Definition and typology of violence

VPA addresses the problem of violence as defined in the World report on violence and health (WRVH),
namely:
"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 WRVH also presents a typology of violence that, while not uniformly accepted, can be a useful way to
understand the contexts in which violence occurs and the interactions between types of violence. This
typology distinguishes four modes in which violence may be inflicted: physical; sexual; and psychological
attack; and deprivation. It further divides the general definition of violence into three sub-types according to
the victim-perpetrator relationship.
 Self-directed violence refers to violence in which the perpetrator and the victim are the same individual and
is subdivided into self-abuse and suicide.
 Interpersonal violence refers to violence between individuals, and is subdivided into family and intimate
partner violence and community violence. The former category includes child maltreatment; intimate partner
violence; and elder abuse, while the latter is broken down into acquaintance and stranger violence and
includes youth violence; assault by strangers; violence related to property crimes; and violence in
workplaces and other institutions.
 Collective violence refers to violence committed by larger groups of individuals and can be subdivided into
social, political and economic violence.
Typology of interpersonal violence

http://www.who.int/violenceprevention/approach/definition/en/

Violence and Injury Prevention

Violence prevention

WHO prevention of violence work focuses on interpersonal violence: child maltreatment, youth violence,
intimate partner violence, sexual violence and elder abuse. Globally, some 470 000 homicides occur each year
and millions of people suffer violence-related injuries. Beyond death and injury, exposure to violence can
increase the risk of smoking, alcohol and drug abuse; mental illness, anxiety disorders and suicidality; chronic
diseases like heart disease, diabetes and cancer; infectious diseases such as HIV, and social problems such as
crime and further violence. Interventions to address violence are delivered as part of a four-step public health
approach that includes (1) defining the problem; (2) identifying causes and risk factors; (3) designing and testing
interventions, and (4) increasing the scale of effective interventions

http://www.who.int/violence_injury_prevention/violence/en/
 Child maltreatment ("child abuse")

UN Photo/A Jongen

Approximately 20% of women and 5–10% of men report being sexually abused as children, while
25–50% of all children report being physically abused. The lifelong consequences of child
maltreatment include impaired physical and mental health, poorer school performance, and job
and relationship difficulties. Ultimately, child maltreatment can contribute to slowing a country's
economic and social development.

Child maltreatment
Fact sheet
Reviewed September 2016

Key facts
 A quarter of all adults report having been physically abused as children.
 One in 5 women and 1 in 13 men report having been sexually abused as a child.
 Consequences of child maltreatment include impaired lifelong physical and mental health, and the social and
occupational outcomes can ultimately slow a country's economic and social development.
 Preventing child maltreatment before it starts is possible and requires a multisectoral approach.
 Effective prevention programmes support parents and teach positive parenting skills.
 Ongoing care of children and families can reduce the risk of maltreatment reoccurring and can minimize its
consequences.

Child maltreatment is the abuse and neglect that occurs to children under 18 years of age. It includes all
types of physical and/or emotional ill-treatment, sexual abuse, neglect, negligence and commercial or other
exploitation, which results 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. Exposure to intimate partner violence is also
sometimes included as a form of child maltreatment.
Scope of the problem
Child maltreatment is a global problem with serious life-long consequences. In spite of recent national
surveys in several low- and middle-income countries, data from many countries are still lacking.
Child maltreatment is complex and difficult to study. Current estimates vary widely depending on the
country and the method of research used. Estimates depend on:
 the definitions of child maltreatment used;
 the type of child maltreatment studied;
 the coverage and quality of official statistics;
 the coverage and quality of surveys that request self-reports from victims, parents or caregivers.
Nonetheless, international studies reveal that a quarter of all adults report having been physically abused as
children and 1 in 5 women and 1 in 13 men report having been sexually abused as a child. Additionally,
many children are subject to emotional abuse (sometimes referred to as psychological abuse) and to neglect.
 Every year, there are an estimated 41 000 homicide deaths in children under 15 years of age. This number
underestimates the true extent of the problem, as a significant proportion of deaths due to child maltreatment
are incorrectly attributed to falls, burns, drowning and other causes.
In armed conflict and refugee settings, girls are particularly vulnerable to sexual violence, exploitation and
abuse by combatants, security forces, members of their communities, aid workers and others.
Consequences of maltreatment
Child maltreatment causes suffering to children and families and can have long-term consequences.
Maltreatment causes stress that is associated with disruption in early brain development. Extreme stress can
impair the development of the nervous and immune systems. Consequently, as adults, maltreated children
are at increased risk for behavioural, physical and mental health problems such as:
 perpetrating or being a victim of violence
 depression
 smoking
 obesity
 high-risk sexual behaviours
 unintended pregnancy
 alcohol and drug misuse.
Via these behavioural and mental health consequences, maltreatment can contribute to heart disease, cancer,
suicide and sexually transmitted infections.
Beyond the health and social consequences of child maltreatment, there is an economic impact, including
costs of hospitalization, mental health treatment, child welfare, and longer-term health costs.
Risk factors
A number of risk factors for child maltreatment have been identified. These risk factors are not present in all
social and cultural contexts, but provide an overview when attempting to understand the causes of child
maltreatment.
Child
It is important to emphasize that children are the victims and are never to blame for maltreatment. A number
of characteristics of an individual child may increase the likelihood of being maltreated:
 being either under four years old or an adolescent
 being unwanted, or failing to fulfil the expectations of parents
 having special needs, crying persistently or having abnormal physical features.
Parent or caregiver
A number of characteristics of a parent or caregiver may increase the risk of child maltreatment. These
include:
 difficulty bonding with a newborn
 not nurturing the child
 having been maltreated themselves as a child
 lacking awareness of child development or having unrealistic expectations
 misusing alcohol or drugs, including during pregnancy
 being involved in criminal activity
 experiencing financial difficulties.
Relationship
A number of characteristics of relationships within families or among intimate partners, friends and peers
may increase the risk of child maltreatment. These include:
 physical, developmental or mental health problems of a family member
 family breakdown or violence between other family members
 being isolated in the community or lacking a support network
 a breakdown of support in child rearing from the extended family.
Community and societal factors
A number of characteristics of communities and societies may increase the risk of child maltreatment. These
include:
 gender and social inequality;
 lack of adequate housing or services to support families and institutions;
 high levels of unemployment or poverty;
 the easy availability of alcohol and drugs;
 inadequate policies and programmes to prevent child maltreatment, child pornography, child prostitution and
child labour;
 social and cultural norms that promote or glorify violence towards others, support the use of corporal
punishment, demand rigid gender roles, or diminish the status of the child in parent–child relationships;
 social, economic, health and education policies that lead to poor living standards, or to socioeconomic
inequality or instability.
Prevention
Preventing child maltreatment requires a multisectoral approach. Effective programmes are those that
support parents and teach positive parenting skills. These include:
 visits by nurses to parents and children in their homes to provide support, education, and information;
 parent education, usually delivered in groups, to improve child-rearing skills, increase knowledge of child
development, and encourage positive child management strategies; and
 multi-component interventions, which typically include support and education of parents, pre-school
education, and child care.
Other prevention programmes have shown some promise.
 Programmes to prevent abusive head trauma (also referred to as shaken baby syndrome, shaken infant
syndrome and inflicted traumatic brain injury). These are usually hospital-based programmes targeting new
parents prior to discharge from the hospital, informing of the dangers of shaken baby syndrome and advising
on how to deal with babies that cry inconsolably.
 Programmes to prevent child sexual abuse. These are usually delivered in schools and teach children about:
o body ownership
o the difference between good and bad touch
o how to recognize abusive situations
o how to say "no"
o how to disclose abuse to a trusted adult.
Such programmes are effective at strengthening protective factors against child sexual abuse (e.g.
knowledge of sexual abuse and protective behaviours), but evidence about whether such programmes reduce
other kinds of abuse is lacking.
The earlier such interventions occur in children's lives, the greater the benefits to the child (e.g. cognitive
development, behavioural and social competence, educational attainment) and to society (e.g. reduced
delinquency and crime).
In addition, early case recognition coupled with ongoing care of child victims and families can help reduce
reoccurrence of maltreatment and lessen its consequences.
To maximize the effects of prevention and care, WHO recommends that interventions are delivered as part
of a four-step public health approach:
1. defining the problem;
2. identifying causes and risk factors;
3. designing and testing interventions aimed at minimizing the risk factors;
4. disseminating information about the effectiveness of interventions and increasing the scale of proven
effective interventions.
WHO response
WHO, in collaboration with a number of partners:
 provides technical and normative guidance for evidence-based child maltreatment prevention;
 advocates for increased international support for and investment in evidence-based child maltreatment
prevention;
 provides technical support for evidence-based child maltreatment prevention programmes in several low-
and middle-income countries.
http://www.who.int/violence_injury_prevention/violence/child/en/
 Prevention of intimate partner and sexual violence (violence
against women)

UN Photo/Martine Perret

Intimate partner violence and sexual violence against women are major public health problems
and violations of human rights. They result in serious short- and long-term physical, sexual and
reproductive, and mental health problems, including increased vulnerability to HIV. Between 15–
71% of women experience physical and/or sexual violence by an intimate partner at some point in
their lives.

Violence against women

Intimate partner and sexual violence against women
Fact sheet
Updated November 2016

Key facts:
 Violence against women - particularly intimate partner violence and sexual violence - are major public
health problems and violations of women's human rights.
 Global estimates published by WHO indicate that about 1 in 3 (35%) women worldwide have experienced
either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime.
 Most of this violence is intimate partner violence. Worldwide, almost one third (30%) of women who have
been in a relationship report that they have experienced some form of physical and/or sexual violence by
their intimate partner in their lifetime.
 Globally, as many as 38% of murders of women are committed by a male intimate partner.
 Violence can negatively affect women’s physical, mental, sexual and reproductive health, and may increase
vulnerability to HIV.
 Factors associated with increased risk of perpetration of violence include low education, child maltreatment
or exposure to violence in the family, harmful use of alcohol, attitudes accepting of violence and gender
inequality.
 Factors associated with increased risk of experiencing intimate partner and sexual violence include low
education, exposure to violence between parents, abuse during childhood, attitudes accepting violence and
gender inequality.
 There is evidence from high-income settings that school-based programmes may be effective in preventing
relationship violence (or dating violence) among young people.
 In low-income settings, strategies to increase women’s economic and social empowerment, such as
microfinance combined with gender equality training and community-based initiatives that address gender
inequality and relationship skills, have shown some effectiveness in reducing intimate partner violence.
 Situations of conflict, post conflict and displacement may exacerbate existing violence, such as by intimate
partners, and present additional forms of violence against women.
 Introduction
The United Nations defines violence against women as "any act of gender-based violence that results in, or
is likely to result in, physical, sexual or mental harm or suffering to women, including threats of such acts,
coercion or arbitrary deprivation of liberty, whether occurring in public or in private life."
Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical,
sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and
controlling behaviours.
Sexual violence is "any sexual act, attempt to obtain a sexual act, or other act directed against a person’s
sexuality using coercion, by any person regardless of their relationship to the victim, in any setting. It
includes rape, defined as the physically forced or otherwise coerced penetration of the vulva or anus with a
penis, other body part or object."
Scope of the problem
Population-level surveys based on reports from victims provide the most accurate estimates of the
prevalence of intimate partner violence and sexual violence in non-conflict settings. The "WHO Multi-
country study on women’s health and domestic violence against women" (2005) in 10 mainly low- and
middle-income countries found that, among women aged 15-49:
 between 15% of women in Japan and 71% of women in Ethiopia reported physical and/or sexual violence by
an intimate partner in their lifetime;
 between 0.3–11.5% of women reported sexual violence by someone other than a partner since the age of 15
years;
 the first sexual experience for many women was reported as forced – 17% of women in rural Tanzania, 24%
in rural Peru, and 30% in rural Bangladesh reported that their first sexual experience was forced.
A 2013 analysis conduct by WHO with the London School of Hygiene and Tropical Medicine and the
Medical Research Council, based on existing data from over 80 countries, found that worldwide, almost one
third (30%) of all women who have been in a relationship have experienced physical and/or sexual violence
by their intimate partner. The prevalence estimates range from 23.2% in high-income countries and 24.6% in
the Western Pacific region to 37% in the WHO Eastern Mediterranean region, and 37.7% in the South-East
Asia region. Furthermore, globally as many as 38% of all murders of women are committed by intimate
partners. In addition to intimate partner violence, globally 7% of women report having been sexually
assaulted by someone other than a partner, although data for this is more limited.
Intimate partner and sexual violence are mostly perpetrated by men against women. Child sexual abuse
affects both boys and girls. International studies reveal that approximately 20% of women and 5–10% of
men report being victims of sexual violence as children. Violence among young people, including dating
violence, is also a major problem.
Risk factors
Factors associated with intimate partner and sexual violence occur at individual, family, community and
wider society levels. Some factors are associated with being a perpetrator of violence, some are associated
with experiencing violence and some are associated with both.
Risk factors for both intimate partner and sexual violence include:
 lower levels of education (perpetration of sexual violence and experience of sexual violence);
 exposure to child maltreatment (perpetration and experience);
 witnessing family violence (perpetration and experience);
 antisocial personality disorder (perpetration);
 harmful use of alcohol (perpetration and experience);
 having multiple partners or suspected by their partners of infidelity (perpetration); and
 attitudes that are accepting of violence and gender inequality (perpetration and experience).
Factors specifically associated with intimate partner violence include:
 past history of violence;
 marital discord and dissatisfaction;
 difficulties in communicating between partners.
Factors specifically associated with sexual violence perpetration include:
 beliefs in family honour and sexual purity
 ideologies of male sexual entitlement and
 weak legal sanctions for sexual violence.
The unequal position of women relative to men and the normative use of violence to resolve conflict are
strongly associated with both intimate partner violence and non-partner sexual violence.
Health consequences
Intimate partner and sexual violence have serious short- and long-term physical, mental, sexual and
reproductive health problems for survivors and for their children, and lead to high social and economic
costs.
 Violence against women can have fatal outcomes like homicide or suicide.
 It can lead to injuries, with 42% of women who experience intimate partner violence reporting an injury as a
consequence of this violence.
 Intimate partner violence and sexual violence can lead to unintended pregnancies, induced abortions,
gynaecological problems, and sexually transmitted infections, including HIV. The 2013 analysis found that
women who had been physically or sexually abused were 1.5 times more likely to have a sexually
transmitted infection and, in some regions, HIV, compared to women who had not experienced partner
violence. They are also twice as likely to have an abortion.
 Intimate partner violence in pregnancy also increases the likelihood of miscarriage, stillbirth, pre-term
delivery and low birth weight babies.
 These forms of violence can lead to depression, post-traumatic stress and other anxiety disorders, sleep
difficulties, eating disorders, and suicide attempts. The same study found that women who have experienced
intimate partner violence were almost twice as likely to experience depression and problem drinking. The
rate was even higher for women who had experienced non partner sexual violence.
 Health effects can also include headaches, back pain, abdominal pain, fibromyalgia, gastrointestinal
disorders, limited mobility and poor overall health.
 Sexual violence, particularly during childhood, can lead to increased smoking, drug and alcohol misuse, and
risky sexual behaviours in later life. It is also associated with perpetration of violence (for males) and being
a victim of violence (for females).
Impact on children
 Children who grow up in families where there is violence may suffer a range of behavioural and emotional
disturbances. These can also be associated with perpetrating or experiencing violence later in life.
 Intimate partner violence has also been associated with higher rates of infant and child mortality and
morbidity (e.g. diarrhoeal disease, malnutrition).
Social and economic costs
The social and economic costs of intimate partner and sexual violence are enormous and have ripple effects
throughout society. Women may suffer isolation, inability to work, loss of wages, lack of participation in
regular activities and limited ability to care for themselves and their children.
Prevention and response
There are a growing number of well-designed studies looking at the effectiveness of prevention and response
programmes. More resources are needed to strengthen the prevention of and response to intimate partner and
sexual violence, including primary prevention, i.e. stopping it from happening in the first place.
Regarding primary prevention, there is some evidence from high-income countries that school-based
programmes to prevent violence within dating relationships have shown effectiveness. However, these have
yet to be assessed for use in resource-poor settings. Several other primary prevention strategies: those that
combine economic empowerment of women with gender equality training; that promote communication and
relationship skills within couples and communities; that reduce access to, and harmful use of alcohol; and
that change cultural gender norms, have shown some promise but need to be evaluated further.
To achieve lasting change, it is important to enact legislation and develop policies that:
 address discrimination against women;
 promote gender equality;
 support women; and
 help to move towards more peaceful cultural norms.
 An appropriate response from the health sector can play an important role in the prevention of violence.
Sensitization and education of health and other service providers is therefore another important strategy. To
address fully the consequences of violence and the needs of victims/survivors requires a multi-sectoral
response.
WHO response
WHO, in collaboration with partners, is:
 Building the evidence base on the size and nature of violence against women in different settings and
supporting countries' efforts to document and measure this violence and its consequences, including
improving the methods for measuring violence against women in the context of SDG monitoring. This is
central to understanding the magnitude and nature of the problem at a global level and to initiating action in
countries.
 Strengthening research and research capacity to assess interventions to address partner violence.
 Undertaking interventions research to test and identify effective health sector interventions to address
violence against women.
 Developing technical guidance for evidence-based intimate partner and sexual violence prevention and for
strengthening the health sector responses to such violence.
 Disseminating information and supporting national efforts to advance women's health and rights and the
prevention of and response to violence against women.
 Supporting countries’ to strengthen the health sector response to violence against women, including the
implementation of WHO tools and guidelines.
 Collaborating with international agencies and organizations to reduce and eliminate violence globally.
Collective violence

UN Photo/Christopher Herwig

Collective violence includes violent conflicts between nations and groups, state and group
terrorism, rape as a weapon of war, the movement of large numbers of people displaced from their
homes, and gang warfare. In 2011, the WHO Global Burden of Disease project estimated that
6.3% – or 86 307 – of all deaths due to violence were directly due to war and civil conflict

http://www.who.int/violence_injury_prevention/violence/collective/en/

Youth violence

UN Photo/Claudio Edinger

Worldwide, an estimated 200 000 homicides occur each year among youth and young adults aged
10-29 years, making homicide the fourth leading cause of death in this age group. Eighty three
percent of homicide victims in this age group are male, and nearly all of these deaths occur in low-
income and middle-income countries. For each young person killed, many more sustain injuries
requiring hospital treatment. Beyond deaths and injuries, youth violence can lead to mental health
problems and increased health-risk behaviours, such as smoking, alcohol and drug use, and
 unsafe sex. Youth violence results in greatly increased health, welfare and criminal justice costs;
reduces productivity; decreases the value of property in areas where it occurs; and generally
undermines the fabric of society.

Youth violence
Fact sheet
Reviewed September 2016

Key facts
 Worldwide some 200 000 homicides occur among youth 10–29 years of age each year, which is 43% of the
total number of homicides globally each year.
 Homicide is the fourth leading cause of death in people aged 10-29 years, and 83% of these homicides
involve male victims.
 For each young person killed, many more sustain injuries requiring hospital treatment.
 In one study, from 3–24% of women report that their first sexual experience was forced.
 When it is not fatal, youth violence has a serious, often lifelong, impact on a person's physical,
psychological and social functioning.
 Youth violence greatly increases the costs of health, welfare and criminal justice services; reduces
productivity; and decreases the value of property.

Youth violence is a global public health problem. It includes a range of acts from bullying and physical
fighting, to more severe sexual and physical assault to homicide.
Scope of the problem
Worldwide an estimated 200 000 homicides occur among youth 10–29 years of age each year, making it the
fourth leading cause of death for people in this age group. Youth homicide rates vary dramatically between
and within countries. Globally, 83% of youth homicide victims are males, and in all countries males also
constitute the majority of perpetrators. Rates of youth homicide among females are much lower than rates
among males almost everywhere. In the years 2000-2012, rates of youth homicide decreased in most
countries, although the decrease has been greater in high-income countries than in low- and middle-income
countries.
For every young person killed by violence, more sustain injuries that require hospital treatment. Firearm
attacks end more often in fatal injuries than assaults that involve fists, feet, knives, and blunt objects.
Sexual violence also affects a significant proportion of youth. For example, 3–24% of women surveyed in
the “WHO Multi-country study on women's health and domestic violence” reported that their first sexual
experience was forced.
Physical fighting and bullying are also common among young people. A study of 40 developing countries
showed that an average of 42% of boys and 37% of girls were exposed to bullying.
Youth homicide and non-fatal violence not only contribute greatly to the global burden of premature death,
injury and disability, but also have a serious, often lifelong, impact on a person's psychological and social
functioning. This can affect victims' families, friends and communities. Youth violence increases the costs
of health, welfare and criminal justice services; reduces productivity; decreases the value of property.
Risk factors within the individual
 attention deficit, hyperactivity, conduct disorder, or other behavioural disorders
 involvement in crime
 early involvement with alcohol, drugs and tobacco
 low intelligence and educational achievement
 low commitment to school and school failure
 unemployment
 exposure to violence in the family
 Risk factors within close relationships (family, friends, intimate partners, and peers)
 poor monitoring and supervision of children by parents
 harsh, lax or inconsistent parental disciplinary practices
 a low level of attachment between parents and children
 low parental involvement in children's activities
 parental substance abuse or criminality
 parental depression
 low family income
 unemployment in the family
 associating with delinquent peers and/or gang membership
Risk factors within the community and wider society
 access to and misuse of alcohol;
 access to and misuse of firearms;
 gangs and a local supply of illicit drugs;
 high income inequality;
 poverty; and
 the quality of a country’s governance (its laws and the extent to which they are enforced, as well as policies
for education and social protection).
Prevention
Promising prevention programmes include:
 life skills and social development programmes designed to help children and adolescents manage anger,
resolve conflict, and develop the necessary social skills to solve problems;
 school-based anti-bullying prevention programmes;
 programmes that support parents and teach positive parenting skills;
 preschool programmes that provide children with academic and social skills at an early age;
 therapeutic approaches for youths at high risk of being involved in violence;
 reducing access to alcohol;
 interventions to reduce the harmful use of drugs;
 restrictive firearm licensing and purchasing policies;
 community and problem-oriented policing; and
 interventions to reduce concentrated poverty and to upgrade urban environments.
Preventing youth violence requires a comprehensive approach that addresses the social determinants of
violence, such as income inequality, rapid demographic and social change, and low levels of social
protection.
Critical to reducing the immediate consequences of youth violence are improvements in pre-hospital and
emergency care, including access to care.
WHO response
WHO and partners decrease youth violence through initiatives that help to identify, quantify and respond to
the problem, these include:
 developing a package for schools-based violence prevention programmes;
 drawing attention to the magnitude of youth violence and the need for prevention;
 building evidence on the scope and types of violence in different settings;
 developing guidance for Member States and all relevant sectors to prevent youth violence and strengthen
responses to it;
 supporting national efforts to prevent youth violence; and
 collaborating with international agencies and organizations to prevent youth violence globally.

Prevention of elder maltreatment

 UN Photo/Gaston Guarda

Between 4-6% of elderly people have experienced some form of maltreatment in the home. Elder
maltreatment can lead to serious physical injuries and long-term psychological consequences. It is
predicted to increase as many countries are experiencing rapidly ageing populations

 Elder maltreatment fact sheet

WHO’s work to address the problem of elder maltreatment promotes the use of science-based
approaches to better understand the magnitude and consequences; causes, and what works to
prevent such violence, and to mitigate the harm suffered by victims.

Elder abuse
Fact sheet
Updated June 2017

Key facts
 Around 1 in 6 older people experienced some form of abuse in the past year.
 Rates of abuse may be higher for older people living in institutions than in the community.
 Elder abuse can lead to serious physical injuries and long-term psychological consequences.
 Elder abuse is predicted to increase as many countries are experiencing rapidly ageing populations.
 The global population of people aged 60 years and older will more than double, from 900 million in 2015 to
about 2 billion in 2050.

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. This type of violence
constitutes a violation of human rights and includes physical, sexual, psychological, and emotional abuse;
financial and material abuse; abandonment; neglect; and serious loss of dignity and respect.
Scope of the problem
Elder abuse is an important public health problem. A 2017 study based on the best available evidence from
52 studies in 28 countries from diverse regions, including 12 low- and middle-income countries, estimated
that, over the past year, 15.7% of people aged 60 years and older were subjected to some form of abuse (1).
This is likely to be an underestimation, as only 1 in 24 cases of elder abuse is reported, in part because older
people are often afraid to report cases of abuse to family, friends, or to the authorities. Consequently, any
prevalence rates are likely to be underestimated.
 Elder abuse prevalence in community settings: a systematic review and meta-analysis
Although rigorous data are limited, the study provides pooled prevalence estimates of number of older
people affected by different types of abuse:
 psychological abuse: 11.6%
 financial abuse: 6.8%
 neglect: 4.2%
 physical abuse: 2.6%
 sexual abuse: 0.9%
Data on the extent of the problem in institutions such as hospitals, nursing homes, and other long-term care
facilities are scarce. A survey of nursing-home staff in the United States of America, however, suggests rates
may be high. Of all nursing-home staff surveyed:
 36% witnessed at least 1 incident of physical abuse of an elderly patient in the previous year;
 10% committed at least 1 act of physical abuse towards an elderly patient;
 40% admitted to psychologically abusing patients (2).
There is even less data on elder abuse in institutional settings in developing countries.
 Abusive acts in institutions include physically restraining patients, depriving them of dignity (for instance,
by leaving them in soiled clothes) and choice over daily affairs; intentionally providing insufficient care
(such as allowing them to develop pressure sores); over- and under-medicating and withholding medication
from patients; and emotional neglect and abuse.
Elder abuse can lead to physical injuries – ranging from minor scratches and bruises to broken bones and
head injuries leading to disability – and serious, sometimes long-lasting, psychological consequences,
including depression and anxiety. For older people, the consequences of abuse can be especially serious
because their bones may be more brittle and convalescence longer. Even relatively minor injuries can cause
serious and permanent damage, or even death. A 13-year follow-up study found that victims of elder abuse
are twice more likely to die prematurely than people who are not victims of elder abuse (3).
Globally, the number of cases of elder abuse is projected to increase as many countries have rapidly ageing
populations whose needs may not be fully met due to resource constraints. It is predicted that by the year
2050, the global population of people aged 60 years and older will more than double, from 900 million in
2015 to about 2 billion, with the vast majority of older people living in low- and middle-income countries. If
the proportion of elder abuse victims remains constant, the number of victims will increase rapidly due to
population ageing, growing to 320 million victims by 2050.
Risk factors
Risk factors that may increase the potential for abuse of an older person can be identified at individual,
relationship, community, and socio-cultural levels.
Individual
Risks at the individual level include poor physical and mental health of the victim, and mental disorders and
alcohol and substance abuse in the abuser. Other individual-level factors which may increase the risk of
abuse include the gender of victim and a shared living situation. While older men have the same risk of
abuse as women, in some cultures where women have inferior social status, elderly women are at higher risk
of neglect and financial abuse (such as seizing their property) when they are widowed. Women may also be
at higher risk of more persistent and severe forms of abuse and injury.
Relationship
A shared living situation is a risk factor for elder abuse. It is not yet clear whether spouses or adult children
of older people are more likely to perpetrate abuse. An abuser's dependency on the older person (often
financial) also increases the risk of abuse. In some cases, a long history of poor family relationships may
worsen as a result of stress when the older person becomes more care dependent. Finally, as more women
enter the workforce and have less spare time, caring for older relatives becomes a greater burden, increasing
the risk of abuse.
Community
Social isolation of caregivers and older persons, and the ensuing lack of social support, is a significant risk
factor for elder abuse by caregivers. Many elderly people are isolated because of loss of physical or mental
capacity, or through the loss of friends and family members.
Socio-cultural
Socio-cultural factors that may affect the risk of elder abuse include:
 depiction of older people as frail, weak and dependent;
 erosion of the bonds between generations of a family;
 systems of inheritance and land rights, affecting the distribution of power and material goods within
families;
 migration of young couples, leaving elderly parents alone in societies where older people were traditionally
cared for by their offspring; and
 lack of funds to pay for care.
Within institutions, abuse is more likely to occur where:
 standards for health care, welfare services, and care facilities for elder persons are low;
 where staff are poorly trained, remunerated, and overworked;
 where the physical environment is deficient; and
 where policies operate in the interests of the institution rather than the residents.
Prevention
 Many strategies have been implemented to prevent elder abuse and to take action against it and mitigate its
consequences. Interventions that have been implemented – mainly in high-income countries – to prevent
abuse include:
 public and professional awareness campaigns
 screening (of potential victims and abusers)
 school-based intergenerational programmes
 caregiver support interventions (including stress management and respite care)
 residential care policies to define and improve standards of care
 caregiver training on dementia.
Efforts to respond to and prevent further abuse include interventions such as:
 mandatory reporting of abuse to authorities
 self-help groups
 safe-houses and emergency shelters
 psychological programmes for abusers
 helplines to provide information and referrals
 caregiver support interventions.
Evidence for the effectiveness of most of these interventions is limited at present. However, caregiver
support after abuse has occurred reduces the likelihood of its reoccurrence and school-based intergeneration
programmes (to decrease negative societal attitudes and stereotypes towards older people) have shown some
promise, as have caregiver support to prevent elder abuse before it occurs and professional awareness of the
problem. Evidence suggests that adult protective services and home visitation by police and social workers
for victims of elder abuse may in fact have adverse consequences, increasing elder abuse.
Multiple sectors and interdisciplinary collaboration can contribute to reducing elder abuse, including:
 the social welfare sector (through the provision of legal, financial, and housing support);
 the education sector (through public education and awareness campaigns); and
 the health sector (through the detection and treatment of victims by primary health care workers).
In some countries, the health sector has taken a leading role in raising public concern about elder abuse,
while in others the social welfare sector has taken the lead.
Globally, too little is known about elder abuse and how to prevent it, particularly in developing countries.
The scope and nature of the problem is only beginning to be delineated. Many risk factors remain contested,
and the consequences and evidence for what works to prevent elder abuse is limited.
WHO response
In May 2016 the World Health Assembly adopted a Global strategy and action plan on ageing and
health that provides guidance for coordinated action in countries on elder abuse that aligns with the
Sustainable Development Goals.
In line with the Global strategy WHO and partners collaborate to prevent elder abuse through initiatives that
help to identify, quantify, and respond to the problem, including:
 building evidence on the scope and types of elder abuse in different settings (to understand the magnitude
and nature of the problem at the global level), particularly in low- and middle-income countries from
Southeast Asia, the Middle East, and Africa, for which there is little data;
 collecting evidence and developing guidance for Member States and all relevant sectors to prevent elder
abuse and strengthen their responses to it;
 disseminating information to countries and supporting national efforts to prevent elder abuse; and
 collaborating with international agencies and organizations to deter the problem globally.
Self-directed violence (suicide)

Suicide is one of the leading causes of death worldwide and is an important public health problem.
Among those aged 15-44 years, self-inflicted injuries are the fourth leading cause of death and the
sixth leading cause of ill-health and disability. The Global Burden of Disease project estimates that
797 823 suicides occurred in 2011, over half of all deaths due to violence.

Violence against health workers

Health workers are at high risk of violence all over the world. Between 8% and 38% of health
workers suffer physical violence at some point in their careers. Many more are threatened or
exposed to verbal aggression. Most violence is perpetrated by patients and visitors. Also in
disaster and conflict situations, health workers may become the targets of collective or political
violence. Categories of health workers most at risk include nurses and other staff directly involved
in patient care, emergency room staff and paramedics.

Violence against health workers is unacceptable. It has not only a negative impact on the
psychological and physical well-being of health-care staff, but also affects their job motivation. As
a consequence, this violence compromises the quality of care and puts health-care provision at
risk. It also leads to immense financial loss in the health sector.

Interventions to prevent violence against health workers in non-emergency settings focus on

strategies to better manage violent patients and high-risk visitors. Interventions for emergency
settings focus on ensuring the physical security of health-care facilities. More research is needed
to evaluate the effectiveness of these programmes, in particular in low-resource settings.

WHO, ILO, ICN and PSI jointly developed Framework guidelines for addressing workplace
violence in the health sector to support the development of violence prevention policies in non-
emergency settings, as well as a questionnaire and study protocol to research the magnitude and
consequences of violence in such settings. For emergency settings, WHO has also developed
methods to systematically collect data on attacks on health facilities, health workers and patients.