The economic dimensions of interpersonal violence - libdoc.who.int ...

the USA, with lifetime medical treatment costs per victim ranging from $37 000to $42 000.Evidence abounds that the public sector - and thus society in general - bearsmuch of the economic burden of interpersonal violence. Several studies in theUSA showed that from 56% to 80% of the costs of care for gun and stabbinginjuries are either directly paid by public financing or are not paid at all - inwhich case they are absorbed by the government and society in the form ofuncompensated care financing and overall higher payment rates. In low- andmiddle-income countries, it is also probable that society absorbs much of thecosts of violence through direct public expenditures and negative effects oninvestment and economic growth.There are relatively few published economic evaluations of interventionstargeting interpersonal violence. Available studies showed that preventiveinterventions to stop interpersonal violence occurring cost less than the moneythat they save, in some cases by several orders of magnitude. The 1994 ViolenceAgainst Women Act in the USA has resulted in an estimated net benefit of $16.4billion, including $14.8 billion in averted victim's costs. A separate analysisshowed that providing shelters for victims of domestic violence resulted in abenefit to cost ratio between 6.8 and 18.4. Similarly, the costs of a programmeto prevent child abuse through counselling equalled 5.0% of the costs of childabuse itself. Implementation of a gun registration law in Canada cost $70million, in comparison with a total annual cost of $5.6 billion for firearm-relatedinjuries in that country. Interventions that targeted juvenile offenders - includingaggression replacement training and foster care treatment - resulted in economicbenefits that were more than 30 times greater than the corresponding costs.The approaches taken to several key methodological issues differed substantiallyacross the studies reviewed. Studies documenting the economic effects ofinterpersonal violence have used a broad range of categories of costs. Thoseestimating indirect costs - including the opportunity cost of time, lostproductivity and reduced quality of life - provided higher cost estimates thanstudies that limited the costs of violence to direct costs alone. Other keymethodological issues included the economic values assigned to human life, lostproductive time and psychological distress. The rate at which future costs andbenefits are discounted, in accounting terms, also varied across studies.Given the wide range of methodological differences and extensive gaps in theexisting literature on the economics of interpersonal violence, there is a clearneed for systematic future research into the costs of violence. Such researchshould follow rigorous methodological guidelines, be inclusive of both direct andindirect cost categories, and - perhaps most importantly - be comparable acrosscountries and settings.The World report on violence and health (Krug et al., 2002) also showed thateffective interventions are available - particularly in the areas of child abuse andneglect by caregivers, youth violence and gun-related violence. Given theoverwhelming evidence of the high costs of interpersonal violence, detailedanalysis of the economic feasibility of interventions is a clear research priority.xi