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Suggested citation: Krug EG et al., eds. World report on violence and health. Geneva, World Health Organization, 2002.
Photograph of Nelson Mandela reproduced with permission from the African National Congress.
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Contents
Foreword
Preface
Contributors
Acknowledgements
Introduction
Chapter 1.
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Chapter 2.
Chapter 3.
Youth violence
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Background
The extent of the problem
Youth homicide rates
Trends in youth homicides
Non-fatal violence
Risk behaviours for youth violence
The dynamics of youth violence
How does youth violence begin?
Situational factors
What are the risk factors for youth violence?
Individual factors
Relationship factors
Community factors
Societal factors
What can be done to prevent youth violence?
Individual approaches
Relationship approaches
Community-based efforts
Societal approaches
Recommendations
Establishing data collection systems
More scientific research
Developing prevention strategies
Disseminating knowledge
Conclusion
References
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Background
How are child abuse and neglect defined?
Cultural issues
Types of abuse
The extent of the problem
Fatal abuse
Non-fatal abuse
What are the risk factors for child abuse and neglect?
Factors increasing a childs vulnerability
Caregiver and family characteristics
Community factors
Societal factors
The consequences of child abuse
Health burden
Financial burden
What can be done to prevent child abuse and neglect?
Family support approaches
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CONTENTS
Chapter 4.
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Background
The extent of the problem
Measuring partner violence
Partner violence and murder
Traditional notions of male honour
The dynamics of partner violence
How do women respond to abuse?
What are the risk factors for intimate partner violence?
Individual factors
Relationship factors
Community factors
Societal factors
The consequences of intimate partner violence
Impact on health
Economic impact of violence
Impact on children
What can be done to prevent intimate partner violence?
Support for victims
Legal remedies and judicial reforms
Treatment for abusers
Health service interventions
Community-based efforts
Principles of good practice
Action at all levels
Womens involvement
Changing institutional cultures
A multisectoral approach
Recommendations
Research on intimate partner violence
Strengthening informal sources of support
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Chapter 5.
Chapter 6.
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Background
How is elder abuse defined?
Traditional societies
The extent of the problem
Domestic settings
Institutional settings
What are the risk factors for elder abuse?
Individual factors
Relationship factors
Community and societal factors
The consequences of elder abuse
Domestic settings
Institutions
What can be done to prevent elder abuse?
Responses at national level
Local responses
Recommendations
Greater knowledge
Stronger laws
More effective prevention strategies
Conclusion
References
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Sexual violence
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Background
How is sexual violence defined?
Forms and contexts of sexual violence
The extent of the problem
Sources of data
Estimates of sexual violence
Sexual violence in schools, health care settings, armed conflicts
and refugee settings
Customary forms of sexual violence
What are the risk factors for sexual violence?
Factors increasing womens vulnerability
Factors increasing mens risk of committing rape
Peer and family factors
Community factors
Societal factors
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CONTENTS
Chapter 7.
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Self-directed violence
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Background
How is suicide defined?
The extent of the problem
Fatal suicidal behaviour
Non-fatal suicidal behaviour and ideation
What are the risk factors for suicidal behaviour?
Psychiatric factors
Biological and medical markers
Life events as precipitating factors
Social and environmental factors
What can be done to prevent suicides?
Treatment approaches
Behavioural approaches
Relationship approaches
Community-based efforts
Societal approaches
Intervention after a suicide
Policy responses
Recommendations
Better data
Further research
Better psychiatric treatment
Environmental changes
Strengthening community-based efforts
Conclusion
References
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viii
Chapter 8.
Chapter 9.
Collective violence
213
Background
How is collective violence defined?
Forms of collective violence
Data on collective violence
Sources of data
Problems with data collection
The extent of the problem
Casualties of conflicts
The nature of conflicts
What are the risk factors for collective violence?
Political and economic factors
Societal and community factors
Demographic factors
Technological factors
The consequences of collective violence
Impact on health
Impact on specific populations
Demographic impact
Socioeconomic impact
What can be done to prevent collective violence?
Reducing the potential for violent conflicts
Responses to violent conflicts
Documentation, research and dissemination of information
Recommendations
Information and understanding
Preventing violent conflicts
Peacekeeping
Health sector responses
Humanitarian responses
Conclusion
References
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Background
Responding to violence: what is known so far?
Major lessons to date
Why should the health sector be involved?
Assigning responsibilities and priorities
Recommendations
Conclusion
References
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254
254
Statistical annex
Resources
Index
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331
Foreword
The twentieth century will be remembered as a century marked by violence. It
burdens us with its legacy of mass destruction, of violence inflicted on a scale
never seen and never possible before in human history. But this legacy the
result of new technology in the service of ideologies of hate is not the only
one we carry, nor that we must face up to.
Less visible, but even more widespread, is the legacy of day-to-day,
individual suffering. It is the pain of children who are abused by people who
should protect them, women injured or humiliated by violent partners, elderly
persons maltreated by their caregivers, youths who are bullied by other
youths, and people of all ages who inflict violence on themselves. This suffering and there are many more
examples that I could give is a legacy that reproduces itself, as new generations learn from the violence of
generations past, as victims learn from victimizers, and as the social conditions that nurture violence are
allowed to continue. No country, no city, no community is immune. But neither are we powerless against it.
Violence thrives in the absence of democracy, respect for human rights and good governance. We often
talk about how a culture of violence can take root. This is indeed true as a South African who has lived
through apartheid and is living through its aftermath, I have seen and experienced it. It is also true that
patterns of violence are more pervasive and widespread in societies where the authorities endorse the use of
violence through their own actions. In many societies, violence is so dominant that it thwarts hopes of
economic and social development. We cannot let that continue.
Many who live with violence day in and day out assume that it is an intrinsic part of the human condition.
But this is not so. Violence can be prevented. Violent cultures can be turned around. In my own country and
around the world, we have shining examples of how violence has been countered. Governments,
communities and individuals can make a difference.
I welcome this first World report on violence and health. This report makes a major contribution to our
understanding of violence and its impact on societies. It illuminates the different faces of violence, from the
invisible suffering of societys most vulnerable individuals to the all-too-visible tragedy of societies in
conflict. It advances our analysis of the factors that lead to violence, and the possible responses of different
sectors of society. And in doing so, it reminds us that safety and security dont just happen: they are the result
of collective consensus and public investment.
The report describes and makes recommendations for action at the local, national and international levels.
It will thus be an invaluable tool for policy-makers, researchers, practitioners, advocates and volunteers
involved in violence prevention. While violence traditionally has been the domain of the criminal justice
system, the report strongly makes the case for involving all sectors of society in prevention efforts.
We owe our children the most vulnerable citizens in any society a life free from violence and fear. In
order to ensure this, we must be tireless in our efforts not only to attain peace, justice and prosperity for
countries, but also for communities and members of the same family. We must address the roots of violence.
Only then will we transform the past centurys legacy from a crushing burden into a cautionary lesson.
Nelson Mandela
Preface
Violence pervades the lives of many people around the world, and touches all
of us in some way. To many people, staying out of harms way is a matter of
locking doors and windows and avoiding dangerous places. To others, escape
is not possible. The threat of violence is behind those doors well hidden from
public view. And for those living in the midst of war and conflict, violence
permeates every aspect of life.
This report, the first comprehensive summary of the problem on a global
scale, shows not only the human toll of violence over 1.6 million lives lost
each year and countless more damaged in ways that are not always apparent but exposes the many faces of
interpersonal, collective and self-directed violence, as well as the settings in which violence occurs. It shows
that where violence persists, health is seriously compromised.
The report also challenges us in many respects. It forces us to reach beyond our notions of what is
acceptable and comfortable to challenge notions that acts of violence are simply matters of family privacy,
individual choice, or inevitable facets of life. Violence is a complex problem related to patterns of thought
and behaviour that are shaped by a multitude of forces within our families and communities, forces that can
also transcend national borders. The report urges us to work with a range of partners and to adopt an
approach that is proactive, scientific and comprehensive.
We have some of the tools and knowledge to make a difference the same tools that have successfully
been used to tackle other health problems. This is evident throughout the report. And we have a sense of
where to apply our knowledge. Violence is often predictable and preventable. Like other health problems, it
is not distributed evenly across population groups or settings. Many of the factors that increase the risk of
violence are shared across the different types of violence and are modifiable.
One theme that is echoed throughout this report is the importance of primary prevention. Even small
investments here can have large and long-lasting benefits, but not without the resolve of leaders and support
for prevention efforts from a broad array of partners in both the public and private spheres, and from both
industrialized and developing countries.
Public health has made some remarkable achievements in recent decades, particularly with regard to
reducing rates of many childhood diseases. However, saving our children from these diseases only to let
them fall victim to violence or lose them later to acts of violence between intimate partners, to the savagery
of war and conflict, or to self-inflicted injuries or suicide, would be a failure of public health.
While public health does not offer all of the answers to this complex problem, we are determined to play
our role in the prevention of violence worldwide. This report will contribute to shaping the global response
to violence and to making the world a safer and healthier place for all. I invite you to read the report
carefully, and to join me and the many violence prevention experts from around the world who have
contributed to it in implementing its vital call for action.
Gro Harlem Brundtland
Director-General
World Health Organization
Contributors
Editorial guidance
Editorial Committee
Etienne G. Krug, Linda L. Dahlberg, James A. Mercy, Anthony B. Zwi, Rafael Lozano.
Executive Editor
Linda L. Dahlberg.
Advisory Committee
Nana Apt, Philippe Biberson, Jacquelyn Campbell, Radhika Coomaraswamy, William Foege, Adam Graycar,
Rodrigo Guerrero, Marianne Kastrup, Reginald Moreels, Paulo Sergio Pinheiro, Mark L. Rosenberg,
Terezinha da Silva, Mohd Sham Kasim.
WHO Secretariat
Ahmed Abdullatif, Susan Bassiri, Assia Brandrup-Lukanow, Alberto Concha-Eastman, Colette Dehlot,
Antonio Pedro Filipe, Viviana Mangiaterra, Hisahi Ogawa, Francesca Racioppi, Sawat Ramaboot, Pang
Ruyan, Gyanendra Sharma, Safia Singhateh, Yasuhiro Suzuki, Nerayo Tecklemichael, Tomris Turmen,
Madan Upadhyay, Derek Yach.
Regional consultants
WHO African Region
Nana Apt, Niresh Bhagwandin, Chiane Esther, Helena Zacarias Pedro Garinne, Rachel Jewkes, Naira Khan,
Romilla Maharaj, Sandra Marais, David Nyamwaya, Philista Onyango, Welile Shasha, Safia Singhateh, Isseu
Diop Toure, Greer van Zyl.
WHO Region of the Americas
Nancy Cardia, Arturo Cervantes, Mariano Ciafardini, Carme Clavel-Arcas, Alberto Concha-Eastman, Carlos
Fletes, Yvette Holder, Silvia Narvaez, Mark L. Rosenberg, Ana Maria Sanjuan, Elizabeth Ward.
WHO South-East Asia Region
Srikala Bharath, Vijay Chandra, Gopalakrishna Gururaj, Churnrutai Kanchanachitra, Mintarsih Latief,
Panpimol Lotrakul, Imam Mochny, Dinesh Mohan, Thelma Narayan, Harsaran Pandey, Sawat Ramaboot,
Sanjeeva Ranawera, Poonam Khetrapal Singh, Prawate Tantipiwatanaskul.
WHO European Region
Franklin Apfel, Assia Brandrup-Lukanow, Kevin Browne, Gani Demolli, Joseph Goicoechea, Karin HelwegLarsen, Maria Herczog, Joseph Kasonde, Kari Killen, Viviana Mangiaterra, Annemiek Richters, Tine Rikke,
Elisabeth Schauer, Berit Schei, Jan Theunissen, Mark Tsechkovski, Vladimir Verbitski, Isabel Yordi.
xiv
Saadia Abenaou, Ahmed Abdullatif, Abdul Rahman Al-Awadi, Shiva Dolatabadi, Albert Jokhadar, Hind
Khattab, Lamis Nasser, Asma Fozia Qureshi, Sima Samar, Mervat Abu Shabana.
WHO Western Pacific Region
Liz Eckermann, Mohd Sham Kasim, Bernadette Madrid, Pang Ruyan, Wang Yan, Simon Yanis.
CONTRIBUTORS
xv
Acknowledgements
The World Health Organization and the Editorial Committee would like to pay a special tribute to the
principal author of the chapter on abuse of the elderly, Rosalie Wolf, who passed away in June 2001. She
made an invaluable contribution to the care and protection of the elderly from abuse and neglect, and
showed an enduring commitment to this particularly vulnerable and often voiceless population.
The World Health Organization acknowledges with thanks the many authors, peer reviewers, advisers
and consultants whose dedication, support and expertise made this report possible.
The report also benefited from the contributions of a number of other people. In particular,
acknowledgement is made to Tony Kahane, who revised the draft manuscript, and to Caroline Allsopp and
Angela Haden, who edited the final text. Thanks are also due to the following: Sue Armstrong and Andrew
Wilson for preparing the summary of the report; Laura Sminkey, for providing invaluable assistance to the
Editorial Committee in the day-to-day management and coordination of the project; Marie Fitzsimmons, for
editorial assistance; Catherine Currat, Karin Engstrom, Nynke Poortinga, Gabriella Rosen and Emily
Rothman, for research assistance; Emma Fitzpatrick, Helen Green, Reshma Prakash, Angela Raviglione,
Sabine van Tuyll van Serooskerken and Nina Vugman, for communications; and Simone Colairo, Pascale
Lanvers, Angela Swetloff-Coff and Stella Tabengwa, for administrative support.
The World Health Organization also wishes to thank the California Wellness Foundation, the Global
Forum for Health Research, the Governments of Belgium, Finland, Japan, Sweden and the United Kingdom,
the Rockefeller Foundation and the United States Centers for Disease Control and Prevention, for their
generous financial support for the development and publication of this report.
Introduction
In 1996, the Forty-Ninth World Health Assembly adopted Resolution WHA49.25, declaring violence a
major and growing public health problem across the world (see Box overleaf for full text).
In this resolution, the Assembly drew attention to the serious consequences of violence both in the
short-term and the long-term for individuals, families, communities and countries, and stressed the
damaging effects of violence on health care services.
The Assembly asked Member States to give urgent consideration to the problem of violence within their
own borders, and requested the Director-General of the World Health Organization (WHO) to set up public
health activities to deal with the problem.
This, the first World report on violence and health, is an important part of WHOs response to Resolution
WHA49.25. It is aimed mainly at researchers and practitioners. The latter include health care workers, social
workers, those involved in developing and implementing prevention programmes and services, educators
and law enforcement officials. A summary of the report is also available.1
Goals
The goals of the report are to raise awareness about the problem of violence globally, and to make the case
that violence is preventable and that public health has a crucial role to play in addressing its causes and
consequences.
More specific objectives are to:
describe the magnitude and impact of violence throughout the world;
describe the key risk factors for violence;
give an account of the types of intervention and policy responses that have been tried and summarize
what is known about their effectiveness;
make recommendations for action at local, national and international levels.
Topics and scope
This report examines the types of violence that are present worldwide, in the everyday lives of people, and
that constitute the bulk of the health burden imposed by violence. Accordingly, the information has been
arranged in nine chapters, covering the following topics:
1. Violence a global public health problem
2. Youth violence
3. Child abuse and neglect by parents and other caregivers
4. Violence by intimate partners
World report on violence and health: a summary. Geneva, World Health Organization, 2002.
xx
INTRODUCTION
xxi
(continued)
(4) ensure the coordinated and active participation of appropriate WHO technical
programmes;
(5) strengthen the Organizations collaboration with governments, local authorities and
other organizations of the United Nations system in the planning, implementation and
monitoring of programmes of violence prevention and mitigation;
4. FURTHER REQUESTS the Director-General to present a report to the ninety-ninth session of the
Executive Board describing the progress made so far and to present a plan of action for
progress towards a science-based public health approach to violence prevention.
5.
6.
7.
8.
9.
Because it is impossible to cover all types of violence fully and adequately in a single document, each
chapter has a specific focus. For example, the chapter on youth violence examines interpersonal violence
among adolescents and young adults in the community. The chapter on child abuse discusses physical,
sexual and psychological abuse, as well as neglect by parents and other caregivers; other forms of
maltreatment of children, such as child prostitution and the use of children as soldiers, are covered in other
parts of the report. The chapter on abuse of the elderly focuses on abuse by caregivers in domestic and
institutional settings, while that on collective violence discusses violent conflict. The chapters on intimate
partner violence and sexual violence focus primarily on violence against women, though some discussion of
violence directed at men and boys is included in the chapter on sexual violence. The chapter on self-directed
violence focuses primarily on suicidal behaviour. The chapter is included in the report because suicidal
behaviour is one of the external causes of injury and is often the product of many of the same underlying
social, psychological and environmental factors as other types of violence.
The chapters follow a similar structure. Each begins with a brief discussion of definitions for the specific
type of violence covered in the chapter, followed by a summary of current knowledge about the extent of the
problem in different regions of the world. Where possible, country-level data are presented, as well as
findings from a range of research studies. The chapters then describe the causes and consequences of
violence, provide summaries of the interventions and policy responses that have been tried, and make
recommendations for future research and action. Tables, figures and boxes are included to highlight specific
epidemiological patterns and findings, illustrate examples of prevention activities, and draw attention to
specific issues.
The report concludes with two additional sections: a statistical annex and a list of Internet resources. The
statistical annex contains global, regional and country data derived from the WHO mortality and morbidity
database and from Version 1 of the WHO Global Burden of Disease project for 2000. A description of data
sources and methods is provided in the annex to explain how these data were collected and analysed.
The list of Internet resources includes web site addresses for organizations involved in violence research,
prevention and advocacy. The list includes metasites (each site offers access to hundreds of organizations
involved in violence research, prevention and advocacy), web sites that focus on specific types of violence,
web sites that address broader contextual issues related to violence, and web sites that offer surveillance tools
for improving the understanding of violence.
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CHAPTER 1
Background
Violence has probably always been part of the
human experience. Its impact can be seen, in
various forms, in all parts of the world. Each year,
more than a million people lose their lives, and
many more suffer non-fatal injuries, as a result of
self-inflicted, interpersonal or collective violence.
Overall, violence is among the leading causes of
death worldwide for people aged 1544 years.
Although precise estimates are difficult to
obtain, the cost of violence translates into billions
of US dollars in annual health care expenditures
worldwide, and billions more for national economies in terms of days lost from work, law
enforcement and lost investment.
The visible and the invisible
The human cost in grief and pain, of course,
cannot be calculated. In fact, much of it is almost
invisible. While satellite technology has made
certain types of violence terrorism, wars, riots
and civil unrest visible to television audiences on
a daily basis, much more violence occurs out of
sight in homes, workplaces and even in the
medical and social institutions set up to care for
people. Many of the victims are too young, weak or
ill to protect themselves. Others are forced by social
conventions or pressures to keep silent about their
experiences.
As with its impacts, some causes of violence are
easy to see. Others are deeply rooted in the social,
cultural and economic fabric of human life. Recent
research suggests that while biological and other
individual factors explain some of the predisposition to aggression, more often these factors interact
with family, community, cultural and other
external factors to create a situation where violence
is likely to occur.
A preventable problem
Despite the fact that violence has always been
present, the world does not have to accept it as an
inevitable part of the human condition. As long as
there has been violence, there have also been
systems religious, philosophical, legal and
communal which have grown up to prevent or
BOX 1.1
Defining violence
Any comprehensive analysis of violence should
begin by defining the various forms of violence in
such a way as to facilitate their scientific measurement. There are many possible ways to define
violence. The World Health Organization defines
violence (2) as:
The intentional use of physical force or power,
threatened or actual, against oneself, another
person, or against a group or community, that
either results in or has a high likelihood of
resulting in injury, death, psychological harm,
maldevelopment or deprivation.
The definition used by the World Health Organization associates intentionality with the committing
of the act itself, irrespective of the outcome it
produces. Excluded from the definition are unintentional incidents such as most road traffic injuries
and burns.
The inclusion of the word power, in addition
to the phrase use of physical force, broadens the
nature of a violent act and expands the conventional
understanding of violence to include those acts that
result from a power relationship, including threats
and intimidation. The use of power also serves to
include neglect or acts of omission, in addition to
the more obvious violent acts of commission. Thus,
the use of physical force or power should be
understood to include neglect and all types of
physical, sexual and psychological abuse, as well as
suicide and other self-abusive acts.
This definition covers a broad range of outcomes
including psychological harm, deprivation and
maldevelopment. This reflects a growing recognition
among researchers and practitioners of the need to
include violence that does not necessarily result in
injury or death, but that nonetheless poses a
substantial burden on individuals, families, communities and health care systems worldwide. Many
forms of violence against women, children and the
elderly, for instance, can result in physical, psychological and social problems that do not necessarily
lead to injury, disability or death. These conse-
Typology of violence
In its 1996 resolution WHA49.25, declaring
violence a leading public health problem, the
World Health Assembly called on the World Health
Organization to develop a typology of violence that
characterized the different types of violence and the
links between them. Few typologies exist already
and none is very comprehensive (5).
Collective violence
Types of violence
Self-directed violence
Interpersonal violence
FIGURE 1.1
A typology of violence
TABLE 1.1
Sources of data
Potential sources of the various
Type of data
Data sources
Examples of information collected
types of information include:
Mortality
Death certificates, vital statistics
Characteristics of the decedent,
individuals;
registries, medical examiners,
cause of death, location, time,
agency or institutional recoroners or mortuary reports
manner of death
cords;
Morbidity and
Hospital, clinic or other medical
Diseases, injuries, information on
other health data records
physical, mental or reproductive
local programmes;
health
community and governSelf-reported
Surveys, special studies, focus
Attitudes, beliefs, behaviours,
ment records;
groups, media
cultural practices, victimization and
population-based and
perpetration, exposure to violence in
the home or community
other surveys;
Community
Population records, local
Population counts and density, levels
special studies.
government records, other
of income and education,
Though not listed in Table 1.1,
institutional records
unemployment rates, divorce rates
almost all sources include basic
Crime
Police records, judiciary records,
Type of offence, characteristics of
demographic information such
crime laboratories
offender, relationship between
victim and offender, circumstances
as a persons age and sex. Some
of event
sources including medical reEconomic
Programme, institutional or
Expenditures on health, housing or
cords, police records, death certiagency records, special studies
social services, costs of treating
ficates and mortuary reports
violence-related injuries, use of
include information specific to
services
the violent event or injury. Data
Policy or
Government or legislative records Laws, institutional policies and
legislative
practices
from emergency departments, for
instance, may provide informanecessary. Such information can help in undertion on the nature of an injury, how it was sustained,
standing the circumstances surrounding specific
and when and where the incident occurred. Data
incidents and in describing the full impact of
collected by the police may include information on
violence on the health of individuals and commuthe relationship between the victim and the
nities. These types of data include:
perpetrator, whether a weapon was involved, and
health data on diseases, injuries and other
other circumstances related to the offence.
health conditions;
Surveys and special studies can provide detailed
information about the victim or perpetrator, and his
self-reported data on attitudes, beliefs, behaor her background, attitudes, behaviours and possiviours, cultural practices, victimization and
ble previous involvement in violence. Such sources
exposure to violence;
can also help uncover violence that is not reported to
community data on population characteristhe police or other agencies. For example, a housetics and levels of income, education and
hold survey in South Africa showed that between
unemployment;
50% and 80% of victims of violence received medical
crime data on the characteristics and circumtreatment for a violence-related injury without
stances of violent events and violent offendreporting the incident to the police (6). In another
ers;
study, conducted in the United States of America,
economic data related to the costs of
46% of victims who sought emergency treatment did
treatment and social services;
not make a report to the police (7).
data describing the economic burden on
health care systems and possible savings
Problems with collecting data
realized from prevention programmes;
The availability, quality and usefulness of the
Types of data and potential sources for collecting information
Availability of data
Other obstacles
Quality of data
10
TABLE 1.2
Type of violence
Homicide
520 000
Suicide
815 000
War-related
310 000
1 659 000
Totalc
Low- to middle-income countries 1 510 000
High-income countries
149 000
Homicide rate
Suicide rate
(per 100 000 population) (per 100 000 population)
Males
5.8
2.1
19.4
18.7
14.8
13.0
13.6
Females
4.8
2.0
4.4
4.3
4.5
4.5
4.0
Males
0.0
1.7
15.6
21.5
28.4
44.9
18.9
Females
0.0
2.0
12.2
12.4
12.6
22.1
10.6
11
FIGURE 1.2
12
13
Relationship
Societal
14
BOX 1.2
15
16
advocacy, as it assures decision-makers that something can be done. Even more importantly, it
provides them with valuable guidance as to which
efforts are likely to reduce violence.
Multifaceted responses
Because violence is a multifaceted problem with
biological, psychological, social and environmental
roots, it needs to be confronted on several different
levels at once. The ecological model serves a dual
purpose in this regard: each level in the model
represents a level of risk and each level can also be
thought of as a key point for intervention.
Dealing with violence on a range of levels
involves addressing all of the following:
. Addressing individual risk factors and taking
steps to modify individual risk behaviours.
. Influencing close personal relationships and
working to create healthy family environments,
as well as providing professional help and
support for dysfunctional families.
. Monitoring public places such as schools,
workplaces and neighbourhoods and taking
steps to address problems that might lead to
violence.
. Addressing gender inequality, and adverse
cultural attitudes and practices.
. Addressing the larger cultural, social and
economic factors that contribute to violence
and taking steps to change them, including
measures to close the gap between the rich and
poor and to ensure equitable access to goods,
services and opportunities.
done here to promote violence prevention. Smallscale pilot programmes and research projects can
provide a means for ideas to be tried out and
perhaps as important for a range of partners to
become used to working together. Structures such
as working groups or commissions that draw
together the different sectors and maintain both
formal and informal contacts are essential for the
success of this type of collaboration.
National level
17
18
BOX 1.3
The costs
Violence in the workplace causes immediate and often long-term disruption to interpersonal
relationships and to the whole working environment. The costs of such violence include:
n Direct costs --- stemming from such things as:
accidents;
illness;
disability and death;
absenteeism;
turnover of staff.
n Indirect costs, including:
reduced work performance;
a lower quality of products or service and slower production;
decreased competitiveness.
n More intangible costs, including:
damage to the image of an organization;
decreased motivation and morale;
diminished loyalty to the organization;
lower levels of creativity;
an environment that is less conducive to work.
The responses
As in dealing with violence in other settings, a comprehensive approach is required. Violence at
work is not simply an individual problem that happens from time to time, but a structural problem
with much wider socioeconomic, cultural and organizational causes.
The traditional response to violence at work, based exclusively on the enforcement of
regulations, fails to reach many situations in the workplace. A more comprehensive approach
focuses on the causes of violence in the workplace. Its aim is to make the health, safety and wellbeing of workers integral parts of the development of the organization.
19
Conclusion
Public health is concerned with the health and wellbeing of populations as a whole. Violence imposes a
References
1. Mercy JA et al. Public health policy for preventing
violence. Health Affairs, 1993, 12:729.
2. WHO Global Consultation on Violence and Health.
Violence: a public health priority. Geneva, World
Health Organization, 1996 (document WHO/EHA/
SPI.POA.2).
3. Walters RH, Parke RD. Social motivation, dependency, and susceptibility to social influence. In:
Berkowitz L, ed. Advances in experimental social
psychology. Vol. 1. New York, NY, Academic Press,
1964:231276.
20
21
CHAPTER 2
Youth violence
Background
Violence by young people is one of the most visible
forms of violence in society. Around the world,
newspapers and the broadcast media report daily on
violence by gangs, in schools or by young people
on the streets. The main victims and perpetrators of
such violence, almost everywhere, are themselves
adolescents and young adults (1). Homicide and
non-fatal assaults involving young people contribute greatly to the global burden of premature
death, injury and disability (1, 2).
Youth violence deeply harms not only its victims,
but also their families, friends and communities. Its
effects are seen not only in death, illness and
disability, but also in terms of the quality of life.
Violence involving young people adds greatly to the
costs of health and welfare services, reduces
productivity, decreases the value of property,
disrupts a range of essential services and generally
undermines the fabric of society.
The problem of youth violence cannot be viewed
in isolation from other problem behaviours. Violent
young people tend to commit a range of crimes.
They also often display other problems, such as
truancy and dropping out of school, substance
abuse, compulsive lying, reckless driving and high
rates of sexually transmitted diseases. However, not
all violent youths have significant problems other
than their violence and not all young people with
problems are necessarily violent (3).
There are close links between youth violence and
other forms of violence. Witnessing violence in the
home or being physically or sexually abused, for
instance, may condition children or adolescents to
regard violence as an acceptable means of resolving
problems (4, 5). Prolonged exposure to armed
conflicts may also contribute to a general culture of
terror that increases the incidence of youth violence
(68). Understanding the factors that increase the
risk of young people being the victims or perpetrators
of violence is essential for developing effective
policies and programmes to prevent violence.
For the purposes of this report, youths are
defined as people between the ages of 10 and 29
years. High rates of offending and victimization
nevertheless often extend as far as the 3035 years
25
26
FIGURE 2.1
Rates were calculated by WHO region and country income level and then grouped according to magnitude.
FIGURE 2.2
27
28
TABLE 2.1
Homicide rates among youths aged 10--29 years by country or area: most
recent year availablea
Country or area
Albania
Argentina
Armenia
Australia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and
Herzegovina
Brazil
Bulgaria
Canada
Chile
China
Hong Kong SAR
Selected rural
and urban areas
Colombia
Costa Rica
Croatia
Cuba
Czech Republic
Denmark
Ecuador
El Salvador
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Ireland
Israel
Italy
Jamaica
Japan
Kazakhstan
Kuwait
Kyrgyzstan
Latvia
Lithuania
Mauritius
Mexico
Netherlands
New Zealand
Nicaragua
Norway
Panama (excluding
Canal Zone)
Paraguay
Year
Total number
of deaths
Males
Females
Male:female
ratio
1998
1996
1999
1998
1999
1999
1999
1995
1991
325
628
26
88
7
194
267
37
2
28.2
5.2
1.9
1.6
b
6.7
8.8
1.4
b
53.5
8.7
3.1
2.2
b
12.1
13.2
1.8
b
5.5
1.6
b
1.0
b
b
4.3
b
b
9.8
5.5
c
2.3
c
c
3.1
c
c
1995
1999
1997
1994
20 386
51
143
146
32.5
2.2
1.7
3.0
59.6
3.2
2.5
5.1
5.2
b
0.9
b
11.5
c
2.7
c
1996
1999
16
778
b
1.8
b
2.4
b
1.2
c
2.1
1995
1995
1999
1997
1999
1996
1996
1993
1999
1998
1998
1992
1999
1998
1999
1997
1997
1997
1991
1997
1999
1999
1999
1999
1999
1999
1997
1999
1998
1996
1997
1997
12 834
75
21
348
36
20
757
1 147
33
19
91
4
156
25
41
10
13
210
2
127
631
14
88
55
59
4
5 991
60
20
139
11
151
84.4
5.5
1.6
9.6
1.2
1.5
15.9
50.2
7.7
b
0.6
b
0.8
0.9
1.4
b
b
1.4
b
0.4
11.5
b
4.6
7.8
5.4
b
15.3
1.5
1.8
7.3
b
14.4
156.3
8.4
b
14.4
1.4
b
29.2
94.8
13.3
b
0.7
b
1.0
1.4
1.4
b
b
2.3
b
0.5
18.0
b
6.7
13.1
8.4
b
27.8
1.8
b
12.5
b
25.8
11.9
b
b
4.6
b
b
2.3
6.5
b
b
0.4
b
0.6
b
1.5
b
b
0.5
b
0.3
5.0
b
2.4
b
b
b
2.8
1.2
b
b
b
b
13.1
c
c
3.2
c
c
12.4
14.6
c
c
1.9
c
1.6
c
0.9
c
c
4.5
c
1.7
3.6
c
2.8
c
c
c
9.8
1.6
c
c
c
c
1994
191
10.4
18.7
29
c
of the world (3238). Around
Ukraine
1999
1 273
8.7
13.0
4.3
3.1
one-third of students report havUnited Kingdom
1999
139
0.9
1.4
0.4
3.9
England and Wales 1999
91
0.7
1.0
0.3
3.4
ing been involved in fighting,
b
b
c
Northern Ireland
1999
7
b
with males 23 times more likely
b
c
Scotland
1999
41
3.1
5.3
Year
Total number
of deaths
30
TABLE 2.2
Austria
Belgium (Flemish
region)
Canada
Czech Republic
Denmark
England
Estonia
Finland
France
Germany
Greece
Greenland
Hungary
Israel
Latvia
Lithuania
Northern Ireland
Norway
Poland
Portugal
Republic of Ireland
Scotland
Slovakia
Sweden
Switzerland
United States of
America
Wales
Sometimes
%
Once a week
%
26.4
52.2
64.2
43.6
9.4
4.1
55.4
69.1
31.9
85.2
44.3
62.8
44.3
31.2
76.8
33.0
55.8
57.1
41.2
33.3
78.1
71.0
65.1
57.9
74.2
73.9
68.9
86.8
42.5
57.5
37.3
27.9
58.7
13.6
50.6
33.3
49.1
60.8
18.9
57.4
38.2
36.4
49.1
57.3
20.6
26.7
31.3
39.7
24.1
24.2
27.3
11.9
52.6
34.9
7.3
3.0
9.5
1.2
5.1
3.8
6.6
7.9
4.3
9.6
6.0
6.6
9.7
9.3
1.3
2.3
3.5
2.4
1.7
1.9
3.9
1.2
5.0
7.6
78.6
20.0
1.4
31
32
traits and both convictions for violence and selfreported violence. Hyperactivity, high levels of
daring or risk-taking behaviour, and poor concentration and attention difficulties before the age of
13 years all significantly predicted violence into
early adulthood. High levels of anxiety and
nervousness were negatively related to violence in
the studies in Cambridge and in the United States.
Low intelligence and low levels of achievement in
school have consistently been found to be associated
with youth violence (78). In the Philadelphia project
(69), poor intelligence quotient (IQ) scores in verbal
and performance IQ tests at the ages of 4 and 7 years,
and low scores in standard school achievement tests at
1314 years, all increased the likelihood of being
arrested for violence up to the age of 22 years. In a
study in Copenhagen, Denmark, of over 12 000 boys
born in 1953, low IQ at 12 years of age significantly
predicted police-recorded violence between the ages
of 15 and 22 years. The link between low IQ and
violence was strongest among boys from lower
socioeconomic groups.
Impulsiveness, attention problems, low intelligence and low educational attainment may all be
linked to deficiencies in the executive functions of the
brain, located in the frontal lobes. These executive
functions include: sustaining attention and concentration, abstract reasoning and concept formation,
goal formulation, anticipation and planning, effective
self-monitoring and self-awareness of behaviour, and
inhibitions regarding inappropriate or impulsive
behaviours (79). Interestingly, in another study in
Montreal of over 1100 children initially studied at
6 years of age and followed onwards from the age of
10 years executive functions at 14 years of age,
measured with cognitive-neuropsychological tests,
provided a significant means of differentiating
between violent and non-violent boys (80). Such a
link was independent of family factors, such as
socioeconomic status, the parents age at first birth,
their educational level, or separation or divorce
within the family.
Relationship factors
33
34
35
BOX 2.1
A profile of gangs
Youth gangs are found in all regions of the world. Although their size and nature may vary greatly
-- from mainly social grouping to organized criminal network -- they all seem to answer a basic
need to belong to a group and create a self-identity.
In the Western Cape region of South Africa, there are about 90 000 members of gangs, while
in Guam, some 110 permanent gangs were recorded in 1993, around 30 of them hard-core gangs.
In Port Moresby, Papua New Guinea, four large criminal associations with numerous subgroups
have been reported. There are an estimated 30 000--35 000 gang members in El Salvador and a
similar number in Honduras, while in the United States, some 31 000 gangs were operating in 1996
in about 4800 cities and towns. In Europe, gangs exist to varying extents across the continent, and
are particularly strong in those countries in economic transition such as the Russian Federation.
Gangs are primarily a male phenomenon, though in countries such as the United States, girls
are forming their own gangs. Gang members can range in age from 7 to 35 years, but typically are
in their teens or early twenties. They tend to come from economically deprived areas, and from
low-income and working-class urban and suburban environments. Often, gang members may
have dropped out of school and hold low-skilled or low-paying jobs. Many gangs in high-income
and middle-income countries consist of people from ethnic or racial minorities who may be socially
very marginalized.
Gangs are associated with violent behaviour. Studies have shown that as youths enter gangs
they become more violent and engage in riskier, often illegal activities. In Guam, over 60% of all
violent crime reported to the police is committed by young people, much of it related to activities
of the islands hard-core gangs. In Bremen, Germany, violence by gang members accounts for
almost half of reported violent offences. In a longitudinal study of nearly 1000 youths in
Rochester, NY, United States, some 30% of the sample were gang members, but they accounted
for around 70% of self-reported violent crimes and 70% of drug dealing.
A complex interaction of factors leads young people to opt for gang life. Gangs seem to
proliferate in places where the established social order has broken down and where alternative
forms of shared cultural behaviour are lacking. Other socioeconomic, community and
interpersonal factors that encourage young people to join gangs include:
a lack of opportunity for social or economic mobility, within a society that aggressively
promotes consumption;
a decline locally in the enforcement of law and order;
interrupted schooling, combined with low rates of pay for unskilled labour;
a lack of guidance, supervision and support from parents and other family members;
harsh physical punishment or victimization in the home;
having peers who are already involved in a gang.
Actively addressing these underlying factors that encourage youth gangs to flourish, and
providing safer, alternative cultural outlets for their prospective members, can help eliminate a
significant proportion of violent crime committed by gangs or otherwise involving young people.
36
Societal factors
Several societal factors may create conditions
conducive to violence among young people. Much
of the evidence related to these factors, though, is
based on cross-sectional or ecological studies and is
mainly useful for identifying important associations, rather than direct causes.
Demographic and social changes
Rapid demographic changes in the youth population, modernization, emigration, urbanization and
changing social policies have all been linked with an
increase in youth violence (111). In places that have
suffered economic crises and ensuing structural
adjustment policies such as in Africa and parts of
Latin America real wages have often declined
sharply, laws intended to protect labour have been
weakened or discarded, and a substantial decline in
basic infrastructure and social services has occurred
(112, 113). Poverty has become heavily concentrated in cities experiencing high population growth
rates among young people (114).
In their demographic analysis of young people
in Africa, Lauras-Locoh & Lopez-Escartin (113)
suggest that the tension between a rapidly swelling
population of young people and a deteriorating
infrastructure has resulted in school-based and
student revolts. Diallo Co-Trung (115) found a
similar situation of student strikes and rebellions in
Senegal, where the population under 20 years of
age doubled between 1970 and 1988, during a
period of economic recession and the implementation of structural adjustment policies. In a survey of
youths in Algeria, Rarrbo (116) found that rapid
demographic growth and accelerating urbanization
together created conditions, including unemployment and grossly inadequate housing, that in turn
led to extreme frustration, anger and pent-up
tensions among youths. Young people, as a result,
were more likely to turn to petty crime and
violence, particularly under the influence of peers.
In Papua New Guinea, Dinnen (117) describes the
evolution of raskolism (criminal gangs) in the
broader context of decolonization and the ensuing
social and political change, including rapid population growth unmatched by economic growth. Such a
37
38
BOX 2.2
39
40
41
TABLE 2.3
Violence prevention strategies by developmental stage (infancy to middle childhood) and ecological context
Ecological context
Developmental stage
Infancy
(ages 0--3 years)
Individual
Preventing unintended
pregnancies
. Increasing access to prenatal and
postnatal care
.
Relationship (e.g.
family, peers)
Community
Home visitationa
Training in parentinga
Early childhood
(ages 3--5 years)
Middle childhood
(ages 6--11 years)
Training in parentinga
Societal
Deconcentrating poverty
. Reducing income inequality
.
Deconcentrating poverty
. Reducing income inequality
. Reducing media violence
. Public information campaigns
.
.
.
.
.
.
a
b
Demonstrated to be effective in reducing youth violence or risk factors for youth violence.
Shown to be ineffective in reducing youth violence or risk factors for youth violence.
42
grammes have been found to have significant longterm effects in reducing violence and delinquency
(138, 149152). The earlier such programmes are
delivered in the childs life and the longer their
duration, the greater appear to be the benefits (3).
Training in parenting
for youth violence (3, 146). Mentoring programmes based on this theory match a young
person particularly one at high risk for antisocial
behaviour or growing up in a single-parent family
with a caring adult, a mentor, from outside the
family (160). Mentors may be older classmates,
teachers, counsellors, police officers or other
members of the community. The objectives of
such programmes are to help young people to
develop skills and to provide a sustained relationship with someone who is their role model and
guide (143). While not as widely evaluated as some
of the other strategies to reduce youth violence,
there is evidence that a positive mentoring relationship can significantly improve school attendance
and performance, decrease the likelihood of drug
use, improve relationships with parents and reduce
self-reported forms of antisocial behaviour (161).
Therapeutic and other approaches
43
TABLE 2.4
Violence prevention strategies by developmental stage (adolescence and early adulthood) and ecological context
Ecological context
Developmental stage
Adolescence
(ages 12--19 years)
Individual
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Community
.
.
.
.
.
.
.
Societal
.
.
.
.
.
.
.
.
Early adulthood
(ages 20--29 years)
Deconcentrating poverty
Reducing income inequality
Public information campaigns
Reducing media violence
Enforcing laws prohibiting illegal transfers of guns to youths
Promoting safe and secure storage of firearms
Strengthening and improving police and judicial systems
Reforming educational systems
.
.
.
.
.
.
.
.
a
b
Deconcentrating poverty
Reducing income inequality
Establishing job creation
programmes for the chronically
unemployed
Public information campaigns
Promoting safe and secure storage
of firearms
Strengthening and improving
police and judicial systems
Demonstrated to be effective in reducing youth violence or risk factors for youth violence.
Shown to be ineffective in reducing youth violence or risk factors for youth violence.
44
about the effectiveness of community-based strategies with regard to youth violence than of those
focusing on individual factors or on the relationships that young people have with others.
Community policing
Increasing the availability and quality of childcare facilities and preschool enrichment programmes to promote healthy development
and facilitate success in school.
Attempts to improve school settings including changing teaching practices and school
policies and rules, and increasing security (for
instance, by installing metal detectors or
surveillance cameras).
45
Societal approaches
Changing the social and cultural environment to
reduce violence is the strategy that is least
frequently employed to prevent youth violence.
Such an approach seeks to reduce economic or
social barriers to development for instance, by
creating job programmes or strengthening the
criminal justice system or to modify the
embedded cultural norms and values that stimulate
violence.
Addressing poverty
46
Recommendations
Deaths and injuries from youth violence constitute
a major public health problem in many parts of the
world. Significant variations in the magnitude of
this problem exist within and between countries
and regions of the world. There are a broad range of
viable strategies for preventing youth violence,
some of which have been shown to be particularly
effective. However, no single strategy is on its own
likely to be sufficient to reduce the health burden of
youth violence. Instead, multiple concurrent approaches will be required and they will need to be
relevant to the particular place where they are
implemented. What is successful in preventing
youth violence in Denmark, for instance, will not
necessarily be effective in Colombia or South Africa.
Over the past two decades, a great amount has
been learnt about the nature and causes of youth
violence and how to prevent it. This knowledge,
although based mainly on research from developed
countries, provides a foundation from which to
develop successful programmes to prevent youth
violence. There is, however, much more to be
learned about prevention. Based on the present state
of knowledge, the following recommendations, if
implemented, should lead to greater understanding
and more effective prevention of youth violence.
Establishing data collection systems
47
48
requires, above all, systematic evaluation of interventions. In particular, the following aspects
relating to youth violence prevention programmes
need much more research:
longitudinal studies evaluating the longterm impact of interventions conducted in
infancy or childhood;
evaluations of the impact of interventions on
the social factors associated with youth
violence, such as income inequality and the
concentration of poverty;
studies on the cost-effectiveness of prevention programmes and policies.
Consistent standards are needed for evaluation
studies assessing the effectiveness of youth violence
programmes and policies. These standards should
include:
the application of an experimental design;
evidence of a statistically significant reduction in the incidence of violent behaviour or
in violence-related injuries;
replication across different sites and different
cultural contexts;
evidence that the impact is sustained over
time.
Disseminating knowledge
Greater efforts need to be made to apply what has
been learnt about the causes and prevention of
youth violence. Currently, knowledge on this
subject is disseminated to practitioners and policymakers worldwide with great difficulty, mainly
because of a poor infrastructure of communication.
The following areas in particular should receive
greater attention:
. Global coordination is needed to develop
networks of organizations that focus on
information sharing, training and technical
assistance.
. Resources should be allocated to the application of Internet technology. In parts of the
world where this presents problems, other
non-electronic forms of information-sharing
should be promoted.
. International clearing houses should be set up
to identify and translate relevant information
6.
7.
8.
Conclusion
The volume of information about the causes and
prevention of youth violence is growing rapidly, as
is the demand worldwide for this information.
Meeting the huge demand will require substantial
investment to improve the mechanisms for
conducting public health surveillance, to carry out
all the necessary scientific research, and to create the
global infrastructure for disseminating and applying
what has been learnt. If the world can meet the
challenge and provide the resources required, youth
violence can, in the foreseeable future, begin to be
regarded as a preventable public health problem.
References
1.
2.
3.
4.
5.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
49
50
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
51
52
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
53
54
55
56
CHAPTER 3
Background
Child abuse has for a long time been recorded in
literature, art and science in many parts of the
world. Reports of infanticide, mutilation, abandonment and other forms of violence against children
date back to ancient civilizations (1). The historical
record is also filled with reports of unkempt, weak
and malnourished children cast out by families to
fend for themselves and of children who have been
sexually abused.
For a long time also there have existed charitable
groups and others concerned with childrens wellbeing who have advocated the protection of
children. Nevertheless, the issue did not receive
widespread attention by the medical profession or
the general public until 1962, with the publication
of a seminal work, The battered child syndrome, by
Kempe et al. (2).
The term battered child syndrome was coined
to characterize the clinical manifestations of serious
physical abuse in young children (2). Now, four
decades later, there is clear evidence that child abuse
is a global problem. It occurs in a variety of forms
and is deeply rooted in cultural, economic and
social practices. Solving this global problem,
however, requires a much better understanding
of its occurrence in a range of settings, as well as of
its causes and consequences in these settings.
59
60
physical abuse;
sexual abuse;
emotional abuse;
neglect.
Physical abuse of a child is defined as those acts
of commission by a caregiver that cause actual
physical harm or have the potential for harm. Sexual
abuse is defined as those acts where a caregiver uses
a child for sexual gratification.
Emotional abuse includes the failure of a
caregiver to provide an appropriate and supportive
environment, and includes acts that have an adverse
effect on the emotional health and development of a
child. Such acts include restricting a childs movements, denigration, ridicule, threats and intimidation, discrimination, rejection and other nonphysical forms of hostile treatment.
Neglect refers to the failure of a parent to provide
for the development of the child where the parent
is in a position to do so in one or more of the
following areas: health, education, emotional
development, nutrition, shelter and safe living
conditions. Neglect is thus distinguished from
circumstances of poverty in that neglect can occur
only in cases where reasonable resources are
available to the family or caregiver.
The manifestations of these types of abuse are
further described in Box 3.1.
BOX 3.1
Sexual abuse
Children may be brought to professional attention because of physical or behavioural concerns
that, on further investigation, turn out to result from sexual abuse. It is not uncommon for
children who have been sexually abused to exhibit symptoms of infection, genital injury,
abdominal pain, constipation, chronic or recurrent urinary tract infections or behavioural
problems. To be able to detect child sexual abuse requires a high index of suspicion and
familiarity with the verbal, behavioural and physical indicators of abuse. Many children will
disclose abuse to caregivers or others spontaneously, though there may also be indirect physical
or behavioural signs.
Neglect
There exist many manifestations of child neglect, including non-compliance with health care
recommendations, failure to seek appropriate health care, deprivation of food resulting in
hunger, and the failure of a child physically to thrive. Other causes for concern include the
exposure of children to drugs and inadequate protection from environmental dangers. In
addition, abandonment, inadequate supervision, poor hygiene and being deprived of an
education have all been considered as evidence of neglect.
61
62
63
64
BOX 3.2
Corporal punishment
Corporal punishment of children --- in the form of hitting, punching, kicking or beating --- is socially
and legally accepted in most countries. In many, it is a significant phenomenon in schools and
other institutions and in penal systems for young offenders.
The United Nations Convention on the Rights of the Child requires states to protect children
from all forms of physical or mental violence while they are in the care of parents and others,
and the United Nations Committee on the Rights of the Child has underlined that corporal
punishment is incompatible with the Convention.
In 1979, Sweden became the first country to prohibit all forms of corporal punishment of
children. Since then, at least 10 further states have banned it. Judgements from constitutional or
supreme courts condemning corporal punishment in schools and penal systems have also been
handed down --- including in Namibia, South Africa and Zimbabwe --- and, in 2000, Israels supreme
court declared all corporal punishment unlawful. Ethiopias 1994 constitution asserts the right of
children to be free of corporal punishment in schools and institutions of care. Corporal
punishment in schools has also been banned in New Zealand, the Republic of Korea, Thailand and
Uganda.
Nevertheless, surveys indicate that corporal punishment remains legal in at least 60 countries
for juvenile offenders, and in at least 65 countries in schools and other institutions. Corporal
punishment of children is legally acceptable in the home in all but 11 countries. Where the practice
has not been persistently confronted by legal reform and public education, the few existing
prevalence studies suggest that it remains extremely common.
Corporal punishment is dangerous for children. In the short term, it kills thousands of children
each year and injures and handicaps many more. In the longer term, a large body of research has
shown it to be a significant factor in the development of violent behaviour, and it is associated
with other problems in childhood and later life.
65
12
b
household
There is evidence to suggest
a
that shouting at children is a b Rural areas.
Question not asked in the survey.
common response by parents
across many countries. Cursing
times included within the definition of neglect.
children and calling them names appears to vary
Because definitions vary and laws on reporting abuse
more greatly. In the five countries of the WorldSAFE
do not always require the mandatory reporting of
study, the lowest incidence rate of calling children
neglect, it is difficult to estimate the global dimennames in the previous 6 months was 15% (see Table
sions of the problem or meaningfully to compare
3.2). The practices of threatening children with
rates between countries. Little research, for instance,
abandonment or with being locked out of the house,
has been done on how children and parents or other
however, varied widely among the countries. In the
caregivers may differ in defining neglect.
Philippines, for example, threats of abandonment
In Kenya, abandonment and neglect were the
were frequently reported by mothers as a disciplinmost commonly cited aspects of child abuse when
ary measure. In Chile, the rate of using such threats
adults in the community were questioned on the
was much lower, at about 8%.
subject (51). In this study, 21.9% of children
Data on the extent that non-violent and nonreported that they had been neglected by their
abusive disciplinary methods are employed by
parents. In Canada, a national study of cases
caregivers in different cultures and parts of the
reported to child welfare services found that,
world are extremely scarce. Limited data from the
among the substantiated cases of neglect, 19%
WorldSAFE project suggest that the majority of
involved physical neglect, 12% abandonment, 11%
parents use non-violent disciplinary practices.
educational neglect, and 48% physical harm
These include explaining to children why their
resulting from a parents failure to provide adequate
behaviour was wrong and telling them to stop,
supervision (54).
withdrawing privileges and using other nonviolent methods to change problem behaviour
What are the risk factors for child
(see Table 3.3). Elsewhere, in Costa Rica, for
abuse and neglect?
instance, parents acknowledged using physical
punishment to discipline children, but reported it
A variety of theories and models have been developed
as their least preferred method (50).
to explain the occurrence of abuse within families.
The most widely adopted explanatory model is the
Neglect
ecological model, described in Chapter 1. As applied
to child abuse and neglect, the ecological model
Many researchers include neglect or harm caused by a
considers a number of factors, including the
lack of care on the part of parents or other caregivers as
characteristics of the individual child and his or her
part of the definition of abuse (29, 5153).
family, those of the caregiver or perpetrator, the
Conditions such as hunger and poverty are some-
66
TABLE 3.3
Sex
67
The size of the family can also increase the risk for
abuse. A study of parents in Chile, for example,
found that families with four or more children were
three times more likely to be violent towards their
children than parents with fewer children (78).
However, it is not always simply the size of the
family that matters. Data from a range of countries
indicate that household overcrowding increases the
risk of child abuse (17, 41, 52, 57, 74, 79). Unstable
family environments, in which the composition of
the household frequently changes as family members and others move in and out, are a feature
particularly noted in cases of chronic neglect (6, 57).
Personality and behavioural characteristics
A number of personality and behavioural characteristics have been linked, in many studies, to
child abuse and neglect. Parents more likely to
abuse their children physically tend to have low
self-esteem, poor control of their impulses, mental
health problems, and to display antisocial behaviour (6, 67, 75, 76, 79). Neglectful parents have
many of these same problems and may also have
difficulty planning important life events such as
marriage, having children or seeking employment.
Many of these characteristics compromise parenting and are associated with disrupted social
relationships, an inability to cope with stress and
difficulty in reaching social support systems (6).
Abusive parents may also be uninformed and
have unrealistic expectations about child development (6, 57, 67, 80). Research has found that
abusive parents show greater irritation and annoyance in response to their childrens moods and
behaviour, that they are less supportive, affectionate, playful and responsive to their children, and
that they are more controlling and hostile (6, 39).
Prior history of abuse
68
69
TABLE 3.4
70
71
72
Therapeutic approaches
Responses to child abuse and neglect depend on
many factors, including the age and developmental
level of the child and the presence of environmental
stress factors. For this reason, a broad range of
therapeutic services have been designed for use
with individuals. Therapeutic programmes have
been set up throughout the world, including in
Argentina, China (Hong Kong SAR), Greece,
Panama, the Russian Federation, Senegal and
Slovakia (7).
73
74
75
76
77
BOX 3.3
78
Recommendations
There are several major areas for action that need to
be addressed by governments, researchers, health
care and social workers, the teaching and legal
professions, nongovernmental organizations and
other groups with an interest in preventing child
abuse and neglect.
Better assessment and monitoring
79
BOX 3.4
80
More research
Disciplinary practices
Conclusion
Child abuse is a serious global health problem.
Although most studies on it have been conducted in
developed countries, there is compelling evidence
that the phenomenon is common throughout the
world.
Much more can and should be done about the
problem. In many countries, there is little recognition of child abuse among the public or health
12.
13.
14.
References
1.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
81
82
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
83
84
86. Cawson P et al. The prevalence of child maltreatment in the UK. London, National Society for the
Prevention of Cruelty to Children, 2000.
87. De Paul J, Milner JS, Mugica P. Childhood
maltreatment, childhood social support and child
abuse potential in a Basque sample. Child Abuse &
Neglect, 1995, 19:907920.
88. Bagley C, Mallick K. Prediction of sexual, emotional
and physical maltreatment and mental health outcomes in a longitudinal study of 290 adolescent
women. Child Maltreatment, 2000, 5:218226.
89. Gillham B et al. Unemployment rates, single parent
density, and indices of child poverty: their relationship to different categories of child abuse and
neglect. Child Abuse & Neglect, 1998, 22:7990.
90. Coulton CJ et al. Community-level factors and child
maltreatment rates. Child Development, 1995,
66:12621276.
91. Coulton CJ, Korbin JE, Su M. Neighborhoods and
child maltreatment: a multi-level study. Child Abuse
& Neglect, 1999, 23:10191040.
92. McLloyd VC. The impact of economic hardship on
black families and children: psychological distress,
parenting, and socioeconomic development. Child
Development, 1990, 61:311346.
93. Korbin JE et al. Neighborhood views on the
definition and etiology of child maltreatment. Child
Abuse & Neglect, 2000, 12:15091527.
94. Bifulco A, Moran A. Wednesdays child: research
into womens experience of neglect and abuse in
childhood, and adult depression. London, Routledge, 1998.
95. Briere JN. Child abuse trauma: theory and treatment
of lasting effects. London, Sage, 1992.
96. Lau JT et al. Prevalence and correlates of physical
abuse in Hong Kong Chinese adolescents: a
population-based approach. Child Abuse & Neglect,
1999, 23:549557.
97. Fergusson DM, Horwood MT, Lynskey LJ. Childhood sexual abuse and psychiatric disorder in
young adulthood. II: Psychiatric outcomes of
childhood sexual abuse. Journal of the American
Academy of Child and Adolescent Psychiatry, 1996;
35:13651374.
98. Trowell J et al. Behavioural psychopathology of
child sexual abuse in schoolgirls referred to a
tertiary centre: a North London study. European Child and Adolescent Psychiatry, 1999,
8:107116.
99. Anda R et al. Adverse childhood experiences and
smoking during adolescence and adulthood. Journal of the American Medical Association, 1999,
282:16521658.
85
86
CHAPTER 4
Violence by
intimate partners
Background
One of the most common forms of violence against
women is that performed by a husband or an
intimate male partner. This is in stark contrast to the
situation for men, who in general are much more
likely to be attacked by a stranger or acquaintance
than by someone within their close circle of
relationships (15). The fact that women are often
emotionally involved with and economically
dependent on those who victimize them has major
implications for both the dynamics of abuse and the
approaches to dealing with it.
Intimate partner violence occurs in all countries,
irrespective of social, economic, religious or
cultural group. Although women can be violent
in relationships with men, and violence is also
sometimes found in same-sex partnerships, the
overwhelming burden of partner violence is borne
by women at the hands of men (6, 7). For that
reason, this chapter will deal with the question of
violence by men against their female partners.
Womens organizations around the world have
long drawn attention to violence against women,
and to intimate partner violence in particular.
Through their efforts, violence against women has
now become an issue of international concern.
Initially viewed largely as a human rights issue,
partner violence is increasingly seen as an important public health problem.
89
90
TABLE 4.1
Physical assault on women by an intimate male partner, selected population-based studies, 1982--1999
Country or area
Year of
study
Africa
Ethiopia
Kenya
Nigeria
South Africa
1995
1984--1987
1993
1998
Zimbabwe
1996
Meskanena Woreda
Kisii District
Not stated
Eastern Cape
Mpumalanga
Northern Province
National
Midlands Province
Sample
Size
Study
populationa
Age
(years)
673
612
1 000
396
419
464
10 190
966
II
VI
I
III
III
III
III
I
515
515
18--49
18--49
18--49
15--49
518
97
264
289
1 000
310
6 097
650
1 064
360
378
8 507
5 940
I
I
I
II
II
II
III
III
III
III
III
III
29--45
20--45
520
22--55
15--49
15--49
515
515
15--49
15--49
15--49
15--49
359
II
17--55
31
4 755
545
III
IIh
15--49
22--55
10e
10b
30d
30c,e
Paraguay
Peru
1997
Puerto Rico
Uruguay
North America
Canada
1995--1996
1997
1991--1992
1993
1995--1996
Toronto
National
National
420
12 300
8 000
I
I
I
18--64
518
518
1996
1992
1993
1996
1993--1994
1993--1994
1995--1996
National
National (villages)
Two rural regions
Six regions
Tamil Nadu
Uttar Pradesh
Uttar Pradesh, five
districts
National
Six states
National, rural villages
Port Moresby
National
Cagayan de Oro City and
Bukidnon Province
National
Bangkok
6 300
1 225
10 368
1 374
859
983
6 695
I
II
II
III
II
II
IV
<50
15--49
15--39
15--39
15--65
3d
19
89 199
9 938
628
298
8 481
1 660
III
III
IIIh
IIIh
V
II
15--49
15--49
15--49
15--49
11i
14
II
IV
520
38/12f
United States
Asia and
Western Pacific
Australia
Bangladesh
Cambodia
India
Republic of Korea
Thailand
1998--1999
1999
1982
1984
1993
1998
1989
1994
707
619
31c
27
28
19
13
17d
11
12
5
6
1995
1997
1998
1995--1996
Nicaragua
45
42
National
National
Three districts
Santiago province
Santiago
National
Guadalajara
Monterrey
Leon
Managua
National
National, except Chaco
region
Metro Lima (middle-income
and low-income)
National
Two regions
Colombia
Mexico
1990
1990
1998
1993
1997
1995
1996
Coverage
17c
26/11f
23
19
27
17
52/37f
69
28/21f
10
27/20f
33/28
12/8f
13g
27c
29d,e
22c
3d,e
1.3c
8d
47
42
16
37
45
30
19i
40/26
67
56
10
26j
20
91
Europe
Netherlands
Norway
Republic of Moldova
Switzerland
Turkey
United Kingdom
Eastern Mediterranean
Egypt
Israel
West Bank and Gaza
Strip
Year of
study
Coverage
Sample
Size
Study
populationa
Age
(years)
989
111
4 790
1 500
599
I
III
III
II
I
20--60
20--49
15--44
20--60
14--75
1993
National
Trondheim
National
National
East and south-east
Anatolia
North London
430
516
12c
30c
1995--1996
1997
1994
National
Arab population
Palestinian population
7 121
1 826
2 410
III
II
II
15--49
19--67
17--65
16j
32
52/37f
34g
1986
1989
1997
1994--1996
1998
57
6e
21/11c,f
18
514
21e
58c
Source: reference 9.
92
BOX 4.1
Improving disclosure
All studies on sensitive topics such as violence face the problem of how to achieve openness from
people about intimate aspects of their lives. Success will depend partly on the way in which the
questions are framed and delivered, as well as on how comfortable interviewees feel during the
interview. The latter depends on such factors as the sex of the interviewer, the length of the interview,
whether others are present, and how interested and non-judgemental the interviewer appears.
Various strategies can improve disclosure. These include:
n Giving the interviewee several opportunities during an interview in which to disclose
violence.
n Using behaviourally specific questions, rather than subjective questions such as Have you
ever been abused?.
n Carefully selecting interviewers and training them to develop a good rapport with the
interviewees.
n Providing support for interviewees, to help avoid retaliation by an abusive partner or family
member.
The safety of both respondents and interviewers must always be taken into account in all
strategies for improving research into violence.
The World Health Organization has recently published guidelines addressing ethical and safety
issues in research into violence against women (15). Guidelines for defining and measuring
partner violence and sexual assault are being developed to help improve the comparability of
data. Some of these guidelines are currently available (16) (see also Resources).
93
with a weapon. Research has shown that behaviourally specific questions such as Have you ever
been forced to have sexual intercourse against your
will? produce greater rates of positive response
than questions asking women whether they have
been abused or raped (17). Such behaviourally specific questions also allow researchers to
gauge the relative severity and frequency of the
abuse suffered. Physical acts that are more severe
than slapping, pushing or throwing an object at a
person are generally defined in studies as severe
violence, though some observers object to defining severity solely according to the act (18).
A focus on acts alone can also hide the
atmosphere of terror that sometimes permeates
violent relationships. In a national survey of
violence against women in Canada, for example,
one-third of all women who had been physically
assaulted by a partner said that they had feared for
their lives at some time in the relationship (19).
Although international studies have concentrated
on physical violence because it is more easily
conceptualized and measured, qualitative studies
suggest that some women find the psychological
abuse and degradation even more intolerable than
the physical violence (1, 20, 21).
94
TABLE 4.2
Percentage of respondents who approve of using physical violence against a spouse, by rationale, selected studies,
1995--1999
Country or area
Year
1999
Chile (Santiago)
1999
Colombia (Cali)
1999
Egypt
1996
1999
Ghanab
1999
1996
1995
1999
Singapore
Venezuela (Caracas)
1996
1999
1996
Respondent
M
F
M
F
M
F
Urban F
Rural F
M
F
M
F
M
M
Urban F
Rural F
M
M
F
Mh
She refuses
him sex
He suspects
her of
adultery
She answers
back or
disobeys
40
61
1
15
25
57
81
43
33
1
5
10
5
28
19a
11a
12a
14a
14a
13a
5a
9a
5c
22
32
33f
8a
8a
71
59
78
10--50
1d
57
95
96
30
that various factors can keep
Canada
12 300
22
26
45
44
women in abusive relationships. Cambodia
1 374
34
1
33
22
1 000
30
16
14
32b/21c
These commonly include: fear of Chile
7 121
47
3
44
retribution, a lack of alternative Egypt
Ireland
679
20
50
37
means of economic support, con- Nicaragua
8 507
37
17
28
34
cern for the children, emotional Republic of Moldova 4 790
6
30
31
430
38
22
46
31
dependence, a lack of support United Kingdom
from family and friends, and an aSource: reproduced from reference 6 with the permission of the publisher.
Women who were physically assaulted in the past 12 months.
abiding hope that the man will b Refers to the proportion of women who told their family.
change (9, 40, 42, 62, 63). In c Refers to the proportion of women who told their partners family.
developing countries, women also
cite the stigmatization associated
According to research, leaving an abusive
with being unmarried as an additional barrier to
relationship is a process, not a one-off event.
leaving abusive relationships (40, 56, 64).
Most women leave and return several times before
Denial and the fear of being socially ostracized
finally deciding to end the relationship. The process
often prevent women from reaching out for help.
includes periods of denial, self-blame and suffering
Studies have shown that around 2070% of abused
before women come to recognize the reality of the
women never told another person about the abuse
abuse and to identify with other women in similar
until they were interviewed for the study (see
situations. At this point, disengagement and recovTable 4.3). Those who do reach out do so mainly to
ery from the abusive relationship begin (69).
family members and friends, rather than to
Recognizing that this process exists can help people
institutions. Only a minority ever contact the police.
to be more understanding and less judgemental
Despite the obstacles, many abused women
about women who return to abusive situations.
eventually do leave violent partners, sometimes
Unfortunately, leaving an abusive relationship
only after many years, once the children have grown
does not of itself always guarantee safety. Violence
up. In the study in Leon, Nicaragua, for example,
can sometimes continue and may even escalate after
70% of the women eventually left their abusive
a woman leaves her partner (70). In fact in Australia,
partners (65). The median time that women spent in
Canada and the United States, a significant propora violent relationship was around 6 years, although
tion of intimate partner homicides involving women
younger women were more likely to leave sooner
occur around the time that a woman is trying to leave
(9). Studies suggest that there is a consistent set of
an abusive partner (22, 27, 71, 72).
factors leading women to separate from their
abusive partners permanently. Usually this occurs
What are the risk factors for
when the violence becomes severe enough to trigger
intimate partner violence?
the realization that the partner is not going to
change, or when the situation starts noticeably to
Researchers have only recently begun to look for
affect the children. Women have also mentioned
individual and community factors that might affect
emotional and logistical support from family or
the rate of partner violence. Although violence
friends as being pivotal in their decision to end the
against women is found to exist in most places, it
relationship (61, 63, 6668).
turns out that there are examples of pre-industrial
97
Individual factors
Black et al. recently reviewed the social science
literature from North America on risk factors for
physically assaulting an intimate partner (76). They
reviewed only studies they considered to be
methodologically sound and that employed either
a representative community sample or a clinical
sample with an appropriate control group. A
number of demographic, personal history and
personality factors emerged from this analysis, as
consistently linked to a mans likelihood of
physically assaulting an intimate partner. Among
the demographic factors, young age and low
income were consistently found to be factors linked
to the likelihood of a man committing physical
violence against a partner.
Some studies have found a relationship between
physical assault and composite measures of socioeconomic status and educational level, although the
data are not fully consistent. The Health and
Development Study in Dunedin, New Zealand
one of the few longitudinal, birth cohort studies to
explore partner violence found that family
poverty in childhood and adolescence, low academic achievement and aggressive delinquency at
the age of 15 years all strongly predicted physical
abuse of partners by men at the age of 21 years
98
TABLE 4.5
Young age
Heavy drinking
Depression
Personality disorders
Low academic achievement
Low income
Witnessing or experiencing
violence as a child
Relationship factors
Community factors
Societal factors
Marital conflict
Marital instability
. Male dominance in the family
. Economic stress
. Poor family functioning
.
.
99
100
TABLE 4.6
101
gastrointestinal disorders;
irritable bowel syndrome;
a variety of reproductive health consequences (see below).
In general, the following are conclusions
emerging from current research about the health
consequences of abuse:
. The influence of abuse can persist long after
the abuse itself has stopped (103, 104).
. The more severe the abuse, the greater its
impact on a womans physical and mental
health (98).
. The impact over time of different types of abuse
and of multiple episodes of abuse appears to be
cumulative (85, 99, 100, 103, 105).
Reproductive health
102
dent, and 11% had been unable to perform household chores because of an incident of violence (141).
Although partner violence does not consistently
affect a womans overall probability of being
employed, it does appear to influence a womans
earnings and her ability to keep a job (139, 142,
143). A study in Chicago, IL, United States, found
that women with a history of partner violence were
more likely to have experienced spells of unemployment, to have had a high turnover of jobs, and
to have suffered more physical and mental health
problems that could affect job performance. They
also had lower personal incomes and were
significantly more likely to receive welfare assistance than women who did not report a history of
partner violence (143). Similarly, in a study in
Managua, Nicaragua, abused women earned 46%
less than women who did not report suffering
abuse, even after controlling for other factors that
could affect earnings (139).
Impact on children
Children are often present during domestic altercations. In a study in Ireland (62), 64% of abused
women said that their children routinely witnessed
the violence, as did 50% of abused women in
Monterrey, Mexico (11).
Children who witness marital violence are at a
higher risk for a whole range of emotional and
behavioural problems, including anxiety, depression, poor school performance, low self-esteem,
disobedience, nightmares and physical health
complaints (9, 144146). Indeed, studies from
North America indicate that children who witness
violence between their parents frequently exhibit
many of the same behavioural and psychological
disturbances as children who are themselves
abused (145, 147).
Recent evidence suggests that violence may also
directly or indirectly affect child mortality (148,
149). Researchers in Leon, Nicaragua, found that
after controlling for other possible confounding
factors, the children of women who were physically
and sexually abused by a partner were six times more
likely to die before the age of 5 years than children of
women who had not been abused. Partner abuse
103
104
105
Alternative sanctions
106
107
108
Womens organizations have long used communication campaigns, small-scale media and other
events in an attempt to raise awareness of partner
violence and change behaviour. There is evidence
that such campaigns reach a large number of
people, although only a few campaigns have been
evaluated for their effectiveness in changing
attitudes or behaviour. During the 1990s, for
instance, a network of womens groups in
Nicaragua mounted an annual mass media campaign to raise awareness of the impact of violence
on women (198). Using slogans such as Quiero
vivir sin violencia (I want to live free of violence),
the campaigns mobilized communities against
abuse. Similarly, the United Nations Development
Fund for Women, together with several other
United Nations agencies, has been sponsoring a
series of regional campaigns against gender
violence around the slogan, A life free of violence:
its our right (199). One communication project
that has been evaluated is the multimedia health
project known as Soul City, in South Africa a
project that combines prime-time television and
radio dramas with other educational activities. One
component is specifically devoted to domestic
violence (see Box 9.1 in Chapter 9). The evaluation
found increased knowledge and awareness of
domestic violence, changed attitudes and norms,
and greater willingness on the part of the projects
audience to take appropriate action.
School programmes
109
BOX 4.2
110
BOX 4.3
111
Womens involvement
Little enduring change is usually achieved by shortterm efforts to sensitize institutional actors, unless
Recommendations
The evidence available shows violence against
women by intimate partners to be a serious and
widespread problem in all parts of the world. There is
also a growing documentation of the damaging
impact of violence on the physical and mental health
of women and their overall well-being. The following are the main recommendations for action:
.
112
Programmes should focus more on the primary prevention of intimate partner violence.
Conclusion
Violence by intimate partners is an important public
health problem. Resolving it requires the involvement of many sectors working together at community, national and international levels. At each level,
responses must include empowering women and
girls, reaching out to men, providing for the needs
of victims and increasing the penalties for abusers. It
is vital that responses should involve children and
young people, and focus on changing community
and societal norms. The progress made in each of
these areas will be the key to achieving global
reductions in violence against intimate partners.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
113
114
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
115
116
117
118
119
120
121
CHAPTER 5
Background
The abuse of older people by family members dates
back to ancient times. Until the advent of initiatives
to address child abuse and domestic violence in the
last quarter of the 20th century, it remained a
private matter, hidden from public view. Initially
seen as a social welfare issue and subsequently a
problem of ageing, abuse of the elderly, like other
forms of family violence, has developed into a
public health and criminal justice concern. These
two fields public health and criminal justice
have therefore dictated to a large extent how abuse
of the elderly is viewed, how it is analysed, and
how it is dealt with. This chapter focuses on abuse
of older people by family members or others
known to them, either in their homes or in
residential or other institutional settings. It does
not cover other types of violence that may be
directed at older people, such as violence by
strangers, street crime, gang warfare or military
conflict.
Mistreatment of older people referred to as
elder abuse was first described in British
scientific journals in 1975 under the term granny
battering (1, 2). As a social and political issue,
though, it was the United States Congress that first
seized on the problem, followed later by researchers and practitioners. During the 1980s scientific
research and government actions were reported
from Australia, Canada, China (Hong Kong SAR),
Norway, Sweden and the United States, and in the
following decade from Argentina, Brazil, Chile,
India, Israel, Japan, South Africa, the United
Kingdom and other European countries. Although
elder abuse was first identified in developed
countries, where most of the existing research has
been conducted, anecdotal evidence and other
reports from some developing countries have
shown that it is a universal phenomenon. That
elder abuse is being taken far more seriously now
reflects the growing worldwide concern about
human rights and gender equality, as well as about
domestic violence and population ageing.
Where older age begins is not precisely
defined, which makes comparisons between studies and between countries difficult. In Western
125
126
127
128
BOX 5.1
129
130
Early researchers in the field played down individual personality disturbances as causal agents of
family violence in favour of social and cultural
factors (27). More recently, though, research on
family violence has shown that abusers who are
physically aggressive are more likely to have
personality disorders and alcohol-related problems
than the general population (28). Similarly, studies
restricted to violence against older people in
domestic settings have found that aggressors are
more likely to have mental health and substance
abuse problems than family members or caregivers
who are not violent or otherwise abusive (2931).
Cognitive and physical impairments of the
abused older person were strongly identified in
the early studies as risk factors for abuse. However,
a later study of a range of cases from a social service
agency revealed that the older people who had been
mistreated were not more debilitated than their
non-abused peers and may even have been less so,
particularly in cases of physical and verbal abuse
(32). In other studies, a comparison of samples of
patients with Alzheimer disease showed that the
degree of impairment was not a risk factor for being
abused (33, 34). However, among cases of abuse
reported to the authorities, those involving the very
131
132
133
134
135
136
137
BOX 5.2
Health care
138
implausible or vague explanations for injuries or ill-health, from either the patient or
his or her caregiver;
differing case histories from the patient and
the caregiver;
frequent visits to emergency departments
because a chronic condition has worsened,
despite a care plan and resources to deal with
this in the home;
functionally impaired older patients who
arrive without their main caregivers;
laboratory findings that are inconsistent with
the history provided.
When conducting an examination (65), the
doctor or health care worker should:
interview the patient alone, asking directly
about possible physical violence, restraints or
neglect;
interview the suspected abuser alone;
pay close attention to the relationship
between, and the behaviour of, the patient
and his or her suspected abuser;
conduct a comprehensive geriatric assessment of the patient, including medical,
functional, cognitive and social factors;
document the patients social networks, both
formal and informal.
Table 5.1 contains a list of indicators that may
serve as a useful guide if mistreatment is suspected.
The presence of any indicator in this table, though,
should not be taken as proof that abuse has actually
taken place.
Legal action
139
TABLE 5.1
Physical
Complaints of being
physically assaulted
Excessive repeat
prescriptions or underusage of medication
Malnourishment or
dehydration without an
illness-related cause
Behavioural and
emotional
.
Change in eating
pattern or sleep
problems
Passivity, withdrawal or
increasing depression
Helplessness,
hopelessness or anxiety
Contradictory
statements or other
ambivalence not
resulting from mental
confusion
Reluctance to talk
openly
Evidence of inadequate
care or poor standards
of hygiene
Avoidance of physical,
eye or verbal contact
with caregiver
Indicators relating to
the caregiver
Sexual
Financial
Complaints of being
sexually assaulted
Withdrawals of money
that are erratic, or not
typical of the older
person
Caregiver seems
excessively concerned or
unconcerned
Caregiver behaves
aggressively
Caregiver responds
defensively when
questioned; may be
hostile or evasive
Untreated medical or
mental health problems
140
BOX 5.3
Recommendations
Although abuse of the elderly by family members,
caregivers and others is better understood today than
it was 25 years ago, a firmer base of knowledge is
needed for policy, planning and programming
purposes. Many aspects of the problem remain
unknown, including its causes and consequences,
and even the extent to which it occurs. Research on
the effectiveness of interventions has to date yielded
almost no useful or reliable results.
Perhaps the most insidious form of abuse against
the elderly lies in the negative attitudes towards,
and stereotypes of, older people and the process of
ageing itself, attitudes that are reflected in the
frequent glorification of youth. As long as older
people are devalued and marginalized by society,
they will suffer from loss of self-identity and
remain highly susceptible to discrimination and all
forms of abuse.
Among the priorities for confronting and
eradicating the problem of elder abuse are:
greater knowledge about the problem;
stronger laws and policies;
more effective prevention strategies.
Greater knowledge
Better knowledge about elder abuse is a top priority
worldwide. In 1990 the Council of Europe convened
a broad-ranging conference on the subject that
looked at definitions, statistics, laws and policies,
prevention and treatment, as well as the available
sources of information on elder abuse (67). A global
working group on elder abuse should be set up to
deal with all these subjects. Among other things,
such a body could bring together and standardize
global statistics, and work out the requirements for a
common data-reporting form. The precise role of
different cultures in elder abuse should also be
researched and better explained.
Research leading to effective interventions is
urgently needed. Studies should be conducted to
ascertain how older people can play a greater part in
designing and participating in prevention pro-
141
142
Abusive traditions
Conclusion
The problem of elder abuse cannot be properly
solved if the essential needs of older people for
food, shelter, security and access to health care are
not met. The nations of the world must create an
143
References
1. Baker AA. Granny-battering. Modern Geriatrics,
1975, 5:2024.
2. Burston GR. Granny battering. British Medical
Journal, 1975, 3:592.
3. Randal J, German T. The ageing and development
report: poverty, independence, and the worlds
people. London, HelpAge International, 1999.
4. Hudson MF. Elder mistreatment: a taxonomy with
definitions by Delphi. Journal of Elder Abuse and
Neglect,1991, 3:120.
5. Brown AS. A survey on elder abuse in one Native
American tribe. Journal of Elder Abuse and
Neglect,1989, 1:1737.
6. Maxwell EK, Maxwell RJ. Insults to the body civil:
mistreatment of elderly in two Plains Indian tribes.
Journal of Cross-Cultural Gerontology, 1992, 7:3
22.
7. What is elder abuse? Action on Elder Abuse Bulletin,
1995, 11 (MayJune).
8. Kosberg JI, Garcia JL. Common and unique themes
on elder abuse from a worldwide perspective. In:
Kosberg JI, Garcia JL, eds. Elder abuse: international
and cross-cultural perspectives. Binghamton, NY,
Haworth Press, 1995:183198.
9. Moon A, Williams O. Perceptions of elder abuse and
help-seeking patterns among African-American,
Caucasian American, and Korean-American elderly
women. The Gerontologist, 1993, 33:386395.
10. Tomita SK. Exploration of elder mistreatment
among the Japanese. In: Tatara T, ed. Understanding
elder abuse in minority populations. Philadelphia,
PA, Francis & Taylor, 1999:119139.
11. Gilliland N, Picado LE. Elder abuse in Costa Rica.
Journal of Elder Abuse and Neglect, 2000, 12:7387.
12. Owen M. A world of widows. London, Zed Books,
1996.
13. Gorman M, Petersen T. Violence against older
people and its health consequences: experience
from Africa and Asia. London, HelpAge International, 1999.
14. Witchcraft: a violent threat. Ageing and Development, 2000, 6:9.
144
145
CHAPTER 6
Sexual violence
149
Background
150
TABLE 6.1
Percentage of women aged 16 years and older who report having been
sexually assaulted in the previous 5 years, selected cities, 1992--1997
Country
Study
population
Year
Sample
size
Percentage of women
(aged 16 years and older)
sexually assaulted in the
previous 5 years
(%)
Africa
Botswana
Egypt
South Africa
Tunisia
Uganda
Zimbabwe
Gaborone
Cairo
Johannesburg
Grand-Tunis
Kampala
Harare
1997
1992
1996
1993
1996
1996
644
1000
1006
1087
1197
1006
0.8
3.1
2.3
1.9
4.5
2.2
Latin America
Argentina
Bolivia
Brazil
Colombia
Costa Rica
Paraguay
Buenos Aires
La Paz
Rio de Janiero
Bogota
San Jose
Asuncion
1996
1996
1996
1997
1996
1996
1000
999
1000
1000
1000
587
5.8
1.4
8.0
5.0
4.3
2.7
Asia
China
India
Indonesia
Philippines
Beijing
Bombay
Jakarta and Surabaya
Manila
1994
1996
1996
1996
2000
1200
1400
1500
1.6
1.9
2.7
0.3
Tirana
Budapest
iauliai,
Kaunas, Klaipeda,
Panevezys,
Vilnius
Ulaanbaatar,
Zuunmod
1996
1996
1997
1200
756
1000
6.0
2.0
4.8
1996
1201
3.1
Eastern Europe
Albania
Hungary
Lithuania
Mongolia
151
152
TABLE 6.2
Percentage of adult women reporting sexual victimization by an intimate partner, selected population-based surveys,
1989--2000
Country
Brazila
Canada
Chile
Finland
Japana
Indonesia
Mexico
Nicaragua
Perua
Puerto Rico
Sweden
Switzerland
Thailanda
Turkey
United Kingdom
United States
West Bank and
Gaza Strip
Zimbabwe
Study
population
Year
Sao Paulo
Pernambuco
National
Toronto
Santiago
National
Yokohama
Central Java
Durango
Guadalajara
Leon
Managua
Lima
Cusco
National
Teg, Umea
National
Bangkok
Nakornsawan
East and south-east
Anatolia
England, Scotland
and Wales
North London,
England
National
Palestinians
2000
2000
1993
1991--1992
1997
1997--1998
2000
1999--2000
1996
1996
1993
1997
2000
2000
1993--1996
1991
1994--1995
2000
2000
1998
Midlands Province
1996
Sample
size
941a
1 188a
12 300
420
310
7 051
1 287a
765
384
650
360
378
1 086a
1 534a
7 079
251
1 500
1 051a
1 027a
599
Percentage
assaulted in
past 12 months
Attempted
or completed
forced sex
(%)
2.8
5.6
Percentage
ever assaulted
Attempted
or completed
forced sex
(%)
10.1
14.3
8.0
15.3b
9.1
2.5
1.3
13.0
5.9
6.2
15.0
42.0
23.0
21.7
17.7
7.1
22.9
22.0
22.5
46.7
5.7b
17.1
15.6
7.5
11.6
29.9
28.9
51.9b
14.2d
1989
1 007
1993
430
6.0b
23.0b
8 000
2 410
0.2b
27.0
7.7b
1995--1996
1995
Completed
forced
sex
(%)
966
25.0
153
TABLE 6.3
Percentage of adolescents reporting forced sexual initiation, selected population-based surveys, 1993--1999
Country or area
Study population
Year
Cameroon
Caribbean
Ghana
Mozambique
New Zealand
Peru
South Africa
United Republic
of Tanzania
United States
Bamenda
Nine countriesb
Three urban towns
Maputo
Dunedin
Lima
Transkei
Mwanza
1995
1997--1998
1996
1999
1993--1994
1995
1994--1995
1996
National
1995
Sample
Sizea
646
15 695
750
1 659
935
611
1 975
892
Females
37.3
47.6c
21.0
18.8
7.0
40.0
28.4
29.1
Males
29.9
31.9c
5.0
6.7
0.2
11.0
6.4
6.9
2 042
15--24
9.1
---
154
BOX 6.1
155
156
157
158
159
TABLE 6.4
.
.
.
Relationship factors
.
Community factors
.
Societal factors
.
160
161
There are considerable variations between countries in their approach to sexual violence. Some
countries have far-reaching legislation and legal
procedures, with a broad definition of rape that
includes marital rape, and with heavy penalties for
those convicted and a strong response in supporting victims. Commitment to preventing or controlling sexual violence is also reflected in an
emphasis on police training and an appropriate
allocation of police resources to the problem, in the
priority given to investigating cases of sexual
assault, and in the resources made available to
support victims and provide medico-legal services.
At the other end of the scale, there are countries
with much weaker approaches to the issue where
conviction of an alleged perpetrator on the evidence
of the women alone is not allowed, where certain
forms or settings of sexual violence are specifically
excluded from the legal definition, and where rape
victims are strongly deterred from bringing the
matter to court through the fear of being punished
for filing an unproven rape suit.
162
Social norms
163
Suicidal behaviour
Women who experience sexual assault in childhood
or adulthood are more likely to attempt or commit
suicide than other women (21, 168173). The
association remains, even after controlling for sex,
age, education, symptoms of post-traumatic stress
disorder and the presence of psychiatric disorders
(168, 174). The experience of being raped or
sexually assaulted can lead to suicidal behaviour as
early as adolescence. In Ethiopia, 6% of raped
schoolgirls reported having attempted suicide
(154). A study of adolescents in Brazil found prior
sexual abuse to be a leading factor predicting several
health risk behaviours, including suicidal thoughts
and attempts (161).
Experiences of severe sexual harassment can also
result in emotional disturbances and suicidal behaviour. A study of female adolescents in Canada found
that 15% of those experiencing frequent, unwanted
sexual contact had exhibited suicidal behaviour in the
previous 6 months, compared with 2% of those who
had not had such harassment (72).
Social ostracization
In many cultural settings it is held that men are
unable to control their sexual urges and that
women are responsible for provoking sexual desire
in men (144). How families and communities react
to acts of rape in such settings is governed by
prevailing ideas about sexuality and the status of
women.
In some societies, the cultural solution to
rape is that the woman should marry the rapist,
thereby preserving the integrity of the woman
and her family by legitimizing the union (175).
Such a solution is reflected in the laws of
some countries, which allow a man who
commits rape to be excused his crime if he
marries the victim (100). Apart from marriage,
families may put pressure on the woman not to
report or pursue a case or else to concentrate on
164
BOX 6.2
165
166
Developmental approaches
Research has stressed the importance of encouraging nurturing, with better and more genderbalanced parenting, to prevent sexual violence
(124, 125). At the same time, Schwartz (186) has
developed a prevention model that adopts a
developmental approach, with interventions before
birth, during childhood and in adolescence and
young adulthood. In this model, the prenatal
element would include discussions of parenting
skills, the stereotyping of gender roles, stress,
conflict and violence. In the early years of childhood, health providers would pursue these issues
and introduce child sexual abuse and exposure to
violence in the media to the list of discussion topics,
as well as promoting the use of non-sexist
educational materials. In later childhood, health
promotion would include modelling behaviours
and attitudes that avoid stereotyping, encouraging
children to distinguish between good and bad
touching, and enhancing their ability and confidence to take control over their own bodies. This
intervention would allow room for talking about
sexual aggression. During adolescence and young
adulthood, discussions would cover myths about
rape, how to set boundaries for sexual activity, and
breaking the links between sex, violence and
coercion. While Schwartzs model was designed
for use in industrialized countries, some of the
principles involved could be applicable to developing countries.
Health care responses
Medico-legal services
167
168
Community-based efforts
Prevention campaigns
Attempts to change public attitudes towards sexual
violence using the media have included advertising
on hoardings (billboards) and in public transport, and on radio and television. Television has
been used effectively in South Africa and Zimbabwe.
The South African prime-time television series Soul
City is described in Box 9.1 of Chapter 9. In
Zimbabwe, the nongovernmental organization
Musasa has produced awareness-raising initiatives
using theatre, public meetings and debates, as well
as a television series where survivors of violence
described their experiences (199).
Other initiatives, besides media campaigns, have
been used in many countries. The Sisterhood Is
Global Institute in Montreal, Canada, for instance,
has developed a manual suitable for Muslim
communities aimed at raising awareness and
BOX 6.3
169
School-based programmes
170
171
an important factor underlying many such marriages and those that stress educational goals, the
health consequences of early childbirth and the
rights of children are more likely to achieve results.
Rape during armed conflicts
172
BOX 6.4
Recommendations
More research
the incidence and prevalence of sexual violence in a range of settings, using a standard
research tool for measuring sexual coercion;
the risk factors for being a victim or a
perpetrator of sexual violence;
the health and social consequences of
different forms of sexual violence;
the factors influencing recovery of health
following a sexual assault;
the social contexts of different forms of
sexual violence, including sexual trafficking,
and the relationships between sexual violence and other forms of violence.
Determining effective responses
Interventions must also be studied to produce a
better understanding of what is effective in
different settings for preventing sexual violence
and for treating and supporting victims. The
following areas should be given priority:
. Documenting and evaluating services and
interventions that support survivors or work
with perpetrators of sexual violence.
. Determining the most appropriate health
sector responses to sexual violence, including
the role of prophylactic antiretroviral therapy
for HIV prevention after rape with different
basic packages of services being recommended
for different settings, depending on the level
of resources.
. Determining what constitutes appropriate
psychological support for different settings
and circumstances.
. Evaluating programmes aimed at preventing
sexual violence, including community-based
interventions particularly those focusing on
men and school-based programmes.
. Studying the impact of legal reforms and
criminal sanctions.
Greater attention to primary prevention
Primary prevention of sexual violence is often
marginalized in favour of providing services for
survivors. Policy-makers, researchers, donors and
nongovernmental organizations should therefore
give much greater attention to this important area.
173
174
Conclusion
Sexual violence is a common and serious public
health problem affecting millions of people each
year throughout the world. It is driven by many
factors operating in a range of social, cultural and
economic contexts. At the heart of sexual violence
directed against women is gender inequality.
In many countries, data on most aspects of sexual
violence are lacking, and there is a great need
everywhere for research on all aspects of sexual
violence. Of equal importance are interventions.
These are of various types, but the essential ones
concern the primary prevention of sexual violence,
targeting both women and men, interventions
supporting the victims of sexual assault, measures
to make it more likely that perpetrators of rape will
be caught and punished, and strategies for changing social norms and raising the status of women.
It is vital to develop interventions for resource-poor
settings and rigorously to evaluate programmes in
both industrialized and developing countries.
Health professionals have a large role to play in
supporting the victims of sexual assault medically
and psychologically and collecting evidence to
assist prosecutions. The health sector is considerably more effective in countries where there are
protocols and guidelines for managing cases and
collecting evidence, where staff are well-trained
and where there is good collaboration with the
judicial system. Ultimately, the strong commitment
and involvement of governments and civil society,
along with a coordinated response across a range of
sectors, are required to end sexual violence.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
References
1.
2.
3.
4.
16.
17.
18.
175
176
177
178
107. Fergusson DM, Horwood LJ, Lynskey MT. Childhood sexual abuse, adolescent sexual behaviours
and sexual revictimization. Child Abuse & Neglect,
1997, 21:789803.
108. Fleming J et al. The long-term impact of childhood
sexual abuse in Australian women. Child Abuse &
Neglect, 1999, 23:145159.
109. Pederson W, Skrondal A. Alcohol and sexual
victimization: a longitudinal study of Norwegian
girls. Addiction, 1996, 91:565581.
110. Olsson A et al. Sexual abuse during childhood and
adolescence among Nicaraguan men and women: a
population-based survey. Child Abuse & Neglect,
2000, 24:15791589.
111. Jewkes R, Penn-Kekana L, Levin J. Risk factors for
domestic violence: findings from a South African
cross-sectional study. Social Science and Medicine
(in press).
112. Jewkes R. Intimate partner violence: causes and
prevention. Lancet, 2002, 359:14231429.
113. Omorodion FI, Olusanya O. The social context of
reported rape in Benin City, Nigeria. African Journal
of Reproductive Health, 1998, 2:3743.
114. Faune MA. Centroamerica: los costos de la guerra y
la paz. [Central America: the costs of war and of
peace.] Perspectivas, 1997, 8:1415.
115. International Clinical Epidemiologists Network.
Domestic violence in India: a summary report of a
multi-site household survey. Washington, DC,
International Center for Research on Women, 2000.
116. Heise L, Moore K, Toubia N. Sexual coercion and
womens reproductive health: a focus on research.
New York, NY, Population Council, 1995.
117. Violence against women: a priority health issue.
Geneva, World Health Organization, 1997 (document WHO/FRH/WHD/97.8).
118. Miczek KA et al. Alcohol, drugs of abuse, aggression
and violence. In: Reiss AJ, Roth JA, eds. Understanding and preventing violence. Vol. 3. Social
influences. Washington, DC, National Academy
Press, 1993:377570.
119. Grisso JA et al. Violent injuries among women in an
urban area. New England Journal of Medicine,
1999, 341:18991905.
120. Abby A, Ross LT, McDuffie D. Alcohols role in
sexual assault. In: Watson RR, ed. Drug and alcohol
reviews. Vol. 5. Addictive behaviors in women.
Totowa, NJ, Humana Press, 1995.
121. McDonald M, ed. Gender, drink and drugs. Oxford,
Berg Publishers, 1994.
122. Drieschner K, Lange A. A review of cognitive factors
in the aetiology of rape: theories, empirical studies
and implications. Clinical Psychology Review,
1999, 19:5777.
179
180
180. Christofides N. Evaluation of Soul City in partnership with the National Network on Violence Against
Women (NNVAW): some initial findings. Johannesburg, Womens Health Project, University of the
Witwatersrand, 2000.
181. Kelly L, Radford J. Sexual violence against women
and girls: an approach to an international overview.
In: Dobash E, Dobash R, eds. Rethinking violence
against women. London, Sage, 1998.
182. Kaufman M. Building a movement of men working
to end violence against women. Development,
2001, 44:914.
183. Welbourn A. Stepping Stones. Oxford, Strategies for
Hope, 1995.
184. Men as partners. New York, NY, AVSC International, 1998.
185. Gordon G, Welbourn A. Stepping Stones and men.
Washington, DC, Inter-Agency Gender Working
Group, 2001.
186. Schwartz IL. Sexual violence against women:
prevalence, consequences, societal factors and
prevention. American Journal of Preventive Medicine, 1991, 7:363373.
187. Du Mont J, Parnis D. Sexual assault and legal
resolution: querying the medical collection of
forensic evidence. Medicine and Law,
2000,19:779792.
188. McGregor MJ et al. Examination for sexual assault: is
the documentation of physical injury associated
with the laying of charges? Journal of the Canadian
Medical Association, 1999, 160:15651569.
189. Chaudhry S et al. Retrospective study of alleged
sexual assault at the Aga Khan Hospital, Nairobi. East
African Medical Journal, 1995, 72:200202.
190. Harrison JM, Murphy SM. A care package for
managing female sexual assault in genitourinary
medicine. International Journal of Sexually Transmitted Diseases and AIDS, 1999, 10:283289.
191. Parnis D, Du Mont J. An exploratory study of postsexual assault professional practices: examining the
standardised application of rape kits. Health Care for
Women International (in press).
192. Resnick H et al. Prevention of post-rape psychopathology: preliminary findings of a controlled
acute rape treatment study. Journal of Anxiety
Disorders, 1999, 13:359370.
193. Ramos-Jimenez P. Philippine strategies to combat
domestic violence against women. Manila, Social
Development Research Center and De La Salle
University, 1996.
194. Violence against women and HIV/AIDS: setting the
research agenda. Geneva, World Health Organization, 2001 (document WHO/FCH/GWH/01.08).
181
CHAPTER 7
Self-directed violence
Background
In the year 2000 an estimated 815 000 people died
from suicide around the world. This represents an
annual global mortality rate of about 14.5 per
100 000 population or one death about every
40 seconds. Suicide is the thirteenth leading cause
of death worldwide (see Statistical annex). Among
those aged 1544 years, self-inflicted injuries are
the fourth leading cause of death and the sixth
leading cause of ill-health and disability (1).
Deaths from suicide are only a part of this very
serious problem. In addition to those who die, many
more people survive attempts to take their own lives
or harm themselves, often seriously enough to
require medical attention (2). Furthermore, every
person who kills himself or herself leaves behind
many others family and friends whose lives are
profoundly affected emotionally, socially and economically. The economic costs associated with selfinflicted death or injuries are estimated to be in the
billions of US dollars a year (3).
185
186
TABLE 7.1
Year
Total number
of suicides
Albania
Argentina
Armenia
Australia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Brazil
Bulgaria
Canada
Chile
China
Hong Kong SAR
Selected rural and
urban areas
Colombia
Costa Rica
Croatia
Cuba
Czech Republic
Denmark
Ecuador
El Salvador
Estonia
Finland
France
Georgia
Germany
Greece
Hungary
Ireland
Israel
Italy
Japan
Kazakhstan
Kuwait
Kyrgyzstan
Latvia
Lithuania
Mauritius
Mexico
Netherlands
New Zealand
Nicaragua
Norway
Panama (excluding
Canal Zone)
Paraguay
Philippines
Poland
Portugal
Male
Female
Male:
female ratio
1998
1996
1999
1998
1999
1999
1999
1995
1991
1995
1999
1997
1994
165
2 245
67
2 633
1 555
54
3 408
2 155
531
6 584
1 307
3 681
801
7.1
8.7
2.3
17.9
20.9
1.1
41.5
24.0
14.8
6.3
16.4
15.0
8.1
9.5
14.2
3.6
28.9
32.7
1.7
76.5
36.3
25.3
10.3
26.2
24.1
15.0
4.8
3.9
b
7.0
10.2
b
11.3
12.7
4.2
2.5
7.7
6.1
1.9
2.0
3.6
b
4.1
3.2
b
6.7
2.9
6.1
4.1
3.4
3.9
8.1
1996
1999
788
16 836
14.9
18.3
19.5
18.0
10.4
18.8
1.9
1.0
1995
1995
1999
1997
1999
1996
1996
1993
1999
1998
1998
1992
1999
1998
1999
1997
1997
1997
1997
1999
1999
1999
1999
1999
1999
1997
1999
1998
1996
1997
1997
1 172
211
989
2 029
1 610
892
593
429
469
1 228
10 534
204
11 160
403
3 328
466
379
4 694
23 502
4 004
47
559
764
1 552
174
3 369
1 517
574
230
533
145
4.5
8.8
24.8
23.0
17.5
18.4
7.2
11.2
37.9
28.4
20.0
5.3
14.3
4.2
36.1
16.8
8.7
8.4
19.5
37.4
2.0
18.7
36.5
51.6
19.2
5.1
11.0
19.8
7.6
14.6
7.8
7.4
14.4
40.6
32.1
30.1
27.2
10.4
16.3
68.5
45.8
31.3
8.7
22.5
6.7
61.5
27.4
14.6
13.4
28.0
67.3
2.2
31.9
63.7
93.0
26.5
9.1
15.2
31.2
11.2
21.6
13.2
1.8
3.0
11.6
14.2
6.3
10.1
4.1
6.8
12.0
11.7
9.9
2.5
6.9
1.8
14.4
6.3
3.3
3.8
11.5
11.6
b
6.3
13.6
15.0
12.1
1.4
7.1
8.9
4.3
8.0
2.3
4.1
4.7
3.5
2.3
4.8
2.7
2.5
2.4
5.7
3.9
3.2
3.4
3.3
3.7
4.3
4.3
4.4
3.5
2.4
5.8
b
5.1
4.7
6.2
2.2
6.3
2.1
3.5
2.6
2.7
5.7
1994
1993
1995
1999
109
851
5 499
545
4.2
2.1
17.9
5.4
6.5
2.5
31.0
9.0
1.8
1.6
5.6
2.4
3.6
1.6
5.5
3.8
187
Rates of suicide are not distributed equally throughout the genof suicides
Total
Male
Female
Male:
eral population. One important
female ratio
demographic marker of suicide risk
Puerto Rico
1998
321
10.8
20.9
2.0
10.4
Republic of Korea
1997
6 024
17.1
25.3
10.1
2.5
is age. Globally, suicide rates tend
Republic of Moldova
1999
579
20.7
37.7
6.3
6.0
to increase with age, although
Romania
1999
2 736
14.3
24.6
4.8
5.1
some countries such as Canada
Russian Federation
1998
51 770
43.1
77.8
12.6
6.2
have also recently seen a secondary
Singapore
1998
371
15.7
18.8
12.7
1.5
Slovakia
1999
692
15.4
27.9
4.3
6.5
peak in young people aged 1524
Slovenia
1999
590
33.0
53.9
14.4
3.7
years. Figure 7.1 shows the global
Spain
1998
3 261
8.7
14.2
3.8
3.8
rates recorded by age and sex in
Sweden
1996
1 253
15.9
22.9
9.2
2.5
Switzerland
1996
1 431
22.5
33.7
12.3
2.7
1995. The rates ranged from 0.9
Tajikistan
1995
199
7.1
10.9
3.4
3.2
per 100 000 in the group aged 5
Thailand
1994
2 333
5.6
8.0
3.3
2.4
14 years to 66.9 per 100 000
The former Yugoslav
1997
155
10.0
15.2
5.2
2.9
Republic of Macedonia
among people aged 75 years and
Trinidad and Tobago
1994
148
16.9
26.1
6.8
3.8
older. In general, suicide rates
Turkmenistan
1998
406
13.7
22.2
5.4
4.1
among those aged 75 years and
Ukraine
1999
14 452
33.8
61.8
10.1
6.1
older are approximately three
United Kingdom
1999
4 448
9.2
14.6
3.9
3.8
England and Wales
1999
3 690
8.5
13.4
3.6
3.7
times higher than those of young
b
Northern Ireland
1999
121
9.9
17.0
b
people aged 1524 years. This
Scotland
1999
637
15.7
25.3
6.3
4.0
trend is found for both sexes, but
United States
1998
30 575
13.9
23.2
5.3
4.4
Uruguay
1990
318
12.8
22.0
4.8
4.6
is more marked among men. For
Uzbekistan
1998
1 620
10.6
17.2
4.4
3.9
women, suicide rates present difVenezuela
1994
1 089
8.1
13.7
2.7
5.0
fering patterns. In some cases,
SAR: Special Administrative Region.
a
female suicide rates increase steaMost recent year available between 1990 and 2000 for countries with 51 million
population.
dily with age, in others the rates
b
Fewer than 20 deaths reported; rate and rate ratio not calculated.
peak in middle age, and in yet
others, particularly in developing
13.9 per 100 000). Unfortunately, little incountries and among minority groups, female rates
formation is available on suicide from countries
peak among young adults (13).
in Africa (11).
Although suicide rates are generally higher
among older people, the absolute number of cases
Two countries, Finland and Sweden, have data on
recorded is actually higher among those under 45
suicide rates dating from the 18th century and both
years of age than among those over 45 years, given
show a trend for increasing suicide rates over time
demographic distributions (see Table 7.2). This is a
(12). During the 20th century, Finland, Ireland, the
remarkable change from just 50 years ago, when
Netherlands, Norway, Scotland, Spain and Sweden
the absolute number of cases of suicide roughly
experienced a significant increase in suicides, while
increased with age. It is not explained in terms of
England and Wales (combined data), Italy, New
the overall ageing of the global population; in fact,
Zealand and Switzerland experienced a significant
it runs counter to this demographic trend. At
decrease. There was no significant change in
present, suicide rates are already higher among
Australia (12). During the period 19601990, at
people under 45 years of age than among those
least 28 countries or territories had rising suicide
over 45 years in approximately one-third of all
rates, including Bulgaria, China (Province of
countries, a phenomenon that appears to exist in all
Taiwan), Costa Rica, Mauritius and Singapore,
continents and is not correlated to levels of
while eight had declining rates, including Australia,
industrialization or wealth. Examples of countries
and England and Wales (combined data) (12).
TABLE 7.1 (continued)
Country or area
Year
Total number
188
FIGURE 7.1
189
190
BOX 7.1
191
192
major depression;
other mood [affective] disorders, such as
bipolar disorder (a condition characterized
by periods of depression, alternating with
periods of elevated mood, or mania, and in
which the changed states can last for days or
even months);
schizophrenia;
anxiety and disorders of conduct and
personality;
impulsivity;
a sense of hopelessness.
Depression plays a major role in suicide and is
thought to be involved in approximately 6590%
of all suicides with psychiatric pathologies (42).
Among patients with depression, the risk seems to
be higher when they do not follow their treatment,
BOX 7.2
193
194
195
196
197
Countries where religious practices are prohibited or strongly discouraged (as was the case
in the former communist countries of Eastern
Europe and in the former Soviet Union).
198
199
200
201
202
FIGURE 7.2
Number of suicides in Samoa in relation to the arrival of pesticides containing paraquat and the control of sales of
paraquat
203
FIGURE 7.3
Impact of detoxification of domestic gas (%CO) on suicide rates, England and Wales, 1950--1995
204
Recommendations
Several important recommendations for reducing
both fatal and non-fatal suicidal behaviour can be
drawn from this chapter.
Better data
There is an urgent need for more information on
the causes of suicide, nationally and internationally, particularly among minority groups. Crosscultural studies should be encouraged. They can
lead to a better understanding of the causative and
protective factors, and consequently can help improve prevention efforts. The following are some
specific recommendations for better information
on suicide:
. Governments should be encouraged to collect
data on both fatal and non-fatal suicidal
behaviour and to make such data available to
the World Health Organization. Hospitals and
other social and medical services should be
strongly encouraged to keep records of nonfatal suicidal behaviour.
. Data on suicide and attempted suicide should
be valid and up to date. There should be a set of
uniform criteria and definitions and once
established these should be consistently
applied and continually reviewed.
. Data collection should be organized so as to
avoid duplication of statistical records; at the
same time, information should be easily
accessible for researchers conducting analytical and epidemiological surveys.
. Efforts should be made to improve data linkage
across a variety of agencies, including hospi-
Further research
More research should be conducted to examine the
relative contribution of psychosocial and biological
factors in suicidal behaviour. A greater coupling of
the two types of factor in research programmes
would allow for major advances in the current
knowledge on suicide. One particularly promising
area is the rapidly expanding research in molecular
genetics, where among other things there is now
greater knowledge relating to the control of
serotonin metabolism.
More clinical research should be carried out on
the causative role of co-morbid conditions, for
example the interaction between depression and
alcohol abuse. There should also be a greater focus
on subgroups of the population based on age (since
suicide among the elderly has different features
from that in young people), personality and
temperament. Brain imaging is another area that
calls for more research effort. Finally, there should
be more research on the role of hostility, aggression
and impulsivity in suicidal behaviour.
Better psychiatric treatment
The considerable contribution that psychiatric
factors make towards suicidal behaviour suggests
that improving treatment for those with psychiatric
disturbances is important in preventing suicide. In
this respect, the following steps should be taken:
. Pharmaceutical companies should be urged to
develop more medications that are effective
for psychiatric disorders. The advent of
205
Environmental changes
A range of environmental changes are suggested for
restricting access to methods of suicide, including:
. Fencing in high bridges.
. Limiting access to the roofs and high exteriors
of tall buildings.
. Obliging car manufacturers to change the
shape of exhaust pipes of vehicles and to
introduce a mechanism by which the engine
automatically turns off after running idle for a
specified time.
. Restricting access by people other than farmers
to pesticides and fertilizers.
. Where potentially lethal medications are
concerned:
requiring strict monitoring of prescriptions by doctors and pharmacists;
206
Conclusion
Suicide is one of the leading causes of death
worldwide and is an important public health
problem. Suicide and attempted suicide are complex phenomena that arise, in very individualistic
ways, from the interplay of biological, psychological, psychiatric and social factors. The complexity
of causes necessarily requires a multifaceted
approach to prevention that takes into account
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
207
208
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
209
210
102. Draper B. Attempted suicide in old age. International Journal of Geriatric Psychiatry, 1996,
11:577587.
103. Dennis MS, Lindsay J. Suicide in the elderly: the
United Kingdom perspective. International Psychogeriatrics, 1995, 7:263274.
104. Hawton K, Fagg J, Simkin S. Deliberate selfpoisoning and self-injury in children and adolescents under 16 years of age in Oxford 197693.
British Journal of Psychiatry, 1996, 169:202208.
105. National injury mortality reports, 19871998.
Atlanta, GA, Centers for Disease Control and
Prevention, 2000.
106. Zhang J. Suicide in Beijing, China, 19921993.
Suicide and Life-Threatening Behavior, 1996,
26:175180.
107. Yip PSF. An epidemiological profile of suicide in
Beijing, China. Suicide and Life-Threatening Behavior, 2001, 31:6270.
108. De Leo D et al. Hanging as a means to suicide in
young Australians: a report to the Commonwealth
Ministry of Health and Family Services. Brisbane,
Australian Institute for Suicide Research and
Prevention, 1999.
109. Schmidtke A, Hafner H. The Werther effect after
television films: new evidence for an old hypothesis. Psychological Medicine, 1998, 18:665676.
110. Wasserman I. Imitation and suicide: a re-examination of the Werther effect. American Sociological
Review, 1984, 49:427436.
111. Mazurk PM et al. Increase of suicide by asphyxiation
in New York City after the publication of Final
Exit. New England Journal of Medicine, 1993,
329:15081510.
112. De Leo D, Ormskerk S. Suicide in the elderly:
general characteristics. Crisis, 1991, 12:317.
113. Rates of suicide throughout the country: fact sheet.
Washington, DC, American Association of Suicidology, 1999.
114. Dudley MJ et al. Suicide among young Australians,
19641993: an interstate comparison of metropolitan and rural trends. Medical Journal of Australia,
1998, 169:7780.
115. Hawton K et al. Suicide and stress in farmers.
London, The Stationery Office, 1998.
116. Bowles JR. Suicide in Western Samoa: an example of
a suicide prevention program in a developing
country. In: Diekstra RFW et al., eds. Preventive
strategies on suicide. Leiden, Brill, 1995:173206.
117. Cantor CH et al. The epidemiology of suicide and
attempted suicide among young Australians: a
report to the NH-MRC. Brisbane, Australian
Institute for Suicide Research and Prevention, 1998.
211
212
163. Oliver RG, Hetzel BS. Rise and fall of suicide rates in
Australia: relation to sedative availability. Medical
Journal of Australia, 1972, 2:919923.
164. Kreitman N. The coal gas history: United Kingdom
suicide rates, 19601971. British Journal of
Preventive and Social Medicine, 1972, 30:8693.
165. Lester D. Preventing suicide by restricting access to
methods for suicide. Archives of Suicide Research,
1998, 4:724.
166. Clarke RV, Lester D. Toxicity of car exhausts and
opportunity for suicide. Journal of Epidemiology
and Community Health, 1987, 41:114120.
167. Lester D, Murrell ME. The influence of gun control
laws on suicidal behaviour. American Journal of
Psychiatry, 1980, 80:151154.
168. Kellerman AL et al. Suicide in the home in relation to
gun ownership. New England Journal of Medicine,
1992, 327:467472.
169. Carrington PJ, Moyer MA. Gun control and suicide
in Ontario. American Journal of Psychiatry, 1994,
151:606608.
170. Reed TJ. Goethe. Oxford, Oxford University Press,
1984 (Past Masters Series).
171. Preventing suicide: a resource for media professionals. Geneva, World Health Organization, 2000
(document WHO/MNH/MBD/00.2).
172. Preventing suicide: how to start a survivors group.
Geneva, World Health Organization, 2000 (document WHO/MNH/MBD/00.6).
173. Prevention of suicide: guidelines for the formulation and implementation of national strategies. New
York, NY, United Nations, 1996 (document ST/
SEA/245).
174. Preventing suicide: a resource for general physicians. Geneva, World Health Organization, 2000
(document WHO/MNH/MBD/00.1).
175. Preventing suicide: a resource for teachers and other
school staff. Geneva, World Health Organization,
2000 (document WHO/MNH/MBD/00.3).
176. Preventing suicide: a resource for primary health
care workers. Geneva, World Health Organization,
2000 (document WHO/MNH/MBD/00.4).
177. Preventing suicide: a resource for prison officers.
Geneva, World Health Organization, 2000 (document WHO/MNH/MBD/00.5).
178. The world health report 2001. Mental health: new
understanding, new hope. Geneva, World Health
Organization, 2001.
179. United States Public Health Service. The Surgeon
Generals call to action to prevent suicide. Washington, DC, United States Department of Health and
Human Services, 1999.
180. Isacsson G. Suicide prevention: a medical breakthrough? Acta Psychiatrica Scandinavica, 2000,
102:113117.
181. Rutz W. The role of family physicians in preventing
suicide. In: Lester D, ed. Suicide prevention:
resources for the millennium. Philadelphia, PA,
Brunner-Routledge, 2001:173187.
182. De Leo D. Cultural issues in suicide and old age.
Crisis, 1999, 20:5355.
183. Schmidtke A et al. Suicide rates in the world: an
update. Archives of Suicide Research, 1999, 5:8189.
CHAPTER 8
Collective violence
Background
Collective violence, in its multiple forms, receives a
high degree of public attention. Violent conflicts
between nations and groups, state and group
terrorism, rape as a weapon of war, the movements
of large numbers of people displaced from their
homes, gang warfare and mass hooliganism all of
these occur on a daily basis in many parts of the
world. The effects of these different types of event
on health in terms of deaths, physical illnesses,
disabilities and mental anguish, are vast.
Medicine has long been involved with the effects
of collective violence, both as a science and in
practice from military surgery to the efforts of the
International Committee of the Red Cross. Public
health, though, began dealing with the phenomenon only in the 1970s, following the humanitarian crisis in Biafra, Nigeria. The lessons learnt there,
largely by nongovernmental organizations, were
the basis for what has become a growing body of
knowledge and medical interventions in the field of
preventive health care.
The world is still learning how best to respond to
the various forms of collective violence, but it is
now clear that public health has an important part
to play. As the World Health Assembly declared in
1981 (1), the role of health workers in promoting
and preserving peace is a significant factor for
achieving health for all.
This chapter focuses mainly on violent conflicts,
with particular emphasis on complex emergencies
related to conflicts. While crises of this type are
often widely reported, many of their aspects,
including the non-fatal impact on victims and the
causes of and responses to the crises, frequently
remain hidden, sometimes deliberately so. Forms
of collective violence that do not have political
objectives, such as gang violence, mass hooliganism and criminal violence associated with banditry,
are not covered in this chapter.
215
As defined by the Inter-Agency Standing Committee (2) the United Nations primary mechanism
for coordination of humanitarian assistance in
response to complex and major emergencies a
complex emergency is:
a humanitarian crisis in a country, region or
society where there is total or considerable breakdown of authority resulting from internal or
external conflict and which requires an international response that goes beyond the mandate or
capacity of any single agency and/or the ongoing
United Nations country programme.
Although occasionally used to describe other
forms of natural or man-made disasters that have a
significant impact, the term is used here to describe
those emergencies strongly associated with violent
conflict, often with major political implications.
Leaning (3) identifies four characteristic outcomes of complex emergencies, all of which have
profound consequences for public health:
dislocation of populations;
the destruction of social networks and
ecosystems;
insecurity affecting civilians and others not
engaged in fighting;
abuses of human rights.
Some analysts (4) use the term complex
political emergencies to highlight the political
nature of particular crises. Complex political
emergencies typically:
216
217
218
219
BOX 8.1
Torture
A number of international treaties have defined torture. The United Nations Convention against
Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment of 1984 refers to an
act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a
person, for a purpose such as obtaining information or a confession, punishment, intimidation or
coercion, or for any reason based on discrimination of any kind. The Convention is concerned
with torture by public officials or others acting in an official capacity.
In preparing its 2000 report on torture (16), the human rights organization Amnesty
International found reports of torture or ill-treatment by officials in more than 150 countries. In
more than 70 countries, the practice was apparently widespread and in over 80 countries, people
reportedly died as a result of torture. Most of the victims appeared to have been people suspected
or convicted of criminal offences, and most of the torturers were police officers.
The prevalence of torture against criminal suspects is most likely to be underreported, as the
victims are generally less able to file complaints. In some countries, a long-standing practice of
torturing common criminals attracts attention only when more overt political repression has
declined. In the absence of proper training and investigative mechanisms, police may resort to
torture or ill-treatment to extract confessions quickly and obtain convictions.
In some instances of torture, the purpose is to extract information, to obtain a confession
(whether true or false), to force collaboration or to break the victim as an example to others. In
other cases, punishment and humiliation are the primary aim. Torture is also sometimes employed
as a means of extortion. Once established, a regime of torture can perpetuate itself.
Torture has serious implications for public health, as it damages the mental and physical health
of populations. The victims may stay in their own country, adapting as best they can, with or
without medical and psychosocial support. If their needs are not properly attended to they risk
becoming increasingly alienated or dysfunctional members of society. The same is true if they go
into exile. Existing data on asylum-seekers, some of whom have undergone torture in their home
country, suggest that they have significant health needs (17, 18 ).
Failure to control the use of torture encourages poor practice by the police and security forces
and an increased tolerance of human rights abuses and violence. Various organizations of health
professionals have taken a vigorous stand against torture, seeing its prevention as closely linked to
their medical calling and to the good of public health (19 ). Nongovernmental organizations have
also promoted prevention (20 ).
One particular control mechanism --- the inspection system of the Council of Europe --- has been
recommended for use at the global level. A draft Optional Protocol to the United Nations
Convention on Torture would provide for a similar such inspection system in places of detention.
To date, progress in elaborating an Optional Protocol has been slow.
Initiatives to investigate and document torture have grown in recent years. The United Nations
guidelines on assessing and recording medical evidence of torture, known as the Istanbul
Protocol, were drawn up in 1999 by forensic scientists, doctors, human rights monitors and
lawyers from 15 countries and published 2 years later (21 ).
220
TABLE 8.1
Indicators of states at risk of collapse and internal conflict
Indicator
Inequality
Signs
. Widening social and economic inequalities --- especially those
between, rather than within, distinct population groups
Rapidly changing
demographic
characteristics
.
.
.
.
.
.
Lack of democratic
processes
Political instability
Ethnic composition of the
ruling group sharply
different from that of the
population at large
Deterioration in
public services
Severe economic
decline
221
Globalization
FIGURE 8.1
222
TABLE 8.2
Technological factors
The level of weapons technology
does not necessarily affect the risk
of a conflict, but it does determine
the scale of any conflict and the
amount of destruction that will take
place. Many centuries ago, the
progression from the arrow to the
crossbow increased the range and
destructive force of projectile
weapons. Much later, simple firearms were developed, followed by
rifles, machine guns and submachine guns. The ability to fire more
bullets, more quickly, and with
greater range and accuracy, has
greatly increased the potential destructive power of such weapons.
Nonetheless, even basic weapons, such as the machete, can
contribute to the occurrence of
massive human destruction, as
was seen in the genocide in
Rwanda in 1994 (29). In the acts
of terrorism in the United States on
11 September 2001, where
hijacked passenger aircraft were
Causes
Increased mortality
Increased morbidity
Increased disability
.
.
.
The increased risk during conflicts of communicable diseases stems generally from:
the decline in immunization coverage;
population movements and overcrowding in
refugee camps;
greater exposure to vectors and environmental hazards, such as polluted water;
the reduction in public health campaigns and
outreach activities;
the lack of access to health care services.
During the fighting in Bosnia and Herzegovina in
1994, fewer than 35% of children were immunized,
compared with 95% before hostilities broke out (32,
33). In Iraq, there were sharp declines in immunization coverage after the Gulf War of 1991 and the
subsequent imposition of economic and political
sanctions. However, recent evidence from El
Salvador indicates that it is possible, with selective
health care interventions and the provision of
adequate resources, to improve certain health
problems during ongoing conflicts (34).
In Nicaragua in 19851986, a measles epidemic
was attributed in large part to the declining ability
of the health service to immunize those at risk in
conflict-affected areas (35). A deterioration in
malaria-control activities was linked to epidemics
of malaria in Ethiopia (36) and Mozambique (37),
223
224
Disability
The impact of conflicts on mental health is influenced by a range of factors. These include (48):
the psychological health of those affected,
prior to the event;
the nature of the conflict;
the form of trauma (whether it results from
living through and witnessing acts of
violence or whether it is directly inflicted,
as with torture and other types of repressive
violence);
the response to the trauma, by individuals
and communities;
the cultural context in which the violence
occurs.
Psychological stresses related to conflicts are
associated with or result from (49):
225
Civilians
Demographic impact
One consequence of the shift in the methods of
modern warfare, where entire communities are
increasingly being targeted, has been the large
numbers of displaced people. The total numbers of
refugees fleeing across national borders rose from
around 2.5 million in 1970 and 11 million in 1983
to 23 million in 1997 (59, 60). In the early 1990s,
in addition, an estimated 30 million people were
internally displaced at any one time (60), most of
them having fled zones of conflict. Those displaced
within countries probably have less access to
resources and international support than refugees
escaping across borders, and are also more likely to
be at continuing risk of violence (61).
Table 8.3 shows the movements of refugees and
internally displaced populations during the 1990s
(62). In Africa, the Americas and Europe during
this period there were far more internally displaced
people than refugees, while in Asia and the Middle
East the reverse was true.
226
TABLE 8.3
Internally displaced people and refugees (in millions), by continent and year
1990
1991
1992
1993
1994
1995
1996
1997
1998
Internally displaced
people (IDP)
Africa
Americas
East Asia and the Pacific
South Asia
Europe
Middle East
13.5
1.1
0.3
3.1
1.0
1.3
14.2
1.2
0.7
2.7
1.8
1.4
17.4
1.3
0.7
1.8
1.6
0.8
16.9
1.4
0.6
0.9
2.8
2.0
15.7
1.4
0.6
1.8
5.2
1.7
10.2
1.3
0.6
1.6
5.1
1.7
8.5
1.2
1.1
2.4
4.7
1.5
7.6
1.6
0.8
2.2
3.7
1.5
8.8
1.8
0.5
2.1
3.3
1.6
Refugees
Africa
Americas
East Asia and the Pacific
South Asia
Europe
Middle East
5.4
0.1
0.7
6.3
0
3.5
5.3
0.1
0.8
6.9
0.1
2.8
5.7
0.1
0.5
4.7
2.5
2.8
5.8
0.1
0.8
3.9
1.9
3.0
5.9
0.1
0.7
3.3
1.8
3.8
5.2
0.1
0.6
2.8
1.8
4.0
3.6
0.1
0.6
3.2
1.9
4.4
2.9
0.1
0.7
3.0
1.3
4.3
2.7
0.4
0.7
2.9
1.3
4.4
2.5
7.5
0.5
0.5
2.7
10.1
0.8
0.4
14.7
0.5
3.0
13.5
1.4
0.4
0.6
0.3
2.9
14.0
0.8
0.2
1.4
0.7
2.7
11.7
0.9
0.5
2.9
0.4
2.0
18.3
0.9
0.6
2.8
0.4
2.4
17.4
1.6
0.8
2.5
0.3
2.6
27.0
1.1
0.8
2.8
0.3
3.2
4.9
0.8
0.7
2.5
0.4
IDP:refugee ratio
Africa
Americas
East Asia and the Pacific
South Asia
Europe
Middle East
0.4
The forced resettlement of populations, something practised by several governments for stated
reasons of security, ideology or development, can
also have a severe impact on health. Between 1985
and 1988, some 5.7 million people, 15% of the
total rural population, were moved from the
northern and eastern provinces to villages in the
south-west under an enforced government programme in Ethiopia (63). During the regime of Pol
Pot in Cambodia (19751979), hundreds of
thousands of urban people were forcibly displaced
to rural areas.
Socioeconomic impact
227
Food production and distribution are often specifically targeted during periods of conflict (67). In the
conflict in Ethiopia between government forces and
Eritrean and Tigrayan separatist
forces in the period 19741991,
farmers were forcibly prevented TABLE 8.4
from planting and harvesting their The impact of conflict on health care services
Manifestation of impact
crops and soldiers looted seeds and Object of impact
. Reduced security (through factors such as landmines and
Access to services
livestock. In Tigray and Eritrea, the
curfews)
. Reduced geographical access (for example, through poor
combatants conscripted farmers,
transport)
mined the land, confiscated food
. Reduced economic access (for example, because of increased
and slaughtered cattle (36). The
charges for health services)
loss of livestock deprives farmers of
. Reduced social access (for example, because service providers
fear being identified as participants in the conflict)
an asset needed to put land into
. Destruction of clinics
production and therefore has an Service infrastructure
. Disrupted referral systems
adverse effect both in the immedi. Damage to vehicles and equipment
. Poor logistics and communication
ate and in the long term.
Human resources
Infrastructure
.
.
.
.
.
.
.
.
.
.
.
.
Formulation of
health policy
.
.
.
.
.
Relief activities
.
.
.
.
.
.
228
had to serve much larger catchment areas. Widespread damage to water supplies, electricity and
sewage disposal further reduced the ability of what
remained of the health services to operate (68). In the
violent conflict in East Timor in 1999 following the
referendum for independence, militia forces destroyed virtually all the health care services. Only the
main hospital in the principal town, Dili, was left
standing.
During and in the wake of conflicts the supply of
medicines is usually disrupted, causing increases in
medically preventable conditions, including potentially fatal ones, such as asthma, diabetes and a
range of infectious diseases. Apart from medicines,
medical personnel, diagnostic equipment, electricity and water may all be lacking, seriously affecting
the quality of health care available.
Human resources in the health care services are
also usually seriously affected by violent conflicts.
In some instances, such as in Mozambique and
Nicaragua, medical personnel have been specifically targeted. Qualified personnel often retreat to
safer urban areas or may leave their profession
altogether. In Uganda between 1972 and 1985,
half of the doctors and 80% of the pharmacists left
the country for their security. In Mozambique, only
15% of the 550 doctors present during the last years
of Portuguese colonial rule were still there at the
end of the war of independence in 1975(69).
229
230
BOX 8.2
231
232
control programmes, but relatively little consideration of coordinating donor responses or setting up
effective policy frameworks.
Documentation, research and
dissemination of information
Surveillance and documentation are core areas for
public health activities relating to conflicts. While it
is the case, as mentioned above, that data on
collective violence are often unsatisfactory and
imprecise, too rigid a concern with precision of
data is not usually warranted in this field. It is
essential, however, that data are valid.
Providing valid data to policy-makers is an
equally important component of public health
action. The United Nations, international agencies,
nongovernmental organizations and health professionals all have key roles to perform in this area. The
International Committee of the Red Cross (ICRC),
for instance, through its extensive research and
campaigning work, played a significant part in
promoting the Ottawa process which led to the
adoption of the anti-personnel Mine Ban Treaty that
entered into force on 1 March 1999. As one ICRC
staff member involved in this effort put it:
Observing and documenting the effects of
weapons does not bring about changes in belief,
behaviour or law unless communicated compellingly to both policy-makers and the public (77).
Some nongovernmental organizations, such as
Amnesty International, have explicit mandates to
speak out about abuses of human rights. So do some
United Nations bodies, such as the Office of the
United Nations High Commissioner for Human
Rights. Some agencies, however, are reluctant to
speak out against those involved in conflicts for fear
that their ability to deliver essential services could
be compromised. In such cases, agencies may
choose to convey information indirectly, through
third parties or the media.
If dissemination is to be effective, good data are
needed and the experiences from interventions
must be properly analysed. Research is crucial for
assessing the impact of conflicts on health and on
health care systems, and for establishing which
interventions are effective.
233
TABLE 8.5
Donor
coordination
Developing
infrastructure
At an early stage, develop policy frameworks within which projects can be based
Encourage donor support to the Ministry of Health for policy development and
for gathering and disseminating information
. Facilitate communication between key participants
.
Specific disease
problems
Reconciliation
work
.
.
.
.
Promoting an
equitable society
.
.
Information
systems
Promote the role of the state in framing policies, setting standards and
monitoring the quality of services
. Recognize at the same time the important role of the private sector in providing
health care
. Develop incentives to promote equitable access to and delivery of important
public health services
Training
.
.
.
.
Recognize that achieving equitable social structures is a prime objective but that
in the short term, in the interests of stability, some reforms may need to be delayed
Build links between competing population groups and different localities as key
elements of post-conflict reform
Recognize the importance of developing human resources
Work out ways to integrate people who have been trained under different
systems
Invest in training for planners and managers
Make documentation a priority
Set up a central repository for information
Make use of new technologies to disseminate information
Make funding conditional on sharing information
Recommendations
Various measures need to be taken to prevent the
occurrence of conflict and where it does occur
to lessen its impact. These measures fall into the
following broad categories:
234
BOX 8.3
Health consequences
Clearly, the involvement of children as combatants in armed conflicts exposes them to risks of
death and combat-related injury. Other serious health effects are less publicized, such as the
mental and public health aspects.
Research (78) has shown that the most frequent combat-related injuries of child soldiers are:
loss of hearing;
loss of sight;
loss of limbs.
These injuries partly reflect the greater sensitivity of childrens bodies and partly the ways in
which they are likely to be involved in conflicts --- such as laying and detecting landmines. Child
recruits are also prone to health hazards not directly related to combat --- including injuries caused
by carrying weapons and other heavy loads, malnutrition, skin and respiratory infections, and
infectious diseases such as malaria.
Girl recruits, and to a lesser extent young boys, are often required to provide sexual services
as well as to fight. This puts them at high risk of sexually transmitted diseases including HIV, as
well as exposing them --- in the case of girls --- to the dangers associated with abortion or
childbirth. In addition, child recruits are often given drugs or alcohol to encourage them to
fight, creating problems of substance dependency, apart from the other associated health
risks.
Teenagers recruited into regular government armies are usually subjected to the same military
discipline as adult recruits, including initiation rites, harsh exercises, punishments and denigration
designed to break their will. The impact of such discipline on adolescents can be highly damaging
--- mentally, emotionally and physically.
235
236
should be more thoroughly researched and documented. More documentation of good practice is
required, particularly with regard to providing
effective services after conflicts an area where new
lessons are beginning to emerge.
Governments should support organizations,
such as the World Health Organization and other
United Nations agencies, in a global effort to devise
more effective policies for the prevention of and
responses to conflicts.
Humanitarian responses
Conclusion
Health sector responses
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
237
238
35. Garfield RM, Frieden T, Vermund SH. Healthrelated outcomes of war in Nicaragua. American
Journal of Public Health, 1987, 77:615618.
36. Kloos H. Health impacts of war in Ethiopia.
Disasters, 1992, 16:347354.
37. Cliff J, Noormahomed AR. Health as a target: South
Africas destabilization of Mozambique. Social
Science and Medicine, 1988, 27:717722.
38. Goma Epidemiology Group. Public health impact of
Rwandan refugee crisis: what happened in Goma,
Zaire, in July 1994? Lancet, 1995, 345:339344.
39. Zwi AB, Cabral AJ. High-risk situations for AIDS
prevention. British Medical Journal , 1991,
303:15271529.
40. AIDS and the military: UNAIDS point of view.
Geneva, Joint United Nations Programme on HIV/
AIDS, 1998 (UNAIDS Best Practice Collection).
41. Mann JM, Tarantola DJM, Netter TW, eds. AIDS in
the world. Cambridge, MA, Harvard University
Press, 1992.
42. Khaw AJ et al. HIV risk and prevention in
emergency-affected populations: a review. Disasters, 2000, 24:181197.
43. Smallman-Raynor M, Cliff A. Civil war and the
spread of AIDS in central Africa. Epidemiology of
Infectious Diseases, 1991, 107:6980.
44. Refugees and AIDS: UNAIDS point of view. Geneva,
Joint United Nations Programme on HIV/AIDS,
1997 (UNAIDS Best Practice Collection).
45. Stover E et al. The medical and social consequences
of land mines in Cambodia. Journal of the American
Medical Association, 1994, 272:331336.
46. The causes of conflict in Africa. London, Department for International Development, 2001.
47. Getting away with murder, mutilation, rape: new
testimony from Sierra Leone. New York, NY,
Human Rights Watch, 1999 (Vol. 11, No. 3(A)).
48. Summerfield D. The psychosocial effects of conflict
in the Third World. Development in Practice, 1991,
1:159173.
49. Quirk GJ, Casco L. Stress disorders of families of the
disappeared: a controlled study in Honduras. Social
Science and Medicine, 1994, 39:16751679.
50. Bracken PJ, Giller JE, Summerfield D. Psychological
responses to war and atrocity: the limitations of
current concepts. Social Science and Medicine,
1995, 40:10731082.
51. Pupavac V. Therapeutic governance: psychosocial
intervention and trauma risk. Disasters, 2001,
25:14491462.
52. Robertson G. Crimes against humanity: the struggle
for global justice. Harmondsworth, Penguin, 1999.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
239
CHAPTER 9
Background
Violence leaves no continent, no country and few
communities untouched. Although it appears
everywhere, violence is not an inevitable part of
the human condition, nor is it an intractable
problem of modern life that cannot be overcome
by human determination and ingenuity.
Earlier chapters of this report have supplied
considerable detail about specific types of violence
and the public health interventions that may be
applied in an attempt to reduce both their
occurrence and their consequences. This final
chapter highlights a number of global patterns
and themes that cut across the various types of
violence. It reiterates the case for a public health
approach and provides a set of recommendations
for decision-makers and practitioners at all levels.
243
244
245
246
Recommendations
The following recommendations aim to mobilize
action in response to violence. All recommendations need to be addressed by a range of sectors and
stakeholders if they are to achieve their objectives.
These recommendations must obviously be
applied with flexibility and with proper understanding of local conditions and capacities. Countries currently experiencing collective violence, or
with scarce financial and human resources, will
find it difficult or impossible to apply some of the
national and local recommendations on their own.
Under such circumstances, they may be able to
work with international organizations or nongov-
247
248
249
250
BOX 9.1
251
Recommendation 7.
Increase collaboration and exchange
of information on violence prevention
Working relations and communications between
international agencies, governmental agencies,
researchers, networks and nongovernmental organizations engaged in the prevention of violence
should be assessed in order to achieve better sharing
of knowledge, agreement on prevention goals, and
coordination of action. All have important roles to
play in violence prevention (see Box 9.2).
A number of international agencies, regional
institutions and United Nations bodies are either
currently working in violence prevention or have
mandates or activities highly relevant to reducing
violence, including those dealing with economic
matters, human rights, international law and
sustainable development. To date, coordination
across all these agencies is still insufficient. This
should be remedied in order to avoid much
needless duplication and to benefit from the
economies of pooling expertise, networks, funding
and in-country facilities. Mechanisms to improve
cooperation should be explored, possibly starting
on a small scale and involving a small number of
organizations with both a mandate and practical
experience in violence prevention (see Box 9.3).
The vastly improved communications technology of recent years is a positive aspect of
globalization, which has permitted thousands of
networks in a whole variety of fields. In violence
prevention and related fields, networks of researchers and practitioners have greatly enhanced
the worlds knowledge base by proposing a range
of prevention models, discussing methodologies
and critically examining research results. Their
exchange of information and ideas is crucial to
future progress, alongside the work of government authorities, service providers and advocacy
groups.
Advocacy groups are also important partners in
public health. Advocacy groups concerned with
violence against women and abuses of human
rights (notably torture and war crimes) are prime
examples. These groups have proved their ability to
mobilize resources, gather and convey information
252
BOX 9.2
status at key international conferences and including them in official working groups.
Another important area where progress could be
made is in the sharing of information between
experts working on the different types of violence.
Experts working on issues such as child abuse,
youth violence, violence against intimate partners,
253
BOX 9.3
254
Recommendation 9.
Seek practical, internationally agreed
responses to the global drugs trade
and the global arms trade
The global drugs trade and the global arms trade are
integral to violence in both developing and
industrialized countries, and come within the
purview of both the national and the international
levels. From the evidence provided in various parts
References
Conclusion
Violence is not inevitable. We can do much to
address and prevent it. The individuals, families and
communities whose lives each year are shattered by
it can be safeguarded, and the root causes of
violence tackled to produce a healthier society for
all.
The world has not yet fully measured the size of
this task and does not yet have all the tools to carry it
out. But the global knowledge base is growing and
much useful experience has already been gained.
This report attempts to contribute to the knowledge base. It is hoped that the report will inspire
and facilitate increased cooperation, innovation and
commitment to preventing violence around the
world.
1.
2.
Statistical annex
STATISTICAL ANNEX
257
Background
Each year, over 100 countries send detailed information on the number of deaths from various
diseases, illnesses or injuries to the World Health
Organization (WHO). Data from these WHO
Member States are compiled from vital registration
systems using the International Classification of
Diseases (ICD) codes (1, 2). National vital registration systems capture about 17 million deaths that
occur annually throughout the world. Data from
these registration systems, as well as from surveys,
censuses and epidemiological studies, are analysed
by the World Health Organization to determine
patterns of causes of death for countries, regions
and the world.
WHO has also used these data, along with other
information, to assess the global burden of disease.
First published in 1996, these estimates represent
the most comprehensive examination of global
mortality and morbidity ever produced (3). A new
assessment of the global burden of disease for the
year 2000 is in progress (4). Estimates of the global
burden of injury for the year 2000 are presented
here. A description of the tables included in the
annex and the data used to produce the 2000 estimates of violence-related deaths is provided below.
Types of tables
The statistical annex includes three types of tables:
global and regional estimates of mortality;
the ten leading causes of death and disabilityadjusted life years (DALYs) for all WHO
Member States combined and for each of the
WHO regions;
country-level rates of mortality.
Global and regional estimates of mortality
Methods
Categories
Deaths and non-fatal injuries are categorically
attributed to one underlying cause using the rules
and conventions of the International Classification
of Diseases (1, 2). The cause list for the Global
Burden of Disease project for 2000 (GBD 2000 project) has four levels of disaggregation and includes
135 specific diseases and injuries (5). Unintentional and intentional injury categories are defined
in terms of external cause codes. For instance, the
codes for intentional injuries are as follows:1
. Homicide ICD-9 E960E969 or ICD10 X85Y09.
. Suicide ICD-9 E950E959 or ICD-10 X60
X84.
. War-related injuries ICD-9 E990E999 or
ICD-10 Y36.
. Legal intervention ICD-9 E970E978 or
ICD-10 Y35.
. All intentional injury ICD-9 E950E978,
E990E999 or ICD-10 X60Y09, Y35, Y36.
Absolute numbers and rates per 100 000 in the
population are presented by sex and WHO region for
1
Based on the International classification of diseases, ninth revision
(ICD-9) (1) and the International statistical classification of diseases
and related health problems, tenth revision (ICD-10) (2).
258
STATISTICAL ANNEX
259
References
1.
2.
3.
4.
5.
International classification of diseases, ninth revision. Geneva, World Health Organization, 1978.
International statistical classification of diseases and
related health problems, tenth revision. Volume 1:
Tabular list; Volume 2: Instruction manual; Volume
3: Index. Geneva, World Health Organization,
19921994.
Murray CJL, Lopez AD. The Global Burden of
Disease: a comprehensive assessment of mortality
and disability from diseases, injuries and risk factors
in 1990 and projected to 2020. Cambridge, MA,
Harvard School of Public Health, 1996 (Global
Burden of Disease and Injury Series, Vol. I).
Murray CJL et al. The Global Burden of Disease
2000 project: aims, methods and data sources.
Geneva, World Health Organization, 2001 (GPE
Discussion Paper, No. 36).
Murray CJL, Lopez AD. Progress and directions in
refining the global burden of disease approach:
response to Williams. Health Economics, 2000,
9:6982.
260
6.
7.
8.
World health report 2000 health systems: improving performance. Geneva, World Health Organization, 2000.
10. Murray CJ, Lopez AD. Global health statistics.
Cambridge, MA, Harvard School of Public Health,
1996 (Global Burden of Disease and Injury Series,
Vol. II).
11. Ahmad OA et al. Age standardization of rates: a new
WHO standard. Geneva, World Health Organization, 2000 (GPE Discussion Paper, No. 31).
9.
262
TABLE A.1
Population (in thousands) by sex and age group, for all WHO Member States, 2000a
Member States by WHO region
and income level
Totalb
All
High-income
Low-income and middle-income
African Region (low-income
and middle-income)c
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Congo
Cote dIvoire
Democratic Republic of the Congo
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Guinea
Guinea-Bissau
Kenya
Lesotho
Liberia
Madagascar
Malawi
Mali
Mauritania
Mauritius
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
South Africa
Swaziland
Togo
Uganda
United Republic of Tanzania
Zambia
Zimbabwe
Region of the Americas
(high-income)
Bahamas
Canada
United States of America
6 045 172
915 866
5 129 306
639 631
All
ages
3 045 375
451 069
2 594 306
318 751
04
years
314 256
27 970
286 286
54 547
Males
514
years
615 986
59 366
556 619
87 461
1529
years
797 048
94 800
702 249
88 948
3044
years
643 148
106 787
536 361
48 416
4559
years
404 000
86 747
317 253
25 515
560
years
270 937
75 398
195 539
13 865
30 291
13 134
6 272
1 541
11 535
6 356
14 876
427
3 717
7 885
706
3 018
16 013
50 948
457
3 659
62 908
1 230
1 303
19 306
8 154
1 199
30 669
2 035
2 913
15 970
11 308
11 351
2 665
1 161
18 292
1 757
10 832
113 862
7 609
138
9 421
80
4 405
43 309
925
4 527
23 300
35 119
10 421
12 627
314 291
15 346
6 499
3 092
755
5 576
3 088
7 405
199
1 811
3 900
354
1 478
8 206
25 245
225
1 817
31 259
609
644
9 613
4 102
591
15 273
1 009
1 465
7 943
5 617
5 624
1 321
579
9 042
868
5 459
57 383
3 765
64
4 697
40
2 165
21 323
456
2 248
11 625
17 422
5 236
6 315
155 035
1 798
1 300
557
113
1 114
559
1 182
31
304
749
59
282
1 219
5 043
40
311
5 628
98
103
1 421
733
105
2 367
148
277
1 436
1 038
1 081
236
48
1 589
142
1 157
9 996
642
10
805
3
403
2 608
70
386
2 358
3 015
954
1 030
11 201
3 601
1 867
900
214
1 713
955
2 046
54
494
1 087
95
413
2 166
7 427
60
496
8 629
150
159
2 555
1 087
156
4 333
256
347
2 140
1 609
1 552
354
103
2 426
245
1 584
16 068
1 040
17
1 303
7
568
4 784
123
620
3 393
4 937
1 497
1 831
23 350
4 724
1 683
839
234
1 531
837
2 099
62
489
1 031
104
391
2 317
6 522
58
488
8 284
147
165
2 836
1 129
154
4 697
281
499
2 122
1 534
1 531
361
154
2 475
242
1 457
15 825
1 137
20
1 296
11
580
6 334
130
628
3 181
4 960
1 501
1 864
32 303
2 959
888
441
118
658
423
1 089
38
268
557
55
212
1 301
3 414
35
287
4 730
95
118
1 526
646
93
2 251
167
183
1 248
783
778
203
145
1 377
132
746
8 410
540
12
731
10
336
4 340
72
335
1 515
2 552
701
898
37 526
1 425
493
227
50
332
211
609
5
158
302
27
113
785
1 834
20
156
2 617
69
66
823
338
53
1 023
99
99
646
420
394
110
84
753
64
352
4 546
267
2
385
6
185
2 270
39
178
774
1 319
369
418
28 679
839
269
127
26
227
104
381
9
98
174
13
68
417
1 005
12
78
1 372
49
32
452
169
31
602
59
61
350
233
287
56
45
421
44
162
2 538
140
3
178
3
94
986
22
100
403
639
214
273
21 977
304
30 757
283 230
150
15 229
139 655
15
920
10 265
30
2 095
21 225
42
3 166
29 095
35
3 817
33 674
17
2 953
25 709
11
2 277
19 689
STATISTICAL ANNEX
263
All
ages
2 999 797
464 797
2 535 000
320 880
04
years
297 863
26 478
271 385
53 609
514
years
582 630
56 255
526 375
86 331
Females
1529
years
761 707
90 803
670 904
88 370
3044
years
621 685
103 963
517 722
48 701
4559
years
402 225
87 204
315 021
27 079
560
years
333 687
100 094
233 593
16 790
14 945
6 635
3 180
787
5 959
3 268
7 471
228
1 907
3 985
352
1 540
7 807
25 703
231
1 842
31 649
621
658
9 692
4 052
608
15 396
1 026
1 448
8 028
5 692
5 727
1 344
583
9 251
889
5 373
56 479
3 844
73
4 723
40
2 239
21 986
469
2 279
11 676
17 697
5 185
6 313
159 256
1 721
1 292
551
111
1 096
555
1 163
30
304
743
57
281
1 202
4 984
40
306
5 568
97
103
1 397
715
105
2 330
145
274
1 430
1 016
1 061
234
47
1 589
140
1 128
9 688
642
10
787
3
403
2 569
69
381
2 333
2 960
933
1 021
10 666
3 435
1 867
899
211
1 694
955
2 021
53
497
1 085
92
420
2 157
7 392
60
494
8 589
149
159
2 527
1 057
156
4 301
250
346
2 137
1 576
1 540
352
100
2 434
242
1 532
15 549
1 047
17
1 281
7
575
4 773
123
617
3 382
4 889
1 465
1 826
22 263
4 515
1 700
849
232
1 642
857
2 088
65
511
1 043
103
405
2 279
6 532
58
490
8 287
148
169
2 827
1 101
156
4 697
276
491
2 122
1 513
1 527
360
149
2 482
238
1 410
15 357
1 150
21
1 292
10
591
6 369
132
629
3 171
5 020
1 466
1 841
31 189
2891
919
503
121
779
459
1 097
48
286
574
55
223
1 141
3 479
36
293
4 815
96
123
1 545
637
96
2 284
170
168
1 258
811
788
210
140
1 407
136
737
8 304
537
15
741
10
350
4 356
75
340
1 480
2 637
669
858
36 916
1 392
534
242
68
417
272
652
14
181
328
29
126
648
2 012
22
165
2 787
73
69
871
348
57
1 103
109
97
675
485
445
117
88
825
77
372
4 700
289
4
405
6
203
2 443
42
192
827
1 425
393
446
29 301
992
324
137
44
331
170
451
18
128
212
16
86
380
1 304
15
94
1 602
58
36
525
194
37
681
75
72
406
291
365
70
59
515
56
193
2 881
179
6
218
4
116
1 476
27
120
482
767
259
320
28 922
154
15 527
143 575
15
874
9 777
29
1 993
20 240
41
3 040
28 108
36
3 773
33 108
20
2 987
26 294
14
2 860
26 048
264
Totalb
513 081
All
ages
254 252
04
years
27 942
Males
514
years
54 610
1529
years
72 444
3044
years
51 530
4559
years
29 507
560
years
18 219
65
37 032
267
226
8 329
170 406
15 211
42 105
4 024
11 199
71
8 373
12 646
6 278
94
11 385
761
8 142
6 417
2 576
98 872
5 071
2 856
5 496
25 662
38
148
113
417
1 294
3 337
24 170
1 535 634
32
18 163
130
115
4 144
84 169
7 531
20 786
2 040
5 611
35
4 254
6 350
3 082
46
5 741
369
3 989
3 230
1 270
48 926
2 523
1 441
2 772
12 726
19
72
56
207
644
1 619
12 161
786 265
3
1 779
9
15
617
8 145
734
2 429
226
368
3
479
747
407
5
942
41
578
491
134
5 705
408
154
394
1 475
2
9
6
20
45
145
1 429
90 144
7
3 436
19
29
1 063
16 804
1 469
4 608
441
850
7
950
1 429
731
9
1 593
76
1 099
874
278
11 012
691
303
711
2 877
4
16
11
44
119
278
2 771
172 450
9
4 785
33
34
1 155
24 344
1 865
5 758
557
1 310
9
1 215
1 857
954
13
1 637
118
1 179
935
370
14 605
741
393
761
3 743
5
22
15
65
188
396
3 371
218 856
7
3 454
35
20
683
18 495
1 737
4 375
438
1 432
7
876
1 239
495
10
828
74
601
524
242
9 374
389
302
509
2 399
4
14
12
45
143
318
2 449
160 218
4
2 612
19
10
393
10 440
1 057
2 318
236
918
4
466
668
293
6
448
36
326
252
132
5 094
189
176
267
1 368
2
7
7
17
91
244
1 404
90 548
3
2 098
14
7
233
5 941
669
1 297
142
733
3
268
410
201
4
292
23
206
153
113
3 136
105
113
129
865
2
5
5
15
57
239
737
54 049
137 439
2 085
22 268
70 858
1 054
11 179
9 562
167
987
17 773
287
2 030
20 431
281
2 789
13 252
157
2 728
6 434
98
1 644
3 405
64
1 001
1 008 937
212 092
291
47 749
23 043
18 924
62 806
394 607
86
8 080
10 249
5 320
5 172
59 238
82 017
10 610
520 312
106 379
149
23 729
11 811
9 718
31 078
193 120
45
3 942
5 020
2 633
2 523
28 856
40 148
5 230
60 014
11 094
24
2 740
1 833
794
2 928
10 797
2
209
282
169
148
1 862
1 965
259
114 668
22 082
41
5 246
3 052
1 734
5 536
23 462
5
481
624
330
329
3 817
4 583
565
142 803
31 038
41
6 885
3 184
2 629
8 776
39 208
10
768
978
499
492
6 081
7 254
1 161
105 142
22 647
23
4 655
1 923
2 214
7 476
46 232
13
1 046
1 198
607
569
6 431
10 564
1 158
60 892
12 123
12
2 696
1 150
1 449
4 049
37 098
8
759
971
564
566
5 526
7 897
965
36 792
7 394
8
1 507
669
898
2 312
36 323
7
680
966
464
420
5 138
7 885
1 122
STATISTICAL ANNEX
265
All
ages
258 829
04
years
26 872
514
years
52 717
Females
1529
years
71 810
3044
years
53 591
4559
years
31 566
560
years
22 273
33
18 868
138
112
4 185
86 238
7 680
21 319
1 983
5 588
36
4 119
6 296
3 196
47
5 645
392
4 153
3 187
1 307
49 946
2 548
1 415
2 725
12 935
19
75
57
210
651
1 718
12 009
749 369
3
1 720
8
14
593
7 860
707
2 331
216
350
3
461
719
390
4
903
40
557
472
129
5 463
393
147
379
1421
2
8
5
20
43
139
1 368
85 306
6
3 330
19
28
1 026
16 268
1 418
4 438
420
809
7
915
1 383
707
9
1 527
75
1 072
844
270
10 590
669
290
688
2794
4
15
11
43
116
266
2 659
162 342
8
4 691
33
34
1 149
24 223
1 821
5 727
528
1 258
9
1 150
1 812
949
12
1 593
119
1 187
910
367
14 694
742
384
740
3727
5
22
15
63
185
383
3 271
204 600
7
3 509
35
20
711
19 206
1 742
4 669
426
1 423
8
841
1 231
573
10
852
86
683
526
268
10 008
414
302
495
2560
4
15
12
46
147
331
2 433
149 046
4
2 780
21
9
426
11 301
1 110
2 555
235
953
5
468
684
327
6
460
43
402
261
139
5 483
203
174
259
1442
3
8
8
20
93
265
1 421
88 487
3
2 839
22
7
280
7 380
882
1 599
158
796
4
284
466
250
5
310
30
253
173
134
3 707
127
118
164
992
2
7
6
19
67
334
857
59 589
66 582
1 032
11 090
9 090
160
945
16 765
276
1 940
19 111
271
2 675
12 132
153
2 629
6 093
99
1 665
3 391
71
1 236
488 626
105 713
142
24 020
11 232
9 206
31 728
201 490
41
4 138
5 229
2 687
2 649
30 382
41 869
5 380
56 384
10 688
23
2 667
1 730
767
2 851
10 224
2
198
269
159
141
1 771
1 861
242
106 854
21 367
39
5 154
2 839
1 681
5 426
22 287
4
456
596
314
315
3 648
4 330
532
131 070
30 239
39
6 866
2 968
2 546
8 815
37 512
9
739
944
481
472
5 875
6 838
1 104
95 662
22 054
22
4 752
1 878
2 113
7 650
45 016
12
992
1 159
581
549
6 483
9 876
1 158
58 596
12 615
11
2 848
1 125
1 238
4 197
37 338
7
758
959
553
560
5 584
7 778
982
40 060
8 750
7
1 734
692
861
2 788
49 109
7
996
1 302
600
612
7 021
11 184
1 361
266
Totalb
All
ages
04
years
Males
514
years
1529
years
3044
years
4559
years
560
years
140
1890
2 980
27 902
215
16
7 862
2 213
4 819
13
19 511
4 375
3 546
29 242
230 651
11
136
316
1 350
14
1
480
149
288
1
939
226
187
1 804
15 396
23
286
560
2 870
28
2
1 005
305
569
1
2 088
599
424
3 972
38 477
32
502
773
5 665
42
3
1 520
437
1 159
3
4 657
817
619
5 733
59 421
31
384
561
6 676
53
4
1 992
509
1 065
3
4 634
941
896
6 896
51 974
24
324
429
5 434
42
3
1 616
437
860
3
3 454
921
764
5 529
36 583
19
258
341
5 908
36
3
1 249
376
879
3
3 738
870
655
5 307
28 800
1 603
1 834
3 959
4 746
1 968
3 864
2 253
4 995
649
2 512
4 756
7 844
2 413
1 116
1 743
193
18 761
2 054
10 977
68 130
2 625
966
3 032
1 017
159
106
314
241
106
162
138
231
31
153
251
648
265
48
95
12
1 024
133
584
3 254
148
46
393
75
326
356
886
732
283
479
292
633
95
399
613
1 570
579
168
272
28
2 767
375
1 511
10 103
391
116
822
162
418
496
1 083
1 153
462
890
486
1 229
155
611
1 149
2 131
676
261
412
44
4 772
539
2 760
16 713
686
222
852
249
365
433
935
1 150
521
813
527
1 045
150
575
1 001
1 807
486
265
423
40
4 143
453
2 376
16 737
590
230
551
226
203
231
392
793
342
773
434
1 096
118
379
983
1 011
230
203
289
40
3 498
325
1 930
11 983
479
201
232
172
131
212
350
677
254
747
377
761
99
395
758
676
177
171
252
28
2 557
229
1 816
9 339
331
151
182
133
33 676
2 345
23 019
12 357
5 248
3 594
3 614
305
1 122
1 407
332
230
6 581
598
3 397
3 182
762
597
10 002
653
5 549
3 538
1 226
783
6 843
463
5 281
2 436
1 109
1 000
4 024
197
4 011
1 045
970
763
2 612
128
3 659
749
848
221
391
1 115
366
1 722
242 847
28
73
27
102
34 697
66
231
50
250
62 275
89
287
62
345
67 412
85
261
141
513
41 988
69
205
74
414
23 809
55
57
13
97
12 666
11 227
1 954
2 923
3 018
1 814
1 008
510
STATISTICAL ANNEX
All
ages
European Region (high-income) (continued)
Iceland
139
Ireland
1 913
Israel
3 060
Italy
29 628
Luxembourg
222
Monaco
17
Netherlands
8 002
Norway
2 256
Portugal
5 197
San Marino
14
Spain
20 400
Sweden
4 467
Switzerland
3 624
United Kingdom
30 173
European Region (low-income
248 317
and middle-income)
Albania
1 531
Armenia
1 953
Azerbaijan
4 082
Belarus
5 441
Bosnia and Herzegovina
2 009
Bulgaria
4 086
Croatia
2 401
Czech Republic
5 276
Estonia
745
Georgia
2 750
Hungary
5 212
Kazakhstan
8 329
Kyrgyzstan
2 508
Latvia
1 305
Lithuania
1 953
Malta
197
Poland
19 844
Republic of Moldova
2 242
Romania
11 461
Russian Federation
77 361
Slovakia
2 773
Slovenia
1 022
Tajikistan
3 055
The former Yugoslav
1 017
Republic of Macedonia
Turkey
32 992
Turkmenistan
2 393
Ukraine
26 549
Uzbekistan
12 524
Yugoslavia
5 305
Eastern Mediterranean Region
2 276
(high-income)
Cyprus
393
Kuwait
800
Qatar
199
United Arab Emirates
884
Eastern Mediterranean Region
232 939
(low-income and middle-income)
Afghanistan
10 538
267
04
years
514
years
Females
1529
years
3044
years
4559
years
560
years
10
128
298
1 271
13
1
457
141
272
1
877
214
178
1 719
14 736
21
270
533
2 726
26
2
960
289
542
1
1 970
569
405
3 778
36 869
31
481
737
5 460
41
3
1 464
420
1 132
3
4 462
781
589
5 447
57 486
31
393
581
6 631
52
4
1 904
487
1 098
3
4 584
898
837
6 704
52 418
23
321
458
5 603
40
3
1 567
422
943
3
3 555
896
743
5 578
40 312
23
321
453
7 937
49
4
1 649
498
1 210
4
4 952
1 109
871
6 947
46 495
150
101
296
227
99
155
131
220
30
146
239
625
259
46
91
12
970
126
553
3 108
141
44
381
70
305
336
836
704
266
457
279
602
91
379
586
1 520
567
160
261
26
2 634
360
1 447
9 657
374
110
801
153
391
479
1 024
1 147
437
852
469
1 178
151
587
1 099
2 094
670
254
400
41
4 594
533
2 659
16 269
662
212
836
238
346
477
996
1 205
511
815
518
1 015
151
611
995
1 818
497
269
427
39
4 080
485
2 351
16 974
580
228
573
220
189
274
437
911
357
831
442
1 136
140
437
1 084
1 141
249
242
341
40
3 724
379
2 044
13 768
515
198
232
176
150
286
493
1 248
339
976
562
1 125
182
591
1 209
1 131
266
334
434
38
3 843
358
2 406
17 584
501
230
233
160
3 494
296
1 068
1 354
308
219
6 332
583
3 254
3 079
710
563
9 528
646
5 399
3 487
1 148
627
6 659
477
5 527
2 506
1 068
440
3 960
212
4 775
1 089
988
289
3 019
179
6 526
1 009
1 083
137
26
71
26
96
33 023
62
224
48
229
59 158
85
262
46
234
64 526
83
126
51
180
39 940
70
88
23
108
22 641
68
28
5
37
13 650
1 852
2 736
2 796
1 679
955
519
268
Totalb
All
ages
04
years
Males
514
years
1529
years
3044
years
4559
years
560
years
368
297
34 364
11 666
35 998
2 554
1 711
2 741
14 964
1 347
72 622
10 872
4 358
15 639
8 200
4 776
9 142
99 320
29
52
4 096
1 817
3 882
390
171
329
1 832
206
11 427
1 630
897
2 412
1 146
430
1 996
5 743
63
86
8 182
3 063
9 640
618
384
589
3 441
363
18 985
2 835
1 216
3 943
2 228
1 013
2 703
11 957
75
80
9 788
3 329
10 578
780
498
877
4 457
334
19 041
2 682
1 154
4 390
2 488
1 441
2 402
22 505
120
38
6 652
1 939
6 420
459
357
473
2 948
223
11 856
1 731
619
2 645
1 400
986
1 308
22 029
64
28
3 721
1 018
3 702
194
163
316
1 429
166
7 234
1 471
314
1 456
575
511
439
20 208
16
14
1 925
501
1 776
113
137
157
856
55
4 080
523
158
792
363
396
294
16 878
9 529
173
62 212
1 861
23 522
2 023
761 540
648
18
3 159
142
1 631
145
63 560
1 368
36
6 424
302
3 517
310
141 345
2 127
41
13 293
393
6 239
412
195 168
2 176
44
12 493
424
6 309
583
182 236
1 788
25
14 004
335
3 679
376
111 291
1 421
9
12 839
265
2 147
197
67 940
6 389
659 410
10
64
414
43
2 636
11 255
26
1 268
6
1
10
2 507
38 092
83
230
52
5
101
38 938
1 070
51 092
1
9
50
6
426
1 350
4
139
1
<1
1
366
5 031
11
41
6
1
16
3 939
1 846
116 265
2
15
90
10
722
2 541
6
315
2
<1
2
635
9 474
23
63
12
1
27
9 293
1 700
165 941
3
16
118
11
719
3 029
7
387
2
<1
2
746
10 973
27
66
15
2
27
11 379
1 050
162 699
2
12
85
8
420
2 286
5
259
1
<1
2
436
6 925
12
33
10
1
17
7 973
518
101 353
1
7
49
5
210
1 357
3
105
1
<1
1
223
3 785
6
18
6
1
9
3 633
205
62 059
1
4
22
3
139
692
2
63
<1
<1
1
101
1 903
5
10
3
<1
5
2 722
STATISTICAL ANNEX
All
ages
269
04
years
514
years
Females
1529
years
3044
years
4559
years
560
years
28
51
3 915
1 739
3 672
372
164
314
1 764
198
10 783
1 556
890
2 316
1 093
403
1 914
5 368
60
85
7 811
2 935
9 107
588
370
563
3 318
352
17 826
2 713
1 206
3 803
2 144
964
2 575
11 142
68
83
9 197
3 178
10 154
713
489
848
4 307
325
18 240
2 590
1 164
4 284
2 417
1 387
2 285
21 475
72
53
6 367
1 875
6 007
392
404
444
2 966
170
11 178
1 330
639
2 641
1 340
1 005
1 378
21 591
30
43
3 871
1 001
3 496
184
197
248
1 511
94
6 542
831
336
1 507
593
522
680
20 276
14
21
2 359
553
1 895
110
162
133
1 049
52
4 065
453
184
905
401
402
375
21 926
615
17
2 993
135
1 474
135
57 838
1 296
34
6 118
288
3 118
289
128 958
2 052
38
12 730
383
5 883
388
184 113
2 179
39
12 229
452
6 107
585
174 027
1 762
19
14 135
337
3 653
370
104 936
1 705
8
16 679
323
2 984
227
74 795
1 037
45 892
1
8
47
6
410
1 280
4
133
1
<1
1
344
4 800
11
38
6
1
14
3 804
1 797
104 807
2
15
85
10
698
2 405
6
305
1
<1
2
583
9 090
21
59
11
1
25
9 034
1 681
155 577
3
15
112
10
705
2 925
6
380
1
<1
2
637
10 641
22
61
13
1
26
11 295
1 170
154 205
2
11
82
7
441
2 269
4
262
1
<1
2
422
6 901
9
34
9
1
17
8 179
665
94 679
1
6
50
4
231
1 314
3
108
1
<1
1
217
3 837
6
17
5
1
8
3 782
366
67 867
1
4
25
3
157
771
2
78
<1
<1
1
98
2 293
6
9
4
<1
5
3 106
270
TABLE A.2
Estimated mortality caused by intentional injury,a by sex, age group, WHO region and income level, 2000
Absolute numbers (in thousands)b
WHO region
Income level
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
Totalc
1 659
149
1 510
311
228
56
171
317
303
55
248
95
1
95
405
37
368
All
ages
1 153
111
1 042
225
196
44
152
216
239
41
198
62
<1
61
216
26
190
04
years
41
1
40
17
2
<1
1
5
2
<1
2
14
<1
14
1
<1
1
514
years
54
1
54
23
3
1
2
15
5
<1
5
5
<1
5
4
<1
4
Males
1529
years
351
24
326
72
87
13
74
69
53
7
46
20
<1
20
50
4
45
3044
years
320
31
288
57
60
14
46
59
78
11
67
11
<1
11
55
6
48
4559
years
205
27
178
31
28
9
19
38
58
10
48
7
<1
7
44
8
36
560
years
182
27
156
25
17
7
10
29
44
12
31
5
<1
5
62
7
55
All
agese
40.5
22.1
44.8
94.6
48.6
27.6
62.1
31.3
52.5
17.8
83.7
27.4
13.9
27.7
26.5
22.3
27.7
04
years
13.0
2.2
14.1
31.2
3.8
4.0
3.8
6.0
6.5
0.9
10.4
39.9
3.9
40.2
1.9
1.1
2.0
514
years
8.8
1.5
9.6
25.9
3.4
2.4
3.8
8.9
7.9
0.7
12.4
7.3
3.3
7.3
2.8
1.2
3.0
Males
1529
years
44.0
25.7
46.5
80.9
83.2
41.8
101.7
31.7
53.7
16.6
78.1
29.1
19.0
29.2
22.7
18.7
23.2
3044
years
49.7
29.4
53.8
118.0
67.2
36.3
89.7
36.6
79.6
24.7
128.4
26.6
17.6
26.9
26.7
27.9
26.6
4559
years
50.7
31.3
56.0
119.7
48.0
30.7
64.9
41.8
78.1
26.7
130.2
27.2
12.3
27.7
33.6
41.3
32.2
560
years
67.4
35.8
79.6
182.5
43.1
33.7
54.5
54.1
67.0
34.3
108.3
40.8
20.2
41.2
72.9
41.8
80.6
All
ages
33.8
35.7
33.6
43.9
44.9
37.9
47.5
24.3
39.3
33.7
40.7
04
years
15.0
12.8
15.1
23.7
8.7
19.6
7.1
7.9
16.0
8.1
17.0
514
years
20.0
14.9
20.1
29.7
17.6
19.6
17.1
18.7
29.7
10.0
31.9
Males
1529
years
39.8
37.2
40.0
56.3
57.7
46.2
60.4
28.1
41.7
28.9
44.5
3044
years
38.7
42.7
38.3
53.4
50.2
42.8
52.9
28.4
43.2
44.0
43.1
4559
years
34.7
41.9
33.8
43.8
41.2
39.9
41.8
26.1
39.2
42.8
38.5
560
years
31.9
26.1
33.2
43.0
26.0
25.7
26.3
21.1
34.6
27.1
38.9
Totalc, e
28.8
14.4
32.1
60.9
27.7
17.2
34.3
22.8
32.0
11.5
49.6
21.6
10.3
21.8
24.3
15.4
26.2
Totalc
32.8
31.6
32.9
41.3
40.6
33.1
43.9
23.1
37.1
29.4
39.4
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
04
years
23
<1
23
12
1
<1
1
4
1
<1
1
4
<1
4
1
<1
1
514
years
37
1
37
13
1
<1
1
13
1
<1
1
5
<1
5
3
<1
3
Females
1529
years
153
6
147
32
11
3
8
37
11
2
9
12
<1
12
50
2
48
3044
years
119
10
109
15
9
4
5
23
17
3
13
5
<1
5
50
2
47
4559
years
77
9
68
9
5
3
2
13
14
4
11
3
<1
3
33
3
31
560
years
97
12
85
6
4
2
2
12
21
6
15
4
<1
4
52
5
47
All
agese
17.3
6.9
19.7
29.6
7.5
7.1
7.6
14.3
12.5
5.7
18.3
15.5
4.4
15.7
22.5
8.8
25.0
04
years
7.7
1.8
8.3
21.9
2.7
3.2
2.6
4.3
3.3
0.7
5.2
13.1
2.1
13.2
2.2
1.3
2.3
514
years
6.4
0.9
7.0
14.6
1.8
1.4
2.0
8.3
2.1
0.5
3.1
8.7
0.7
8.8
2.4
0.9
2.5
Females
1529
years
20.1
6.7
21.9
36.1
10.5
8.2
11.5
18.2
11.3
4.4
15.7
19.1
5.7
19.2
24.5
8.4
26.3
3044
years
19.1
9.2
21.1
31.5
10.1
10.8
9.6
15.2
17.2
7.5
25.5
12.9
6.0
13.0
25.3
9.9
27.2
4559
years
19.1
10.3
21.5
32.2
8.4
9.3
7.5
14.2
18.4
9.7
26.5
11.6
4.0
11.7
26.6
12.8
29.2
560
years
29.2
12.2
36.5
36.4
7.2
6.6
7.9
19.7
21.6
11.7
31.9
27.2
6.1
27.4
53.3
21.0
62.8
All
ages
30.7
24.4
31.4
35.8
25.3
22.6
27.3
20.9
30.8
21.8
35.1
04
years
10.3
14.8
10.2
19.0
9.2
22.4
7.1
7.9
11.7
8.9
12.1
514
years
18.1
17.1
18.1
27.2
18.1
19.6
17.7
14.6
18.7
12.9
19.5
Females
1529
years
42.9
35.2
43.3
60.8
42.1
32.6
46.3
29.1
39.1
31.0
41.0
3044
years
42.3
45.3
42.0
44.3
41.0
39.1
42.6
26.5
47.6
50.8
46.8
4559
years
37.3
43.1
36.6
36.8
32.3
35.0
29.6
23.8
38.2
48.1
35.7
560
years
26.0
13.7
29.9
27.4
9.0
8.1
10.3
14.5
21.6
12.5
30.1
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
271
All
ages
506
38
468
86
31
12
19
101
64
15
50
34
<1
34
189
11
178
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
272
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
28.2
19.9
28.3
33.1
33.0
33.2
All
ages
28.9
19.5
29.0
28.5
33.5
27.9
04
years
41.0
15.8
41.1
1.9
5.0
1.8
514
years
17.9
17.2
17.9
7.6
10.5
7.5
Males
1529
years
33.1
21.4
33.3
29.3
32.4
29.1
3044
years
28.4
23.0
28.5
31.6
41.5
30.7
4559
years
23.2
15.1
23.4
33.5
43.8
31.8
560
years
21.0
16.6
21.1
39.3
25.1
42.3
All
ages
3.9
2.7
4.1
4.1
6.2
3.3
8.4
2.8
4.8
2.1
6.6
2.9
3.0
2.9
3.4
3.3
3.4
04
years
0.7
1.4
0.7
0.8
0.6
2.2
0.4
0.3
1.2
0.7
1.3
1.8
1.3
1.8
0.2
0.8
0.2
514
years
7.4
7.3
7.4
10.5
7.4
11.0
6.8
5.9
16.2
4.0
18.1
5.9
9.7
5.9
3.8
5.2
3.7
Males
1529
years
18.6
26.4
18.2
13.8
40.3
35.3
41.3
12.7
29.5
18.8
32.0
15.3
16.2
15.3
17.3
22.8
16.9
3044
years
10.6
15.7
10.2
6.4
20.3
16.7
21.7
7.4
19.7
14.6
20.9
6.9
9.7
6.9
11.4
16.4
11.0
4559
years
4.7
5.2
4.6
5.0
6.0
4.7
6.8
3.1
7.0
4.6
7.9
2.6
2.1
2.6
4.5
7.2
4.2
560
years
1.3
0.8
1.4
2.7
0.9
0.7
1.1
0.9
1.3
0.8
1.7
0.7
0.5
0.7
1.6
1.2
1.6
Totalc
3.0
1.9
3.2
2.9
3.9
2.1
5.4
2.2
3.1
1.4
4.3
2.4
2.4
2.4
3.6
2.6
3.7
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
middle
middle
middle
middle
middle
middle
middle
273
All
ages
27.1
22.3
27.1
40.8
32.2
41.5
04
years
12.2
13.4
12.2
2.3
7.4
2.2
514
years
25.3
9.3
25.3
10.1
17.0
10.0
Females
1529
years
44.7
34.2
44.7
52.3
46.2
52.6
3044
years
34.5
26.1
34.6
56.3
52.1
56.5
4559
years
27.5
18.0
27.5
50.4
48.1
50.6
560
years
24.7
13.8
24.8
43.0
22.7
47.1
All
ages
1.9
1.0
2.1
1.7
1.1
0.9
1.4
1.6
1.4
0.7
1.8
1.8
1.1
1.8
3.7
1.8
4.0
04
years
0.4
1.5
0.4
0.6
0.5
2.2
0.4
0.2
0.7
0.6
0.8
0.6
0.8
0.6
0.3
1.1
0.3
514
years
5.2
4.8
5.2
5.7
5.1
9.1
4.5
4.8
6.9
4.1
7.4
6.7
2.8
6.7
3.8
6.6
3.7
Females
1529
years
8.8
18.1
8.6
4.1
13.7
17.9
12.7
7.5
17.4
14.2
18.2
9.7
14.2
9.7
24.7
25.0
24.7
3044
years
5.8
10.0
5.6
1.9
6.3
9.3
5.0
4.2
11.6
9.3
12.4
4.0
5.3
4.0
16.5
13.3
16.7
4559
years
2.9
3.3
2.8
2.0
1.8
2.4
1.3
1.5
4.0
3.4
4.2
1.4
1.1
1.4
5.9
5.4
5.9
560
years
0.7
0.3
0.8
0.6
0.2
0.2
0.2
0.4
0.5
0.3
0.7
0.6
0.2
0.6
1.5
0.8
1.7
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
274
TABLE A.3
Estimated mortality caused by homicide,a by sex, age group, WHO region and income level, 2000
Absolute numbers (in thousands)b
WHO region
Income level
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
Totalc
520
26
494
116
159
19
140
78
78
4
74
31
<1
30
59
2
57
All
ages
401
19
382
82
142
15
128
54
58
3
56
20
<1
19
45
1
44
04
years
18
1
18
10
1
<1
1
3
<1
<1
<1
2
<1
2
1
<1
1
514
years
13
<1
13
4
2
<1
2
4
1
<1
<1
1
<1
1
2
<1
2
Males
1529
years
155
8
147
30
72
7
65
13
15
1
14
8
<1
8
17
<1
17
3044
years
120
6
114
19
44
4
39
14
23
1
22
5
<1
5
15
<1
15
4559
years
60
3
57
10
17
2
15
11
13
1
13
2
<1
2
6
<1
6
560
years
35
1
34
9
7
1
6
9
6
<1
6
2
<1
2
3
<1
3
All
agese
13.6
4.3
15.6
33.4
34.7
9.9
51.0
8.1
13.0
1.4
23.2
9.4
6.0
9.4
5.1
1.3
5.6
04
years
5.8
2.2
6.1
17.9
3.5
4.0
3.3
3.9
1.7
0.9
2.2
5.0
1.4
5.1
1.9
1.1
2.0
514
years
2.1
0.7
2.3
4.0
2.4
1.2
2.9
2.2
0.8
0.3
1.2
2.0
0.6
2.0
1.5
0.5
1.5
Males
1529
years
19.4
8.4
20.9
34.1
68.6
21.4
89.7
6.0
15.1
1.7
23.9
11.3
10.1
11.3
7.9
1.5
8.6
3044
years
18.7
5.5
21.3
39.6
49.1
11.6
76.4
8.8
23.5
2.1
42.6
11.1
9.1
11.1
7.4
2.0
8.0
4559
years
14.8
3.3
17.9
39.6
28.9
6.7
50.4
11.6
18.1
1.6
34.8
9.8
4.1
10.0
4.9
1.6
5.5
560
years
13.0
1.9
17.3
63.3
16.4
3.7
31.9
16.9
9.3
1.1
19.7
13.6
5.7
13.7
3.4
1.1
3.9
All
ages
11.7
6.0
12.3
16.0
32.6
12.6
39.9
6.1
9.6
2.3
11.4
04
years
6.7
12.7
6.6
13.6
8.0
19.6
6.2
5.1
4.2
8.1
3.7
514
years
4.8
6.9
4.8
4.6
12.5
9.9
13.1
4.6
3.1
3.9
3.0
Males
1529
years
17.6
12.2
18.0
23.7
47.5
23.7
53.2
5.3
11.7
3.0
13.6
3044
years
14.5
8.0
15.1
17.9
36.7
13.7
45.1
6.8
12.8
3.8
14.3
4559
years
10.1
4.4
10.8
14.5
24.7
8.7
32.5
7.3
9.1
2.6
10.3
560
years
6.2
1.4
7.2
14.9
9.9
2.8
15.4
6.6
4.8
0.9
7.1
Totalc, e
8.8
2.9
10.1
22.2
19.3
6.5
27.5
5.8
8.4
1.0
14.8
7.1
4.2
7.2
3.4
1.1
3.8
Totalc
10.3
5.5
10.8
15.4
28.4
11.4
35.8
5.7
9.5
2.2
11.7
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
04
years
14
<1
14
7
1
<1
1
3
<1
<1
<1
2
<1
2
1
<1
1
514
years
12
<1
11
2
1
<1
1
4
<1
<1
<1
2
<1
2
1
<1
1
Females
1529
years
33
2
32
12
7
1
5
3
4
<1
4
4
<1
3
4
<1
4
3044
years
27
2
25
7
5
2
4
4
6
<1
5
2
<1
2
4
<1
4
4559
years
18
1
17
4
2
1
1
5
4
<1
4
1
<1
1
2
<1
2
560
years
15
1
14
2
1
<1
1
4
5
<1
5
1
<1
1
2
<1
1
All
agese
4.0
1.5
4.6
11.8
4.0
3.0
4.8
3.5
3.9
0.6
6.8
4.8
1.2
4.8
1.7
0.8
1.8
04
years
4.8
1.8
5.1
12.7
2.6
3.2
2.3
3.5
1.2
0.7
1.6
5.5
0.4
5.5
2.2
1.3
2.3
514
years
2.0
0.5
2.1
2.9
1.2
1.0
1.3
2.6
0.7
0.2
1.0
3.6
0.0
3.6
1.0
0.4
1.0
Females
1529
years
4.4
2.0
4.7
14.1
6.4
4.4
7.3
1.6
4.0
0.7
6.1
5.4
1.5
5.4
1.9
0.8
2.0
3044
years
4.3
2.1
4.7
13.8
5.7
4.2
6.6
2.5
5.7
0.8
9.9
4.3
1.3
4.4
2.0
1.1
2.1
4559
years
4.5
1.2
5.4
14.6
3.3
2.2
4.3
5.7
5.6
0.7
10.1
3.8
1.4
3.8
1.4
0.8
1.6
560
years
4.5
1.0
6.1
11.8
2.6
1.7
3.8
7.3
5.3
0.7
10.3
5.9
2.6
5.9
1.6
0.8
1.9
All
ages
7.2
4.4
7.5
14.3
13.7
8.8
17.4
4.9
9.3
2.0
12.8
04
years
6.4
14.7
6.3
11.0
8.7
22.4
6.5
6.4
4.4
8.9
3.8
514
years
5.6
10.2
5.5
5.4
11.8
13.5
11.4
4.6
6.2
6.0
6.2
Females
1529
years
9.4
10.4
9.3
23.7
25.6
17.2
29.3
2.6
13.8
4.6
16.0
3044
years
9.5
10.4
9.5
19.4
23.0
15.3
29.6
4.3
15.9
5.7
18.2
4559
years
8.8
5.2
9.2
16.7
12.7
8.3
17.0
9.5
11.6
3.5
13.7
560
years
4.1
1.1
5.0
8.9
3.3
2.1
5.0
5.4
5.3
0.7
9.7
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
275
All
ages
119
7
112
34
17
5
12
24
20
1
18
11
<1
11
14
1
13
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
276
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
9.0
8.3
9.1
4.8
2.0
5.1
All
ages
9.2
8.7
9.2
5.9
1.8
6.4
04
years
5.2
5.6
5.2
1.9
5.0
1.8
514
years
4.9
3.0
4.9
3.9
4.5
3.9
Males
1529
years
12.9
11.4
12.9
10.1
2.5
10.8
3044
years
11.8
11.8
11.8
8.7
2.9
9.3
4559
years
8.4
5.0
8.5
4.9
1.7
5.5
560
years
7.0
4.7
7.0
1.8
0.7
2.1
All
ages
1.4
0.5
1.5
1.5
4.5
1.1
7.0
0.7
1.2
0.1
1.8
0.9
1.4
0.9
0.7
0.2
0.8
04
years
0.3
1.4
0.3
0.4
0.5
2.2
0.4
0.2
0.3
0.7
0.3
0.2
0.5
0.2
0.2
0.8
0.2
514
years
1.8
3.4
1.8
1.6
5.3
5.5
5.2
1.4
1.7
1.6
1.7
1.6
1.7
1.6
1.9
2.2
1.9
Males
1529
years
8.2
8.7
8.2
5.8
33.2
18.1
36.4
2.4
8.3
2.0
9.8
5.9
8.6
5.9
6.0
1.8
6.3
3044
years
4.0
2.9
4.0
2.2
14.8
5.3
18.5
1.8
5.8
1.2
6.9
2.9
5.0
2.9
3.1
1.2
3.3
4559
years
1.4
0.6
1.5
1.7
3.6
1.0
5.3
0.9
1.6
0.3
2.1
0.9
0.7
0.9
0.7
0.3
0.7
560
years
0.3
0.0
0.3
0.9
0.4
0.1
0.7
0.3
0.2
0.0
0.3
0.2
0.2
0.2
0.1
0.0
0.1
Totalc
0.9
0.3
1.0
1.1
2.7
0.7
4.4
0.5
0.8
0.1
1.3
0.8
1.0
0.8
0.5
0.2
0.6
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
middle
middle
middle
middle
middle
middle
middle
277
All
ages
8.8
5.9
8.8
3.0
2.4
3.0
04
years
5.1
2.9
5.1
2.3
7.4
2.2
514
years
10.5
0.2
10.5
4.1
7.6
4.0
Females
1529
years
12.6
9.3
12.6
4.0
4.6
4.0
3044
years
11.6
5.5
11.7
4.4
5.6
4.4
4559
years
9.0
6.3
9.0
2.7
3.0
2.7
560
years
5.4
6.0
5.4
1.3
0.8
1.4
All
ages
0.5
0.2
0.5
0.7
0.6
0.3
0.9
0.4
0.4
0.1
0.7
0.6
0.3
0.6
0.3
0.1
0.3
04
years
0.3
1.4
0.3
0.3
0.5
2.2
0.3
0.2
0.3
0.6
0.2
0.2
0.2
0.2
0.3
1.1
0.3
514
years
1.6
4.0
1.6
1.1
3.3
6.3
2.9
1.5
2.3
1.9
2.4
2.8
0.1
2.8
1.5
2.9
1.5
Females
1529
years
1.9
5.4
1.8
1.6
8.3
9.5
8.0
0.7
6.1
2.1
7.1
2.7
3.9
2.7
1.9
2.5
1.9
3044
years
1.3
2.3
1.3
0.8
3.5
3.7
3.5
0.7
3.9
1.1
4.8
1.3
1.1
1.4
1.3
1.4
1.3
4559
years
0.7
0.4
0.7
0.9
0.7
0.6
0.8
0.6
1.2
0.2
1.6
0.5
0.4
0.5
0.3
0.3
0.3
560
years
0.1
0.0
0.1
0.2
0.1
0.0
0.1
0.2
0.1
0.0
0.2
0.1
0.1
0.1
0.0
0.0
0.1
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
278
TABLE A.4
Estimated mortality caused by suicide,a by sex, age group, WHO region and income level, 2000
Absolute numbers (in thousands)b
WHO region
Income level
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
Totalc
815
122
692
27
65
36
29
168
186
51
135
24
<1
23
344
35
309
All
ages
509
91
418
21
52
29
22
107
149
38
111
12
<1
12
169
24
144
04
years
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
514
years
10
<1
10
1
1
<1
<1
5
1
<1
1
1
<1
1
2
<1
2
Males
1529
years
124
16
108
6
14
6
8
37
30
6
24
5
<1
5
32
4
28
3044
years
138
25
113
5
15
9
6
30
46
10
35
3
<1
3
39
6
33
4559
years
115
24
91
5
11
7
4
21
39
9
29
2
<1
2
38
8
30
560
years
122
25
96
4
10
6
4
14
33
12
21
1
<1
1
59
7
52
All
agese
18.9
17.7
19.5
10.6
13.2
17.4
10.2
15.7
32.2
16.4
46.8
6.3
4.1
6.4
21.2
20.9
21.8
04
years
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
514
years
1.7
0.8
1.8
1.4
0.7
1.2
0.5
3.1
1.8
0.4
2.6
0.8
0.4
0.8
1.1
0.7
1.2
Males
1529
years
15.6
17.0
15.4
6.4
13.7
19.9
11.0
16.9
30.2
14.8
40.3
7.6
5.2
7.6
14.7
17.1
14.4
3044
years
21.5
23.6
21.1
11.2
17.1
24.1
12.1
18.5
46.7
22.6
68.2
7.6
5.6
7.7
19.0
25.8
18.2
4559
years
28.4
27.9
28.6
18.1
18.7
23.8
13.9
23.3
52.3
25.1
79.9
8.5
4.1
8.6
28.7
39.7
26.7
560
years
44.9
33.8
49.2
26.6
26.0
29.9
21.2
26.1
51.3
33.2
74.1
10.8
7.3
10.8
69.2
40.7
76.2
All
ages
14.9
28.8
13.5
4.0
11.8
24.9
7.0
12.1
24.5
31.3
22.8
04
years
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
514
years
3.8
7.7
3.7
1.6
3.5
9.6
2.1
6.6
6.6
6.1
6.7
Males
1529
years
14.1
24.7
13.2
4.5
9.5
22.1
6.5
15.0
23.5
25.8
23.0
3044
years
16.7
34.4
15.0
5.1
12.8
28.5
7.1
14.3
25.4
40.1
22.9
4559
years
19.5
37.2
17.3
6.6
16.1
30.9
8.9
14.6
26.2
40.2
23.6
560
years
21.3
24.7
20.5
6.3
15.7
22.8
10.2
10.2
26.5
26.2
26.6
Totalc, e
14.5
11.4
15.5
6.7
8.1
10.6
6.3
12.0
19.1
10.5
26.6
5.9
3.4
5.9
20.8
14.3
22.3
Totalc
16.1
25.9
15.1
3.6
11.7
21.5
7.4
12.3
22.8
27.2
21.5
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
04
years
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
514
years
12
<1
11
1
<1
<1
<1
8
<1
<1
<1
1
<1
1
2
<1
1
Females
1529
years
93
4
88
2
4
1
3
30
5
1
4
6
<1
6
46
2
45
3044
years
77
7
70
2
4
3
1
15
8
3
5
2
<1
2
46
2
44
4559
years
50
8
43
1
3
2
1
5
9
3
5
1
<1
1
31
2
29
560
years
74
11
63
1
2
1
1
4
15
5
10
1
<1
1
50
4
46
All
agese
10.6
5.4
11.9
3.1
3.3
4.1
2.7
8.3
6.8
5.0
8.4
5.4
2.1
5.4
20.7
8.0
23.2
04
years
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
514
years
2.0
0.4
2.1
0.7
0.6
0.4
0.6
4.7
0.4
0.2
0.5
2.0
0.1
2.0
1.1
0.5
1.1
Females
1529
years
12.2
4.7
13.2
1.7
4.0
3.9
4.1
14.5
5.8
3.8
7.0
8.6
3.2
8.6
22.6
7.6
24.3
3044
years
12.4
7.1
13.4
4.8
4.3
6.6
2.8
9.9
8.1
6.6
9.4
6.2
3.5
6.2
23.3
8.9
25.0
4559
years
12.6
9.0
13.5
4.1
5.0
7.1
3.1
5.7
11.4
9.0
13.6
4.4
1.7
4.4
25.1
12.0
27.7
560
years
22.1
11.3
26.8
7.5
4.4
4.9
3.9
7.2
15.7
11.0
20.6
7.0
2.0
7.0
51.7
20.2
60.9
All
ages
18.5
20.0
18.4
2.8
11.2
13.8
9.3
12.6
17.9
19.7
17.1
04
years
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
514
years
5.6
6.6
5.6
1.2
5.6
5.9
5.5
8.2
3.7
6.2
3.4
Females
1529
years
26.0
24.7
26.0
2.9
16.1
15.3
16.5
23.2
19.9
26.4
18.4
3044
years
27.4
34.9
26.8
6.7
17.6
23.8
12.4
17.2
22.5
45.0
17.2
4559
years
24.6
37.9
23.1
4.6
19.3
26.7
12.2
9.5
23.6
44.4
18.3
560
years
19.7
12.6
22.0
5.6
5.6
6.0
5.0
5.3
15.8
11.8
19.4
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
279
All
ages
305
31
274
7
14
7
7
61
37
13
24
11
<1
11
175
10
164
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
280
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
7.0
6.5
7.0
28.1
31.0
27.8
All
ages
5.8
5.8
5.8
22.3
31.6
21.2
04
years
0.0
0.0
0.0
0.0
0.0
0.0
514
years
2.0
2.3
2.0
3.0
6.0
2.9
Males
1529
years
8.6
5.9
8.6
18.9
29.7
18.1
3044
years
8.1
7.3
8.1
22.5
38.3
21.0
4559
years
7.2
5.0
7.3
28.6
42.0
26.3
560
years
5.6
6.0
5.5
37.2
24.4
40.0
All
ages
1.7
2.2
1.6
0.4
1.6
2.2
1.2
1.4
3.0
1.9
3.7
0.6
0.9
0.6
2.7
3.1
2.6
04
years
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
514
years
1.4
3.8
1.4
0.6
1.5
5.4
0.8
2.1
3.6
2.4
3.8
0.7
1.3
0.7
1.5
3.0
1.5
Males
1529
years
6.6
17.5
6.0
1.1
6.6
16.8
4.5
6.8
16.6
16.8
16.5
4.0
4.5
4.0
11.1
20.9
10.5
3044
years
4.6
12.7
4.0
0.6
5.2
11.1
2.9
3.7
11.6
13.3
11.1
2.0
3.1
2.0
8.1
15.2
7.5
4559
years
2.6
4.6
2.4
0.8
2.3
3.7
1.5
1.7
4.7
4.3
4.9
0.8
0.7
0.8
3.9
7.0
3.4
560
years
0.9
0.8
0.9
0.4
0.6
0.7
0.4
0.4
1.0
0.8
1.2
0.2
0.2
0.2
1.5
1.1
1.5
Totalc
1.5
1.5
1.5
0.3
1.1
1.3
0.9
1.2
1.9
1.3
2.3
0.6
0.8
0.6
3.0
2.4
3.1
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
middle
middle
middle
middle
middle
middle
middle
281
All
ages
9.0
10.8
9.0
37.7
29.7
38.3
04
years
0.0
0.0
0.0
0.0
0.0
0.0
514
years
5.8
0.9
5.8
4.6
9.4
4.5
Females
1529
years
20.0
19.3
20.0
48.3
41.7
48.5
3044
years
16.5
15.1
16.5
51.7
46.5
52.0
4559
years
10.4
7.7
10.4
47.7
45.1
47.9
560
years
6.3
4.5
6.3
41.7
21.9
45.7
All
ages
1.2
0.8
1.2
0.1
0.5
0.5
0.5
0.9
0.8
0.7
0.9
0.6
0.5
0.6
3.5
1.6
3.7
04
years
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
514
years
1.6
2.6
1.6
0.3
1.6
2.8
1.4
2.7
1.4
2.0
1.3
1.5
0.3
1.6
1.7
3.7
1.7
Females
1529
years
5.3
12.7
5.1
0.2
5.2
8.4
4.5
6.0
8.9
12.1
8.1
4.4
8.0
4.3
22.7
22.5
22.8
3044
years
3.7
7.7
3.5
0.3
2.7
5.7
1.5
2.7
5.5
8.3
4.6
1.9
3.1
1.9
15.1
11.9
15.3
4559
years
1.9
2.9
1.8
0.3
1.0
1.9
0.5
0.6
2.4
3.1
2.2
0.5
0.5
0.5
5.5
5.0
5.6
560
years
0.5
0.3
0.6
0.1
0.1
0.1
0.1
0.2
0.4
0.3
0.4
0.2
0.0
0.2
1.5
0.8
1.6
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
282
TABLE A.5
Estimated mortality caused by war-related injuries,a by sex, age group, WHO region and income level, 2000
Absolute numbers (in thousands)b
WHO region
Income level
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
Totalc
310
<1
310
167
2
<1
2
63
37
<1
37
39
<1
39
2
0
2
All
ages
233
<1
233
122
2
<1
2
49
30
<1
30
29
<1
28
1
0
1
04
years
22
<1
22
7
<1
0
<1
2
1
0
1
12
<1
12
0
0
0
514
years
30
<1
30
18
<1
0
<1
6
3
0
3
3
<1
3
<1
0
<1
Males
1529
years
69
<1
69
36
<1
0
<1
18
8
<1
8
7
<1
7
<1
0
<1
3044
years
58
<1
58
33
<1
0
<1
13
9
<1
9
3
<1
3
<1
0
<1
4559
years
29
<1
29
16
<1
<1
<1
5
5
<1
5
2
<1
2
0
0
0
560
years
25
<1
25
13
<1
<1
<1
5
4
<1
4
2
<1
2
<1
0
<1
All
agese
7.8
0.0
9.4
50.6
0.4
0.0
0.7
6.6
7.0
0.0
13.0
11.2
3.7
11.3
0.2
0.0
0.2
04
years
7.1
0.0
7.8
13.3
0.3
0.0
0.4
1.9
4.2
0.0
7.1
34.6
2.5
34.8
0.0
0.0
0.0
514
years
4.9
0.0
5.4
20.4
0.3
0.0
0.4
3.3
5.3
0.0
8.5
4.1
2.3
4.2
0.3
0.0
0.3
Males
1529
years
8.6
0.0
9.8
40.4
0.4
0.0
0.6
8.0
8.0
0.0
13.3
9.8
3.6
9.9
0.1
0.0
0.1
3044
years
9.1
0.0
10.9
67.2
0.5
0.0
0.9
8.2
8.7
0.0
16.5
7.5
2.9
7.6
0.2
0.0
0.2
4559
years
7.1
0.0
9.0
62.1
0.3
0.0
0.5
5.9
7.2
0.0
14.5
8.2
4.1
8.3
0.0
0.0
0.0
560
years
9.2
0.0
12.7
92.6
0.6
0.1
1.3
10.0
6.3
0.0
14.3
15.4
7.2
15.6
0.3
0.0
0.4
All
ages
6.8
0.1
7.5
23.9
0.4
0.0
0.5
5.5
5.0
0.0
6.2
04
years
8.2
0.1
8.3
10.1
0.7
0.0
0.8
2.6
10.2
0.0
11.5
514
years
11.0
0.2
11.3
23.4
1.5
0.0
1.8
7.0
19.7
0.0
21.8
Males
1529
years
7.8
0.0
8.4
28.1
0.3
0.0
0.4
7.1
6.2
0.0
7.6
3044
years
7.1
0.0
7.7
30.4
0.4
0.0
0.5
6.3
4.8
0.0
5.5
4559
years
4.9
0.1
5.4
22.7
0.2
0.0
0.3
3.7
3.6
0.0
4.3
560
years
4.3
0.0
5.3
21.8
0.4
0.0
0.6
3.9
3.3
0.0
5.1
Totalc, e
5.2
0.0
6.2
32.0
0.2
0.0
0.4
4.4
4.2
0.0
7.6
8.1
2.7
8.2
0.1
0.0
0.1
Totalc
6.1
0.0
6.8
22.3
0.4
0.0
0.5
4.6
4.5
0.0
5.8
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
middle
04
years
8
<1
8
5
<1
0
<1
<1
<1
0
<1
2
<1
2
0
0
0
514
years
14
<1
14
10
<1
0
<1
1
1
<1
1
2
<1
2
<1
0
<1
Females
1529
years
26
<1
26
18
<1
0
<1
4
1
0
1
3
<1
3
0
0
0
3044
years
14
<1
14
6
<1
0
<1
4
3
<1
3
1
<1
1
<1
0
<1
4559
years
8
<1
8
4
<1
0
<1
2
1
0
1
1
<1
1
0
0
0
560
years
8
<1
8
3
<1
0
<1
3
<1
<1
<1
2
<1
2
0
0
0
All
agese
2.6
0.0
3.0
14.7
0.1
0.0
0.1
2.2
1.5
0.0
2.6
4.9
1.0
4.9
0.1
0.0
0.1
04
years
2.6
0.0
2.9
9.2
0.2
0.0
0.2
0.6
0.7
0.0
1.3
6.6
1.6
6.7
0.0
0.0
0.0
514
years
2.3
0.0
2.6
11.0
0.1
0.0
0.1
0.9
1.0
0.0
1.5
2.8
0.6
2.8
0.3
0.0
0.4
Females
1529
years
3.4
0.0
3.9
20.3
0.1
0.0
0.1
1.8
1.5
0.0
2.4
4.8
0.9
4.8
0.0
0.0
0.0
3044
years
2.2
0.0
2.7
12.9
0.1
0.0
0.1
2.5
3.0
0.0
5.6
2.0
1.3
2.1
0.1
0.0
0.1
4559
years
1.9
0.0
2.4
13.5
0.1
0.0
0.1
2.6
1.2
0.0
2.4
3.0
0.9
3.0
0.0
0.0
0.0
560
years
2.4
0.0
3.4
17.1
0.1
0.0
0.2
4.8
0.4
0.0
0.8
13.7
1.5
13.8
0.0
0.0
0.0
All
ages
4.7
0.0
5.2
18.8
0.3
0.0
0.5
3.0
3.1
0.0
4.5
04
years
3.5
0.1
3.6
8.0
0.5
0.0
0.6
1.1
2.6
0.0
2.9
514
years
6.6
0.3
6.7
20.6
0.7
0.0
0.9
1.5
8.5
0.6
9.5
Females
1529
years
7.3
0.0
7.7
34.2
0.4
0.0
0.5
2.9
5.1
0.0
6.4
3044
years
5.0
0.0
5.4
18.1
0.3
0.0
0.6
4.3
8.3
0.0
10.2
4559
years
3.7
0.0
4.1
15.5
0.2
0.0
0.5
4.4
2.6
0.0
3.2
560
years
2.1
0.0
2.8
12.9
0.1
0.0
0.3
3.5
0.4
0.0
0.8
All
African Regiond
Region of the Americas
all
high
low and
low and
all
high
low and
low and
all
high
low and
middle
middle
middle
middle
middle
283
All
ages
77
<1
77
45
<1
0
<1
14
6
<1
6
10
<1
10
1
0
1
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
284
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
middle
middle
middle
middle
middle
middle
middle
11.5
5.0
11.6
0.2
0.0
0.2
All
ages
13.4
4.9
13.5
0.2
0.0
0.2
04
years
35.6
10.2
35.6
0.0
0.0
0.0
514
years
10.1
11.9
10.1
0.7
0.0
0.7
Males
1529
years
11.2
4.1
11.3
0.2
0.0
0.2
3044
years
8.0
3.8
8.0
0.2
0.0
0.3
4559
years
7.0
5.1
7.0
0.0
0.0
0.0
560
years
7.9
5.9
8.0
0.2
0.0
0.2
All
ages
0.8
0.0
0.9
2.3
0.1
0.0
0.1
0.6
0.6
0.0
1.0
1.3
0.8
1.3
0.0
0.0
0.0
04
years
0.4
0.0
0.4
0.3
0.0
0.0
0.1
0.1
0.8
0.0
0.9
1.5
0.8
1.5
0.0
0.0
0.0
514
years
4.1
0.1
4.2
8.3
0.6
0.0
0.7
2.2
10.8
0.0
12.4
3.4
6.7
3.4
0.3
0.0
0.3
Males
1529
years
3.7
0.0
3.8
6.9
0.2
0.0
0.3
3.2
4.4
0.0
5.4
5.2
3.1
5.2
0.1
0.0
0.1
3044
years
1.9
0.0
2.1
3.7
0.2
0.0
0.2
1.6
2.2
0.0
2.7
1.9
1.6
1.9
0.1
0.0
0.1
4559
years
0.7
0.0
0.7
2.6
0.0
0.0
0.1
0.4
0.6
0.0
0.9
0.8
0.7
0.8
0.0
0.0
0.0
560
years
0.2
0.0
0.2
1.4
0.0
0.0
0.0
0.2
0.1
0.0
0.2
0.3
0.2
0.3
0.0
0.0
0.0
Totalc
0.6
0.0
0.7
1.6
0.0
0.0
0.1
0.4
0.4
0.0
0.6
1.0
0.6
1.0
0.0
0.0
0.0
STATISTICAL ANNEX
All
African Regiond
Region of the Americas
all
high
low and middle
all
high
low and middle
middle
middle
middle
middle
middle
middle
middle
285
All
ages
8.4
5.6
8.4
0.1
0.0
0.1
04
years
6.2
10.6
6.2
0.0
0.0
0.0
514
years
8.0
8.2
8.0
1.4
0.0
1.4
Females
1529
years
11.3
5.6
11.3
0.0
0.0
0.0
3044
years
5.5
5.4
5.5
0.1
0.0
0.2
4559
years
7.1
4.0
7.1
0.0
0.0
0.0
560
years
12.5
3.4
12.5
0.0
0.0
0.0
All
ages
0.3
0.0
0.4
0.9
0.0
0.0
0.0
0.2
0.1
0.0
0.2
0.5
0.3
0.5
0.0
0.0
0.0
04
years
0.1
0.0
0.2
0.2
0.0
0.0
0.0
0.0
0.2
0.0
0.2
0.3
0.6
0.3
0.0
0.0
0.0
514
years
1.9
0.1
1.9
4.3
0.2
0.0
0.2
0.5
3.1
0.2
3.6
2.1
2.5
2.1
0.5
0.0
0.5
Females
1529
years
1.5
0.0
1.5
2.3
0.1
0.0
0.1
0.7
2.3
0.0
2.8
2.4
2.3
2.4
0.0
0.0
0.0
3044
years
0.7
0.0
0.7
0.8
0.1
0.0
0.1
0.7
2.0
0.0
2.7
0.6
1.1
0.6
0.0
0.0
0.0
4559
years
0.3
0.0
0.3
0.9
0.0
0.0
0.0
0.3
0.3
0.0
0.4
0.4
0.2
0.4
0.0
0.0
0.0
560
years
0.1
0.0
0.1
0.3
0.0
0.0
0.0
0.1
0.0
0.0
0.0
0.3
0.0
0.3
0.0
0.0
0.0
Income level
all
high
low and
low and
all
high
low and
low and
all
high
low and
all
high
low and
all
high
low and
286
TABLE A.6
The ten leading causes of death and DALYs, and rankings for violence-related deaths and DALYs, by WHO region, 2000
ALL MEMBER STATES
Total
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
13
22
30
Proportion of total
(%)
12.4
9.2
6.9
5.3
4.5
4.4
3.8
3.0
2.3
2.2
1.5
0.9
0.6
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
17
21
32
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
16
19
26
Perinatal conditions
Lower respiratory infections
HIV/AIDS
Diarrhoeal diseases
Ischaemic heart disease
Road traffic injuries
Unipolar depressive disorders
Cerebrovascular disease
Tuberculosis
Malaria
Interpersonal violence
Self-inflicted injuries
War
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
18
43
49
HIV/AIDS
Lower respiratory infections
Perinatal conditions
Unipolar depressive disorders
Diarrhoeal diseases
Ischaemic heart disease
Cerebrovascular disease
Malaria
Congenital anomalies
Chronic obstructive pulmonary disease
Self-inflicted injuries
Interpersonal violence
War
Proportion of total
(%)
6.4
6.2
6.1
4.4
4.2
3.8
3.1
2.8
2.7
2.4
1.3
1.1
0.7
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
13
17
27
Proportion of total
(%)
12.2
8.1
7.0
5.0
4.6
4.4
4.0
3.5
3.1
3.0
1.7
1.4
0.8
Proportion of total
(%)
6.4
6.4
5.8
4.2
4.2
4.0
3.4
3.0
2.9
2.5
1.6
1.5
1.0
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
17
37
46
Proportion of total
(%)
12.6
10.4
6.9
5.6
4.4
4.4
3.6
2.4
2.1
1.9
1.2
0.5
0.3
Proportion of total
(%)
6.5
6.4
6.0
5.5
4.2
3.4
3.2
3.0
2.2
2.1
1.1
0.5
0.4
STATISTICAL ANNEX
287
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
13
35
61
Proportion of total
(%)
17.9
10.7
5.6
4.7
3.5
3.2
2.3
2.0
2.0
1.8
1.5
0.3
0.0
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
12
31
88
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
19
21
31
Proportion of total
(%)
8.8
6.7
5.4
4.9
4.3
3.1
3.0
2.7
2.5
2.5
2.0
0.7
0.0
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
14
21
27
Proportion of total
(%)
11.5
8.9
7.3
6.1
5.1
4.7
4.4
3.4
2.4
2.3
1.5
1.0
0.7
Proportion of total
(%)
6.8
6.7
6.6
4.6
4.6
4.0
3.5
3.0
2.9
2.8
1.2
1.1
0.8
288
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
11
14
42
HIV/AIDS
Lower respiratory infections
Malaria
Diarrhoeal diseases
Perinatal conditions
Measles
Tuberculosis
Ischaemic heart disease
Cerebrovascular disease
Road traffic injuries
War
Homicide
Suicide
Proportion of total
(%)
22.6
10.1
9.1
6.7
5.5
4.3
3.6
3.1
2.9
1.6
1.6
1.1
0.3
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
11
15
58
HIV/AIDS
Malaria
Lower respiratory infections
Perinatal conditions
Diarrhoeal diseases
Measles
Tuberculosis
Whooping cough
Road traffic injuries
Proteinenergy malnutrition
War
Interpersonal violence
Self-inflicted injuries
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
12
44
HIV/AIDS
Lower respiratory infections
Malaria
Perinatal conditions
Diarrhoeal diseases
Measles
Tuberculosis
Road traffic injuries
War
Whooping cough
Interpersonal violence
Self-inflicted injuries
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
18
25
69
HIV/AIDS
Malaria
Lower respiratory infections
Diarrhoeal diseases
Perinatal conditions
Measles
Tuberculosis
Whooping cough
Proteinenergy malnutrition
Unipolar depressive disorders
War
Interpersonal violence
Self-inflicted injuries
Proportion of total
(%)
20.6
10.1
8.6
6.3
6.1
4.5
2.8
1.8
1.6
1.6
1.6
1.0
0.2
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
13
28
HIV/AIDS
Lower respiratory infections
Malaria
Diarrhoeal diseases
Perinatal conditions
Tuberculosis
Measles
Ischaemic heart disease
War
Cerebrovascular disease
Homicide
Suicide
Proportion of total
(%)
20.9
11.2
8.4
7.2
6.1
4.8
4.2
2.9
2.3
2.1
1.5
0.4
Proportion of total
(%)
18.7
9.6
9.5
7.2
6.7
4.5
3.6
2.1
2.1
1.8
1.4
0.3
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
17
22
53
HIV/AIDS
Malaria
Lower respiratory infections
Diarrhoeal diseases
Perinatal conditions
Measles
Cerebrovascular disease
Ischaemic heart disease
Tuberculosis
Whooping cough
War
Homicide
Suicide
Proportion of total
(%)
24.4
9.9
8.9
6.1
4.8
4.4
3.7
3.3
2.4
1.6
0.9
0.7
0.1
Proportion of total
(%)
22.4
10.7
7.6
5.5
5.4
4.5
1.9
1.9
1.5
1.4
1.0
0.7
0.1
STATISTICAL ANNEX
289
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
11
14
42
HIV/AIDS
Lower respiratory infections
Malaria
Diarrhoeal diseases
Perinatal conditions
Measles
Tuberculosis
Ischaemic heart disease
Cerebrovascular disease
Road traffic injuries
War
Homicide
Suicide
Proportion of total
(%)
22.6
10.1
9.1
6.7
5.5
4.3
3.6
3.1
2.9
1.6
1.6
1.1
0.3
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
11
15
58
HIV/AIDS
Malaria
Lower respiratory infections
Perinatal conditions
Diarrhoeal diseases
Measles
Tuberculosis
Whooping cough
Road traffic injuries
Proteinenergy malnutrition
War
Interpersonal violence
Self-inflicted injuries
Proportion of total
(%)
20.6
10.1
8.6
6.3
6.1
4.5
2.8
1.8
1.6
1.6
1.6
1.0
0.2
290
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
21
62
Proportion of total
(%)
15.6
7.7
4.4
3.9
3.7
3.5
2.7
2.6
2.4
2.3
1.1
0.0
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
26
86
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
19
73
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
27
42
87
Proportion of total
(%)
8.1
4.4
4.4
3.9
3.8
3.3
3.2
2.7
2.6
2.6
1.1
0.0
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
15
51
Proportion of total
(%)
15.5
6.5
4.6
4.5
4.1
3.6
3.3
3.1
2.8
2.4
1.6
0.1
Proportion of total
(%)
6.6
6.2
5.5
4.9
4.5
4.1
2.8
2.7
2.6
2.5
1.5
0.1
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
30
32
66
Proportion of total
(%)
15.7
9.1
4.7
4.5
3.4
3.2
3.2
2.7
2.3
2.0
0.6
0.5
0.3
Proportion of total
(%)
11.2
3.8
3.8
3.7
2.8
2.8
2.7
2.6
2.0
2.0
0.9
0.6
0.0
STATISTICAL ANNEX
291
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
14
22
66
Proportion of total
(%)
20.8
7.0
6.6
4.5
4.0
2.8
2.8
2.2
2.0
1.8
1.3
0.7
0.0
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
12
18
87
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
30
82
Proportion of total
(%)
11.0
7.1
6.7
3.4
3.3
3.2
3.1
2.8
2.8
2.6
1.7
1.4
0.0
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
24
60
Proportion of total
(%)
11.2
8.2
4.7
4.5
4.4
4.2
2.9
2.7
2.6
2.4
0.9
0.1
Proportion of total
(%)
6.7
5.1
4.8
3.4
3.4
3.2
3.2
3.1
3.1
2.8
0.8
0.1
292
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
16
28
34
Proportion of total
(%)
13.7
9.5
7.1
6.7
5.7
4.8
3.1
2.6
2.2
1.9
1.2
0.5
0.4
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
19
38
41
Perinatal conditions
Lower respiratory infections
Diarrhoeal diseases
Unipolar depressive disorders
Ischaemic heart disease
Tuberculosis
Road traffic injuries
Congenital anomalies
HIV/AIDS
Anaemia
Self-inflicted injuries
Interpersonal violence
War
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
17
27
32
Perinatal conditions
Lower respiratory infections
Diarrhoeal diseases
Road traffic injuries
Ischaemic heart disease
Tuberculosis
Unipolar depressive disorders
HIV/AIDS
Congenital anomalies
Hearing loss, adult onset
Self-inflicted injuries
War
Interpersonal violence
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
25
51
63
Perinatal conditions
Lower respiratory infections
Unipolar depressive disorders
Diarrhoeal diseases
Ischaemic heart disease
Tuberculosis
Congenital anomalies
Anaemia
Cerebrovascular disease
HIV/AIDS
Self-inflicted injuries
Interpersonal violence
War
Proportion of total
(%)
8.9
7.4
5.5
4.7
4.4
3.5
3.3
3.0
2.7
2.3
1.2
0.5
0.5
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
14
22
25
Proportion of total
(%)
13.6
9.8
7.1
6.8
5.3
5.1
4.3
3.1
2.1
1.9
1.4
0.7
0.6
Proportion of total
(%)
9.0
7.2
5.4
5.0
4.8
4.0
3.7
3.3
3.1
2.1
1.3
0.8
0.7
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
20
37
48
Proportion of total
(%)
13.9
9.0
7.5
6.3
6.2
4.3
2.3
2.0
2.0
1.8
0.9
0.4
0.2
Proportion of total
(%)
8.7
7.6
5.7
5.6
4.1
3.1
2.9
2.7
2.1
2.1
1.0
0.3
0.2
STATISTICAL ANNEX
293
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
16
28
34
Proportion of total
(%)
13.7
9.5
7.1
6.7
5.7
4.8
3.1
2.6
2.2
1.9
1.2
0.5
0.4
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
19
38
41
Perinatal conditions
Lower respiratory infections
Diarrhoeal diseases
Unipolar depressive disorders
Ischaemic heart disease
Tuberculosis
Road traffic injuries
Congenital anomalies
HIV/AIDS
Anaemia
Self-inflicted injuries
Interpersonal violence
War
Proportion of total
(%)
8.9
7.4
5.5
4.7
4.4
3.5
3.3
3.0
2.7
2.3
1.2
0.5
0.5
294
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
18
34
Proportion of total
(%)
24.3
15.4
3.9
3.0
2.8
2.5
1.9
1.9
1.8
1.6
0.8
0.4
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
18
33
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
15
26
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
21
34
58
Proportion of total
(%)
10.1
6.8
6.0
3.4
3.0
2.6
2.5
2.4
2.3
2.2
1.4
0.7
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
14
29
Proportion of total
(%)
23.4
11.6
6.0
3.6
3.0
3.0
2.4
2.2
2.2
1.9
1.2
0.6
Proportion of total
(%)
11.0
5.6
5.1
4.0
3.7
3.4
3.2
2.6
2.5
2.1
1.9
1.0
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
16
28
44
Proportion of total
(%)
25.2
19.3
3.3
3.1
2.5
2.0
2.0
1.8
1.6
1.6
0.8
0.4
0.1
Proportion of total
(%)
9.0
8.6
8.3
4.2
2.9
2.8
2.5
2.3
2.0
1.8
1.1
0.7
0.3
STATISTICAL ANNEX
295
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
15
44
68
Proportion of total
(%)
18.4
11.3
5.1
4.1
3.4
3.4
2.3
2.1
1.9
1.8
1.3
0.1
0.0
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
14
53
86
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
12
24
Proportion of total
(%)
7.9
7.5
6.1
5.3
5.1
3.1
2.9
2.7
2.5
2.4
1.9
0.2
0.0
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
13
21
Proportion of total
(%)
28.3
18.1
3.1
2.4
2.3
2.3
2.1
1.8
1.8
1.8
1.3
0.6
Proportion of total
(%)
11.4
7.7
5.1
3.0
2.9
2.5
2.4
2.3
2.2
2.1
1.9
1.0
296
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
18
21
25
Proportion of total
(%)
10.5
9.1
7.5
7.1
5.3
3.4
2.3
2.2
2.0
1.8
1.0
0.8
0.6
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
20
29
34
Perinatal conditions
Lower respiratory infections
Diarrhoeal diseases
Unipolar depressive disorders
Congenital anomalies
Ischaemic heart disease
Road traffic injuries
Tuberculosis
Measles
Cerebrovascular disease
War
Interpersonal violence
Self-inflicted injuries
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
15
25
37
Perinatal conditions
Lower respiratory infections
Diarrhoeal diseases
Road traffic injuries
Ischaemic heart disease
Congenital anomalies
Tuberculosis
Unipolar depressive disorders
Measles
Cerebrovascular disease
War
Interpersonal violence
Self-inflicted injuries
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
36
39
40
Proportion of total
(%)
8.4
8.4
6.9
3.5
3.3
3.1
2.5
2.2
2.2
2.0
1.0
0.7
0.5
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
15
21
26
Proportion of total
(%)
11.7
8.6
7.6
6.7
5.0
4.3
3.2
2.1
1.9
1.8
1.3
0.9
0.6
Proportion of total
(%)
8.9
8.3
6.7
3.7
3.6
3.3
2.8
2.8
2.1
2.0
1.5
0.9
0.5
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
26
27
29
Proportion of total
(%)
9.6
9.2
7.5
7.4
5.7
2.3
2.2
2.1
2.0
1.7
0.6
0.6
0.5
Proportion of total
(%)
8.4
7.9
7.1
4.2
3.2
2.6
2.3
2.2
2.0
1.7
0.6
0.6
0.5
STATISTICAL ANNEX
297
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
16
22
27
Proportion of total
(%)
20.7
11.3
6.3
4.2
3.1
2.3
2.3
2.2
1.8
1.6
1.0
0.8
0.6
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
22
31
35
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
20
29
34
Perinatal conditions
Lower respiratory infections
Diarrhoeal diseases
Unipolar depressive disorders
Congenital anomalies
Ischaemic heart disease
Road traffic injuries
Tuberculosis
Measles
Cerebrovascular disease
War
Interpersonal violence
Self-inflicted injuries
Proportion of total
(%)
7.5
7.2
6.9
5.5
3.4
3.1
2.7
2.5
2.3
2.3
1.0
0.7
0.6
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
18
20
26
Proportion of total
(%)
10.4
9.1
7.6
7.1
5.3
3.4
2.2
2.2
2.0
1.8
1.0
0.8
0.6
Proportion of total
(%)
8.5
8.4
6.9
3.5
3.3
3.1
2.5
2.2
2.2
2.0
1.0
0.7
0.5
298
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
27
66
Cerebrovascular disease
Chronic obstructive pulmonary disease
Ischaemic heart disease
Lower respiratory infections
Trachea, bronchus and lung cancers
Liver cancer
Stomach cancer
Suicide
Tuberculosis
Perinatal conditions
Homicide
War
Proportion of total
(%)
16.2
13.8
8.2
4.7
3.5
3.5
3.2
3.0
3.0
2.8
0.5
0.0
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
33
85
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
13
27
75
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
51
86
Proportion of total
(%)
7.3
5.8
5.8
5.2
4.6
3.7
3.2
3.0
2.8
2.6
0.7
0.1
Males
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
23
56
Cerebrovascular disease
Chronic obstructive pulmonary disease
Ischaemic heart disease
Liver cancer
Trachea, bronchus and lung cancers
Lower respiratory infections
Stomach cancer
Road traffic injuries
Tuberculosis
Suicide
Homicide
War
Proportion of total
(%)
15.8
13.1
8.3
4.5
4.5
4.0
3.8
3.4
3.3
2.7
0.7
0.0
Proportion of total
(%)
7.3
6.1
4.9
4.8
4.6
4.3
3.2
3.1
2.8
2.7
2.3
0.9
0.1
Females
Rank
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
39
67
Cerebrovascular disease
Chronic obstructive pulmonary disease
Ischaemic heart disease
Lower respiratory infections
Suicide
Perinatal conditions
Hypertensive heart disease
Tuberculosis
Stomach cancer
Trachea, bronchus and lung cancers
Homicide
War
Proportion of total
(%)
16.6
14.6
8.1
5.6
3.5
3.2
2.8
2.7
2.5
2.3
0.3
0.0
Proportion of total
(%)
7.2
7.1
5.9
5.5
4.9
3.5
3.3
2.6
2.5
2.4
0.4
0.0
STATISTICAL ANNEX
299
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
43
a
Cerebrovascular disease
Ischaemic heart disease
Lower respiratory infections
Trachea, bronchus and lung cancers
Stomach cancer
Colon and rectum cancers
Liver cancer
Suicide
Road traffic injuries
Diabetes mellitus
Homicide
War
Proportion of total
(%)
15.7
10.8
7.4
5.3
5.1
3.4
3.3
2.4
2.2
2.1
0.2
a
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
52
a
Cerebrovascular disease
Unipolar depressive disorders
Ischaemic heart disease
Osteoarthritis
Road traffic injuries
Alcohol use disorders
Self-inflicted injuries
Stomach cancer
Diabetes mellitus
Trachea, bronchus, lung cancers
Interpersonal violence
War
Rank
Cause
DALYs
1
2
3
4
5
6
7
8
9
10
32
83
Proportion of total
(%)
7.6
6.4
4.2
3.4
3.4
3.1
2.9
2.7
2.7
2.6
0.3
a
Cause
Deaths
1
2
3
4
5
6
7
8
9
10
26
64
Cerebrovascular disease
Chronic obstructive pulmonary disease
Ischaemic heart disease
Lower respiratory infections
Liver cancer
Tuberculosis
Trachea, bronchus and lung cancers
Perinatal conditions
Suicide
Stomach cancer
Homicide
War
Proportion of total
(%)
16.2
15.5
7.8
4.4
3.5
3.3
3.3
3.2
3.1
3.0
6.0
0.0
Proportion of total
(%)
7.7
5.8
5.7
5.5
5.0
3.7
3.3
2.8
2.8
2.6
0.7
0.1
300
TABLE A.7
Mortality caused by intentional injury,a by sex, age group and country, most recent year available between 1990
and 2000b
Country or area
Year
Albania
1998
Argentina
1996
Armenia
1999
Australia
1998
Austria
1999
Azerbaijan
1999
Bahamas
19951997
Barbados
19931995
Belarus
1999
Belgium
1995
Brazil
1995
Bulgaria
1999
Canada
1997
Chile
1994
China
(Hong Kong SAR)
1996
Selected urban
and rural areas
1999
Colombia
1995
Costa Rica
1995
Croatia
1999
Cuba
1997
Czech Republic
1999
Denmark
1996
Ecuador
1996
El Salvador
1991
Estonia
1999
Finland
1998
Measurec
Totald, e
Males
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
846
26.7
3 980
11.4
167
4.3
2 954
14.9
1 629
16.3
430
5.8
47
16.0
36
14.0
4 537
41.4
2 330
19.5
43 866
27.7
1 550
14.9
4 145
12.8
1 226
9.0
All
agesd
689
46.4
3 145
19.0
128
6.9
2 325
23.6
1 161
25.0
367
10.0
40
28.4
28
22.1
3 664
72.5
1 653
28.9
39 046
50.2
1 143
23.5
3 222
20.1
1 070
16.5
04
years
4
37
2.1
2
99
1.2
4
14
10
514
years
16
85
1.7
3
23
1.1
7
10
27
2.7
14
573
2.2
12
65
2.1
16
1529
years
333
93.1
936
21.0
29
5.9
727
34.6
174
22.1
185
17.5
21
50.4
11
755
67.6
276
26.6
20 183
89.1
156
17.0
784
24.8
365
19.7
3044
years
193
53.2
720
21.9
45
10.4
803
37.4
304
29.6
107
12.6
11
1 226
105.9
505
42.7
12 011
71.9
227
27.2
1 091
28.4
329
21.5
4559
years
103
45.9
689
28.5
27
12.0
435
25.7
279
36.7
41
10.9
3
968
125.6
395
44.4
4 344
49.5
293
37.0
758
28.7
191
22.2
560
years
39
27.8
678
34.1
22
10.3
328
24.0
394
60.4
24
8.3
2
685
101.5
460
50.4
1 835
35.8
451
57.9
510
23.8
159
28.1
No.
Rate
No.
863
12.3
19 276
548
15.9
9 719
16
14
143
105
15.0
1 766
181
19.8
2 702
103
20.0
1 944
141
33.6
3 148
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
15.5
24 728
65.1
394
12.0
1 134
21.4
2 819
23.5
1 769
14.4
955
14.8
2 242
20.8
2 776
61.9
701
42.9
1 355
23.3
15.9
22 685
122.4
330
20.1
825
34.8
2 024
33.9
1 386
24.1
670
21.6
1 905
36.0
2 491
119.2
546
74.0
1 053
37.3
56
2.3
3
1.1
310
4.6
9
17
34
1.6
31
2.9
4
10.1
12 169
220.5
124
24.9
131
27.1
511
35.7
245
19.9
92
16.7
872
50.7
1 464
204.9
102
63.6
188
38.1
17.2
7 272
191.3
124
32.9
207
39.6
581
44.4
335
31.8
178
29.9
643
58.5
552
143.2
156
101.8
334
57.3
20.7
2 141
116.5
50
27.0
197
49.8
375
42.7
426
39.6
184
34.6
234
41.5
250
106.3
167
138.7
312
57.2
47.7
737
65.1
21
18.3
281
86.2
533
78.0
370
49.1
210
47.1
117
32.6
192
125.2
115
112.8
213
52.8
STATISTICAL ANNEX
Country or area
Year
Albania
1998
Argentina
1996
Armenia
1999
Australia
1998
Austria
1999
Azerbaijan
1999
Bahamas
19951997
Barbados
19931995
Belarus
1999
Belgium
1995
Brazil
1995
Bulgaria
1999
Canada
1997
Chile
1994
China
Hong Kong SAR
1996
Selected urban
and rural areas
1999
Colombia
1995
Costa Rica
1995
Croatia
1999
Cuba
1997
Czech Republic
1999
Denmark
1996
Ecuador
1996
El Salvador
1991
Estonia
1999
Finland
1998
Measurec
301
Females
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
All
agesd
156
9.1
835
4.4
39
1.9
629
6.2
468
8.4
63
1.8
7
873
14.2
677
10.7
4 820
6.0
407
7.1
923
5.6
156
2.2
04
years
5
35
2.1
0
10
84
1.0
1
10
514
years
10
60
1.2
2
13
13
302
1.2
5
32
1.1
12
1529
years
76
17.4
214
4.9
3
161
7.9
50
6.5
14
143
13.2
73
1 977
8.7
44
5.0
189
6.2
50
2.7
3044
years
39
10.8
176
5.2
10
209
9.7
101
10.3
22
2.4
3
215
18.1
195
17.0
1 518
8.8
64
7.7
303
8.0
42
2.7
4559
years
16
160
6.2
8
118
7.2
109
14.3
12
219
24.9
156
17.5
569
6.0
86
10.1
233
8.7
25
2.7
560
years
11
190
7.1
16
117
7.1
201
20.6
11
279
22.8
241
19.2
370
6.0
207
20.7
156
5.7
22
2.9
No.
Rate
No.
315
8.6
9 557
19
13
120
65
9.0
2 117
83
8.8
2 587
39
8.9
1 757
110
23.4
2 957
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
15.2
2 043
10.4
64
3.7
309
9.9
795
13.4
383
5.7
285
8.3
337
5.8
285
11.5
155
16.3
302
9.9
34
1.5
1
1.0
151
2.3
4
14
28
1.4
23
2.2
4
13.1
982
17.8
31
6.5
21
4.5
208
15.1
54
4.6
21
4.0
185
11.0
164
21.6
14
9.2
43
9.1
17.5
575
14.2
20
5.3
50
9.9
212
16.1
64
6.3
73
12.8
70
6.4
50
11.6
35
22.7
77
13.7
19.6
218
10.9
7
74
17.1
164
18.1
99
8.9
90
17.2
24
4.2
29
11.4
43
29.7
99
18.4
40.5
83
6.0
1
160
31.1
193
26.3
156
14.0
99
16.8
24
5.9
18
56
29.7
79
13.2
302
Year
Measurec
Totald, e
Males
All
agesd
France
1998
Georgia
1992
Germany
1999
Greece
1998
Guyana
19941996
Hungary
1999
Iceland
19941996
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kazakhstan
1992
Kuwait
1999
Kyrgyzstan
1999
Latvia
1999
Lithuania
1999
Luxembourg
19951997
Malta
19971999
Mauritius
1999
Mexico
1997
Netherlands
1999
New Zealand
1998
Nicaragua
1996
Norway
1997
Panama (excluding
Canal Zone)
1997
Paraguay
1994
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
10 997
15.6
214
4.1
11 928
11.5
548
4.3
126
19.1
3 628
29.5
29
10.6
498
13.4
430
7.3
5 416
7.3
24 300
15.1
5 844
36.7
97
4.2
906
22.6
1 075
38.6
1 856
45.8
75
15.4
25
6.1
214
17.5
17 153
19.8
1 729
9.5
638
16.6
522
14.4
575
11.8
453
8 058
24.1
160
6.8
8 532
17.7
425
6.9
99
32.3
2 724
49.0
24
17.8
398
21.6
335
12.1
4 108
11.8
16 376
21.4
4 569
60.3
71
5.1
727
38.1
806
64.4
1 498
80.5
55
23.4
19
144
23.6
15 131
36.5
1 166
13.1
479
25.3
398
23.8
416
17.4
401
14
27
1.3
1
32
1.1
14
129
2.2
4
36
0.6
0
65
1.0
1
19
11
86
0.9
99
3.7
3
16
13
434
2.6
15
16
13
1 092
17.8
38
7.0
1 185
15.9
82
6.9
43
37.1
302
25.9
8
156
33.8
108
14.6
748
12.1
2 036
14.9
1 470
68.8
24
7.5
201
30.1
132
50.5
282
68.7
8
40
26.2
6 636
46.6
202
12.9
180
44.0
193
30.1
94
20.4
186
2 358
36.6
42
8.4
2 348
22.6
107
9.5
32
47.8
747
72.8
6
118
31.2
82
15.1
933
14.6
3 145
26.1
1 706
91.6
38
7.9
272
56.2
256
96.4
482
115.1
17
66
45.6
4 540
53.5
380
19.5
132
30.8
108
31.7
114
23.0
125
1 938
36.7
30
8.6
2 133
26.9
100
10.6
16
873
90.5
5
76
25.8
48
12.4
873
16.2
5 963
43.2
845
86.3
3
153
74.3
246
122.4
468
163.3
14
22
27.5
2 116
46.3
308
19.5
77
24.0
51
32.2
91
22.6
44
2 620
51.7
50
16.9
2 774
36.4
134
12.4
8
780
102.3
4
42
16.9
95
28.4
1 543
27.4
5 114
43.1
434
74.3
2
84
52.7
171
99.1
251
100.9
16
11
1 276
45.0
257
20.9
69
26.5
30
32.9
110
29.6
32
Rate
No.
Rate
17.0
577
15.9
30.1
508
28.6
11
48.5
203
31.8
45.3
162
37.2
28.0
76
39.8
31.1
53
50.4
STATISTICAL ANNEX
Country or area
Year
France
1998
Georgia
1992
Germany
1999
Greece
1998
Guyana
19941996
Hungary
1999
Iceland
19941996
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kazakhstan
1992
Kuwait
1999
Kyrgyzstan
1999
Latvia
1999
Lithuania
1999
Luxembourg
19951997
Malta
19971999
Mauritius
1999
Mexico
1997
Netherlands
1999
New Zealand
1998
Nicaragua
1996
Norway
1997
Panama (excluding
Canal Zone)
1997
Paraguay
1994
Measurec
303
Females
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
2 939
7.9
54
1.9
3 396
5.9
123
1.9
27
7.5
904
12.7
5
100
5.1
95
3.0
1 308
3.3
7 923
9.0
1 275
15.1
26
3.2
179
8.2
269
16.7
358
15.1
20
8.3
6
70
11.4
2 022
4.2
563
6.1
159
8.1
124
5.7
159
6.4
52
16
42
1.5
18
109
2.0
1
23
0.4
0
42
0.7
1
14
82
0.9
40
1.5
0
10
236
1.5
10
18
308
5.1
12
303
4.3
15
13
73
6.6
1
26
5.8
14
173
2.9
903
6.9
299
14.6
6
56
8.5
27
10.7
44
11.0
3
29
19.7
825
5.7
96
6.3
58
14.2
71
10.9
28
6.3
22
721
11.1
13
685
7.0
26
2.3
8
173
16.9
0
24
6.2
25
4.4
252
4.0
1 139
9.6
354
18.6
18
39
7.9
63
23.5
78
18.4
7
26
18.8
467
5.2
156
8.3
51
11.3
17
46
9.7
10
781
14.7
9
783
10.0
37
3.8
4
222
20.8
1
24
8.3
8
279
5.0
2 078
14.9
239
21.8
1
21
9.4
66
27.3
87
25.6
5
195
4.0
147
9.6
22
6.8
10
47
12.1
5
1 098
15.8
20
4.4
1 567
14.3
44
3.4
2
422
34.8
2
24
7.8
45
10.4
588
7.8
3 679
23.7
325
30.1
1
48
20.9
103
31.8
135
31.4
5
190
5.7
153
9.4
19
37
7.5
6
Rate
No.
Rate
3.7
69
3.7
5.9
25
4.0
19
10
304
Year
Philippines
1993
Poland
1995
Portugal
1999
Puerto Rico
1998
Republic of Korea
1997
Republic of
Moldova
1999
Romania
1999
Russian Federation
1998
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Saint Lucia
19931995
Sweden
1996
Switzerland
1996
Tajikistan
1995
Thailand
1994
The former
Yugoslav Republic
of Macedonia
Measurec
Totald, e
Males
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
8 677
15.9
6 619
16.0
671
5.2
1 129
28.6
7 061
14.9
999
7 770
28.5
5 364
27.3
494
8.3
1 022
53.7
4 794
21.3
794
20
0.4
12
17
80
0.6
82
1.8
4
11
71
1.3
15
3 296
34.9
944
21.8
70
6.0
557
112.6
1 141
17.2
150
3 039
53.4
1 919
42.1
98
9.3
238
65.2
1 646
26.3
255
1 041
35.4
1 485
50.2
85
10.0
125
45.1
1 125
33.9
221
294
20.0
922
37.9
234
27.0
89
38.1
794
45.3
149
1997
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
26.7
3 560
14.1
85 511
53.7
446
13.9
825
13.8
623
26.0
3 620
7.3
21
16.0
1 367
13.0
1 513
17.8
557
13.7
6 530
11.6
202
46.2
2 817
23.3
68 013
91.9
280
17.4
680
24.1
476
42.4
2 757
11.7
17
947
18.4
1 060
26.5
451
22.4
5 133
18.5
153
10
98
2.9
0
21
0.8
0
57
2.6
581
4.0
3
10
106
1.3
1
33.6
479
17.2
15 476
95.7
67
19.3
111
16.3
65
29.5
561
11.8
9
147
17.0
197
28.5
149
19.6
1 881
20.6
18
66.0
763
32.3
25 190
146.3
97
21.4
208
34.9
125
55.0
636
14.3
5
239
25.8
265
30.8
175
37.2
1 866
29.9
53
82.9
843
44.5
16 695
143.5
57
21.3
215
46.4
135
68.8
489
14.9
2
274
31.3
262
38.6
74
36.3
885
27.7
31
76.3
665
37.2
9 973
111.7
56
37.2
141
42.9
145
97.7
1 060
29.2
1
286
33.7
324
55.7
43
28.7
375
19.5
50
Trinidad and
Tobago
1994
Rate
No.
9.7
313
15.0
243
82
23.5
78
19.7
52
39.1
27
Turkmenistan
1998
Ukraine
1999
United Kingdom
1999
Rate
No.
Rate
No.
Rate
No.
Rate
No.
26.1
742
18.9
20 762
36.9
4 920
7.6
4 015
39.0
603
31.4
16 255
63.8
3 803
12.0
3 077
28
2.5
20
1.1
19
19
148
3.2
34
0.6
29
45.3
249
38.1
2 862
51.8
886
15.1
667
53.1
215
47.9
5 133
96.7
1 329
19.3
1 050
64.5
94
53.0
4 710
117.4
868
15.9
736
48.1
23
20.1
3 373
93.5
666
12.7
576
Rate
No.
Rate
6.9
145
8.8
10.8
123
14.9
0.6
1
12.9
49
25.9
17.2
50
27.6
15.2
15
12.3
8
England and
Wales
1999
Northern Ireland
1999
STATISTICAL ANNEX
Country or area
Year
Measurec
305
Females
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
907
3.3
1 255
5.6
177
2.5
107
5.1
2 267
9.2
205
11
14
19
46
0.4
25
0.6
8
72
1.5
11
403
4.4
168
4.0
18
43
8.9
663
10.5
28
226
4.0
379
8.4
33
3.0
30
7.2
690
11.6
49
136
4.6
301
9.4
25
2.7
13
363
10.8
48
86
4.7
368
10.1
90
7.6
14
460
17.2
64
9.9
743
5.5
17 498
19.2
166
10.4
145
4.5
147
11.4
863
3.2
3
420
7.7
453
9.9
106
5.3
1 397
4.9
49
11
90
2.8
0
15
20
1.0
303
2.2
0
78
1.0
1
6.3
114
4.2
3 000
19.3
50
14.5
18
15
122
2.7
2
48
5.8
53
7.7
38
5.0
550
6.2
6
11.8
157
6.7
4 342
24.8
30
6.7
42
7.2
28
12.3
174
4.0
0
90
10.2
102
12.2
31
6.4
418
6.7
18
15.4
177
8.8
3 862
28.6
29
11.1
40
8.0
48
24.6
162
4.8
0
132
15.5
114
16.9
15
210
6.3
5
21.3
264
11.1
5 902
34.5
56
32.4
44
8.8
56
24.6
399
8.3
0
139
12.7
176
21.8
21
11.0
126
5.3
19
Philippines
1993
Poland
1995
Portugal
1999
Puerto Rico
1998
Republic of Korea
1997
Republic of
Moldova
1999
Romania
1999
Russian Federation
1998
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Saint Lucia
19931995
Sweden
1996
Switzerland
1996
Tajikistan
1995
Thailand
1994
The former
Yugoslav Republic
of Macedonia
1997
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Trinidad and
Tobago
1994
Rate
No.
4.7
70
33
19
Turkmenistan
1998
Ukraine
1999
United Kingdom
1999
Rate
No.
Rate
No.
Rate
No.
Rate
No.
11.6
139
7.1
4 507
13.6
1 117
3.2
938
22
2.0
7
72
1.6
14
13
21.2
59
9.1
559
10.5
195
3.5
152
35
7.6
983
17.7
330
4.9
272
18
1 100
22.9
261
4.7
219
21
13.5
1 771
27.4
310
4.5
275
Rate
No.
Rate
3.0
22
2.7
3.1
11
4.6
8
4.5
1
4.5
2
England and
Wales
1999
Northern Ireland
1999
306
Year
Measurec
Totald, e
Males
All
agesd
Scotland
1999
United States of
America
1998
Uruguay
1990
Uzbekistan
1998
Venezuela
1994
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
760
14.1
49 586
603
22.9
38 974
396
894
170
33.4
12 511
229
38.7
11 688
117
25.3
6 885
82
18.7
6 600
Rate
No.
Rate
No.
Rate
No.
Rate
17.4
457
14.0
2 414
12.1
4 704
23.2
28.3
357
23.5
1 821
19.0
4 254
42.0
4.1
1
16
3.0
5
73
1.6
104
2.6
44.2
64
17.8
585
17.6
2 435
80.8
36.4
90
31.5
690
29.7
1 109
53.1
30.1
86
36.7
315
33.0
357
33.4
34.6
111
50.3
156
22.2
232
38.6
STATISTICAL ANNEX
Country or area
Scotland
Year
1999
United States of
America
1998
Uruguay
1990
Uzbekistan
1998
Venezuela
1994
Measurec
307
Females
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
157
5.4
10 612
326
613
32
6.5
2 297
50
8.4
3 524
41
8.5
2 170
33
5.4
1 682
Rate
No.
Rate
No.
Rate
No.
Rate
7.1
100
5.6
593
5.7
450
4.4
3.5
2
16
2.2
6
17
43
1.1
8.3
25
7.1
266
8.1
202
6.9
10.8
14
147
6.2
116
5.6
9.0
13
77
7.8
38
3.5
6.6
39
13.6
84
8.7
35
5.1
308
TABLE A.8
Mortality caused by homicide,a by sex, age group and country, most recent year available between 1990 and 2000b
Country or area
Year
Measurec
Totald, e
Males
All
agesd
Albania
1998
Argentina
1996
Armenia
1999
Australia
1998
Austria
1999
Azerbaijan
1999
Bahamas
19951997
Belarus
1999
Belgium
1995
Brazil
1995
Bulgaria
1999
Canada
1997
Chile
1994
China
Hong Kong SAR
1996
Selected urban
and rural areas
1999
Colombia
1995
Costa Rica
1995
Croatia
1999
Cuba
1997
Czech Republic
1999
Denmark
1996
Ecuador
1996
El Salvador
1993
Estonia
1999
Finland
1998
France
1998
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
660
21.0
1 611
4.7
98
2.6
295
1.6
68
0.8
375
5.0
43
14.9
1 123
10.5
169
1.6
37 076
23.0
238
2.6
431
1.4
410
3.0
573
38.7
1 347
8.1
77
4.2
201
2.1
32
0.8
323
8.7
37
26.1
784
15.6
100
1.9
33 751
42.5
174
4.0
285
1.9
356
5.4
37
2.1
2
99
1.2
4
14
10
35
1.0
1
10
436
2.5
1
12
286
79.9
514
11.5
20
4.1
59
2.8
3
176
16.6
20
48.4
203
18.2
24
2.3
18 400
81.2
38
4.1
100
3.2
125
6.7
165
45.5
371
11.3
29
6.7
66
3.1
15
86
10.1
10
303
26.2
34
2.9
10 352
61.9
47
5.6
76
2.0
118
7.7
84
37.2
239
9.9
16
42
2.5
4
32
8.5
3
171
22.1
22
2.5
3 393
38.7
48
6.1
48
1.8
58
6.7
27
19.4
152
7.6
9
17
19
102
15.1
16
1 071
20.9
36
4.6
35
1.6
41
7.2
No.
Rate
No.
63
1.0
2 405
39
1.3
1 655
16
44
514
10
684
264
133
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
1.8
23 443
61.6
179
5.4
128
2.6
747
6.2
151
1.4
59
1.1
1 632
15.3
2 480
55.6
227
14.8
125
2.2
436
0.7
2.5
21 705
116.8
153
9.3
95
4.0
584
9.6
97
1.8
36
1.4
1 501
28.2
2 290
108.4
168
23.1
90
3.3
269
0.9
56
2.3
3
14
0.5
239
5.5
1
21
1.5
35
5.1
0
12
3.0
11 730
212.5
57
11.5
17
263
18.4
22
1.8
12
684
39.8
1 043
133.1
29
18.0
15
56
0.9
4.4
7 039
185.1
62
16.6
33
6.3
210
16.0
36
3.4
14
535
48.7
659
165.4
59
38.4
38
6.5
80
1.2
2.8
2 016
109.7
22
12.2
22
5.6
63
7.2
27
2.5
4
178
31.5
344
139.5
56
46.3
22
4.0
75
1.4
2.0
625
55.2
7
21
6.4
36
5.3
8
78
21.8
201
122.7
23
22.2
13
32
0.6
STATISTICAL ANNEX
Country or area
Year
Albania
1998
Argentina
1996
Armenia
1999
Australia
1998
Austria
1999
Azerbaijan
1999
Bahamas
19951997
Belarus
1999
Belgium
1995
Brazil
1995
Bulgaria
1999
Canada
1997
Chile
1994
China
Hong Kong SAR
1996
Selected urban
and rural areas
1999
Colombia
1995
Costa Rica
1995
Croatia
1999
Cuba
1997
Czech Republic
1999
Denmark
1996
Ecuador
1996
El Salvador
1993
Estonia
1999
Finland
1998
France
1998
Measurec
309
Females
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
87
5.3
264
1.5
21
1.0
94
1.0
36
0.8
52
1.4
7
339
5.8
69
1.2
3 325
4.1
64
1.3
146
1.0
54
0.8
36
2.1
0
10
85
1.1
1
10
15
183
1.1
1
10
31
7.2
86
2.0
3
26
1.3
4
12
60
5.5
12
1 484
6.5
12
33
1.1
17
30
8.3
63
1.9
6
26
1.2
16
19
102
8.6
24
2.1
1 089
6.3
13
48
1.3
17
12
30
1.2
5
15
78
8.8
9
308
3.3
15
25
0.9
5
35
1.3
5
16
90
7.3
18
177
2.8
22
2.2
20
0.7
7
No.
Rate
No.
24
0.8
750
19
37
218
283
117
76
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
1.2
1 738
9.0
26
1.4
33
1.2
163
2.7
54
1.0
23
0.8
131
2.5
190
8.4
59
7.4
35
1.2
167
0.5
33
1.4
1
0.4
106
2.5
2
1.4
827
15.0
15
78
5.7
14
54
3.2
72
8.8
4
31
0.5
1.9
511
12.6
7
55
4.2
9
40
3.7
56
12.4
19
12
42
0.6
1.3
189
9.4
1
13
13
34
12.9
21
14.4
14
41
0.8
1.0
72
5.2
0
12
12
18
20
9.8
11
39
0.6
310
Year
Measurec
Totald, e
Males
All
agesd
Germany
1999
Greece
1998
Guyana
19941996
Hungary
1999
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kazakhstan
1999
Kuwait
1999
Kyrgyzstan
1999
Latvia
1999
Lithuania
1999
Mauritius
1999
Mexico
1997
Netherlands
1999
New Zealand
1998
Nicaragua
1996
Norway
1997
Panama (excluding
Canal Zone)
Paraguay
1997
1994
Philippines
1993
Poland
1995
Portugal
1999
Puerto Rico
1998
Republic of Korea
1997
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
720
0.9
144
1.2
42
6.6
291
2.6
30
0.8
30
0.5
720
1.1
719
0.6
2 448
17.1
39
2.2
341
8.6
308
11.6
297
7.5
33
2.9
13 542
15.9
203
1.3
57
1.5
285
8.4
41
0.9
293
10.9
459
12.6
7 726
14.2
1 088
2.7
118
1.1
804
20.6
987
2.0
410
11.2
418
1.0
109
1.9
35
11.8
170
3.2
21
1.2
24
0.9
561
1.8
435
0.7
1 841
27.4
26
2.4
266
14.2
213
17.3
209
11.3
19
12 170
29.6
144
1.7
32
1.7
246
15.1
28
1.3
265
19.8
420
23.4
7 181
26.4
785
4.0
82
1.6
731
38.1
602
2.4
307
18.0
04
years
514
years
1529
years
3044
years
4559
years
560
years
27
1.3
1
32
1.1
14
129
2.3
4
20
0.4
12
17
12
19
17
224
2.1
4
59
0.7
10
23
0.7
5
95
1.3
21
1.8
14
19
11
170
2.7
72
0.5
483
24.8
9
63
9.4
47
18.0
45
11.0
3
5 281
37.1
36
2.3
10
117
18.2
7
136
35.3
171
26.8
3 020
31.9
132
3.0
30
2.6
500
101.0
168
2.5
78
17.5
127
1.2
38
3.4
12
54
5.3
6
207
3.2
80
0.7
738
45.5
12
110
22.7
69
26.0
72
17.2
9
3 810
44.9
58
3.0
6
66
19.3
11
75
27.1
144
33.0
2 845
49.9
292
6.4
19
149
40.8
243
3.9
106
27.4
101
1.3
31
3.3
6
58
6.0
5
101
1.9
132
1.0
380
42.4
2
59
28.7
61
30.4
55
19.2
2
1 751
38.3
31
2.0
6
37
23.3
6
29
18.5
61
31.9
977
33.2
211
7.1
14
59
21.3
112
3.4
65
24.4
56
0.7
18
31
4.1
1
77
1.4
99
0.8
209
36.1
1
30
18.8
36
20.9
32
12.9
3
975
34.4
11
19
18
37
35.9
260
17.7
128
5.3
16
15
39
2.2
49
25.1
STATISTICAL ANNEX
Country or area
Year
Germany
1999
Greece
1998
Guyana
19941996
Hungary
1999
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kazakhstan
1999
Kuwait
1999
Kyrgyzstan
1999
Latvia
1999
Lithuania
1999
Mauritius
1999
Mexico
1997
Netherlands
1999
New Zealand
1998
Nicaragua
1996
Norway
1997
Panama (excluding
Canal Zone)
Paraguay
1997
1994
Philippines
1993
Poland
1995
Portugal
1999
Puerto Rico
1998
Republic of Korea
1997
Republic of Moldova
1999
Measurec
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
311
Females
All
agesd
04
years
514
years
302
0.7
35
0.5
7
121
2.0
9
159
0.5
284
0.4
607
7.9
13
75
3.5
95
6.6
88
4.0
14
1 372
3.1
59
0.8
25
1.3
39
2.2
13
28
2.0
39
2.2
545
2.1
303
1.4
36
0.7
73
3.7
385
1.6
103
5.2
16
42
1.5
2
110
2.0
1
11
14
19
17
21
0.3
19
97
0.9
4
33
0.4
5
19
1529
years
3044
years
4559
years
560
years
53
0.7
4
19
36
0.6
37
0.3
130
6.8
4
22
3.4
8
10
496
3.4
21
1.4
9
16
13
16
173
1.9
46
1.1
6
33
6.8
100
1.6
13
98
1.0
6
35
3.4
1
28
0.4
29
0.2
184
11.0
7
17
31
11.5
21
5.0
6
360
4.0
16
11
10
160
2.8
93
2.1
10
23
5.6
141
2.4
31
7.5
58
0.7
9
23
2.2
3
27
0.5
64
0.5
117
11.2
1
12
23
9.5
16
148
3.0
7
108
3.6
56
1.8
9
59
1.8
19
60
0.5
16
36
3.0
2
60
0.8
91
0.6
156
15.4
1
16
27
8.3
33
7.7
2
161
4.8
10
59
3.3
89
2.4
6
47
1.8
30
10.0
312
Year
Measurec
Totald, e
Males
All
agesd
Romania
1999
Russian Federation
1998
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Sweden
1996
Switzerland
1996
Tajikistan
1995
Thailand
1994
The former
1997
Yugoslav Republic
of Macedonia
Trinidad and Tobago 1994
Turkmenistan
1998
Ukraine
1999
United Kingdom
1999
1999
Northern Ireland
1999
Scotland
1999
United States of
America
Uruguay
1998
1990
Uzbekistan
1998
Venezuela
1994
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
803
3.3
33 553
21.6
45
1.3
132
2.3
30
1.3
355
0.8
110
1.2
77
1.1
354
8.5
4 161
7.5
47
572
4.8
25 130
34.0
29
1.7
89
3.2
20
1.8
255
1.2
74
1.5
48
1.4
301
14.3
3 481
12.6
38
10
99
2.9
0
21
0.8
0
12
147
1.3
0
83
1.4
0
122
4.4
6 067
37.5
9
21
3.1
3
70
1.5
11
10
107
14.0
1 138
12.5
5
164
6.9
10 595
61.5
13
38
6.4
6
91
2.1
28
3.0
17
129
27.4
1 394
22.3
19
140
7.4
5 792
49.8
5
18
50
1.5
21
2.4
11
38
18.6
628
19.7
7
124
6.9
2 429
27.2
2
12
39
1.1
14
21
14.0
217
11.3
7
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
2.2
146
12.1
333
8.6
6 260
11.7
440
0.8
295
0.6
24
1.4
121
2.4
17 893
6.9
136
4.4
790
4.1
3 353
16.0
3.7
108
17.1
279
14.6
4 421
17.8
335
1.2
214
0.9
20
2.4
101
4.1
13 652
10.7
105
7.1
567
6.0
3 120
29.7
28
2.5
20
1.1
19
396
4.1
1
15
41
1.2
10
257
1.3
1
18
60
2.3
39
21.6
116
17.8
941
17.0
108
1.8
68
1.3
4
36
7.1
6 670
23.6
22
6.0
178
5.3
1 926
63.9
35
23.8
114
25.5
1 674
31.6
109
1.6
61
1.0
11
37
6.3
3 984
12.4
36
12.6
222
9.6
787
37.7
23
28.5
32
18.2
1 196
29.8
60
1.1
34
0.7
3
23
5.0
1 609
7.0
22
9.2
100
10.5
232
21.7
12
541
15.0
28
0.5
24
0.5
1
736
3.9
24
10.8
47
6.7
100
16.7
STATISTICAL ANNEX
Country or area
Year
Romania
1999
Russian Federation
1998
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Sweden
1996
Switzerland
1996
Tajikistan
1995
Thailand
1994
The former
Yugoslav Republic
of Macedonia
Trinidad and Tobago
1997
1994
Turkmenistan
1998
Ukraine
1999
United Kingdom
1999
1999
Northern Ireland
1999
Scotland
1999
United States of
America
Uruguay
1998
1990
Uzbekistan
1998
Venezuela
1994
Measurec
313
Females
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
231
1.8
8 423
9.8
16
43
1.4
10
100
0.4
36
0.8
29
0.8
53
2.8
680
2.5
9
11
90
2.8
0
15
135
1.3
0
62
1.1
1
37
1.4
1 632
10.5
5
24
0.5
5
16
208
2.4
0
56
2.4
2 452
14.0
4
14
22
0.5
14
18
216
3.4
5
48
2.4
1 907
14.1
3
11
15
109
3.3
1
74
3.1
2 207
12.9
3
13
38
0.8
5
11
71
3.0
2
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
38
6.6
54
3.0
1 839
6.1
105
0.4
81
0.3
4
20
0.7
4 241
3.1
31
1.9
223
2.4
233
2.3
22
2.0
7
327
3.5
2
16
36
1.1
6
202
1.1
1
18
15
13
285
5.3
26
0.5
19
1 268
4.6
12
58
1.8
103
3.5
11
21
4.5
500
9.0
38
0.6
28
0.5
2
1 446
4.4
5
67
2.8
67
3.2
454
9.5
15
11
542
2.2
2
49
4.9
14
11
541
8.4
13
10
457
1.8
9
39
4.0
15
314
TABLE A.9
Mortality caused by suicide,a by sex, age group and country, most recent year available between 1990 and 2000b
Country or area
Year
Albania
1998
Argentina
1996
Armenia
1999
Australia
1998
Austria
1999
Azerbaijan
1999
Belarus
1999
Belgium
1995
Bosnia and
Herzegovina
1991
Brazil
1995
Bulgaria
1999
Canada
1997
Chile
1994
China
Hong Kong SAR
1996
Selected urban
and rural areas
1999
Colombia
1995
Costa Rica
1995
Croatia
1999
Cuba
1997
Czech Republic
1999
Denmark
1996
Ecuador
1996
El Salvador
1993
Estonia
1999
Finland
1998
Measurec
Totald, e
Males
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
165
5.3
2 245
6.5
67
1.7
2 633
13.3
1 555
15.5
54
0.8
3 408
30.9
2 155
17.9
531
104
7.1
1 709
10.6
49
2.6
2 108
21.4
1 126
24.2
44
1.3
2 877
56.9
1 550
27.1
457
14
22
2.9
10
15
46
12.7
402
9.0
9
666
31.7
171
21.7
9
552
49.4
252
24.3
167
28
7.8
328
10.0
16
732
34.1
289
28.2
21
2.5
923
79.7
471
39.9
151
18
442
18.3
11
393
23.2
275
36.1
9
797
103.4
373
41.9
83
10
523
26.3
13
311
22.7
389
59.7
5
583
86.3
444
48.7
41
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
11.3
6 584
4.7
1 307
12.3
3 681
11.3
801
6.1
19.4
5 174
7.6
965
19.6
2 914
18.1
704
11.1
38
0.2
7
39
1.9
2
27.0
1 812
8.0
118
12.8
682
21.6
240
12.9
29.4
1 649
9.9
180
21.5
1 010
26.3
211
13.8
22.9
935
10.7
245
30.9
708
26.8
133
15.5
20.4
740
14.4
415
53.3
475
22.1
118
20.9
No.
Rate
No.
788
11.2
16 836
501
14.6
8 048
83
96
13.8
1 252
168
18.5
2 018
99
19.4
1 680
131
31.2
3 015
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
13.7
1 172
3.4
211
6.6
989
18.5
2 029
17.1
1 610
13.0
892
13.6
593
5.5
429
8.5
469
28.1
1 228
21.1
13.5
905
5.5
174
10.9
716
30.2
1 401
23.8
1 285
22.3
631
20.2
396
7.8
276
12.1
376
50.9
962
34.0
0.9
15
7.2
427
7.7
66
13.4
112
23.2
235
16.4
223
18.1
80
14.5
188
10.9
168
21.5
73
45.5
173
35.1
12.9
230
6.1
61
16.4
170
32.5
355
27.1
298
28.2
163
27.4
107
9.7
56
14.0
97
63.6
296
50.8
17.9
123
6.7
27
14.8
171
43.2
310
35.3
399
37.1
180
33.8
56
9.9
26
10.7
111
92.5
290
53.2
45.7
110
9.7
14
258
79.1
496
72.6
362
48.1
207
46.5
38
10.5
21
13.0
92
90.3
200
49.6
STATISTICAL ANNEX
Country or area
Year
Measurec
1998
Argentina
1996
Armenia
1999
Australia
1998
Austria
1999
Azerbaijan
1999
Belarus
1999
Belgium
1995
Bosnia and
Herzegovina
1991
Brazil
1995
Bulgaria
1999
Canada
1997
Chile
1994
China
Hong Kong SAR
1996
Selected urban
and rural areas
1999
Colombia
1995
Costa Rica
1995
Croatia
1999
Cuba
1997
Czech Republic
1999
Denmark
1996
Ecuador
1996
El Salvador
1993
Estonia
1999
Finland
1998
315
Females
All
agesd
Albania
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
61
3.6
536
3.0
18
525
5.2
429
7.6
10
531
8.5
605
9.4
74
42
9.7
129
2.9
0
135
6.6
46
6.0
2
83
7.7
61
6.1
19
113
3.3
4
183
8.5
85
8.6
3
113
9.5
171
14.9
17
130
5.1
3
103
6.3
101
13.2
3
142
16.1
147
16.5
16
155
5.8
11
101
6.1
196
20.1
2
189
15.4
223
17.8
18
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
3.3
1 410
1.9
342
5.8
767
4.6
97
1.4
36
0.2
3
12
496
2.2
32
3.6
156
5.1
33
1.8
430
2.5
51
6.1
255
6.7
25
1.6
258
2.7
71
8.4
208
7.8
20
2.2
190
3.1
185
18.5
136
5.0
15
No.
Rate
No.
287
7.9
8 788
64
61
8.5
1 899
74
7.9
2 304
36
8.2
1 640
110
23.4
2 881
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
14.0
267
1.4
37
2.3
273
8.6
628
10.6
325
4.7
261
7.5
197
3.2
153
5.3
93
8.9
266
8.8
0.8
10
17
13
11.8
153
2.8
16
18
130
9.5
40
3.4
14
130
7.7
103
12.5
10
40
8.5
15.6
63
1.6
12
41
8.1
157
11.9
55
5.4
66
11.6
30
2.7
18
17
65
11.6
18.3
29
1.4
6
65
15.0
151
16.6
86
7.7
85
16.2
14
11
22
15.3
85
15.8
39.5
11
148
28.8
184
25.1
144
12.9
96
16.3
6
44
23.4
74
12.3
316
Year
Measurec
Totald, e
Males
All
agesd
France
1998
Georgia
1992
Germany
1999
Greece
1998
Guyana
19941996
Hungary
1999
Iceland
19941996
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kazakhstan
1999
Kuwait
1999
Kyrgyzstan
1999
Latvia
1999
Lithuania
1999
Luxembourg
19951997
Mauritius
1999
Mexico
1997
Netherlands
1999
New Zealand
1998
Nicaragua
1996
Norway
1997
Panama (excluding
Canal Zone)
1997
Paraguay
1994
Philippines
1993
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
10 534
14.8
204
3.9
11 160
10.6
403
3.1
84
12.5
3 328
26.9
28
10.4
466
12.5
379
6.5
4 694
6.2
23 502
14.5
4 004
27.9
47
1.5
559
14.0
764
27.0
1 552
38.4
72
14.7
174
14.3
3 369
3.9
1 517
8.3
574
15.0
230
5.9
533
10.9
145
7 771
23.2
151
6.4
8 082
16.7
315
4.9
64
20.5
2 550
45.7
24
17.5
376
20.4
301
10.8
3 547
9.9
15 906
20.7
3 340
50.3
34
1.8
460
23.9
593
47.1
1 287
69.2
53
22.5
120
19.7
2 828
6.9
1 015
11.3
442
23.6
147
8.4
387
16.1
124
10
26
0.6
0
11
34
0.5
49
3.2
1
12
81
0.8
7
1 036
16.9
35
6.4
1 087
14.6
61
5.2
28
24.6
283
24.3
8
148
32.0
95
12.8
578
9.3
1 964
14.4
963
49.4
11
138
20.6
85
32.5
237
57.8
8
35
23.0
1 350
9.5
165
10.5
170
41.5
76
11.8
87
18.8
48
2 278
35.3
37
7.4
2 221
21.3
69
6.1
20
30.2
693
67.5
6
112
29.6
70
12.9
726
11.4
3 064
25.4
1 172
72.2
21
4.3
162
33.5
187
70.4
410
97.9
16
56
38.7
731
8.6
321
16.5
126
29.4
41
12.0
103
20.8
46
1 863
35.3
29
8.3
2 032
25.6
69
7.3
10
815
84.5
5
71
24.1
44
11.4
772
14.3
5 829
42.2
711
79.3
1
94
45.6
185
92.1
413
144.1
14
20
25.0
365
8.0
276
17.5
71
22.1
13
85
21.1
15
2 584
51.0
50
16.9
2 716
35.6
116
10.7
5
749
98.2
4
41
16.5
90
26.9
1 466
26.0
5 015
42.3
445
76.9
0
54
34.0
135
78.3
219
88.1
15
300
10.6
246
20.0
66
25.3
11
109
29.3
14
Rate
No.
Rate
No.
Rate
5.8
109
3.2
851
1.5
9.8
82
5.1
509
1.9
12.5
30
4.8
256
2.7
16.7
18
163
2.9
14
59
2.0
15
31
2.1
STATISTICAL ANNEX
Country or area
Year
Measurec
1998
Georgia
1992
Germany
1999
Greece
1998
Guyana
19941996
Hungary
1999
Iceland
19941996
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kazakhstan
1999
Kuwait
1999
Kyrgyzstan
1999
Latvia
1999
Lithuania
1999
Luxembourg
19951997
Mauritius
1999
Mexico
1997
Netherlands
1999
New Zealand
1998
Nicaragua
1996
Norway
1997
Panama (excluding
Canal Zone)
1997
Paraguay
1994
Philippines
1993
317
Females
All
agesd
France
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
2 763
7.4
53
1.9
3 078
5.1
88
1.4
20
5.6
778
10.7
5
90
4.7
78
2.4
1 147
2.9
7 596
8.5
664
8.7
13
99
4.7
171
10.0
265
11.2
19
54
8.9
541
1.1
502
5.4
132
6.8
83
3.5
146
5.9
21
19
10
30
0.3
5
12
277
4.6
11
250
3.5
11
10
54
4.8
1
24
5.4
12
137
2.3
866
6.6
187
9.8
2
34
5.2
19
34
8.5
3
28
19.0
327
2.3
75
4.9
49
12.0
55
8.5
25
5.6
9
679
10.4
13
587
6.0
20
1.8
5
138
13.5
0
23
5.9
20
3.5
224
3.5
1 110
9.4
163
9.7
11
22
4.5
32
11.9
57
13.4
7
20
14.5
107
1.2
140
7.5
40
8.9
10
43
9.1
5
740
14.0
9
725
9.2
28
2.9
3
199
18.6
1
21
7.3
7
252
4.5
2 013
14.4
136
13.1
0
43
17.9
71
20.9
5
47
1.0
139
9.1
20
6.2
4
43
11.0
4
1 058
15.3
20
4.4
1 507
13.7
28
2.1
1
386
31.8
2
22
7.1
39
9.0
528
7.0
3 588
23.2
167
16.6
0
32
13.9
76
23.5
102
23.7
5
29
0.9
143
8.8
19
35
7.1
3
Rate
No.
Rate
No.
Rate
1.7
27
1.5
342
1.2
226
2.5
64
1.1
27
0.9
24
1.3
318
Year
Poland
1995
Portugal
1999
Puerto Rico
1998
Republic of Korea
1997
Republic of
Moldova
1999
Romania
1999
Russian Federation
1998
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Sweden
1996
Switzerland
1996
Tajikistan
1995
Thailand
1994
The former
Yugoslav Republic
of Macedonia
Measurec
Totald, e
Males
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
5 499
13.4
545
4.0
321
8.1
6 024
12.8
579
4 562
23.2
407
6.7
290
15.6
4 162
18.8
482
60
1.9
1
31
0.9
6
809
18.7
39
3.3
58
11.7
966
14.6
72
1 625
35.7
78
7.4
89
24.4
1 398
22.3
149
1 274
43.0
71
8.3
66
23.7
1 012
30.5
155
794
32.7
218
25.1
74
31.6
755
43.1
100
1997
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
15.5
2 736
10.8
51 770
32.1
371
11.7
692
11.5
590
24.6
3 261
6.5
1 253
11.8
1 431
16.7
199
5.2
2 333
4.1
155
28.1
2 235
18.5
42 785
57.9
221
14.1
590
20.8
453
40.3
2 499
10.5
872
16.9
1 010
25.1
146
8.1
1 631
5.9
115
35
2.2
335
3.0
3
16.1
357
12.8
9 414
58.2
50
14.4
90
13.2
61
27.7
490
10.3
135
15.6
187
27.0
42
5.5
743
8.1
13
38.6
599
25.4
14 614
84.9
66
14.5
170
28.5
119
52.3
545
12.3
211
22.8
248
28.9
46
9.8
473
7.6
34
58.2
703
37.1
10 898
93.7
50
18.8
197
42.5
128
65.3
439
13.3
253
28.9
251
37.0
36
17.7
257
8.1
24
51.2
541
30.3
7 524
84.3
52
34.7
128
38.9
141
95.0
1 021
28.1
272
32.0
320
55.0
22
14.7
158
8.2
43
Trinidad and
Tobago
1994
Rate
No.
7.4
148
11.3
118
35
15.1
35
15.3
28
33.6
18
Turkmenistan
1998
Ukraine
1999
United Kingdom
1999
Rate
No.
Rate
No.
Rate
No.
Rate
No.
12.6
406
10.4
14 452
25.2
4 448
6.8
3 690
19.5
322
16.9
11 806
46.0
3 443
10.8
2 840
15
80
2.3
4
19.3
133
20.3
1 922
34.8
777
13.2
598
23.8
101
22.5
3 460
65.2
1 220
17.7
989
34.7
62
34.8
3 514
87.6
806
14.8
700
11
2 830
78.4
636
12.1
551
Rate
No.
Rate
No.
Rate
No.
6.3
121
7.3
637
11.7
30 575
9.9
103
12.5
500
18.8
24 538
241
11.5
45
23.8
134
26.3
5 718
16.2
39
21.5
192
32.5
7 523
14.4
12
94
20.3
5 218
11.8
7
78
17.8
5 838
Rate
10.4
17.3
1.2
20.2
23.4
22.8
30.6
England and
Wales
1999
Northern Ireland
1999
Scotland
1999
United States of
America
1998
STATISTICAL ANNEX
Country or area
Year
Measurec
1995
Portugal
1999
Puerto Rico
1998
Republic of Korea
1997
Republic of
Moldova
1999
Romania
1999
Russian Federation
1998
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Sweden
1996
Switzerland
1996
Tajikistan
1995
Thailand
1994
The former
Yugoslav Republic
of Macedonia
319
Females
All
agesd
Poland
04
years
514
years
1529
years
3044
years
4559
years
560
years
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
937
4.2
138
1.9
31
1.5
1 862
7.6
97
34
1.1
0
121
2.9
12
10
563
8.9
15
286
6.3
23
2.1
7
549
9.3
18
245
7.7
16
303
9.0
29
279
7.6
84
7.1
8
413
15.5
34
1997
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
4.7
501
3.6
8 985
9.4
150
9.4
102
3.2
137
10.6
762
2.8
381
6.9
421
9.1
53
2.5
702
2.4
40
79
0.8
0
77
2.9
1 369
8.8
45
12.9
14
14
98
2.1
43
5.2
47
6.8
22
2.8
342
3.9
6
101
4.3
1 893
10.8
26
5.8
28
4.8
24
10.5
152
3.5
76
8.6
97
11.6
13
202
3.2
13
9.3
129
6.4
1 955
14.5
26
9.9
29
5.8
48
24.6
147
4.3
126
14.8
110
16.3
8
101
3.0
4
11.3
190
8.0
3 689
21.6
53
30.5
31
6.2
51
22.4
361
7.5
134
12.2
167
20.7
10
56
2.4
17
Trinidad and
Tobago
1994
Rate
No.
3.8
30
18
Turkmenistan
1998
Ukraine
1999
United Kingdom
1999
Rate
No.
Rate
No.
Rate
No.
Rate
No.
5.0
84
4.1
2 646
7.6
1 005
2.9
850
14
47
7.1
275
5.1
169
3.0
133
14
484
8.7
292
4.4
244
10
645
13.4
246
4.5
208
10
1 228
19.0
297
4.3
265
Rate
No.
Rate
No.
Rate
No.
2.7
18
137
4.7
6 037
83
2.7
9
27
5.5
1 029
4.1
6
42
7.1
2 076
4.3
1
37
7.7
1 624
4.3
2
30
5.0
1 225
Rate
4.0
0.4
3.7
6.4
6.7
4.8
England and
Wales
1999
Northern Ireland
1999
Scotland
1999
United States of
America
1998
320
Year
Uruguay
1990
Uzbekistan
1998
Venezuela
1994
Measurec
No.
Rate
No.
Rate
No.
Rate
Totald, e
318
9.6
1 620
8.0
1 089
6.1
Males
All
agesd
04
years
514
years
1529
years
3044
years
4559
years
560
years
251
16.4
1 252
13.0
890
10.3
53
1.7
26
1.0
42
11.8
407
12.2
349
11.6
54
19.0
468
20.1
262
12.6
65
27.5
215
22.5
121
11.3
87
39.4
109
15.5
131
21.8
STATISTICAL ANNEX
Country or area
Year
Measurec
1990
Uzbekistan
1998
Venezuela
1994
No.
Rate
No.
Rate
No.
Rate
321
Females
All
agesd
Uruguay
67
3.7
368
3.3
199
2.1
04
years
0
514
years
3
1529
years
3044
years
4559
years
560
years
13
208
6.3
98
3.3
80
3.3
49
2.4
11
28
2.8
23
2.1
30
10.5
45
4.7
20
2.9
322
TABLE A.10
Firearm-related mortality, by manner of deatha and country, most recent year available between 1990 and 2000b
Country or area
Year
Albania
1998
Australia
1998
Austria
1999
Belgium
1995
Bulgaria
1999
Canada
1997
1996
Croatia
1999
Czech Republic
1999
Denmark
1996
Estonia
1999
Finland
1998
France
1998
Germany
1999
Greece
1998
Hungary
1999
Iceland
19941996
Ireland
1997
Israel
1997
Italy
1997
Japan
1997
Kuwait
1999
Latvia
1999
Lithuania
1999
Luxembourg
19951997
Malta
19971999
Netherlands
1999
Measurec
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
Total
741
22.1
334
1.8
293
3.6
379
3.7
133
1.6
1 034
3.4
6
226
5.0
259
2.5
101
1.9
71
4.9
295
5.7
2 964
5.0
1 201
1.5
194
1.8
129
1.3
7
54
1.5
161
2.8
1 171
2.0
83
0.1
16
92
3.8
67
1.8
12
131
0.8
Firearm-related deaths
Homicide
591
17.6
56
0.3
17
59
0.6
51
0.6
159
0.5
3
69
1.5
46
0.4
15
31
2.1
22
0.4
170
0.3
155
0.2
74
0.7
31
0.3
1
15
463
0.8
22
0.0
16
34
1.4
18
75
0.5
Suicide
98
2.9
248
1.3
272
3.4
289
2.9
55
0.7
818
2.7
3
145
3.2
185
1.8
80
1.5
32
2.2
267
5.2
2 386
4.1
906
1.1
86
0.8
96
1.0
5
44
1.2
73
1.3
626
1.1
45
0.0
0
47
1.9
35
0.9
9
51
0.3
Unintentional Undetermined
50
2
1.5
23
7
0.1
3
1
2
29
0.3
20
7
0.2
45
12
0.1
0
0
11
1
17
11
4
2
1
7
3
3
68
340
0.1
0.6
16
124
0.2
34
0
0.3
1
1
0
1
3
0
0
73
1.3
38
44
0.1
0.1
10
6
0
0
5
6
4
10
0
2
1
0
5
0
STATISTICAL ANNEX
323
Year
New Zealand
1998
Norway
1997
Portugal
1999
Republic of Korea
1997
Republic of Moldova
1999
Romania
1999
Singapore
1998
Slovakia
1999
Slovenia
1999
Spain
1998
Sweden
1996
Thailand
1994
1997
United Kingdom
1999
1999
Northern Ireland
1999
Scotland
1999
Measurec
Total
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
84
2.2
139
3.2
202
2.0
59
0.1
68
1.9
73
0.3
6
171
3.2
61
3.1
352
0.9
183
2.1
2 434
4.2
41
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
No.
Rate
2.1
197
0.3
159
0.3
28
1.7
25
0.5
30 419
11.3
Firearm-related deaths
Homicide
4
10
61
0.6
19
45
1.2
19
43
0.8
9
85
0.2
11
2 184
3.8
20
1.0
45
0.1
23
0.0
15
11 802
4.4
Suicide
72
1.9
127
2.9
62
0.6
22
0.0
7
24
0.1
5
88
1.6
49
2.5
224
0.6
163
1.8
158
0.3
16
140
0.2
115
0.2
11
14
17 432
6.4
Unintentional Undetermined
6
2
2
0
2
77
0.8
9
9
9
7
26
4
0.1
1
0
20
20
0.4
0.4
2
1
43
0
0.1
3
6
84
8
0.1
5
0
866
0.3
15
319
0.1
Resources
326
agency reports, book reviews, and listings of employment opportunities in the injury and violence research
and prevention field.
Minnesota Center Against Violence and Abuse: electronic clearing house
http://www.mincava.umn.edu
The electronic clearing house of the Minnesota Center Against Violence and Abuse provides articles, fact
sheets and other information resources, as well as links to web sites on a wide variety of violence-related
topics, including child abuse, gang violence and abuse of the elderly. The site also provides searchable
databases with over 700 training manuals, videos and other educational resources.
Web site
http://www.casa-alianza.org/EN/index-en.shtml
http://child-abuse.com
http://www.glarrc.org/Resources/EPVD.cfm
http://www.ispcan.org
http://www.mincava.umn.edu
http://www.unhchr.ch/html/menu2/6/crc.htm
http://www.unicef.org
http://www.unicef-icdc.org
Collective violence
Centre for the Study of Violence and Reconciliation
http://www.wits.ac.za/csvr
http://www.umich.edu/*cowproj
http://www.idpproject.org
http://www.isn.ethz.ch/infoservice
http://www.reliefweb.int/ocha_ol
http://www.unhcr.ch
http://www.sipri.se
Elder abuse
Action on Elder Abuse
http://www.elderabuse.org.uk
http://www.mun.ca/elderabuse
HelpAge International
http://www.helpage.org
http://www.inpea.net
http://www.elderabusecenter.org
http://www.preventelderabuse.org/index.html
RESOURCES
TABLE 1 (continued)
Type of violence
Web site
Suicide
American Association of Suicidology
http://www.suicidology.org
http://www.gu.edu.au/school/psy/aisrap
http://www.mentalhealth.org/suicideprevention
http://www.suicideinfo.ca
http://www.suicide-parasuicide.rumos.com
http://www.inet.co.en/org/gaatw
http://www.icrw.org
http://www.reddesalud.web.cl
http://www.nsvrc.org
http://www.neww.org/index.htm
http://www.unhchr.ch/women/index.html
http://www.rainbo.org
http://www.undp.org/unifem
http://www.undp.org/gender
http://www.wave-network.org
Youth violence
Center for the Prevention of School Violence
http://www.ncsu.edu/cpsv
http://www.colorado.edu/cspv
http://www.iadb.org/sds/SOC/site_471_e.htm
http://www.cdc.gov/ncipc
http://www.ncjrs.org/intlwww.html
http://pavnet.org
http://www.goldsmiths.ac.uk/tmr
http://www.uncjin.org/Statistics/statistics.html
327
328
Web site
Amnesty International
http://www.amnesty.org/
http://www.aic.gov.au/campbellcj/
http://www.cdc.gov/ncipc
http://www.cdc.gov/ncipc/pub_res/intimate.htm (Intimate partner
surveillance: uniform elements and recommended data elements)
http://www.ensp.fiocruz.br/claves.html
http://www1.rhbnc.ac.uk/sociopolitical-science/vrp/realhome.htm
http://www.hrw.org/
http://www.iss.co.za
http://www.iacpv.org
http://www.iansa.org
http://www.icbl.org/
http://www.crime-prevention-intl.org
http://www.ilo.org
http://www.mrc.ac.za/crime/crime.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
http://www.paho.org/English/hcp/hcn/violence-unit-page.htm
http://www.paho.org/English/HCP/HCN/guidelines-eng.htm
(Guidelines for the epidemiological surveillance of violence
and injuries in the Americas)
http://www.redandina.org
Trauma.org
http://www.trauma.org/trauma.html
http://www.unesco.org
http://www.unhabitat.org/default.asp
http://www.unog.ch/unidir
http://www.unicri.it
http://www.odccp.org/crime_prevention.html
http://www.unfpa.org
http://www.unrisd.org
http://www.upeace.org
http://www.who.int/
http://www.who.int/violence_injury_prevention/pdf/
injuryguidelines.pdf (Injury surveillance guidelines)
RESOURCES
For readers without access to the Internet, the WHO Department of Injuries and Violence Prevention
would be pleased to provide the full mailing address of the organizations listed. Kindly contact the
Department at the following address:
Department of Injuries and Violence Prevention
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
Tel.: +41 22 791 3480
Fax: +41 22 791 4332
Email: vip@who.int
329
Index
Note: Page numbers in bold type refer to main entries and definitions.
A
Aboriginal peoples 190
Abuse (see also Child abuse; Elder abuse; Intimate
partner violence; Sexual violence)
adult consequences 15, 7374, 158
human rights 217, 219, 232
range of 5
self 67, 185206, 244
Abusers
characteristics 6668, 130131, 139
education 76, 165
help for 143
treatment 75, 106
Acquired immunodeficiency syndrome (AIDS) (see also
Human immunodeficiency virus) 12, 34, 102
older people 126
sexual violence 164
Action on Elder Abuse, United Kingdom 126127, 135,
326
Action plans, violence prevention 110111, 247248
Adolescents (see also Youth violence) 11, 3031, 34,
192
sexual violence against 66, 152155, 162164
suicidal behaviour 191, 194195
Adults, abused as children 15, 7374, 158
Advocacy groups 251252
Africa 2526, 28, 36, 127
AIDS pandemic 34, 102, 126
child marriage 156157
elder care 129, 132, 135
homicide statistics 1011, 26, 60, 274277
intentional injury mortality 270273
leading causes of death/DALYs 288289
partner violence 90
population statistics 262263
prevention initiatives 165, 168, 171
refugees 226
sexual violence 151, 152153, 155156, 162
suicide statistics 1011, 187, 198, 278281
war-related casualties 217218, 223, 224, 282285
African Americans 11, 188, 198
Age
attempted suicide 191, 205
child abuse 60, 66, 80
332
B
Battered child syndrome 59, 61
Battered women
crisis centres 104, 165, 168
partner violence 89, 9394
Behavioural therapies 76, 199200
Belief systems, sexual violence 162
Biases, collective violence data 217
Biological factors
suicide 193194, 199, 205
youth violence 32
Bipolar disorder 192193
Blumers model, elder abuse 134135
Boys (see also Men; Youth violence) 66, 154155
Bullying 18, 2930, 40, 194
C
Campaigns
child abuse prevention 76
elder abuse prevention 138141
media 249, 250
partner violence prevention 108
sexual violence prevention 168169
Carbon monoxide, suicide reduction 202
Caregivers
child abuse 5960, 6667
INDEX
333
334
Crisis centres
abused women 104
elder abuse 136137
sexual assault 165, 167168
suicide prevention 201
Crisis intervention programmes
child abuse 7172
collective violence 229231
elder abuse 136137
Cross-national studies
partner violence 99100
suicide 191, 204
violence prevention recommendations 248
youth violence 29, 30
Cultural factors 11, 16, 98
child abuse 66, 6869, 80
child marriage 156157, 171
elder abuse 126, 127129, 131, 142
female genital mutilation 171, 172
male partner violence 9395, 100
parenting 59, 63, 64
sexual violence 98, 157, 162, 163164
suicide 188, 196197, 206
violence in general 5, 13, 243245
youth violence 38
D
DALYs, see Disability-adjusted life years
Data
comparability 89, 91, 92, 189, 248
sources/types 78
Data collection 4, 246, 247248
child protection 7879
collective violence 217, 232, 234
sexual violence 150
suicide 189, 204205
youth violence 47
Day care, abused children 73
Decision-making, violence prevention 17, 19, 245, 246
Definitions
armed conflict 216
child abuse 5960
collective violence 215217
complex emergencies 215
elder abuse 126129
genocide 216
intimate partner violence 89
old age 125
prevention 15
rape 149
self-directed violence 185186
sexual violence 149150
social capital 36
suicide 185
torture 219
violence 56
war 216
youth 25
Dementia 130, 131, 141
Demographic factors
child abuse 6667
collective violence 220, 222, 225226
older populations 125126
partner violence 9798
suicide 187189
youth violence 3637
Depression 192193, 199
Deprivation 67
Detection, child abuse 72, 74
Developed countries
elder abuse 129130, 132133, 138
older population increase 125126
partner violence 9394, 105
Developing countries
demographic change 125126
elder abuse 125126, 127129, 132, 141142
HIV/AIDS 34, 102, 126, 165, 167
partner violence 9495, 103104
violence prevention initiatives 103104, 141
Disability, conflict-related 222, 224
Disability-adjusted life years (DALYs) 257, 258259,
286299
Discipline (see also Punishment)
children 33, 6266, 80
wives 9495, 100, 243244
Disclosure
child abuse 76
partner violence 92
Diseases (see also Morbidity)
child abuse consequences 6970
collective violence 222224
communicable 126, 222223, 225
global burden 257
leading causes of death/DALYs 257, 258259,
286299
older people 126
partner violence 101102
sexually transmitted 162, 163, 223, 235
suicide 194
Displaced people, see Refugees
Domestic gas, suicide 202, 203
Domestic violence (see also Intimate partner violence)
15
children 68, 73, 101, 103
elder abuse 132133, 143
legislation 103106
local variations 97
outreach work 107
INDEX
E
Eastern Europe (see also Europe)
early marriage 156
elder abuse 132
sexual violence 151
suicide 186, 196197
youth homicide 25, 26
Eastern Mediterranean
family honour killings 93
homicide statistics 11, 274277
intentional injury mortality 270273
leading causes of death/DALYs 296297
partner violence 91
population statistics 266269
suicide statistics 11, 278281
war-related mortality 282285
Ecological model 1216
child abuse 6566
elder abuse 130132, 142
youth violence prevention 41
Economic factors (see also Socioeconomic factors)
collective violence 220221, 226228
suicide 197
youth violence 37
Economic impacts
collective violence 226228
globalization 14
violence against women 102103
violence in general 3, 1112, 18
Education (see also Training) 4, 251
child abuse prevention 7576
elder abuse prevention 138141, 142143
female circumcision 172
HIV/AIDS 164
media prevention campaigns 249, 250
parenting 7071
sexual violence prevention 165, 169
violence to women link 158
youth violence 38, 4041, 44
Elder abuse 12, 15, 125143
consequences 132134
definitions 126129
extent 129130
indicators 137138, 139
mortality 128, 130, 133
335
prevention 134143
public awareness campaigns 138141, 142143
recommendations 141143
risk factors 130132
web sites 326
Elder care
family settings 129
institutions 129130
Emergencies, complex 215216, 231
Emergency shelters (see also Crisis centres)
battered women 104
elder abuse 136137
Emotional abuse (see also Psychological violence)
children 60, 6465
older people 127
Employment (see also Socioeconomic factors)
abused women 103
suicide 197
Environments (see also Infrastructures)
suicide 196197, 205206
toxin reduction 45
violence prevention recommendations 249
youth violence 3437
Epidemics
AIDS 34, 102, 164, 226
armed conflict 223
Equality, promotion recommendations 251
Ethics, aid provision 231
Ethnic minorities
genocide 216
suicide 188189, 190, 196197
EU, see European Union
Europe (see also Eastern Europe)
elder abuse 135, 141
homicide statistics 1011, 2627, 274277
intentional injury mortality 270273
leading causes of death/DALYs 294295
partner violence 91
population statistics 264267
refugees 226
sexual trafficking 155
suicide statistics 1011, 186187, 278281
war-related mortality 282285
youth violence 35
European Union (EU)
anti-trafficking initiatives 171
workplace violence 18
Evaluation
child abuse initiatives 72, 73, 76, 80
elder abuse interventions 140141, 142
media campaigns 250
parenting training 42, 7071
partner violence initiatives 103104, 106, 108109
public health interventions 16
336
Evaluation (continued)
sexual violence initiatives 173
suicide prevention 206
youth violence programmes 48
Explanatory models, ecological 1216, 41, 6566,
130132, 142
Extracurricular activities, schools 44
F
Families 6, 198, 244
abused women 9596, 98, 113
child abuse 6667, 6768, 7072
elder abuse 125, 129, 130, 132133, 141, 143
honour crimes 93, 160161
sexual violence 160161
support services 7172
violence prevention initiatives 4143, 4546,
7072, 143
youth violence 3334, 4143, 4546
Famine, conflict-related 218
Fatalities, see Homicides; Mortality
Financial abuse, older people 127, 129, 131, 139
Firearms (see also Guns; Weapons)
mortality by country 322323
recommendations 249
Food production, armed conflict 227
G
Gangs
rape 149, 153, 160
youth violence 3436, 38, 4445
Gender
abused children 64, 66
child abusers 67
elder abuse 131
equality promotion 251
homicide statistics 10, 274277, 308313
intentional injury mortality 270273, 300307
life expectancy 126
sexual violence 173
suicide 10, 187, 188, 191, 278281, 314321
war-related injury mortality 282285
WHO Member State populations 262269
youth violence 2529
Genetics, suicide 193194, 205
Geneva Conventions (1949) 170, 216, 225, 228
Genital mutilation, females 150, 171, 172
Genocide 216, 253
Geographical variations
child abuse 60, 80
elder abuse 131132
mortality estimates 1011
partner violence 9495, 97
self-directed violence 186189
H
Harassment, sexual 18, 155156, 163
Health care
armed conflict 227229, 232233, 234
child abuse 7273
costs of violence 3, 1112
domestic violence 106107
elder abuse 137138
PAHO/WHO initiatives 230231
personnel training 72, 80, 166167, 250
INDEX
337
I
ICD, see International Classification of Diseases
Ideation, suicidal 189, 191
IHDC, see Institute for Health and Development
Communication
Imitation, suicides 196, 203
Immigration 196197
Immunization, armed conflict 223, 230
Income inequality, homicide link 37
Indicators
collective violence 220, 234
elder abuse 137138, 139
suicidal behaviour 205
Indigenous peoples
conflict-related deaths 218
elders 126
suicide 189, 190, 198
Individuals
ecological model of violence 1213
partner violence 9799
rape risk factors 159
response to trauma 224
support services 165
youth violence prevention 38, 4041, 43
Inequalities
collective violence 220221
gender/social 251
globalization 14, 221
health sector role 229
homicide link 37
Infant mortality 61, 66, 102, 222223
Infantalization, older people 127
Information collection, see Data collection
Information exchange 14, 246, 247248, 251253
collective violence 232, 234
youth violence 47, 4849
Infrastructures (see also Environments)
armed conflict impacts 227
impoverished 36, 68
improvements in 249
338
Injuries
child abuse 60, 61
child soldiers 235
global burden 257
landmines 224
leading causes of death/DALYs 258259, 286299
male partner violence 102
mortality by country 300307
mortality by WHO region 270273, 282285
sexual violence 149, 162163
war-related mortality 282285
youth violence 2730
INPEA, see International Network for the Prevention of
Elder Abuse
Institute for Health and Development Communication
(IHDC), South Africa 250
Institutions
corporal punishment 64
elder abuse 129130, 133134, 143
reform 111
Intelligence quotient (IQ), youth violence 33
Intentionality 56, 59
Inter-American Coalition for the Prevention of Violence
252, 328
Inter-American Development Bank 12, 252, 327
Interagency forums, partner violence 107108
Internally displaced people, see Refugees
International agencies, collaboration recommendations
251
International Classification of Diseases (ICD) 217, 248,
257
International Committee of the Red Cross 215, 232
International Covenant on Civil and Political Rights 228,
253
International Criminal Court, Rome Statute 170, 254
International Federation of Red Cross and Red Crescent
Societies 231
International Network for the Prevention of Elder Abuse
(INPEA) 126127, 135136, 326
International Society for Prevention of Child Abuse and
Neglect 59, 326
International treaties (see also Conventions)
child rights 64, 7778, 79, 170, 254
collective violence 228
human rights 170, 216, 219, 253254
sexual violence 170, 253
Internet
information sharing 48
violence-related web sites 326327, 328
Interventions (see also Prevention; Programmes)
child abuse 7073
elder abuse 136141, 142
post-armed conflict 232233, 236
post-suicide 203204
L
Landmines 224, 232, 234
Latin America (see also Americas)
child rights legislation 79
domestic violence initiatives 104, 105, 108, 109
early marriage 156, 157
elder care 130, 135
partner violence 89, 90
sexual violence 151, 169
suicide rates 186187
violence-related costs 12
youth violence 25, 28, 36, 38
Law enforcement, see Police
Legislation
child abuse 7475
corporal punishment 64
domestic violence 103106
elder abuse 138, 142
human rights 228, 253254
sexual violence 161, 169170
Leisure activities, youth violence prevention 44
Lessons, violence prevention 243245
Life events, suicide 194195
Life-skills training 165
INDEX
Links
child abuse/adult problems 15, 69, 7374, 158
data sources 9
demographic/social change/youth violence 36
domestic violence/child abuse 68
globalization/inequalities/conflict 221
homicide/income inequality 37
violence variables 1315, 25, 112113, 244
Local initiatives 1617, 247248
elder abuse 136141
partner violence 110111
Loss, suicide 194, 195, 203204
M
Mandatory arrest, domestic violence 105
Mandatory reporting
child abuse 74
elder abuse 138
Mandatory treatment, child abusers 75
Marital violence, see Intimate partner violence
Markers, suicide 193194
Marriage 99, 163, 195
child 156157, 160161, 171
Mass media, see Media
Maternal mortality 102
Media 249, 250
child abuse prevention 76
elder abuse prevention 140, 142143
sexual violence prevention 168
suicide 203
youth violence 38, 3940
Medical markers, suicide 193194
Medico-legal services, sexual violence 166, 169
Men (see also Boys)
child abuse 64, 67
depression 192
homicide/suicide rates 1011, 2627, 190
identity crises 161
sexual violence 159160, 165, 169
violence against 9394, 153, 154155
violence against women 89113
workplace violence 18
youth violence 2528
Mental health
child abuse 6970
collective violence 224225
partner violence 101, 102
sexual violence 149, 163
suicide prevention 199
Mentoring programmes, youth violence 42
Methods
suicide 196, 202203
youth homicide 27
Middle East, refugees 226
339
Models
ecological 1215, 41, 6566, 130132, 142
sexual violence prevention 166
Monitoring
child abuse 78
youth violence 47
Mood disorders, suicide 192193, 199
Morbidity (see also Diseases; Injuries)
collective violence 222
data sources 7
global 3
violence-related costs 12
Mortality
abused women 93, 102
child 60, 66, 7475, 103, 222223
collective violence 10, 216218, 222223, 225
country-level rates 259
elder abuse 127, 128, 130, 133
firearm-related by country 322323
global estimates 3, 711, 2529, 257, 258,
286287
homicide statistics 274277, 308313
infant 61, 66, 222223
intentional injuries 270273, 300307
leading causes by WHO region 288299
maternal 102
sexual violence 149, 150
suicide 185190, 198
suicide statistics 278281, 315321
war-related 217218, 225, 282285
youth homicide 2529, 3538, 46
Motivations
partner violence 9495
rape 149
youth violence 31
Multidisciplinary approach
suicide prevention 206
violence prevention 3, 17, 244, 246, 247
Mutilation
armed conflict 224
female genital 171, 172
N
National action plans, violence prevention 110111,
247248
National Center on Elder Abuse, USA 134135, 326
National initiatives 17, 19
child abuse prevention 7677, 79
elder abuse prevention 134136
partner violence prevention 111
social protection 3738
violence research 248
NATO, see North Atlantic Treaty Organization
Nazi holocaust 216
340
Neglect 5, 7, 12, 15
child 33, 60, 61, 65, 77, 80, 326
older people 126, 127, 129, 134
poorest populations 245
youth violence 33
Neurobiology, suicide 194, 199
Non-fatal violence (see also Injuries) 8, 9
against children 6065
against women 101
attempted suicide 185, 189, 191
global estimates 11
intimate partners 8993
youths 2729
Nongovernmental organizations 19
armed conflict initiatives 228229
campaigns 250
child rights 79
coordination recommendations 251
domestic violence prevention initiatives 107, 110
elder abuse prevention initiatives 140, 140
female circumcision prevention initiatives 172
human rights data 217, 232
personnel deaths 218
torture prevention 219
North America (see also Americas)
elder abuse 129, 133, 138
partner violence 91, 94, 99, 105, 108
sexual assault care centres 167168
suicide 186187, 190
violence prevention 140, 252
youth violence 27, 3031, 32, 33
North Atlantic Treaty Organization (NATO) 218, 220
O
Office of the United Nations High Commissioner for
Human Rights 17, 232, 326, 327
Office of the United Nations High Commissioner for
Refugees 17, 156, 171, 326
Older people (see also Elder abuse)
AIDS pandemic 126
human rights 142
population increase 125126
suicide 191192, 196
OMCT, see World Organization against Torture
Organization of American States 252
Orphans, AIDS epidemic 126
Outreach programmes
domestic violence 107
suicide 201
youth violence 45
P
Pan American Health Organization (PAHO) 108, 109,
230231, 252
INDEX
Populations
elder increase 125126
forced resettlement 226
WHO Member States 262269
Post-traumatic stress disorder 6970, 101, 163, 224
Poverty
child abuse 68
older people 126, 128, 132
partner violence 99
sexual violence 158159, 161
suicide 197
violence link 244245
youth violence 36, 4546
Power, abuse of 5, 149
Predictors (see also Risk factors)
partner violence 97100
suicide 193, 198
violence in general 243
youth violence 30, 3233
Pregnancy 101102, 162
Preschool enrichment programmes 38, 4041, 45
Prevalence
child abuse 6065
collective violence 217220
elder abuse 129130
partner violence 8993, 97
self-directed violence 186191
sexual violence 150157
youth violence 2529
Prevention (see also Interventions; Programmes) 3,
1419
child abuse 7081
collective violence 228236
definitions 15
elder abuse 134143
media campaigns 249, 250
national action plans 247248
partner violence 103113
public health approach 35, 912, 1517, 243254
recommendations 246254
self-directed violence 199204
sexual violence 154155, 164173
suicide 199204
workplace violence 1819
youth violence 38, 4049
Primary prevention 15, 243, 248249
elder abuse 142
partner violence 110, 113
sexual violence 173
Priorities
elder abuse prevention 141
setting of 248249
sexual violence prevention 173
victim support 249
341
342
Q
Quality, data collection 9
R
Rape (see also Sexual violence)
armed conflict 156, 171, 218
crisis centres 165, 168
definition 149
family honour killings 93
gang 153, 160
HIV risk 163, 164, 167
law reforms 169170
of males 154155
physical consequences 162163
as punishment 149, 160
reported 11, 150151
risk factors 158, 159160
societal factors 161, 162, 163164
suicidal behaviour 163
Rapists, characteristics 159
Recommendations
child abuse prevention 7880
collective violence 233234, 236237
elder abuse 141143
partner violence 111113
sexual violence 172173
suicide prevention 204206
violence prevention 246254
youth violence prevention 4749
Red Cross, International Committee of the 215, 232
Red Cross and Red Crescent Societies, International
Federation of 231
Refugees 219, 225226
health service provision 229
HIV risk 223224
sexual violence 156, 171
Rehabilitation, child soldiers 235236
Relationships
abusive 96, 109
ecological model 12, 13
elder abuse 131
partner violence 97, 99
rape risk factors 159
suicide 194195, 200201
youth violence 3334, 4143
Religion, suicide 197198, 244
Reporting practices
child abuse 62, 72, 74, 77
cultural factors 11
elder abuse 138
sexual violence 150151, 154, 169
suicide 189, 203
Reproductive health
child abuse 77
S
Safe houses
battered women 99, 104
elder abuse 136137
Safety, partner violence interventions 92, 111
Schizophrenia, suicide risk 193, 199
Schools
child abuse prevention 7576
corporal punishment 64
elder abuse prevention 140
partner violence prevention initiatives 108109, 110
sexual violence 155156
sexual violence prevention 164, 169
social development programmes 38, 4041
suicide prevention 201202
youth violence prevention 40, 44, 45
Screening
child abuse/neglect 72
partner violence 107
Secondary prevention 15, 249250
Security forces, torture 219
Selective serotonin reuptake inhibitors (SSRIs) 199, 205
Self-directed violence (see also Suicide) 67, 185206,
244
INDEX
343
344
Statistics (continued)
mortality by WHO region 270273, 274277,
278281, 282285, 288299
WHO Member State populations 262269
Stereotyping, older people 141
Stigma
HIV/AIDS 164
male partner abuse 96
sexual violence 149
suicide 189
Stockholm International Peace Research Institute (SIPRI)
217, 326
Strategic planning, prevention recommendations 246
Strategies (see also Prevention; Programmes)
abused women 9596
partner violence disclosure 92
youth violence prevention 38, 4047
Stress
child abuse 68
collective violence 224, 224
elder abuse 131, 141
Student rebellion 36
Substance abuse, child abuse link 68
Sudden infant death syndrome 60, 75
Suicide (see also Self-directed violence) 6, 15, 102,
185206, 244
attempted 185, 189, 191
costs 12
definitions 185
erroneous estimates 189
extent 186189
firearm-related by country 322323
global estimates 10, 186188
ideation 185, 191, 194195
methods 196, 202203
mortality statistics 186189, 278281, 314321
precipitating factors 194195
predictors 193
prevention 199204
protective factors 195, 198
recommendations 204206
risk factors 191198
sexual abuse 149, 163
trends over time 187
web sites 327
workplace abuse 18
Support services
adults abused as children 7374
child abuse 7071, 73
collective violence 229232, 236
domestic violence 104, 112
elder abuse 136137
families 7172
post-suicide 203204, 206
refugees 171
sexual violence victims 154155, 165, 167168
suicide prevention 200
victims 249251
Surveillance, armed conflict 229, 232, 234
T
Teachers, sexual abuse 155156
Teams, child fatality reviews 7475
Technologies, new weaponry 222, 237
Telephone counselling 137, 165, 200
Television 38, 3940, 76, 168, 250
Terrorism 6, 216, 222, 237
Tertiary prevention 15
Therapies (see also Treatments)
child abuse 7374, 76
suicidal behaviour 199200, 205
youth violence prevention 42
Torres Strait Islanders, suicide 190
Torture, armed conflict 218, 219
Toxins, youth violence 45
Traditions (see also Cultural factors)
elder care 127128, 142
male partner violence 93, 9495, 100
Trafficking
disease risks 163
sexual exploitation 150, 153, 155, 162, 170171
Training (see also Education)
child abuse prevention 7071, 72, 7577, 80
domestic violence detection 106107
elder abuse prevention 138139, 142143
health personnel 166167, 250
parenting programmes 42, 7071
suicide prevention 201202, 205, 206
Treaties
child rights 64, 7779, 170, 254
collective violence prevention 228
human rights 253254
sexual violence prevention 170
Treatments (see also Therapies)
child abusers 75
partner abusers 106
sex abusers 165
suicide prevention 192, 199200, 205
Twentieth century, conflict-related deaths 218
Twin studies, suicidal behaviour 193194
Typology of violence 67
U
Unemployment 3637, 67, 197
United Nations Charter 234
United Nations Development Fund for Women 104,
108, 327
INDEX
V
Verbal abuse
children 65
older people 129
Victim support
abused women 104
improved services recommendation 249251
male victims 154155
protection 251
sexual violence 165, 167168
Victimization, child sexual abuse 158
Violence
definitions 56
typology of 67
Vulnerability
at risk groups 157, 244245
children 66
older people 127, 132133
W
War (see also Armed conflict; Collective violence) 15
armed conflict distinction 216
changes in 219220
definitions 216
disability 224
history 218, 220
leading causes of death/DALYs 286299
mortality estimates 10, 217218
rape 156, 218
Weapons (see also Guns)
collective violence 221, 222, 234, 237
male partner violence 93
345
suicide 196
youth violence 2730, 46
Web sites, violence-related 326327, 328
Welfare expenditures, lower homicide link 3738
Western Pacific
homicide statistics 1011, 274277
intentional injury mortality 270273
leading causes of death/DALYs 298299
partner violence 90
population statistics 268269
suicide statistics 1011, 278281
war-related mortality 282285
WHA, see World Health Assembly
WHO, see World Health Organization
Widows
suicide risk 195
violence towards 127, 142
Women (see also Girls; Widows) 5, 11, 64, 67, 99,
158159
abuse by health workers 156
abused as elders 127, 128, 142
all-women police stations 105106
domestic violence programmes 111
genital mutilation 171, 172
HIV/AIDS stigma 164
life expectancy 126
mortality rates 10, 93, 101, 102, 149
partner violence 89113
poverty risks 244245
response to abuse 9596, 108
sexual trafficking 153, 155, 170171
sexual violence against 149174
suicide 191, 195
violence prevention web sites 326327
vulnerability factors 157159
wife abuse 9495, 100, 243244
wife inheritance 157
witchcraft accusations 127, 128, 142
workplace violence 18
Workplace violence 1819
World Bank 252
World Health Assembly (WHA), peace initiatives 215
World Health Organization (WHO) 5, 1011, 17
child homicide estimates 60
collective violence prevention 229, 236
Consultation on Child Abuse Prevention 59
guidelines for injury surveillance 248
partner violence guidelines 92
partner violence study 99100
peace initiatives 215, 230231
suicide prevention 204
war casualty estimates 217
web site 328
World Organization against Torture (OMCT) 153
346
Y
Youth violence 11, 14, 2549, 32
definitions 25
development 3031
dynamics 3032
extent 2529
homicides 2529, 36, 3738, 46
media influence 38, 3940
non-fatal 2729
poverty link 244
prevention 38, 4049
recommendations 4749
risk factors 3238, 4647
trends 2627
web sites 327