a briefing for the U.S. congress in Washington, D.C., on Sept. 15, cosponsored by PAHO and the Global Health Council.

Among the findings presented in the WHO report:

• In the Americas, 159,000 people were victims of homicide in 2000, and 65,000 more died from suicide. In most other regions, suicide outranks homicide as a cause of death.
• Worldwide, violence is a leading cause of death for people aged 15–44 years, accounting for some 14 percent of deaths among males and 7 percent of deaths among females.
• For every death due to violence there are many more nonfatal injuries that often bring long-term physical or mental health consequences.
• In addition to the toll of human suffering, violence exacts substantial social and economic costs.

"Death is just the tip of the iceberg," said Etienne Krug, director of WHO's Violence and Injury Prevention program and principal editor of the report. "An enormous proportion of societies all over the world are affected by [violence] in a very, very big way, and this is still not the full picture."

Speaking at the Sept. 15 Washington briefing, Etienne noted: "In some countries, up to 70 percent of women report having been victims of domestic violence at some stage in their lives. In some countries, up to 40 percent of women say their first sexual intercourse was forced, and up to 30 percent of the men say the same."

He and other experts emphasized that violence can be prevented and that public health offers some of the best means for doing so.

"Public health has not yet fully started playing its role," Etienne told the Capitol Hill audience. "We can collect data. We have first access to victims in emergency departments, in morgues, etc., where we can be there to collect information on the problem. We can contribute to research and to prevention, just as we do for many other public health problems.

"Violence is amenable to the tools that we use to address all public health problems, and we need to start using them more than we have already to address this preventable problem."