Violence

Estimates of disability-adjusted life years from physical violence, per 100,000 inhabitants in 2004.[1]
  no data
  <200
  200-400
  400-600
  600-800
  800-1000
  1000–1200
  1200–1400
  1400–1600
  1600–1800
  1800–2000
  2000-3000
  >3000

Violence is defined by the World Health Organization as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation," although the group acknowledges that the inclusion of "the use of power" in its definition expands on the conventional understanding of the word.[2]

Globally, violence resulted in the deaths of an estimated 1.28 million people in 2013 up from 1.13 million in 1990.[3] Of the deaths in 2013, roughly 842,000 were attributed to self-harm (suicide), 405,000 to interpersonal violence, and 31,000 to collective violence (war) and legal intervention.[3] In Africa, out of every 100,000 people, each year an estimated 60.9 die a violent death.[4] Corlin, past president of the American Medical Association said: "The United States leads the world—in the rate at which its children die from firearms." He concluded: "Gun violence is a threat to the public health of our country."[5] For each single death due to violence, there are dozens of hospitalizations, hundreds of emergency department visits, and thousands of doctors' appointments.[6] Furthermore, violence often has lifelong consequences for physical and mental health and social functioning and can slow economic and social development.

In 2013, assault by firearm was the leading cause of death due to interpersonal violence, with 180,000 such deaths estimated to have occurred. The same year, assault by sharp object resulted in roughly 114,000 deaths, with a remaining 110,000 deaths from personal violence being attributed to other causes.[3]

Violence in many forms is preventable. There is a strong relationship between levels of violence and modifiable factors such as concentrated poverty, income and gender inequality, the harmful use of alcohol, and the absence of safe, stable, and nurturing relationships between children and parents. Strategies addressing the underlying causes of violence can be effective in preventing violence.[7]

Types

Typology of violence[2]

Violence can be divided into three broad categories:[2]

  • self-directed violence
  • interpersonal violence
  • collective violence

Violent acts can be:

  • physical
  • sexual
  • psychological
  • emotional

This initial categorization differentiates between violence a person inflicts upon himself or herself, violence inflicted by another individual or by a small group of individuals, and violence inflicted by larger groups such as states, organized political groups, militia groups and terrorist organizations. These three broad categories are each divided further to reflect more specific types of violence.

Violence is primarily classified as either instrumental or reactive / hostile.[8]

Self-directed violence

Self-directed violence is subdivided into suicidal behaviour and self-abuse. The former includes suicidal thoughts, attempted suicides – also called para suicide or deliberate self-injury in some countries – and completed suicides. Self-abuse, in contrast, includes acts such as self-mutilation.

Collective violence

Massacre of Polish civilians during Nazi occupation of Poland, 1939

Collective violence is subdivided into structural violence and economic violence. Unlike the other two broad categories, the subcategories of collective violence suggest possible motives for violence committed by larger groups of individuals or by states. Collective violence that is committed to advance a particular social agenda includes, for example, crimes of hate committed by organized groups, terrorist acts and mob violence. Political violence includes war and related violent conflicts, state violence and similar acts carried out by larger groups. Economic violence includes attacks by larger groups motivated by economic gain – such as attacks carried out with the purpose of disrupting economic activity, denying access to essential services, or creating economic division and fragmentation. Clearly, acts committed by larger groups can have multiple motives.[9]

This typology, while imperfect and far from being universally accepted, does provide a useful framework for understanding the complex patterns of violence taking place around the world, as well as violence in the everyday lives of individuals, families and communities. It also overcomes many of the limitations of other typologies by capturing the nature of violent acts, the relevance of the setting, the relationship between the perpetrator and the victim, and – in the case of collective violence – possible motivations for the violence. However, in both research and practice, the dividing lines between the different types of violence are not always so clear.[citation needed]. State violence also involves upholding, forms of violence of a structural nature, such as poverty, through dismantling welfare, creating strict policies such as 'welfare to work', in order to cause further stimulation and disadvantage[9] Poverty as a form of violence may involve oppressive policies that specifically target minority or low socio-economic groups. The 'war on drugs', for example, rather than increasing the health and well-being of at risk demographics, most often results in violence committed against these vulnerable demographics through incarceration, stigmatization and police brutality[9][10]

Warfare

A United States M8 Greyhound armoured car in Paris during World War II

War is a state of prolonged violent large-scale conflict involving two or more groups of people, usually under the auspices of government. It is the most extreme form of collective violence.[11] War is fought as a means of resolving territorial and other conflicts, as war of aggression to conquer territory or loot resources, in national self-defence or liberation, or to suppress attempts of part of the nation to secede from it. We know also ideological, religious and revolutionary wars.[12]

Since the Industrial Revolution, the lethality of modern warfare has grown. World War I casualties were over 40 million and World War II casualties were over 70 million.

Non-physical

Violence includes those acts that result from a power relationship, including threats and intimidation, neglect or acts of omission. Such non-physical violence has a broad range of outcomes – including psychological harm, deprivation and maldevelopment. Violence may not necessarily result in injury or death, but nonetheless poses a substantial burden on individuals, families, communities and health care systems worldwide. Many forms of violence can result in physical, psychological and social problems that do not necessarily lead to injury, disability or death. These consequences can be immediate, as well as latent, and can last for years after the initial abuse. Defining outcomes solely in terms of injury or death thus limits the understanding of the full impact of violence.[2]

Interpersonal violence

Deaths due to interpersonal violence per million persons in 2012
  0-8
  9-16
  17-24
  25-32
  33-54
  55-75
  76-96
  97-126
  127-226
  227-878

Interpersonal violence is divided into two subcategories: Family and intimate partner violence – that is, violence largely between family members and intimate partners, usually, though not exclusively, taking place in the home. Community violence – violence between individuals who are unrelated, and who may or may not know each other, generally taking place outside the home. The former group includes forms of violence such as child abuse, intimate partner violence and abuse of the elderly. The latter includes youth violence, random acts of violence, rape or sexual assault by strangers, and violence in institutional settings such as schools, workplaces, prisons and nursing homes. When interpersonal violence occurs in families, its psychological consequences can affect parents, children, and their relationship in the short- and long-terms.[13]

Child maltreatment

Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other child exploitation, which results in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust, or power. Exposure to intimate partner violence is also sometimes included as a form of child maltreatment.[14]

Child maltreatment is a global problem with serious lifelong consequences, which is, however, complex and difficult to study.[15]

There are no reliable global estimates for the prevalence of child maltreatment. Data for many countries, especially low- and middle-income countries, are lacking. Current estimates vary widely depending on the country and the method of research used. Approximately 20% of women and 5–10% of men report being sexually abused as children, while 25–50% of all children report being physically abused.[2][16]

Consequences of child maltreatment include impaired lifelong physical and mental health, and social and occupational functioning (e.g. school, job, and relationship difficulties). These can ultimately slow a country's economic and social development.[17][18] Preventing child maltreatment before it starts is possible and requires a multisectoral approach. Effective prevention programmes support parents and teach positive parenting skills. Ongoing care of children and families can reduce the risk of maltreatment reoccurring and can minimize its consequences.[19][20]

Youth violence

The Kids off the Block memorial featuring hundreds of simple stone blocks, one for each child killed by violence in Roseland, Chicago

Following the World Health Organization, youth are defined as people between the ages of 10 and 29 years. Youth violence refers to violence occurring between youths, and includes acts that range from bullying and physical fighting, through more severe sexual and physical assault to homicide.[21]

Worldwide some 250,000 homicides occur among youth 10–29 years of age each year, which is 41% of the total number of homicides globally each year ("Global Burden of Disease", World Health Organization, 2008). For each young person killed, 20-40 more sustain injuries requiring hospital treatment.[21] Youth violence has a serious, often lifelong, impact on a person's psychological and social functioning. Youth violence greatly increases the costs of health, welfare and criminal justice services; reduces productivity; decreases the value of property; and generally undermines the fabric of society.

Prevention programmes shown to be effective or to have promise in reducing youth violence include life skills and social development programmes designed to help children and adolescents manage anger, resolve conflict, and develop the necessary social skills to solve problems; schools-based anti-bullying prevention programmes; and programmes to reduce access to alcohol, illegal drugs and guns.[22] Also, given significant neighbourhood effects on youth violence, interventions involving relocating families to less poor environments have shown promising results.[23] Similarly, urban renewal projects such as business improvement districts have shown a reduction in youth violence.[24]

Intimate partner violence

Intimate partner violence refers to behaviour in an intimate relationship that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.[2]

Population-level surveys based on reports from victims provide the most accurate estimates of the prevalence of intimate partner violence and sexual violence in non-conflict settings. A study conducted by WHO in 10 mainly developing countries[25] found that, among women aged 15 to 49 years, between 15% (Japan) and 70% (Ethiopia and Peru) of women reported physical and/or sexual violence by an intimate partner.

Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and reproductive health problems for victims and for their children, and lead to high social and economic costs. These include both fatal and non-fatal injuries, depression and post-traumatic stress disorder, unintended pregnancies, sexually transmitted infections, including HIV.[26]

Factors associated with the perpetration and experiencing of intimate partner violence are low levels of education, history of violence as a perpetrator, a victim or a witness of parental violence, harmful use of alcohol, attitudes that are accepting of violence as well as marital discord and dissatisfaction. Factors associated only with perpetration of intimate partner violence are having multiple partners, and antisocial personality disorder.

A recent theory named "The Criminal Spin" suggests a mutual flywheel effect between partners that is manifested by an escalation in the violence.[27] A violent spin may occur in any other forms of violence, but in Intimate partner violence the added value is the mutual spin, based on the unique situation and characteristics of intimate relationship.

The primary prevention strategy with the best evidence for effectiveness for intimate partner violence is school-based programming for adolescents to prevent violence within dating relationships.[28] Evidence is emerging for the effectiveness of several other primary prevention strategies – those that: combine microfinance with gender equality training;[29] promote communication and relationship skills within communities; reduce access to, and the harmful use of alcohol; and change cultural gender norms.[30]

Sexual violence

Sexual violence is any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a penis, other body part or object.[31]

Population-level surveys based on reports from victims estimate that between 0.3–11.5% of women reported experiencing sexual violence.[32] Sexual violence has serious short- and long-term consequences on physical, mental, sexual and reproductive health for victims and for their children as described in the section on intimate partner violence. If perpetrated during childhood, sexual violence can lead to increased smoking,[33] drug and alcohol misuse, and risky sexual behaviors in later life. It is also associated with perpetration of violence and being a victim of violence.

Many of the risk factors for sexual violence are the same as for domestic violence. Risk factors specific to sexual violence perpetration include beliefs in family honor and sexual purity, ideologies of male sexual entitlement and weak legal sanctions for sexual violence.

Few interventions to prevent sexual violence have been demonstrated to be effective. School-based programmes to prevent child sexual abuse by teaching children to recognize and avoid potentially sexually abusive situations are run in many parts of the world and appear promising, but require further research. To achieve lasting change, it is important to enact legislation and develop policies that protect women; address discrimination against women and promote gender equality; and help to move the culture away from violence.[30]

Elder maltreatment

Elder maltreatment is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person. This type of violence constitutes a violation of human rights and includes physical, sexual, psychological, emotional; financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.[2]

While there is little information regarding the extent of maltreatment in elderly populations, especially in developing countries, it is estimated that 4–6% of elderly people in high-income countries have experienced some form of maltreatment at home[34][35] However, older people are often afraid to report cases of maltreatment to family, friends, or to the authorities. Data on the extent of the problem in institutions such as hospitals, nursing homes and other long-term care facilities are scarce. Elder maltreatment can lead to serious physical injuries and long-term psychological consequences. Elder maltreatment is predicted to increase as many countries are experiencing rapidly ageing populations.

Many strategies have been implemented to prevent elder maltreatment and to take action against it and mitigate its consequences including public and professional awareness campaigns, screening (of potential victims and abusers), caregiver support interventions (e.g. stress management, respite care), adult protective services and self-help groups. Their effectiveness has, however, not so far been well-established.[36][37]

Targeted violence

Several rare but painful episodes of assassination, attempted assassination and school shootings at elementary, middle, high schools, as well as colleges and universities in the United States, led to a considerable body of research on ascertainable behaviors of persons who have planned or carried out such attacks. These studies (1995–2002) investigated what the authors called "targeted violence," described the "path to violence" of those who planned or carried out attacks and laid out suggestions for law enforcement and educators. A major point from these research studies is that targeted violence does not just "come out of the blue".[38][39][40][41][42][43]

Everyday violence

As an anthropological concept, "everyday violence" may refer to the incorporation of different forms of violence (mainly political violence) into daily practices.[44][45][46]