Preventing violence and reducing its impact: how development agencies can help

Violence has long been considered a criminal justice and human rights issue. More recently it has also been viewed as a public health problem. But violence has rarely been regarded as a development issue. Yet, in many low and middle income countries, the health consequences and costs of violence seriously hinder economic and social development. In addition to its obvious physical consequences, such as injury and death, recent studies show that the health, psychological, social, and occupational consequences of violence reach much further than previously suspected.1 2 The health and criminal justice costs of reacting to violence divert billions of dollars from more constructive societal spending. Research is also beginning to show that the much larger indirect economic costs of violence due to lost productivity and lost opportunity impede development, exacerbate socioeconomic inequality, and erode human and social capital.3 Moreover, pervasive violence and deprivation often fuel each other, forming a vicious circle …

Violence has long been considered a criminal justice and human rights issue. More recently it has also been viewed as a public health problem. But violence has rarely been regarded as a development issue. Yet, in many low and middle income countries, the health consequences and costs of violence seriously hinder economic and social development. In addition to its obvious physical consequences, such as injury and death, recent studies show that the health, psychological, social, and occupational consequences of violence reach much further than previously suspected. 1 2 The health and criminal justice costs of reacting to violence divert billions of dollars from more constructive societal spending. Research is also beginning to show that the much larger indirect economic costs of violence due to lost productivity and lost opportunity impede development, exacerbate socioeconomic inequality, and erode human and social capital. 3 Moreover, pervasive violence and deprivation often fuel each other, forming a vicious circle that stifles economic growth.
To help highlight violence as a development issue, WHO has developed a new publication calling for increased attention to, and greater investment in, violence prevention by development agencies. Its primary audience is policy-makers, highlevel planners, and others who influence the international health and development agenda and donor policy. Produced under the aegis of the WHO-led Violence Prevention Alliance, the document was written by WHO staff with contributions from many experts worldwide.
Every year, more than 1.6 million people die because of violence. Of these deaths, over 90% occur in low and middle income countries. 4 This is more than the annual death toll exacted by malaria and about the same as that due to tuberculosis. This document focuses on self-directed and interpersonal violence, as these two forms of violence account for 54% and 35%, respectively, of the global death toll due to violence, whereas war and other forms of collective violence make up 11%. 4 By contrast, a review of Official Development Assistance agency websites and documents suggests that the attention these agencies pay to the main forms of violence is inversely proportional to their actual incidence. For instance, suicide prevention is not mentioned on these web-sites despite the almost one million deaths it causes; male-to-male interpersonal violence, which is also a major contributor to the burden of violence, is only receiving limited attention; whereas collective violence, which makes up the smallest proportion of the overall global death toll due to violence, features most prominently. And scant reference is made to the following activities, critical to successful violence prevention: evidence-based interventions, systematic data collection, research, and intersectoral cooperation.
The guidance document identifies these gaps-and the many strengths-in current violence prevention priorities of development agencies and makes concrete recommendations for a strengthened agenda that can contribute more effectively to violence prevention. The agenda includes: This agenda prioritizes the following 10 scientifically credible violence prevention strategies: 1. Increasing safe, stable, and nurturing relationships between children and their parents and care givers 2. Reducing availability and misuse of alcohol 3. Reducing access to lethal means such as firearms and pesticides 4. Improving life skills and enhancing opportunities for children and youth 5. Promoting gender equality and empowering women 6. Changing cultural norms that support violence 7. Improving criminal justice systems 8. Improving social welfare systems 9. Reducing social distance between conflicting groups through, for instance, the creation of joint business organizations, trade unions, or political parties

Reducing economic inequality and concentrated poverty
The document also advocates that a strengthened agenda should focus on the following four strategies for reducing the impact of violence: 1. Engage the health sector in violence prevention 2. Provide mental health and social services for victims of violence 3. Improve emergency response to injuries from violence 4. Reduce recidivism among perpetrators The strategy would necessarily prioritize the capacity building that is required, at both national and international level, to make these strategies both effective and sustainable.
It is in low and middle income countries, which receive the bulk of official development assistance, that the stakes for getting violence prevention right are highest. Scaled-up investment in evidence-based prevention strategies should conclusively demonstrate that violence is preventable in these countries and free up the development potential currently lost to violence. We therefore urge policy-makers, researchers, and practitioners to consult this document, which will be freely downloadable from the WHO Prevention of Violence website (http://whqlibdoc.who. int/publications/2008/9789241596589_eng. pdf) or can be obtained in hard copy from WHO. For further information, please contact Christopher Mikton (miktonc@who.int) or Alex Butchart (butcharta@who.int).