SoV-Oct2008

Handbook of WMA Policies
World Medical Association ½ S-2003-04-2008

WMA STATEMENT
ON
VIOLENCE AND HEALTH
Adopted by the 54th
WMA General Assembly, Helsinki, Finland, September 2003
and reaffirmed by the 59th
WMA General Assembly, Seoul, Korea, October 2008
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 ice-
berg – available data tends to come from higher income countries with established re-
porting 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 under-
reported, 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 vio-
lence 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.
S-2003-04-2008½ Seoul
Violence and Health

INVOLVEMENT OF THE INTERNATIONAL MEDICAL COMMUNITY
Irrespective of the diversity of factors that give rise to violence, there is one feature com-
mon to all forms of violence: the health effects suffered are a direct concern for the medi-
cal 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 psy-
chiatrist 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 struc-
tured 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 inte-
grate 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 appro-
aches 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 profes-
sion 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.
Handbook of WMA Policies
World Medical Association ½ S-2003-04-2008

Medical training – in recognition of the substantial burden of global morbidity and mor-
tality 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 en-
counters, 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 ap-
propriate 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 under-
standing 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 reinforce-
ment 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 pre-
vention policies and plans of action. The medical profession should encourage the develop-
ment of such policies and in some cases take a leading role in developing them