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R E C O M M E N D A T I O Nfrom the World report on violence and healthGiven the huge, and often hidden, complexity behindviolence it w ill take a w ide rang e of actors to success-fully implement violence-prevention programmes.From health professionals to community workers,from law enfo rcement off icials to school a uthorities,from urban planners to med ia campa igners – violenceprevention has to f orm ma ny alliances and t ake vari-ous forms. Most important of all, tackling violenceprevention requires political and financial commit-ment . The enga gement of g overnments and otherstakeho lders at all levels of d ecision-ma king – local,national and international is also crucial to the success

of any p rogram me t o prevent violence. Recognisingviolence and its effects ma y require a grea t de al ofcourage and fortitude as the many faces of violencego deep into th e root s of fa milies, societies and cul-ture s. The me ssag e of t he World repo rt on violence

and health is that this political commitment must bema de a nd t hat chang e is possible. The f ollow ing rec-omme nda tions for preventing violence reflect theneed for multi-sectoral a nd collabora tive a pproaches:

1. Create, implement and monitor a national actionplan for violence prevention

Nat ional planning to prevent violence should b ebased on a consensus developed by a w ide rang e ofgovernmental and nongovernmental actors. It shouldinclude a timetable and evaluation mechanism, andenable collaborat ion betw een sectors that might con-tribute to preventing violence, such a s the criminaljustice, huma n rights, education, lab our, health, andsocial w elfa re secto rs. Many coun tries currently donot ha ve a nat ional p lan nor a coordinat ing a gencyor depa rtment th at d eals w ith violence comprehen -sively. To d a te, f or exa mple, in ma ny coun tries theresponse if mostly focused on law and order, w ith onlylimited strateg ic cooperat ion w ith other a utho rities tohelp reduce violence. Formulating and implement inga coherent and multi-disciplinary national plan is thefirst critical step to w ard s violence prevention.

2. Enhance capacity for collecting data on violence

Most a cts and conseque nces of violence remain hid-den and unreported . Conseq uently, there is insuffi-cient d at a o n w hich to form coherent policy respons-es. Reliab le dat a on violence a re crucial not only forsetting priorities, guiding prog ramme design andmonitoring prog ress, but a lso f or ad vocacy to helpraise a w areness ab out the issue. Withou t informa tion,

there is l it t le pressure on a nyone to acknow ledge o rrespond to the problem. Data needs to be collected atvarious sett ings such a s hospitals, po lice stat ions, com -munity centres and othe r places where a utho ritiescome into contact w ith victims and perpetua tors ofviolence. It is also equally important that this informa-tion be shared a cross ag encies and tha t internationa l-ly accepted standards for data collection be adoptedto enhance the comparability of data across theseagencies and even between nations and cultures.

3. Define priori t ies for, and support research on, thecauses, consequences, costs and prevention of violence

Al tho ugh t here has been g reat prog ress in theunderstand ing of violence and violence prevention,questions still remain. At the national and local level,research can be a dvanced b y go vernment policy, bydirect involvement of go vernment institutions, andby funding to academic institutions and independentresearchers. Among many research priorities, there isa pressing need t o d evelop o r ada pt , tes t and evalu-ate many more prevent ion prog rammes in bo thdeveloping and developed countries. At the g loballevel, issues ca lling fo r cross-na tiona l research includethe relat ionship betw een violence and various aspectsof g lobalization; risk and protective factors commo nto different cultures and societies; and promising pre-vention app roaches applicable in a variety of con-texts. Resources for conducting and evaluating thisresearch are needed.

4. Promote primary prevention responses

The importa nce of prima ry prevention – an d t he lackof such prog ramming in many countries – is a themeechoed throughout the World report o n violence and

health . Some of the important primary preventioninterventions for reducing violence include:

prenata l and per inata l health care for mo thers, asw ell as preschool enrichment and social d evelop-ment progra mmes for children and a dolescents;

training for good parenting practices and improvedfa mily functioning;

improvement s to urba n infrastructure, bo th ph ysi-cal and socioeconomic;

measures to reduce firearm injuries and improvefirearm-relat ed saf ety;

media campaigns to change a t t itudes , behaviourand social norms.

The first tw o interventions are importa nt f or reducingchild abuse an d neg lect a s w ell as violence perpetra t-ed d uring ad olescence a nd a dulthood . The latte r threecan have significant impacts on several types of vio-lence such a s youth an d collective violence o r suicide.

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5. Strengthen responses for victims of violence

Nat ional health systems as a w hole should a im toprovide high-qu ality care to victims of all types ofviolence, as w ell as the rehab ilitation and supportservices needed to prevent f urther complicat ions.Priorities include:

improvement s to emerg ency response systems a ndthe a bi lity of the hea l th care sector to t reat a ndrehabilitate victims;

recog nition of signs of violent incidents or ong oingviolent situa tions, and ref erral of victims to a ppro-priat e ag encies for fo llow -up and support;

ensuring t hat hea lth, judicial, po licing and socialservices avoid a renew ed victimization of earliervictims, and that these services effectively deterperpetra to rs f rom reoffending;

social support, prevention prog rammes, and othe rservices to p rot ect f am ilies at risk of violence a ndredu ce stress on careg ivers;

incorporat ion of mod ules on violence preventioninto th e curricula for m edical and nursing student s.

Each of these responses can help minimize the impactof violence on individua ls and fa milies and the cost t ohealth and social systems.

6. Integrate violence prevention into social and educa-tional policies, and thereby promot e gender and socialequality

Much of violence has links w ith ge nder a nd socialinequa lities tha t place large sections of the p opula-tion a t increased risk. In ma ny parts of the w orld,social protection policies and progra mmes are u nderconsiderable strain. Many count ries have seen rea lw ag es fa ll, basic infrastructure deteriorate, and steadyreduct ions in the qua l ity and qua nt i ty of hea lth , edu-cat ion a nd socia l services. Since such con ditions a relinked w ith increa sed risks fo r violence, go vernmen tsshould do their utmost to ma intain social protectionservices, if necessary reo rdering th e priorities in t heirnat ional budget s.

7. Increase collaboration and exchange of informationon violence prevention

Better w orking re la t ions betw een in ternat ional ag en-cies, governments, researchers, net w orks and non-governmental organizations engaged in violenceprevention are needed to achieve better sharing

of know ledge, a greement on prevent ion go als andcoordina tion of a ction. The contribut ions of a dvocacyg roups – such as tho se concerne d w ith violenceag ainst wo men or children, human right s ab uses,

ab use of t he elderly and suicide – should a lso b e rec-ognized a nd encouraged through pract ica l measuressuch a s offering the se g roups official sta tus at keyinternationa l confe rences and including them in offi-cial w orking group s.

8. Promote and monitor adherence to internationaltreaties, laws and other mechanisms to protect humanrights

Over the pa st half-century, na tional g overnments havesigned a variety of international legal agreements that

have direct relevance to violence and its prevention.They include the Convention o n th e Right s of th eChild, the Con vention a ga inst Tortu re and ot her Cruel,Inhuma n or Degra ding Treat ment o r Punishment, theConvention on the Elimination of All Forms of RacialDiscrimination and many others. While many coun-tries have ma de prog ress in ha rmonizing n at ional leg -islation w ith their interna tional ob liga tions and com-mitments, othe rs have no t. Where the ob sta cle is thescarcity of resources or informa tion, the internationa lcommunity should do more t o a ssist .

9. Seek practical, internationally agreed responsesto the global drug trade and the global arms trade

The g loba l drug t rade a nd the global arms t rade arerisk fa ctors for differen t t ypes of violence such a s youthviolence, suicide and collective violence, and are inte-gra l to violence in both developing a nd industrializedcountries. A supply of g ang s, gu ns and drug s in alocality is a p ote nt mixture t hat strong ly increases thelikelihoo d of violence. Studies have show n pa rticularlyhigh rates of homicide and violence among youthfulgang members involved in the trafficking of drugsand gun s. Even mode st prog ress on either front w illcontribute to reducing t he amo unt and degree of v io-lence suffered by millions of people.

Conclusion

Violence is not an intractable social problem or aninevitable part o f the h uma n condition. We can domuch to a ddress and prevent i t . The w orld has notyet fully measured the size of the task and does notyet ha ve all the t ools to carry it out . But the g lobalknow ledge b ase is grow ing and much useful experi-ence has a lready been g ained w hich needs to beimplemented.

For more information, please visit: http://ww w.who.int/violence_injury_prevention, or e-mail: violenceprevention@who.int© World Health Organization 200 2. All rights reserved.