Violence: a public health perspective

Violence is one of the most important causes of suffering and death on the planet. The incidence of different forms of violence varies markedly within and between populations with high rates of violence driven largely by poverty and social injustice and sustained by inept policy responses rooted in legal and moral frameworks. Violence therefore poses a major challenge for public health which is the discipline concerned with assuring the conditions for a healthy society. Over the past five decades it has become increasingly clear that public health has important contributions to make to the challenge of understanding and preventing violence, contributions which extend and complement conventional legal and moral approaches to violence. This work was led initially by the US Centre for Disease Control (CDC) and more recently by the World Health Organisation (WHO) which in 2002 published the first World Report on Violence and Health . Public health is a relatively atheoretical discipline. While a number of useful theoretical frameworks have emerged to better understand and prevent violence, there is no agreed or dominant public health theory of violence. James Gilligan has proposed a detailed and potentially useful public health theory of violence based on the notion that shame/humiliation, which violates an individual's self-respect and dignity, is the pathogen that causes violence; a pathogen intimately linked with cruelty and neglect in childhood, spread by the vector of inequalities in power, wealth and status in society and sustained by punishment and humiliation within the criminal justice system. This notion of violence resonates with Vittorio Bufacchi's concept of violence as a violation of integrity.