Violence ― whether self-inflicted, interpersonal or collective ― constitutes a global health problem of enormous dimensions, but much of it is preventable, an audience was told at a technical briefing followed by a discussion during the Fifty-fourth World Health Assembly.

Almost 1.7 million people were intentionally killed by another person or by themselves in 1999, according to the World Health Report 2000. A large proportion of victims of fatal violence are young males. It is estimated that as many as 40 million children could be the victims of child abuse every year around the world. An estimated one-third of all women are victims of acts of violence during their lifetime, according to a 1999 Johns Hopkins School of Public Health report.

"Regional differences in homicide and firearm death rates suggest, however, that much violence is preventable," said Dr Etienne Krug, Director of the Injuries and Violence Prevention Department at the World Health Organization (WHO). Homicide rates for Japan, the United States and Brazil are respectively 0.6, 7 and 25 per 100 000 population. Firearm death rates in Asia are almost 100 times lower than in the Americas. "We need to learn from these cross-cultural differences. Such insight could help in prevention and response," added Dr Krug.

Violence is a multifaceted and complex problem. No single factor explains why some individuals behave violently toward others or why violence is more prevalent in some communities and not in others.

A combination of factors predictive of violence intervene at a number of levels. At the individual level, for example, impulsiveness and alcohol abuse are risk factors for all types of violence. As regards the family, lack of parental skills is a risk factor for child abuse. At the community level, isolation of women and negative peer influence are risk factors for violence. Gender inequality, a large gap between rich and poor, easy availability of firearms and social acceptability of violence can provide fertile ground for violence in the society at large. To prevent violence, interventions are needed at each of these levels.

A case study on Brazil was presented at the technical briefing on Violence and Health, which took place on 17 May. Data given illustrated that homicide is disproportionately urban. In São Paulo, homicides occur mainly in the poorest areas and affect primarily male youth (ages 16-24), for whom homicide is the leading cause of death. During past decades, homicides have doubled in São Paulo every ten years. The problem is being consolidated in affected districts, and is spilling over to neighbouring districts in the city.

"There is a catch-22 situation as regards education. When violence occurs around or in schools, the quality of education suffers. But education is very much needed to prevent violence in the first place, " said Dr Nancy Cardia, Director of Research at the Center for the Study of Violence, University of São Paulo.

In addition, violence puts added strain on health services, including health workers, especially in poor areas. Taking care of victims of violence requires a large amount of human and financial resources.

Victims of violence can suffer from a range of health problems, aside of injuries, according to Dr Krug. These include: depression, suicidal behaviour, eating disorders, smoking and alcohol or drug use. Victims of sexual violence can also suffer from sexually transmitted diseases or unwanted pregnancy. Populations exposed to political violence or conflict often suffer malnutrition or from infectious diseases.

Because of the sheer magnitude of the violence problem and its far-reaching and wide-ranging impacts, WHO plans to launch the first World Report on Violence and Health in spring 2002. The goals of the report include raising awareness about violence as a global health problem and increasing prevention by the public health community.