National efforts leading to significant progress, reports WHO

Governments around the world are taking new and stronger measures to quell interpersonal violence and its life-long health consequences, a new WHO report shows. This week in Scotland, 200 of the world's leading experts in preventing violence gather for "Milestones 2007", to assess the advances that have been made, identify strategies for further expanding these, and advocate for increased investment by international development partners.

In the context of Milestones 2007, the WHO report documents progress in countries since 2002. Some key national achievements are:

• Brazil has published its first national report on violence and health and has completed a national inventory of over 300 violence prevention programmes;
• Malaysia has released its first national report on violence and health, developed one-stop crisis centres for victims of child maltreatment, and created services for survivors of intimate partner and sexual violence in all government hospitals throughout the country;
• Mexico has published its first national report on violence and health and established within the Ministry of Health a national centre for the prevention of violence and injuries;
• Mozambique has developed surveillance systems recording details of violence-related deaths and injuries and has assessed the number and quality of medico-legal services for victims of sexual violence; and
• The United Kingdom has published its first national report on violence and health, created the Violence Reduction Unit within the Scottish Executive, and has promoted the work of the Cardiff Violence Crime Task Group as a model for community safety partnerships nationwide

"With an improved understanding about what works to prevent violence in families and communities, the violence prevention field has reached a critical turning point," notes Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. "Milestones 2007 is an opportunity to draw lessons from the good work being done in many countries and define ways to scale up implementation in countries around the world."

Increased efforts to scale up violence prevention come when health policy makers and practitioners begin to fully understand the long-term consequences of violence.

For instance, a 2004 WHO study reported that the lifetime impacts of child sexual abuse account for approximately

• 6% of cases of depression;
• 6% of alcohol abuse/dependence;
• 6% of illicit drug abuse/dependence;
• 8% of suicide attempts;
• 10% of panic disorders; and
• 27% of post-traumatic stress disorders.

Other studies have also linked child physical abuse, intimate partner violence and sexual violence to excessive smoking, eating disorders, and high-risk sexual behaviour, which in turn are associated with some of the leading causes of death including HIV/AIDS, cancers and cardiovascular disorders.

"Globally, the greatest challenge to scaling up violence prevention efforts remains a lack of investment in scientific, large-scale outcome evaluation studies, especially from low- and middle-income countries, where both the burden of violence and the cost of failure to invest in effective prevention are the highest," notes Dr Etienne Krug, Director of WHO's Department of Violence and Injury Prevention. "With those studies in hand, we would be well placed to scale up and globalize prevention."

Milestones 2007 is being hosted for WHO by the Scottish Violence Reduction Unit in Kincardine, Scotland, United Kingdom, from 17 to 19 July 2007. It is the third in a series of meetings marking the anniversary of the launch of the landmark World report on violence and health released by WHO in 2002.

The impact of violence

The report demonstrated the extent of the impact of violence. In 2002 (the latest year for which global estimates are available) an estimated 1.6 million people lost their lives to violence; more than 90% of those deaths are concentrated in low- and middle-income countries. Physical, sexual and psychological abuse undermines the health and well-being of many millions of people in all countries on a daily basis. Suicide and homicide are the 5th and 6th leading causes of death in people aged 15-44 years. Between three and seven million adolescents and young adults receive hospital treatment each year for a violence-related injury.

"For the Violence Reduction Unit, the World report on violence and health was a revelation, in that it offered an innovative approach to the traditional methods of policing violent crime," notes Detective Superintendent John Carnochan, Head of the Scottish Violence Reduction Unit. "We are pleased to host Milestones 2007, and to share our experiences and learn from others."

Evidence shows that a major proportion of violence-related death and suffering is avoidable through investment in positive approaches such as

• parent training;
• home visitation services;
• reducing alcohol availability and access to firearms;
• helping high-risk adolescents to complete schooling;
• changing cultural norms that condone the use of violence; and
• providing adequate emergency medical care

Cost-effectiveness studies show that most of these strategies are less expensive to implement than paying the costs of responding to violence.

In addition to showcasing some of the significant violence prevention work under way around the world, Milestones 2007 will serve as a platform for discussing scaled-up country implementation of these recommendations, and efforts to measure effectiveness using the outcomes that really matter - such as rates for violence-related deaths, non-fatal injuries and other violence-related health conditions.