File Name: world report on violence and health 2002 .zip
Many of us have become inured to the presence of violence. Its ubiquity in the news and, for some of us, in our own neighborhoods has numbed us to the shock of this largely preventable condition.
Abstract This policy statement proposes that APHA officially deem violence a public health crisis, that public health approaches have proven effective in reducing violence, and that a comprehensive system is needed to prevent the loss of 60, lives and countless traumas each year. Current efforts to reduce violence have not been sufficiently effective. National data demonstrate a recent increase in violent events.
In addition, there is increasing evidence of the profoundly harmful effects of violence on child development, the long-term health of affected populations, and the economic development of entire communities, especially communities of color.
The current fragmented approach that leans heavily on the justice system needs to be updated to an integrated one that supports extensive cross-sectoral collaboration with an emphasis on health.
This will allow all agencies to be involved and held accountable for preventing violence and its health effects. In this approach, health departments, hospitals, schools, universities, nonprofit organizations, and justice systems share data on all forms of violence, identify protocols for screenings and referrals, develop and enhance programs and policies to prevent and reduce violence, and use data to continuously increase the efficiency and effectiveness of these efforts.
A unified effort that works mainly through existing infrastructure, addresses systemic and institutionalized trauma, and connects the health sector to other sectors is the most effective way to address the violence that devastates so many American communities and jeopardizes the health of the nation. This policy statement serves as an introductory statement that can be expanded upon through additional policies. The existing APHA policy on gun violence illustrates strategies and policies that can be applied to other types of violence as well and social transmission of violence in neighborhoods that are known as violence hotspots.
Violence prevention programs can be implemented in parallel with gun control legislation. The existing policy on youth violence was a significant step for the public health field to take toward deeming violence a threat to the health of the nation. However, that statement was specific to youths and excluded domestic violence and suicide.
A focus on the interconnectedness of all forms of violence, along with a call for a system of health approaches to prevent all forms of violence in all populations, is imperative for the health of our nation. Problem Statement The recognition of violence as a health issue is founded on an understanding of violent behavior as arising from contextual, biological, environmental, systemic, and social stressors. Within the health system, every interaction is an opportunity to prevent violence directly.
Thus, the public health system must play a primary role in preventing the spread of violence, with the public health workforce involved in the critical functions of training, educating, and analyzing, and there must be an explicit focus on addressing inequities and reducing racial bias in the system's institutions.
This approach not only prevents harm and injustice but also saves a significant amount in funding. This builds on a growing body of work, including the surgeon general's report on youth violence, showing that the health approach to violence can be effective.
In this foundational document, Dr. David Satcher stated that "the key to preventing a great deal of violence is understanding where and when it occurs, determining what causes it, and scientifically documenting which of many strategies for prevention and intervention are truly effective.
Several models of prevention and health care delivery have seen success through employment of "credible messengers" or community health workers, including outreach workers, prevention professionals, hospital responders, and violence interrupters.
These individuals can help young people and families navigate systems, resolve differences, and choose alternative paths and can speak up for the need for more positive resources in communities.
They function as an integrated team across all sectors in a community. The issue of violent behavior is much broader and deeper than current law enforcement, firearm control, and mental health debates may suggest. If we want to reduce violence in our local and global communities, we must acknowledge that it is predictable and preventable.
Violence is almost never "senseless" or "random"; rather, it is an epidemic, meaning that it spreads, clusters, and transmits through exposure. Our current system for addressing violence was born largely from a misdiagnosis of the problem. With a new scientific understanding, the health system can implement strategies to reduce and eliminate violence. More than 30 years ago, U. Everett Koop issued a public health call to action that included the following components: "education of the public on the causes and effects of violence, education of health professionals as to better care for victims and better approaches to violence prevention, improved reporting and data-gathering, some additional research, and increased cooperation and coordination Koop had a prescient vision for a health-centered response to violence in which the health system assumes a central role in both treatment and prevention.
This statement was echoed by the World Health Organization, particularly in regard to the use of data to inform violence prevention efforts. Many areas globally and locally lack collection mechanisms to strategize appropriately or evaluate the success of existing efforts. This has led to missed opportunities to comprehensively address violence in a sustainable manner.
All forms of violence, including community or peer violence, suicide, intimate partner violence, bullying, workplace violence, elder abuse, child abuse, and sexual abuse and trafficking, must be addressed and prevented. Every day in our nation, an average of 39 people are killed and die by suicide.
For example, the homicide rate among Black male youths between 10 and 25 years old is nearly 20 times higher than the rate among White male youths.
Beyond direct injury, exposure to violence increases the risk of other medical illnesses, including asthma, hypertension, cancer, and stroke. Negative health outcomes are also seen in statistics related to HIV, maternal health, and adoption of unhealthy behaviors such as alcohol and substance abuse. It is understood that doctors, nurses, and other health workers play a key role in saving the victims of violence in trauma units and emergency departments.
However, we must expand the role of health care workers to helping people and communities stay safe in the first place by preventing violence. A crucial way to do this is by treating violence as a public health problem addressed by health practitioners. Just as health campaigns in the flu season encourage hand washing and vaccination, violence prevention programs should encourage conflict resolution to interrupt transmission of violence. Most people who have mental illnesses are not dangerous, but many people at risk for violence are at risk due to mental health issues, suicidal thoughts, or feelings of desperation.
As people with mental illnesses are more likely to be victims of violent crime than members of the general population, strategies and interventions must be developed and implemented with a focus on building resilience among these individuals and providing resources and connections that address their needs.
To prevent violence at home and in communities, the public health approach focuses on building healthy gender norms, healthy relationships, socially just institutions; changing norms; and creating protective environments.
As stated previously, violence disproportionately impacts people of color and other oppressed groups such as the lesbian, gay, transgender, queer, intersex, and asexual LGBTQIA population and those living below the poverty line.
Communities living without adequate resources and those facing unfair treatment are more susceptible to all health issues, including violence. The factors that enhance or inhibit health also impact violence, while violence in turn affects determinants such as housing, education, transportation, and economic conditions. Thus, violence itself should be seen as a social determinant in that violence begets violence and exposure to violence is the greatest predictor of future violence.
To mitigate the various risk factors for violence, communities must address environmental factors that increase susceptibility to violence in order to both reduce communities' susceptibility and bolster their resistance.
Grassroots mobilization of community members is also essential for improving health, in particular by holding systems accountable and changing social norms to prevent violence rather than accept it.
It is critical that members of impacted communities be deeply involved in all aspects of development, implementation, and evaluation of the components of this integrated, collaborative health system.
In combination with violence prevention strategies such as those just described, health intervention strategies can address historical and systemic inequities that allow violence to persist.
The comprehensive, integrated approach would also allow for pilots, enhancements, and dissemination of promising practices in all sectors. Given the lack of research and successful efforts in some areas of violence prevention, including efforts addressing child sexual assault, trafficking, elder abuse, and more, this innovative approach has the potential for immeasurable impact.
Evidence-Based Interventions and Strategies Rigorous evaluations of health approaches to violence prevention and intervention have shown reductions in injuries, shootings, and deaths as well as changes in attitudes and norms. Examples are outlined below. The strategies just listed and many other promising practices are intentionally focusing on those at highest risk for violence.
In the United States, we know that communities of color are experiencing higher rates of violence and exposure to violence. If violence is reduced in these communities, inequities related to violence e. Cities across the country are using the public health approach to address violence across all sectors. In Minneapolis, for example, this comprehensive strategy was designed by city agencies; community, civic, and business groups; and hundreds of young people. The body of knowledge and evidence supporting this approach has grown tremendously.
Although much work is still needed, the health responses emphasized above have been shown to have impact. The CDC provides technical packages largely based on these findings. In this new framework, cooperation will occur at all levels and be facilitated through regular cross-sector meetings designed to exchange information and develop coordinated responses. Cross-sector collaboration also focuses on particular sectors that have natural linkages in their work as it relates to violence prevention, with leadership coming from health stakeholders such as local health departments, universities, and nonprofit organizations with expertise in this area.
Opposing Arguments Much of the resistance to the public health approach to violence revolves around our current framing of violence as an issue that is the responsibility of law enforcement and the criminal justice system.
Focusing on punishing violent actors after a violent incident has occurred fails to acknowledge the larger societal factors contributing to perpetuation of violence and the fact that violence is in fact preventable.
Public health methods are inherently designed to address upstream factors to improve downstream outcomes, and these strategies have been proven to be effective in the prevention of violence.
Another argument attempting to dissuade people from adopting health approaches is that there often is a lack of funding available to address the problem. However, numerous studies show that our nation is paying extremely high costs, many of which are avoidable by investing in prevention and intervention.
For example, HVIPs have been proven to be cost effective. Those promoting prevention strategies are often challenged to prove the role of these strategies in reducing the occurrence of violence.
However, there is a long history of violence being treated as a public health issue, and the evidence that has driven these approaches is extensive. Well-designed studies comparing neighborhoods have controlled for such effects as gentrification and law enforcement measures and still proven that public health methods are having a significantly positive impact.
Health professionals often understand the data and see the need but may be unsure how to address the issue given existing resources. Centers for Disease Control and Prevention. Preventing multiple forms of violence.
Accessed January 8, History of violence as a public health problem. Virtual Mentor. World Health Organization. Definition of violence. Center for Nonviolence and Social Justice. Healing hurt people. Violence is a public health issue. J Public Health Manage Pract. Peace Alliance. Statistics on violence and peace. Suicide and suicidal attempts in the United States: costs and policy implications. Suicide Life Threat Behav.
Office of the Surgeon General. Washington, DC: U. Department of Health and Human Services; American Public Health Association. Community health workers.
Abstract This policy statement proposes that APHA officially deem violence a public health crisis, that public health approaches have proven effective in reducing violence, and that a comprehensive system is needed to prevent the loss of 60, lives and countless traumas each year. Current efforts to reduce violence have not been sufficiently effective. National data demonstrate a recent increase in violent events. In addition, there is increasing evidence of the profoundly harmful effects of violence on child development, the long-term health of affected populations, and the economic development of entire communities, especially communities of color. The current fragmented approach that leans heavily on the justice system needs to be updated to an integrated one that supports extensive cross-sectoral collaboration with an emphasis on health.
Krug et al. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In.
PDF | In , the World Health Assembly declared violence a major public health issue. The report analyses different types of violence including child abuse and neglect, youth violence, Lancet ; –
Violence against women VAW is, collectively, violent acts that are primarily or exclusively committed against women. This type of violence is gender-based, meaning that the acts of violence are committed against women expressly because they are women. Violence against women and girls is a problem of pandemic proportions. At least one out of every three women around the world has been beaten, coerced into sex, or otherwise abused in her lifetime with the abuser usually someone known to her. Violence against women can fit into several broad categories.
Violence is a global phenomenon resulting in the deaths of more than 1.
The Healthy People Social Determinants of Health topic area is organized into 5 place-based domains:. Crime and violence experienced by individuals living in a community is an important public health issue. People can be exposed to violence in many ways. They may be victimized directly, witness violence or property crimes in their community, or hear about crime and violence from other residents. Violence can lead to premature death or cause non-fatal injuries. Exposure to violence in a community can be experienced at various levels, including victimization, directly witnessing acts of violence, or hearing about events from other community members.
Тепло дня здесь сменяется влажной прохладой, а шум улицы приглушается мощными каменными стенами. Никакое количество люстр под сводами не в состоянии осветить бесконечную тьму. Тени повсюду. И только в вышине витражи окон впускают внутрь уродство мира, окрашивая его в красновато-синие тона. Севильский собор, подобно всем великим соборам Европы, в основании имеет форму креста.
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Suggested citation: Krug EG et al., eds. World report on violence and health. Geneva, World Health Organization, Photograph of Nelson.Reply
Geneva, World Health Organization, Photograph of Nelson Mandela reproduced with permission from the African National Congress. The World Health.Reply