World Medical Association: talking points for the World report on violence and health
(12 January 2004, milestones meeting)

By Dr Delon Human

Doctors cannot escape the reality that violence is a health issue. In emergency departments and clinics doctors repair the damage done to victims of all types of violence. They also treat the injuries of perpetrators, whose involvement with violence make them more likely to end up as victims themselves. Doctors are often responsible for informing family members that the life of their loved one has been ended by violence. Doctors may be the first and only professionals in a position to recognize violence in their patients' lives, and doctors care for millions of women and children whose health and well being undermined by violence in their homes. Doctors can be victims of violence in the workplace and in other settings. In some cases doctors can be involved in committing acts of violence or neglect.

Beyond the direct and immediate consequences of violence such as injuries and disabilities, research is increasingly demonstrating that violence is a cross-cutting risk factors at the root of many other conditions the medical community addresses. For example, a major US study⁽¹⁾ estimates that 78% of intravenous drug use is related to severe child abuse and other adverse childhood experiences, as is 65% of alcohol abuse, 58% of suicide attempts and 54% of current depression.

Despite clear empirical evidence for the health impact of violence and the central role of the medical community in treating its consequences and advocating for prevention, the links between violence, medicine and health remain unrecognized by far too many authorities.

The World report on violence and health and the Global Campaign for Violence Prevention have done much to begin correcting this state of affairs. Alongside the groundbreaking efforts of the honourable health ministers that have spoken before me, the WMA is proud to have contributed very directly to this awareness raising process with its Statement on Violence and Health.

This Statement, adopted by the WMA General Assembly in September 2003, was directly inspired by the World report on violence and health. It encourages national medical associations to: advocate for effective prevention strategies and victims services; ensure routine data collection; ensure the integration of violence prevention into medical curricula; promote violence prevention through counselling during clinical encounters; coordinate victim assistance; strengthen research; set a social example of non-violence, and encourage the development of national violence prevention policies and plans.

WMA will support its members in acting on this Statement by providing training and ongoing advocacy for violence prevention. WMA is thus closely aligned with the undertaking to implement the recommendations of the World report on violence and health made by all 199 WHO member states in the May 2003 World Health Assembly Resolution on this matter.

WMA therefore congratulates WHO Director General Dr JW Lee for his vision and commitment to ensuring that WHO fulfils its role as a global leader of the health response to violence. WMA urges Dr JW Lee to further strengthen WHO violence prevention activities to ensure that the powerful momentum achieved in the first year of the Global Campaign for Violence Prevention is converted into sustained activities at country, regional and global levels.

⁽¹⁾ Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58.