The document provides information on different types of violence and their health impacts. It discusses youth violence, child abuse, intimate partner violence, elder abuse, and sexual violence. For each type of violence, it outlines risk factors, definitions, examples of abusive behaviors, and potential physical and psychological health consequences. The document aims to educate on the typology, nature, and prevention of violence, as well as promote a public health approach to addressing this important issue.

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6. Violence and health
DR.M.SUGANYA
3 rd year MD,ICM ,MMC
,
ICM,MMC
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7. Thanks to
Guide :Dr .Chitra MD Associate Professor
Co guide : Dr. Balaji MD assistant professor
• Thanks to all faculties of ICM for guiding me for the preparation of the
seminar.
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8. SYNOPSIS
Background
Objective
Definition
Typology and nature of violence
Violence in detail
Level of prevention
Multifaceted approach
Public health approach
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9. Background
• Violence has always been part of the human experience.
• Its impact 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 15–44 years.
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10. • The visible and the invisible :
• 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 human cost in grief and pain, of course, cannot be calculated
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11. • Thro satellite technology ,there are 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.
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12. Objective
• General objectives:
• The learner should be able to
• 1.Enlist the typology and nature of violence.
• 2.Enlist the types of prevention in violence.
• Specific learning objective:
• At the end of the class ,the learner should be able to
• 1.Enlist the risk factors and health consequence of different types of
violence.
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13. Definition
• The World Health Organization defines violence 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.
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14. DEFINITION -CONTD
• 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.
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15. Typology of violence and nature of violence
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16. • Self - directed violence:
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Inter personal
violence
Family or initimate
partner violence
Community violence
Child abuse
Initimate
partner abuse
Elderly abuse
Youth violence
Public place
violence –
school,colleges,priso
n

18. TYPES AND NATURE -CONTD
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Collective violence
Social Political economic

19. Violence in detail
• Youth violence
• Child abuse and neglect by parents and other caregivers
• Violence by intimate partners
• Abuse of the elderly
• Sexual violence
• Self-directed violence
• Collective violence
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20. Youth violence
• Violence by young people is one of the most visible forms of violence
in society.
• 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.
• .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.
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21. Risk behaviour
• Participating in physical fights,
• bullying and
• carrying of weapons are important risk behaviours for youth violence.
• Most studies examining these behaviours have involved primary and
secondary school pupils.
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22. Risk factors
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Individual factors
1.Biological characteristics –birth
complication .
2.Psychological and behavioural
characteristics-hyperactivity,
impulsiveness, poor behavioural control
and attention problems.
Relationship factors
1.Family influences- (Parental behaviour)
Poor monitoring and supervision of children
by parents and the use of harsh, physical
punishment to discipline children are strong
predictors of violence during adolescence and
adulthood.teenage pregnancy,poor
attachment. •peer influences.
Community factors
1.Gangs , guns and drugs –
•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.
• decline locally in the enforcement of law and
order; interrupted schooling,
• combined with low rates of pay for unskilled
labour;
Societal factors
1. modernization, emigration, urbanization and
changing social policies.
2. Income inequality.
3. Political structures and Cultural influences

23. Child abuse and neglect by parents and other caregivers
• Definitions:
• ‘Child abuse or maltreatment constitutes all forms of physical and or
emotional ill-treatment,sexual abuse,neglect or negligent treatment or
commercial or other exploitation, resulting in actual or potential harm
to the child’s health, survival, development or dignity in the context of
a relationship of responsibility, trust or power.’’
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24. Types of abuse
1.Physical abuse:
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sno Severe physical punishment Moderate physical punishment
1 Hit the child with an object
(not on buttocks)
Spanked buttocks (with hand
2 Kick the child Hit the child on buttocks (with object
3 Burn the child Slap the child’s face or head
4 Beat the child Pull the child’s hair
5 Threaten the child with a knife
or gun
Shook the child, Pinch the child, Twisted
the child’s ear, Force the child to kneel or
stand in an uncomfortable position, Put
hot pepper in the child’s mouth
6 Choke the child Hit the child with knuckles

25. TO BE CONTD
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2.Emotional abuse:
• restricting a child’s
movement,denigration,•ridicul
e, threats and intimidation,
•discrimination, rejection and
other nonphysical forms of
hostile treatment.
4.Neglect :failure of a parent to
provide for the development of
the child –where the parent is in a
position to do so
health, education,
emotional development,
nutrition,
shelter and safe living conditions.
3.Sexual
abuse

26. Risk factor
• Factors increasing a child’s vulnerability :
1.Age -physical, sexual or through neglect – depends on child’s age
2.sex- girls are at higher risk than boys for
infanticide,sexualabuse,educational and nutritional neglect, and forced
prostitution.
3.Special characteristics-low birth weight,prematurity,illness,or physical
or mental handicaps in the infant or child interfere with attachment and
bonding and may make the child more vulnerable to abuse.
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27. CONTD…
4.Family structure and resources:
• Physically abusive parents are more likely to be young, single, poor
and unemployed and to have less education than their non-abusing
counterparts
5. Family size and house hold composition:
The size of the family can also increase the risk for abuse.
6.Personality and behavioural characteristics:
children who abused physically tend to have low self-esteem, poor
control of their impulses, mental health problems, and to display
antisocial behaviour
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28. CONTD…
7.Violence in the home :
In a recent study in India, the occurrence of domestic violence in the
home doubled the risk of child abuse.
8. Other characteristics:
stress resulting from job changes, loss of income, health problems or
other aspects of the family environment such as poverty, overcrowding,
mental disorders and health problems .
9.Community factors:Cultural norms surrounding gender roles, parent–
child relationships and the privacy of the family.
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29. CONTD..
• Inequalities related to sex and income–factors present in other types of
violence and likely to be related to child maltreatment as well.
Rates of abuse are higher in communities with high levels of
unemployment and concentrated poverty.
Social capital: Children living in areas with less ‘‘social capital’’ or
social investment in the community appear to be at greater risk of abuse
and have more psychological or behavioural problems.
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30. Health consequences of child abuse
• Health consequences of child abuse
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Physical Sexual and reproductive Psychological and behavioural Other longer-term
health consequences
Abdominal/thoracic
injuries, Brain injuries,
Bruises and welts,
Burns and scalds,
Central nervous system
injuries, Disability
,Fractures ,Lacerations
and abrasions ,Ocular
damage.
Reproductive health
problems ,Sexual
dysfunction, Sexually
transmitted diseases,
including HIV/AIDS
,Unwanted pregnancy.
Alcohol and drug abuse,
Cognitive impairment,
Delinquent, violent and other
risk-taking behaviours
,Depression and anxiety,
Developmental delays, Eating
and sleep disorders ,Feelings of
shame and guilt, Hyperactivity,
Poor relationships, Poor school
performance, Poor self-esteem,
Post-traumatic stress disorder
.Psychosomatic disorders
Suicidal behaviour and self-
harm
Cancer, Chronic lung
disease ,Fibromyalgia
,Irritable bowel
syndrome ,Ischaemic
heart disease, Liver
disease, Reproductive
health problems such as
infertility.

31. Violence by intimate partners
• One of the most common forms of violence against women is that
performed by a husband or an intimate male partner.
• Intimate partner violence occurs in all countries, irrespective of social,
economic, religious or cultural group.
• Domestic violence can be broadly defined as pattern of abusive
behaviours by one or both the partners in an intimate relationship such
as marriage,dating,family,friends and cohabitation.
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32. RISK FACTORS
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Individual factors Relationship factors Community factors Societal factors
Young age .
Heavy drinking .
Depression .
Personality disorders . Low
academic achievement . Low
income .
Witnessing or experiencing
violence as a child.
Marital conflict .
Marital instability .
Male dominance in
the family .
Economic stress .
Poor family
functioning.
Weak community
sanctions against
domestic violence .
Poverty. Low social
capital.
Traditional
gender norms .
Social norms
supportive of
violence.

33. Health consequences of intimate partner
violence
Physical Sexual and reproductive Psychological and
behavioural
Fatal health consequences
Abdominal/thoracic injuries,
Bruises and welts,
Chronic pain syndromes,
Disability, Fibromyalgia,
Fractures, Gastrointestinal
disorders,
Irritable bowel syndrome,
Lacerations and abrasions,
Ocular damage, Reduced
physical functioning.
Gynaecological disorders,
Infertility ,
Pelvic inflammatory disease,
Pregnancy
complications/miscarriage,
Sexual dysfunction, Sexually
transmitted diseases,
including HIV/AIDS,
Unsafe abortion, Unwanted
pregnancy.
Alcohol and drug abuse,
Depression and anxiety,
Eating and sleep disorders
Feelings of shame and guilt
,
Phobias and panic disorder,
Physical inactivity, Poor self-
esteem, Post-traumatic
stress disorder,
Psychosomatic disorders,
Smoking, Suicidal behaviour
and self-harm
Unsafe sexual behaviour .
AIDS-related mortality,
Maternal mortality,
Homicide,
Suicide.
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34. Abuse of the elderly
• Definition developed by Action on Elder Abuse in the United
Kingdom and adopted by the International Network for the Prevention
of Elder Abuse states that: ‘‘Elder abuse is a single or repeated act,
or lack of appropriate action, occurring within any relationship
where there is an expectation of trust which causes harm or
distress to an older person.
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35. Types of elderly abuse
Physical abuse – beating and physical
man handling.
Financial abuse – extortion and control of pension money, theft of property, and
exploitation of older people to force them to care for grandchildren.
Emotional and verbal abuse – discrimination on the basis of age, insults and hurtful
words, denigration, intimidation, false accusations, psychological pain and distress
Sexual abuse – incest, rape and other types of sexual coercion.
. Neglect – loss of respect for elders, withholding of affection, and lack of
interest in the older person’s well-being
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36. Health consequence of elder abuse
Physical Behavioural and
emotional
Sexual Financial Indicators relating
to the caregiver
1. Complaints of
being physically
assaulted.
2.Unexplained falls
and injuries.
3.Burns and bruises
in unusual places or
of an unusual type.
4.Cuts, finger marks
or other evidence
of physical
restraint.
1.Change in eating
pattern or sleep
problems.
2.Fear, confusion
or air of
resignation.
3.Passivity or
withdrawal or
increasing
depression.
4.Helplessness,
hopelessness or
anxiety.
1.Complaints of
being sexually
assaulted.
2. Sexual behaviour
that is out of
keeping with the
older person’s usual
relationships and
previous
personality.
3.Unexplained
changes in
behaviour, such as
aggression,
4.withdrawal or
self-mutilation.
1.Withdrawals of
money that are
erratic, or not
typical of the older
person.
2.Withdrawals of
money that are
inconsistent with
the older person’s
means.
3. Changing a will or
property title to
leave house or
assets to "new
friends or relatives"
4. Property is
missing.
1.Caregiver
appears tired or
stressed.
2.Caregiver seems
excessively
concerned or
unconcerned.
3.Caregiver blames
the older person for
acts such as
incontinence.
4. Caregiver
behaves
aggressively.
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37. • Physical
• BehavPhysicl
• Behavioural and emotional
• Sexual
• Financial
• Indicators relating to td emotional
• Sexu
• Financial
• Indicators relating to the caregiver
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Physical Behavioural and
emotional
Sexual Financial Indicators relating to
the caregiver
5.Excessive repeat
prescriptions or
underusage of
medication.
6. Malnourishment or
dehydration without an
illness-related cause.
7.Evidence of
inadequate care or
poor standards of
hygiene.
8.Person seeks medical
attention from a variety
of doctors or medical
centres
5. Contradictory
statements or other
ambivalence not
resulting from mental
confusion.
6.Reluctance to talk
openly.
7. Avoidance of
physical, eye or verbal
contact with caregiver.
8.Older person is
isolated by others
5. Frequent complaints
of abdominal pain, or
unexplained vaginal or
anal bleeding.
6.Recurrent genital
infections, or bruises
around the breasts or
genital area.
7.Torn, stained or
bloody underclothes
5.Older person "can’t
find" jewellery or
personal belongings.
6.Suspicious activity on
credit card account.
7.Lack of amenities,
when the older person
could afford them.
8. Untreated medical or
mental health
problems
9. Level of care is not
commensurate with
the older person’s
income or assets.
5.Caregiver treats the
older person like a child
or in a dehumanized
way.
6.Caregiver has a
history of substance
abuse or abusing
others.
7. Caregiver does not
want the older person
to be interviewed
alone.
8.Caregiver responds
defensively when
questioned; may be
hostile or evasive.
9. Caregiver has been
providing care to the
older person for a long
period of time.

38. sexual violence
• Sexual violence is defined as: any sexual act, attempt to obtain a
sexual act, unwanted sexual comments or advances,or acts to traffic, or
otherwise directed, against a person’s sexuality using coercion,by any
person regardless of their relationship to the victim, in any setting,
including but not limited to home and work.
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39. Factors increasing men’s risk of committing rape
Individual factor Relationship factors Community factors Societal factors
1. Alcohol and drug use .
2.Coercive sexual fantasies
and other attitudes and
beliefs supportive of
sexual violence .
3.Impulsive and
antisocialtendencies
4.Preference for
impersonal sex . 5.Hostility
towards women .
6.History of sexual abuse
as a child . Witnessed
family violence as a child
1.Sexually aggressive and
delinquent peers.
2.Family environment
characterized by physical
violence and few
resources . 3.Strongly
patriarchal relationship or
family environment
4.Emotionally
unsupportive family
environment . 5.Family
honour considered more
important than the health
and safety of the victim
1.poverty.
2.Lack of employment
opportunities .
3.Lack of institutional
support from police and
judicial system .
4.General tolerance of
sexual assault within the
community .
5. Weak community
sanctions against
perpetrators of sexual
violence
1.Societal norms
supportive of sexual
violence.
2.Societal norms
supportive of male
superiority and sexual
entitlement .
3.Weak laws and policies
related to sexual violence .
4.Weak laws and policies
related to gender equality
5.High levels of crime and
other forms of violence
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40. Health consequences of sexual violence
• Psychological consequences,both in the immediate period after the
assault and over the longer term.
• These include guilt, anger, anxiety, depression, post-traumatic stress
disorder, sexual dysfunction, somatic complaints, sleep disturbances,
withdrawal from relationships and attempted suicide. In addition to
these reactions, studies of adolescent males have also found an
association between suffering rape and substance abuse,violent
behaviour,stealing and absenteeism from school.
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41. Measuring violence and its impact
• Types of data and potential sources for collecting information
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S NO Type of data Data sources Examples of information collected
1 Mortality Death certificates, vital statistics registries,
medical examiners’, coroners’ or mortuary
reports.
Characteristics of the decedent,
cause of death, location, time,
manner of death
2. Morbidity and other health
data
Hospital, clinic or other medical records Diseases, injuries, information on
physical, mental or reproductive
health
3. Self-reported Surveys, special studies, focus groups,
media
Attitudes, beliefs, behaviours,
cultural practices, victimization and
perpetration, exposure to violence
in the home or community
4. Community Population records, local government
records, other institutional records.
Population counts and density,
levels of income and education,
unemployment rates, divorce rates

42. Contd…
sno Type of data Data source Examples of information
collected
5. Crime Police records, judiciary
records, crime laboratories
Type of offence, characteristics of
offender, relationship between
victim and offender,
circumstances of event
6. Economic Programme, institutional or
agency records, special
studies
Expenditures on health, housing
or social services, costs of treating
violence-related injuries, use of
services
7. Policy or legislative Government or legislative
records
Laws,institutional policies and
practices
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43. Types of prevention of violence
Primary
prevention- aim to
prevent violence
before it occurs.
Secondary prevention
– more immediate
responses to violence,
such as pre-hospital
care, emergency
services or treatment
for sexually
transmitted diseases
following a rape .
Tertiary prevention –
long-term care such
as rehabilitation and
reintegration, and
attempts to lessen
trauma or reduce the
long-term disability
associated with
violence.
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44. Multifaceted responses
• The public health approach also emphasizes collective action from
such diverse sectors as health, education, social services, justice and
policy .
• Each sector has an important role to play in addressing the problem of
violence and, collectively, the approaches taken by each have the
potential to produce important reductions in violence .
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45. ECOLOGICAL MODEL
Addressing the larger cultural, social
and economic factors .
Monitoring public places such as schools,
workplaces.
create healthy family environments
modify individual risk
behaviours
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46. Comprehensive approaches at all levels.Locallevel
Multisectoral partnerships may
include health care providers,
police, educators, social workers,
employers and government
officials to promote violence
prevention.
Small scale pilot programmes
and research projects can be
done to found out the solution.
Nationallevel
government ministries not only
those concerned with law
enforcement, social services and
health – have important
contributions to make in
preventing violence.
Education ministries -intervening
in school
Ministries of labour -reduce
violence in the workplace .
Defence ministries -can
positively shape the attitudes
towards violence, by
encouraging discipline,
promoting codes of honour, and
impressing a strong awareness
of the lethalness of weapons
Globallevel-
The World Health Organization
clearly has an important global
role to play in this respect as the
United Nations agency
responsible for health.
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47. Public health Approach
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Define the
health problem.
Identify risk factors
associated with the
problem.
Develop and test
community-level
interventions to control
or prevent the cause or
the problem
Implement interventions to
improve the health of the
population
Monitor those
interventions to assess
their effectiveness

48. Legislation against domestic violence
• The Crimes identified under the Indian Penal Code (IPC):
• (1) Section 376 (rape)
• (2) Kidnapping and abduction for different purposes (Sec.363 – 373
IPC)
• (3) Homicide for dowry, dowry deaths or their attempts (Sec.302, 304-
B IPC)
• (4) Torture, both mental and physical (Sec.498-A IPC)
• (5) Importation of girls (up to 21 years of age.(Sec.366-B IPC)
• (6) Molestation (Sec.354 IPC and Sexual harassment (Sec.509 IPC)
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;

49. CONTD ..
• The Crimes identified under the Special Laws :
• 1)Commission of Sati (Prevention) Act 1987
• 2) Dowry (Prohibition) Act 1961
• 3) Immoral Traffic (Prevention) Act 1956,
• 4) Indecent Representation of women (Prohibition) Act 1986
• 5) The Medical Termination of Pregnancy Act 1971 and so on.
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50. Interventions
• Universal interventions – aimed at groups or the general population
without regard to individual risk;
• examples include violence prevention curricula delivered to all
students in a school or children of a particular age and community-
wide media campaigns.
• Selected interventions – aimed at those considered at heightened risk
for violence (having one or more risk factors for violence); an example
of such an intervention is training in parenting provided to low
income, single parents.
•
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51. CONTD
• Indicated interventions – approaches aimed at those who have already
demonstrated violent behaviour, such as treatment for perpetrators of
domestic violence.
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52. Haddon Matrix
• Haddon’s Matrix is a brainstorming tool that combines the
epidemiology triangle (host, agent, environment) and levels of
prevention.
Columns:
The Host refers to the person at risk .
2. The Agent .
3. The Physical Environment includes all the characteristics of the
setting in which the injury event takes place .
4. The Social Environment refers to the social and legal norms and
practices in the culture and society at the time
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53. • Rows :
• 1. Pre-injury event phase / Primary prevention.
• 2. Injury event phase / Secondary prevention.
• 3. Post injury event phase / Tertiary prevention (Treatment and
Rehabilitation).
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54. Exercise
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55. • Reference:
1.World report on violence" WHO-2002
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56. Thank you
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