The World Health Organization's recent report on global violence marks a remarkable and progressive step toward applying public-health strategies and resources to the problem. The report raises awareness of the huge impact of violence worldwide.

The Oct. 3 report found that of the 1.6 million world deaths each year, about 3 percent occur as a result of violence. Almost as many deaths occur from suicide as they do from homicide and war.

When releasing the report in Brussels, Etienne Krug, a Belgian physician who worked on the 346-page, three-year analysis, said, "This is not only an emotional issue. It also has to be treated as any other public-health problem. We need to study the data, the risk factors, the interventions."

For far too long, violence - especially that occurring among families, friends and acquaintances - has been tolerated as an inevitable part of human existence. But for a little more than two decades, the U.S. public-health movement has been engaged in various efforts to address violence as a preventable problem.

Within the United States, since the U.S. surgeon general's first conference on violence as a public-health issue in 1985, significant gains have been made in both the use of epidemiology to elucidate and understand risk factors for violence and in the application of prevention strategies.

The biggest gains from arguing that violence in the United States is a preventable public-health problem have been in greater awareness and understanding of the complexity of the problem and potential solutions. This, in turn, has led to a decline in violence in some cities, especially among youths. Most remarkable is the acceptance and endorsement of prevention as a possibility and a goal. Now, with the World Health Organization report, we can expect similar gains globally.

The report makes specific recommendations for actions that could allow countries to begin to understand their existing violence-prevention efforts as part of a larger global picture.

The report emphasizes building healthy communities, providing positive activities for children and teens, adhering to international treaties and creating national action plans for violence prevention. Governmental and community strategies are highlighted, along with research-based efforts to monitor efforts. Countries taking similar prevention-oriented public-health approaches can learn from each other's through the World Health Organization's campaign.

In the United States, we learned to focus on public-health strategies because we found that stitching people up, and locking people up, is not enough to prevent violence.

When hospital emergency rooms treat violently injured patients and send them out without discussing subsequent risks for violence, it indicates one of two things: a lack of concern for the patient or a perceived inevitability of subsequent violent injury, negating any purpose in prevention efforts. If the same patients came with a different problem - heart disease, for instance - they would receive a full array of treatment and prevention strategies. However, the perceived inevitability of violence interferes with prevention.

Even today, with a wide acceptance of violence as a public-health problem in the United States, hospital emergency workers do not have uniform protocols for responding to all types of violence. (Protocols for domestic violence and child abuse do exist.) The report raises the awareness of the need for such protocols throughout the world.The report shows there is also a need for greater exploration and understanding of the relationship between national and international forms of violence and interpersonal violence. Beyond acknowledging the violent impact of war on individuals (rape of women and murder of civilians), there needs to be a full exploration of the role governments play in violence.

The report fails to place enough emphasis on the impact of culture on violence. As we experience more girls and women participating in violent behavior in the United States, for example, we are forced to acknowledge the role of cultural influences among the risk factors for violence. The world can learn from the mistakes made in America and not repeat them.

Risk factors such as poverty, victimization, gun availability and substance abuse are variables that relate directly to home, neighborhood and environment. Since girls and boys are in the same homes and neighborhoods and are therefore exposed to most risk factor changes equally, explaining the rise of girls' violence and a fall in boys' violence becomes a challenge. The cultural factors, including the media, appear to explain the differential.

While violence is not a new issue for the World Health Organization, the report sets the stage for action. At the meeting in Brussels to unveil the report, officials highlighted the tragic magnitude of violence in the world and the possibilities for prevention that lie in the public-health approaches presented in the report.

Following the report, the World Health Organization kicked off an anti-violence campaign, calling on governments to do more. Developing countries with few resources will have difficulty kicking off a new campaign; however, the public-health approach can help countries use existing resources more effectively.

Now is the time for the world's public health practitioners to join with law enforcement and respond.

By Deborah Prothrow-Stith 30 October 2002

Deborah Prothrow-Stith, a professor at the Harvard School of Public Health, is co-author of "Deadly Consequences: How Violence Is Destroying Our Teenage Population and a Plan to Begin Solving the Problem"