Books & Electronic Media

World report on violence and health

Preface by Nelson Mandela Foreword by Gro Harlem Brundtland Edited by Etienne Krug, Linda L.Dahlberg, James A. Mercy, Anthony Zwi, & Rafael Lozano. Published by the World Health Organization, Geneva, 2002 ISBN 92 4 154561 5, price Sw.fr. 30, US$ 27. In developing countries Sw.fr. 15

Those doing research on violence and carrying out violence prevention activities have been eagerly awaiting this report. In countries where homicide is the major cause of death among young males, it is no longer possible to be unaware that violence is a public health problem. It is made even more painfully obvious when, as is often the case, the same countries have been successful in reducing child mortality. Public health researchers and demographers were among the first to call attention to this problem, as they saw the numbers of deaths caused by homicide relentlessly rising.

In many parts of Latin America, where for at least a decade the human and societal costs of violence have been widely recognized, WHO's recent decision to take up this issue was welcomed as a highly significant event. It is seen as an important reinforcement in the struggle to stop and reverse the growth of violence. It will certainly make it harder for public authorities to ignore that a great deal of the violence now occurring could be prevented. There were fears, however, that WHO might adopt an overly biomedical model of violence. The report, published on 3 October, dismisses these fears.

One of its great achievements is to spell out the causes of violence, describe the different forms it takes, and indicate the means of preventing it. It does all this in clear language while bringing together the contributions the different relevant disciplines make to our understanding of this complex topic. This is no small achievement, and it is repeated in each of the chapters.

The body of the report consists of an analysis of the seven types of violence that appear to afflict the largest numbers of people: youth violence, child abuse, violence between intimate partners, abuse of elderly people, sexual violence, self- directed violence (suicide and suicide attempts) and collective forms of violence. Each section presents findings from different fields of knowledge and different regions of the world, doing so in a cohesive and integrated fashion which allows readers to compare their own national situation with that of others.

The sheer volume of research data on causes and effects, and the huge diversity of the prevention programmes in each of the forms of violence examined, can be overwhelming. Researchers on violence know very well how hard it is simply to keep up with the literature in their own specific part of the subject. Those who have easy access to the latest data and reliable statistics are not always additionally blessed with the energy and time to incorporate contributions from other disciplines or other cultures - not forgetting the skills and further time needed to overcome language barriers. Other researchers, particularly in the South, lack access to much of the literature, having to rely on the relatively few journals and books that local universities can afford. They not only have little access to reliable official statistics but also have difficulties in sharing information with researchers in similar circumstances.

Readers will readily appreciate the effort that went into surmounting these difficulties, particularly that of collating data from different countries to produce a more informed estimate of the size of the problem. This brings us to another great achievement of this report: it brings researchers from the different fields of violence studies closer together. This broadens their horizons, bringing more points of view and cultural diversity to their perception of their own field. These varied contributions are well documented in the carefully compiled bibliographies at the end of each section.

Since the theme of violence includes so much material, it is not unusual for researchers and practitioners to specialize in certain areas such as youth, the family, or the elderly, while maintaining only tangential contact with the other areas of violence. This report gives them a comprehensive overview of the field and in doing so sheds new light on their work. In Latin America attention has been focused mainly on violence in youth and intimate partners, and child abuse. Violence against oneself and against the elderly receives much less attention, but the report shows how these too are extremely serious problems in many societies. That the number of suicides annually exceeds that of homicides by nearly 50% is a troubling fact, as is the increase in violence and abuse against the elderly. Such phenomena raise very hard questions about the true nature of the civilizing process in any society.

The chapter on collective forms of violence is perhaps the only one that could have done with a more extensive treatment. Issues of the utmost importance such as genocide, extrajudicial killings promoted by governments, mob killings and crimes of hatred need specific sections devoted to them. That they are not examined in more depth may reflect the fact that although these phenomena have become more common in recent years, their occurrence in their present forms is more recent and there is relatively little literature on them. They are pressing issues, as the numbers of people who fall victim to these forms of violence seem to be growing. This points to another need: for more accurate monitoring systems. Most of what is known about these events comes from qualitative research and monitoring by human rights organizations rather than official data. Governments can and should be pressured to account for such violence within their territories.

The report is a valuable resource for researchers and practitioners in the field. It will also be useful for civil servants involved in designing, selecting and implementing public policies, for the media, and for nongovernmental organizations. As a resource, let us hope it will become a regular document perhaps along the same lines as the Human Development Report.

Nancy Cardia¹