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Initiated: May 2003
Adopted by the WMA General Assembly, Helsinki 2003
- INTRODUCTION
- In the year 2000 there were over 1.6 million people who
lost their lives to violence - meaning that every day more
than 4,000 people around the world die a violent death.
Roughly half of these deaths are due to suicide, almost
a third due to homicide, and the remainder arise from conflict-related
violence. These fatalities are only the tip of the iceberg
- available data tends to come from higher income countries
with established reporting systems and it is known that
many forms of violence are more prevalent in lower income
settings that may not provide data to the World Health Organization.
In addition to potential data collection problems, a variety
of different forms of violence, child abuse and neglect,
intimate partner violence and elder abuse, to name a few,
are systematically underreported, owing to fear, shame,
or cultural norms.
- For every young person killed by homicide, at least 20-40
other youth receive hospital treatment for violence-related
injuries. One in five females and 5-10% of males report
being sexually abused during childhood. International population-based
studies indicate that between 10 and 69 percent of women
report having been physically assaulted by an intimate partner.
In addition to the direct effects of injury arising from
violence there are a wide range of health effects, including
mental and reproductive health problems, sexually transmitted
diseases, and other health problems. Health effects arising
from violence can last for years, and may include permanent
mental or physical disability. From a societal perspective,
the economic costs associated with violence are substantial,
with direct costs for health services alone amounting to
5.0% of GDP in some countries.
- No single factor drives violence, either at the level
of the community or the individual. Violence arises out
of a complex interplay of individual, relationship, community,
societal and political factors.
- In 1996 the World Health Assembly adopted resolution WHA49.25,
which declared violence a global public health priority.
One year later, resolution WHA50.19 was adopted, which endorsed
the World Health Organization's integrated plan of action
for a science-based public health approach to the prevention
of violence and called for further work in this field.
- INVOLVEMENT OF THE INTERNATIONAL MEDICAL COMMUNITY
- Irrespective of the diversity of factors that give rise
to violence, there is one feature common to all forms of
violence: the health effects suffered are a direct concern
for the medical community. Doctors can be victims of violence
in the workplace or in other settings. In some cases doctors
can be involved in committing acts of violence or neglect.
Doctors of every description also deal with the victims
of violence on a daily basis. They make decisions regarding
referral and coordinated care across specialties and health
sectors, they plan for long-term follow-up and care of disabilities,
and in some settings they have contributed as a profession
to the prevention of violence. Whether as a pediatrician
assessing if a child is a victim of abuse, an emergency
physician or surgeon tending to a shooting victim, a psychiatrist
dealing with the psychosocial impacts of intimate partner
violence or any number of other possible encounters, the
reality is that more than any other profession the medical
community is absolutely central in terms of responding to
the health effects of violence.
- The manner in which the medical community can respond
is varied and will depend as much as anything else upon
contextual features and realities. In some settings more
structured forms of data collection are of paramount concern
and doctors may be the only group within such settings with
the ability to lobby for health systems to adequately integrate
systematic data collection related to violent injury. In
other settings that are more advanced, clinicians and public
health practitioners can play a major role in facilitating
or conducting focused studies that examine an aspect of
violence or violence prevention. The provision of such data
to policy-makers in a timely and appropriate fashion can
contribute to further development of evidence-based policies
to reduce violence.
- RECOMMENDATIONS
National Medical Associations are encouraged to contribute to
more systematic approaches to dealing with violence, including:
- Advocacy - violence is a global health problem
and its victims are frequently among the poorest, most powerless
or otherwise most vulnerable within society. The medical
profession should advocate at local, national and international
levels for effective strategies to prevent violence and
limit its impact on health. Moreover, the medical profession
should denounce all depictions or uses of violent behaviour
as solutions for personal, societal or political problems.
- Data collection - the medical profession should
play a central role in ensuring that routine data collection
occurs and is of a sufficient standard and comprehensive
enough to be a valuable tool to guide public health policy.
Research has shown that a large proportion of victims of
violence are not reported in police statistics because they
are not the victims of a crime (e.g. forms of family violence,
bullying, etc.) or have avoided being reported to the police.
- Medical training - in recognition of the substantial
burden of global morbidity and mortality that is related
to violence and the fact that violence and injury as a threat
to health is largely absent from medical training, the medical
profession should take steps to ensure the integration of
injury and violence prevention into medical school curricula.
- Prevention - the medical profession should use
the unique opportunity during clinical encounters, where
appropriate, to counsel patients and families with respect
to creating safer, less violent household environments.
They can also use their clinical judgment to detect victims
of violence or those at potential risk for violence and
make arrangements for appropriate care.
- Coordination of victim assistance - whether through
detecting victims that may suffer from violence but do not
know how to bring themselves to medical attention, or through
appropriate referral to deal with the related health conditions
or the physical, psychosocial or long-term disability associated
with injury, doctors can play a vital role in enhancing
the quality and comprehensiveness of victim assistance.
- Research - violence is an under-documented global
public health problem. Better understanding of causes and
consequences of violence is necessary, along with an enhanced
understanding of the effectiveness of various strategies
to prevent violence.
- Social example - the medical profession should
contribute to the creation and reinforcement of social norms
by not participating in or tolerating various forms of violence,
such as torture or mistreatment or neglect of certain populations
such as prisoners, and actively opposing such violence.
- Policy-making - many countries still lack comprehensive
national or local violence prevention policies and plans
of action. The medical profession should encourage the development
of such policies and in some cases take a leading role in
developing them.
17.9.2003
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