Intro
Violence kills more than 1.6 million people each year. The impact of nonfatal violence cannot be quantified, but it is even more pernicious given resultant disabilities and long-term physical, psychological, economic, and social consequences.
The direct and indirect costs of violence are enormous. Violence directly affects health care expenditures worldwide. Indirectly, violence has a negative effect on national and local economies—stunting economic development, increasing economic inequality, eroding human and social capital, and increasing law enforcement expenditures (Waters and others 2004).
The U.S.-based Centers for Disease Control and Prevention identified violence as a leading public health problem in the mid 1980s and early 1990s (Rosenberg 1985; Rosenberg and Fenley 1991), as did the World Health Assembly in 1996 (Resolution WHA49.25). Contributing to the World Health Organization (WHO) report on global violence and health, Dahlberg and Krug (2002) divided violence into the following categories:
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self-directed violence, or violence in which the perpetrator is the victim (for example, suicide)
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interpersonal violence, or violence inflicted by another individual or a small group of individuals
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collective violence, or violence committed by larger groups, such as states, organized political groups, militia groups, and terrorist organizations.
This chapter focuses on interpersonal violence, which disproportionately affects low- and middle-income countries (LMICs).1 The WHO report on violence and health estimates that more than 90 percent of all violence-related deaths occur in LMIC countries (Dahlberg and Krug 2002). The estimated rate of violent death in LMICs was 32.1 per 100,000 people in 2000, compared with 14.4 per 100,000 in high-income countries.
This chapter is based on a public health approach to preventing interpersonal violence. A public health approach has three overriding characteristics: it applies scientific methodology, emphasizes prevention, and encourages collaboration.
Applying a scientific methodology to a public health approach involves collecting and analyzing data to define the magnitude, scope, and characteristics of the problem, examining the factors that increase or decrease the risk for violence, and identifying the factors that can be modified through interventions. Interventions are designed, tested, and evaluated. Efficacious and promising interventions are implemented, and their effects and cost-effectiveness are evaluated. Ongoing monitoring of intervention effects on risk factors and target problems builds the database to allow quantitative assessment of successes and clear identification of remaining needs.
Fundamentally, public health is focused on prevention of harm caused by disease or violence. Although criminal justice systems have traditionally focused on capturing perpetrators of violence and punishing them for their actions (typically through incarceration), the public health system attempts to prevent violence from occurring and concentrates on identifying ways to keep people from committing acts of violence. Interventions may eliminate or reduce the underlying risk factors and shore up protective factors. Prevention strategies are conceived and implemented with reference to the interaction of risk factors among people at different stages of the life cycle (Mercy and Hammond 1999; additional sources online).
A public health approach must be collaborative, drawing on contributions from different sectors and disciplines. Public health analyses of violence aim to encourage integrated actions by diverse sectors such as health, education, social services, and justice. Each sector has a role to play, and collectively their actions have the potential to reduce violence.
