An assessment of the current situation

Violence among young people has its root causes in family, society, culture and economic conditions and persists in many countries in the WHO European Region.

5.1.1 Why interpersonal violence among young people matters in the Region

Interpersonal violence takes an enormous toll on the lives of young people in the Region, and every year more than 15 000 young people lose their lives from interpersonal violence, amounting to more than 40 deaths a day. Of these deaths, an estimated 40% are enabled by knives or sharp implements. Adding to the burden of deaths are the 300 000 young people admitted to hospital annually due to injuries from interpersonal violence and the millions more who seek help and support from health, justice, social, occupational and educational services in the Region. The costs of services and those due to lost productivity due to ill health and incarceration are enormous, as are the costs borne by families whose lives are shattered by the loss of loved ones.

Not only may young victims be severely injured, but interpersonal violence also interferes with their psychosocial and emotional development and increases the likelihood of anxiety, depression and suicidal behaviour (1). Violence is a self-perpetuating cycle, and victims of violence are at increased risk of being involved in further violence in later life both as victims and perpetrators (2–4).

Evidence also shows that violence increases risk-taking behaviour such as smoking and alcohol misuse, which worsen health outcomes in adulthood, such as by increasing the risk of cancer and cardiovascular diseases (1,5). Longitudinal studies are needed in the European Region to better understand the longer-term health, social and economic costs of violence.

Within the Region, concern is growing about violence among young people and especially about knife-related violence. A recent survey of focal people for preventing violence from the health ministries of 35 countries confirmed this interest across the Region (Table 5.1).

5.1.2 Inequality persists in the European Region

The likelihood of a young person dying from homicide is almost seven times higher in low- and middle-income countries than in high-income countries in the WHO European Region. The difference between the country with the highest homicide rate among young people, the Russian Federation, and the one with the lowest rate, Germany, is 34-fold. This inequality is also reflected in how countries respond to the problem of interpersonal violence in the Region. Countries can therefore learn from others’ successes and failures, and examples of evidence-based good practice can be transferred and adapted to different settings.

5. Addressing violence among young people in the European Region: opportunities for action 77 Country Is violence involving knives

a problem in your country? Is violence involving knives a current political priority?¹

Are data available on knife-related violence in your

country?²

Are there any specific interventions in place

to prevent knife-related violence?²

Are you interested in more information

on knife-related violence?²

Denmark No answer üü ü ü ü

Albania

It is already a big problem

ü Í Í ü

Finland Í ü Í Í

Ireland üü ü ü ü

Russian Federation Í Í Í ü

United Kingdom üü ü ü ü

Belgium

It is a growing problem

Í Í Í ü

Hungary Í Í ü ü

Iceland Í ü Í ü

Israel Í ü – ü

Italy Í Í Í ü

Lithuania Í Í Í ü

The former Yugoslav

Republic of Macedonia ü ü ü ü

Uzbekistan Í ü Í ü

Spain Not any more³ Í Í Í Í

Armenia

It occurs, but it is not a problem

Í ü Í ü

Austria Í Í Í Í

Azerbaijan Í Í Í ü

Bosnia and Herzegovina Í Í Í ü

Bulgaria Í ü ü ü

Cyprus ü Í Í ü

Greece ü Í Í ü

Hungary Í Í Í Í

Israel Í Í Í ü

Kyrgyzstan ü Í Í ü

Latvia Í ü Í ü

Malta Í ü Í ü

Montenegro Í ü Í ü

Poland ü Í Í ü

Romania ü ü Í ü

Slovenia Í Í Í Í

Andorra

It is not a problem at all

Í ü Í Í

San Marino Í Í Í Í

Slovakia Í Í Í Í

Table 5.1. Survey results of concern at health ministries regarding knife-related violence in 35 responding countries in the WHO European Region

1 üü: yes, a high priority; ü: yes, a low priority; Í: no.

2 ü: yes; Í: no; –: no answer.

3 It used to be a problem, but it is now reduced.

Source: unpublished data from a WHO Regional Office for Europe survey on knife-related violence, 2010.

78 5. Addressing violence among young people in the European Region: opportunities for action

The social determinants of health differ greatly between and within the countries in the Region (6). The evidence gathered here shows that young people from socially disadvantaged backgrounds are more likely to experience fatal and nonfatal interpersonal violence. Children and adolescents living in families with social deprivation have increased exposure to family conflict and violence within the home. Young people living in deprived areas have greater exposure to violence, have greater fear of violence, lack social support and see violence as a normal way of resolving conflict or carrying out punishment. Communities with high levels of violence may lose out on scarce resources diverted to criminal justice systems away from services such as education but also on public health and social services because of concerns of staff safety. Violence may also hinder health-promoting activities such as physical exercise.

Living in societies with greater income inequality, lower social trust and poorer societal resources is also associated with greater violence (7,8).

Whereas social determinants are key for violence developing, violence itself perpetuates and deepens health, social and economic inequality.

Resources need to be targeted to reduce inequity in health and to strive for greater social justice (6).

5.1.3 A period of rapid change in the Region

The last 30 years have been associated with great political, economic and social change in the European Region and with the challenges of rapid globalization (6,9–12). Countries in the eastern part of the Region have changed rapidly to market economies, and the infrastructure and regulatory systems have been under tremendous strain.

Social support networks and social capital have been eroded in many countries, leaving children and adolescents vulnerable. The transition has been associated with marked rises in interpersonal violence and homicide in some countries. This is also true at the subnational level: for example, state social security dissolved in the Russian Federation, and the regions that experienced the highest unemployment experienced the highest rates of homicide (13). Deregulation and the

increased consumption of alcohol in parts of the Region have also led to increases in alcohol-related violence (14). In the current economic downturn, there is concern that lower levels of public spending on social welfare may adversely affect health and increase violence (9).

The Region has also had large population movements. A combination of asylum-seekers, economic migrants and travellers may be vulnerable to new ways of life in unfamiliar societies, where they may live in deprived urban neighbourhoods in conditions of economic poverty compared to native populations.

Homicide rates among young migrants have been reported to be higher than in indigenous populations (15), although much of this effect is due to socioeconomic deprivation (16).

5.1.4 Young people are vulnerable to violence

This report has emphasized the vulnerability of young people to being a victim or perpetrator of violence. This is particularly true of young men, who are at greater risk of being a victim of homicide than young women, who are at greater risk of being a victim of sexual violence. Adolescent development involves changing relations between the individual

5. Addressing violence among young people in the European Region: opportunities for action 79 and the family, institutions and society. This may

put adolescents at risk related to alcohol use, drug use, exclusion from mainstream education, bullying and violence. Poverty and social exclusion exacerbate these risks (17). Adversity in childhood and exposure to violence in the home, school and community and to risk factors such as alcohol and drug use contribute to young people being involved in violence (1,5,18). To protect young people, a commitment is needed to a preventive approach to tackle the root causes of violence and enable young people to live free from violence.

This necessarily involves various sectors such as health, education, labour and justice. Preventing these root causes will act to reduce the carrying of knives and other weapons among young people.

Resources need to be targeted to reduce inequity in health, to strive for social justice and to protect the rights of vulnerable people.

5.1.5 Alcohol has a leading role in precipitating violence among young people in the Region

Globalization and deregulation in many countries have led to an increasing number of young people who drink alcohol at an early age, drink regularly and drink to excess (19–22). This behaviour increases the likelihood of a young person being either a victim or perpetrator of violence. In the eastern part of the European Region, deregulation and the freer availability of alcohol have been associated with sharp increases in alcohol intake among young people (10–12). Changes in the volumes and patterns of alcohol consumption have been noted among young people throughout the Region, with increases in binge-drinking (20). This is a risk factor for young people being a victim or

perpetrator of violence. For example, steep rises in homicide rates have been found at the times of greatest change, and these are also linked to increased alcohol consumption levels in the Russian Federation (14,23). Alcohol use is strongly associated with violence and weapon-carrying among young people. The introduction of minimum pricing, regulation and enforcement to reduce access to alcohol and its misuse are important measures, as is modifying drinking environments to make them safer (24).

5.1.6 Violence among young people is preventable

The report presents the available facts on the burden and risk factors and argues that young people are vulnerable, as the causes of violence are linked to their early development, cultural and social determinants, access to alcohol and drugs and inadequate social support networks.

Evidence is presented on how long-standing benefits may be gained through cost-effective programmes that ameliorate risks and boost protective factors to prevent violence and the carrying of weapons (25). Such approaches are more cost-effective than incarceration. The report draws from the experience of several countries that have developed programmes resulting in great gains in safety through sustained and systematic commitment.

This report promotes the public health approach endorsed by the World report on violence and health and emphasizes primary prevention to avert violence rather than coping with its effects (1).

It argues that equal importance should be given to investing in primary prevention compared with

80 5. Addressing violence among young people in the European Region: opportunities for action

the criminal justice response, which is essential for limiting the damage from violence through control and deterrence (1,26,27).