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VIOLENCE AND HOMICIDE There were an estimated 475 000 deaths globally in 2012 as a result of interpersonal violence (homicide). 5 Four out of five homicide deaths were men, most of them age 15–44, which makes homicide the third leading cause of death in this age group. Globally, as many as 38% of homicides occurring in women are committed by their male partners; by comparison, only 6% of homicides in men are committed by their female partners. 5,24 There is very large variation in homicide rates between regions. Victims of nonfatal violence far outnumber victims of homicide. While young to middle-aged men generally experience higher rates of nonfatal violence than others, women, children and elderly people also suffer from the nonfatal consequences of physical violence and sexual and psychological abuse. Nearly one quarter of all adults report having been physically abused as children, while 18% of women report having been sexually abused as children. 5 Violence against women is all too common and takes many forms, including violence committed by an intimate partner, sexual violence by any perpetrator, trafficking for purposes of sex, murders in the name of honour or dowry, and early child and forced marriage (see also Chapter 4). About one in three women report having been a victim of physical or sexual violence by an intimate partner at some point in their lives. 25 TRENDS During 2000–2012, there has been a marked decline in homicide rates (Figure 8.8), which are estimated to have fallen by around 17% globally (from 8.0 to 6.7 per 100 000 population), and by an impressive 39% in high-income countries (from 6.2 to 3.8 per 100 000 population). In the low- and middle-income countries of the European Region, homicide rates have seen an even steeper decline, falling by more than one half since 2000. In several other regions, modest declines were observed with the exception of the low- and middle-income countries of the Region of the Americas, where homicide rates continue to be very high. The differences in levels between regions are striking. The low- and middle-income countries of the Region of the Americas has 28.5 homicides per 100 000 population. This is four times higher than the global average and almost 14 times higher than in the low- and middle-income countries in the low- and middle-income countries of the Western Pacific Region, where murders occur at a rate of 2.1 per 100 000 population per year. Organized criminal violence and violence related to illicit drugs have been important contributors to rising homicide rates in some countries of Latin and Central America. 12 Globally, approximately half of homicides are committed with a firearm, but murder methods vary markedly by region. For example, firearm homicides account for 75% of all homicides in the low- and middleincome countries of the Region of the Americas, but only 23% in the low- and middle-income countries of the Western Pacific Region. Figure 8.8 Trends in homicide rates by region and globally, a 2000–2012 5 Deaths per 100 000 population 30 25 20 15 10 5 0 -24% 2000 2012 AFR +5% 2000 2012 AMR 2000 2012 -22% -52% SEAR 2000 2012 EUR 2000 2012 EMR 2000 2012 WPR 2000 2012 Highincome 2000 2012 Global POSITIVE DEVELOPMENTS Roughly one third of countries are undertaking steps to implement promising strategies to reduce violence, including: 14 • increasing safe, stable and nurturing relationships between children and their parents and caregivers; • developing life skills in children and adolescents; • reducing availability and harmful use of alcohol; • reducing access to guns, knives and poisons (particularly pesticides); • promoting gender equality and the empowerment of women; • changing cultural norms that support violence; • victim identification, care and support; • identification and prosecution of perpetrators in order to reduce the “culture of impunity”. -7% a % change during the period is shown at the top of each bar. -35% -39% -17% It is unknown to what extent interventions such as these have contributed to the observed declines in homicide since 2000. Homicide as well as most forms of interpersonal violence are strongly associated with social determinants such as social norms, gender inequality, poverty and unemployment, and other cross-cutting risk factors. 5 182 HEALTH IN 2015: FROM MDGs TO SDGs
CHALLENGES The Global Status Report on Violence Prevention 2014 and the Report on Global and Regional Estimates of Violence Against Women 2013 identified several core concerns: • Continued extremely high homicide rates in the low- and middleincome countries of the Region of the Americas; • Few countries are implementing social, economic and educational policy measures to address the social, cultural and economic risk factors for violence; • Violence prevention laws are widely enacted, but enforcement is often inadequate; • While nearly all countries have national laws to regulate firearms, enforcement is often inadequate, and few countries report having special firearms control programmes such as gun buy-backs and firearms collection and destruction programmes; • Availability of services to identify, refer, protect and support victims varies markedly; • Prevalence estimates for intimate partner violence are substantially higher in the low- and middle-income countries of the African Region, the Eastern Mediterranean Region and the South-East Asia Region, compared to other regions of the world (Figure 8.9), but only half of countries in these regions are implementing wide-scale social and cultural norm-change strategies to address sexual and intimate partner violence; • In many settings, intimate partner violence against women and child maltreatment are considered socially acceptable and are often condoned; • Discrimination against women and girls, including in legislation, continues to detract from efforts to address violence against women and girls; • National surveys of violence against children conducted in Africa have documented high rates of childhood physical, sexual and emotional abuse; • Violence prevention requires a multisectoral response, but few countries report the existence of lead agencies to coordinate the activities of different sectors and report periodically on progress. STRATEGIC PRIORITIES The global violence prevention field’s vision for the post-2015 era is to cut worldwide levels of interpersonal violence by half within the next 30 years. 19,20 While not as ambitious as the SDG targets, which aim to eliminate several forms of violence in the next 15 years, this vision aligns well with SDGs 5 and 16, that explicitly target violence reduction. Several UN agencies have focussed on violence reduction as a priority, including WHO, UNESCO, UNODC, UNDP, UNICEF and UN Women as well as the UN General Assembly. In 2014, the World Health Assembly drew attention to the important role of health systems in addressing violence, in particular against women and girls and against children, and called upon the WHO Director-General to develop a global plan of action to strengthen the role of the health system in addressing interpersonal violence, in particular against women and girls and against children. 18 A 15-year global plan of action on strengthening the role of the health system in addressing interpersonal violence, in particular against women and girls and against children, will be considered by WHO Member States at the May 2016 World Health Assembly. It will include actions to address four strategic directions to address violence, in particular against women and girls and against children: • strengthening leadership and governance of the health system; • strengthening health service delivery and the capacity of health workers to respond to violence; • strengthening programming for prevention; • improving research and information. Figure 8.9 Prevalence of intimate partner violence by region, 2010 8 AFR AMR SEAR EUR EMR WPR High income 23.2% High income 25.4% 37.0% 24.6% 29.8% 37.7% 36.6% INJURIES AND VIOLENCE 183
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from M I L L E N N I U M DEVELOPMEN
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WHO Library Cataloguing-in-Publicat
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CONTENTS vii Abbreviations 1 1 From
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7 153 Mental health and substance u
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IHR IPCC ITN LLIN MCV MDG MDR TB mh
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SUMMARY This report aims to describ
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sourced development finance. 11 The
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Despite their overall success, the
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The 13 targets that underpin the br
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Box 1.1 Life expectancy improvement
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40 Advanced research on European he
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SUMMARY The SDGs position health as
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Figure 2.2 Trends in fertility by r
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Ageing Populations around the world
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The recent influx of refugees into
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and implementing policies and progr
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that dialogue is to demonstrate an
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One of the challenges we face as we
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Most recently, the right to health
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2100 Figure 2.15 Global average sur
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Figure 2.17 Proportion of health fa
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42 World development report 2014: r
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3 UNIVERSAL HEALTH COVERAGE
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UHC is coverage that provides peopl
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Figure 3.4 Per capita government he
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living in poverty, are pushed furth
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integration of all SDG health targe
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GOVERNANCE Governance in the health
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HEALTH FINANCING A country’s heal
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HEALTH WORKFORCE Health systems and
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MEDICAL PRODUCTS Access to quality
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HEALTH INFORMATION Health informati
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SERVICE DELIVERY In order to achiev
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RESEARCH FOR UHC Research evidence
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NOTES AND REFERENCES 1 World health
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89 Implementing the Commission on I
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173 Labrique A, Vasudevan L, Chang
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SUMMARY Deaths among pregnant women
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Figure 4.3 MDG and SDG targets rela
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have declined from 25% to 14% betwe
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Chapter 5). As noted above, there h
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Figure 4.8 Wealth-related inequalit
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young children. 61 Specific indicat
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CHALLENGES Access to skilled care a
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CHALLENGES Scaling up effective int
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CHALLENGES Leaving no country behin
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CHALLENGES Endemic countries: Polio
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Figure 4.22 Prevalence of stunting
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CHALLENGES Spurring action in count
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CHALLENGES Ending child marriage: D
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43 Financing global health 2014: sh
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5 INFECTIOUS DISEASES
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Infectious and parasitic diseases a
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Figure 5.4 Global number of deaths
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International TB funding increased
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Improving quality of care: The qual
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Table 5.1 Summary of specific targe
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HIV/AIDS More than 30 years since t
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TUBERCULOSIS TB is a treatable and
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MALARIA Almost half the world’s p
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NEGLECTED TROPICAL DISEASES NTDs 89
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HEPATITIS Viral hepatitis is caused
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WATERBORNE DISEASES Waterborne dise
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CHOLERA Cholera is an acute diarrho
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SEXUALLY TRANSMITTED INFECTIONS STI
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NOTES AND REFERENCES 1 Global Healt
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84 Dye C, Maher D, Weil D, Espinal
Page 143 and 144: SUMMARY NCDs are included as a spec
Page 145 and 146: Figure 6.2 Probability of death fro
Page 147 and 148: as task sharing using community hea
Page 149 and 150: The stated aim of the strategy is p
Page 151 and 152: CHALLENGES Despite declines in mort
Page 153 and 154: CHALLENGES Lack of access to effect
Page 155 and 156: CHALLENGES Diabetes is an increasin
Page 157 and 158: CHALLENGES Increasing use in some r
Page 159 and 160: CHALLENGES Air pollution remains a
Page 161 and 162: 40 From burden to “best buys”:
Page 163: 7 MENTAL HEALTH AND SUBSTANCE USE
Page 166 and 167: Mental disorders, including dementi
Page 168 and 169: the effectiveness of task sharing b
Page 170 and 171: • To provide comprehensive, integ
Page 172 and 173: DEPRESSION AND SUICIDE Mental disor
Page 174 and 175: DEMENTIA The world’s population i
Page 176 and 177: SUBSTANCE USE AND SUBSTANCE USE DIS
Page 178 and 179: NOTES AND REFERENCES 1 Global Healt
Page 181: 8 INJURIES AND VIOLENCE
Page 184 and 185: Injuries, whether sustained acciden
Page 186 and 187: due to limited data. However, the s
Page 188 and 189: aiming to stop the predicted increa
Page 190 and 191: ROAD TRAFFIC INJURIES Every year, a
Page 194 and 195: WAR AND CONFLICT In 2012, an estima
Page 196 and 197: DISASTERS Disasters are often assoc
Page 198 and 199: NOTES AND REFERENCES 1 Global repor
Page 201 and 202: SUMMARY In September 2015, heads of
Page 203 and 204: A 10-page declaration precedes the
Page 205 and 206: THE PLACE OF HEALTH IN THE SDGs 1 H
Page 207 and 208: that health systems providing integ
Page 209 and 210: FOLLOW-UP AND REVIEW 9 Monitoring t
Page 211 and 212: NOTES AND REFERENCES 1 Transforming
Page 213 and 214: WHO South-East Asia Region: Banglad
Page 216: ISBN 978 92 4 156511 0
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