Two reports from WHO focus on action: against violence & promoting healthy life.

• Tenlastelegging: World Health Organization

Violence and Health

The World Report on Violence and Health from the World Health Organisation, published on October 3, is the first comprehensive report of its kind to address violence as a global public health problem.

Violence kills more than 1.6 million people every year. Public health experts say these statistics are just the `tip of the iceberg' with the majority of violent acts being committed behind closed doors and going largely unreported. In addition to providing data on collective violence such as war and conflict, this report aims to examine the equally significant yet frequently overlooked issues such as youth violence, child abuse, elderly abuse, intimate partner violence, sexual violence, and self-inflicted violence or suicides.

Midwives will be aware of the many aspects of the impact of violence, especially on reproductive health. Highlighted in this issue of International Midwifery (pp 4-5) are reports from midwives working in South Africa, Zimbabwe, Trinidad and Tobago who are taking positive and dynamic action to help women suffering violence within the home; sadly this is often initiated or exacerbated around the time of pregnancy and birth, and therefore is the direct concern of a midwife.

Another concern perennially impacting on midwives' ability to provide comprehensive care, which was discussed at the ICM Council meeting in April 2003, is the issue of women and families suffering from conflict and unrest within or between countries.

The death and disability caused by violence make it a major public health issue, says the WHO report. Violence is among the leading causes of death for people aged 15-44 years of age, accounting for 14% of deaths among males and 7% of deaths among females. On an average day, 1,424 people are killed in acts of homicide; one person commits suicide roughly every 40 seconds. About 35 people are killed every hour as a direct result of armed conflict. In addition to the deaths, millions of people are left injured as a result of violence and suffer from physical, sexual, reproductive and mental health problems.

In the 20th century, an estimated 191million people lost their lives directly or indirectly as a result of conflict, and well over half of them were civilians. Studies have shown that in some countries, health care expenditures due to violence account for up to 5% of the gross domestic product.

Women often face the greatest risk at home and in familiar settings, says the report. Almost...