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Day 15: Measuring the Cost of Violence

Posted on 09 December 2000
 

Measuring the Cost of Violence

What to measure and where to find the information

No single indicator or source of information is sufficient to describe the magnitude, health and social consequences of violence. Vital statistics provide a count and a rate - usually per 100 000 people - for deaths from homicide, suicide and other forms of violence. Hospitals, clinics and emergency rooms will have data on admission for injuries. Police maintain statistics of reported cases of violence, and in some settings social welfare authorities or nongovernmental organisation (NGOs) may maintain registers of cases of domestic violence, child abuse or violence against other vulnerable groups.

No single indicator or source of information is sufficient to describe the magnitude, health and social consequences of violence. Vital statistics provide a count and a rate - usually per 100 000 people - for deaths from homicide, suicide and other forms of violence. Hospitals, clinics and emergency rooms will have data on admission for injuries. Police maintain statistics of reported cases of violence, and in some settings social welfare authorities or nongovernmental organisation (NGOs) may maintain registers of cases of domestic violence, child abuse or violence against other vulnerable groups.

 

Deaths from violence: no country is immune

Mortality statistics are most readily available information for monitoring trends and making comparisons of homicide and suicide rates within and between countries. Violence-related deaths may be hidden in mortality statistics when such deaths are erroneously recorded or attributed to accidental injuries. Many violent deaths and injuries of women, children and the elderly are ascribed to falls or burns by the perpetrators and/or the authorities. While mortality data provide a picture of the tip of the iceberg of injuries and suffering, it is often an incomplete picture.

In 1993 worldwide, over one million people died as a result of suicide or homicide. To this, one must add the victims of wars which have killed millions of people - especially children and women - in the last few years.

The patterns of death from violence - by level and cause (as shown in Table below), age, sex and circumstance vary widely among countries, but appear fairly consistent within countries from year to year.

Table: Deaths from violence as a percentage of total deaths and suicide as a percentage of violent deaths

Country - Mortality rate for Violence (Year)
(Deaths per 100 000 population)
Violence as % of all deaths Suicide as % of violence
France - 26.7 (1993) 2.9 79.4
Mexico - 23.5 (1993) 5.1 11.1
Republic of Korea - 12.1 (1994) 2.3 78.3
Russian Federation - 109.3 (1994) 7.0 38.3
United Kingdom - 12.1 (1994) 1.1 62.2

 

Without rigorous monitoring and surveillance systems for data collection and analysis it is difficult to determine to what extent such differences can be attributed to incomplete reporting.

 

Non-fatal injuries and disabilities from violence

WHO and the World Bank have estimated that injury and violence contribute 14.5% of the burden of disease in the developed world and 15.2% in the developing world. Intentional violence accounts for 4.2% and 4.1% of the total burden respectively. However, there is substantial variation in the regional patterns, particularly of intentional injury. In 1990 violence posed a relatively greater burden in Sub-Saharan Africa (6%), China (4.7%), Latin America/Caribbean (4.5%), the Middle Eastern crescent (6.2%), and in countries with formerly socialist economies (5.8%) than in other regions of the world. There was, however, considerable variation in the types of violence. Interpersonal violence was elevated relative to other regions in Sub-Saharan Africa, Latin America and the Caribbean, and in countries with formerly socialist economies. The burden of self-directed violence was relatively greater in China, countries with formerly socialist economies and countries with established market economies.

 

Sexual assault : fear of reporting

Sexual assault goes largely unreported in industrialized and developing countries. The reasons are manifold and in large part relate to the position, social role and situation of women. Reporting is often futile in situations where there is a pattern of assault against women by law enforcement agents and other authorities. In many societies the blame for sexual assault is unjustifiably placed on women, with the perpetrators, if brought to justice, escaping with limited punishment. In some settings assaulted women become outcasts and ostracized, even by their own families.

Total mortality rates obscure the disproportionate impact of violence on specific subgroups, most notably youth, women and children, and the poor.

The American Medical Association estimates that in the United States, there:

  • are two to four million women battered each year;
  • is a 20-30% lifetime risk for a woman to be battered;
  • are 1.8 million elderly victims of maltreatment;
  • are 1.7 million yearly reports of child abuse.

 

Violence hidden from view - the special needs of women, children and the elderly

Witnessing violence in the home can be as traumatic for children as experiencing violence. Younger children are more likely to suffer post-traumatic stress disorder (PTSD), particularly when the violence they witness is frequent and is perpetrated in close proximity to them. They experience significant psychological and behavioral problems, which interfere with their ability to function in school, at home and with peers. Children who grow up in violent homes are more likely to be aggressive with peers, and as adults are more likely to become batterers or victims.

 

The cost of violence

A one-year population based study of all hospitalizations for firearm-related injuries in the State of California showed the following results:

  • $164 million for total hospital costs of over 9000 patients.
  • $17 888 average charge per patient.

 

In the USA, the average annual financial cost in relation to victims of assaultive injuries occurring from 1987 to 1990, was estimated at $34 billion, with lost quality of life costing another $145 billion.

 

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