World report on violence and health.

Books & Electronic Media World report on violence and health Preface by Nelson Mandela Foreword by Gro Harlem Brundtland Edited by Etienne Krug, Linda L.Dahlberg, James A. Mercy, Anthony Zwi, & Rafael Lozano. Published by the World Health Organization, Geneva, 2002 ISBN 92 4 154561 5, price Sw.fr. 30, US$ 27. In developing countries Sw.fr. 15 Those doing research on violence and carrying out violence prevention activities have been eagerly awaiting this report. In countries where homicide is the major cause of death among young males, it is no longer possible to be unaware that violence is a public health problem. It is made even more painfully obvious when, as is often the case, the same countries have been successful in reducing child mortality. Public health researchers and demographers were among the first to call attention to this problem, as they saw the numbers of deaths caused by homicide relentlessly rising. In many parts of Latin America, where for at least a decade the human and societal costs of violence have been widely recognized, WHO’s recent decision to take up this issue was welcomed as a highly significant event. It is seen as an important reinforcement in the struggle to stop and reverse the growth of violence. It will certainly make it harder for public authorities to ignore that a great deal of the violence now occurring could be prevented. There were fears, however, that WHO might adopt an overly biomedical model of violence. The report, published on 3 October, dismisses these fears. One of its great achievements is to spell out the causes of violence, describe the different forms it takes, and indicate the means of preventing it. It does all this in clear language while bringing together the contributions the different relevant disciplines make to our understanding of this complex topic. This is no small achievement, and it is repeated in each of the chapters. The body of the report consists of an analysis of the seven types of violence that appear to afflict the largest numbers of people: youth violence, child abuse, violence between intimate partners, abuse of elderly people, sexual violence, self-directed violence (suicide and suicide attempts) and collective forms of violence. Each section presents findings from different fields of knowledge and different regions of the world, doing so in a cohesive and integrated fashion which allows readers to compare their own national situation with that of others. The sheer volume of research data on causes and effects, and the huge diversity of the prevention programmes in each of the forms of violence examined, can be overwhelming. Researchers on violence know very well how hard it is simply to keep up with the literature in their own specific part of the subject. Those who have easy access to the latest data and reliable statistics are not always additionally blessed with the energy and time to incorporate contributions from other disciplines or other cultures — not forgetting the skills and further time needed to overcome language barriers. Other researchers, particularly in the South, lack access to much of the literature, having to rely on the relatively few journals and books that local universities can afford. They not only have little access to reliable official statistics but also have difficulties in sharing information with researchers in similar circumstances. Readers will readily appreciate the effort that went into surmounting these difficulties, particularly that of collating data from different countries to produce a more informed estimate of the size of the problem. This brings us to another great achievement of this report: it brings researchers from the different fields of violence studies closer together. This broadens their horizons, bringing more points of view and cultural diversity to their perception of their own field. These varied contributions are well documented in the carefully compiled bibliographies at the end of each section. Since the theme of violence includes so much material, it is not unusual for researchers and practitioners to specialize in certain areas such as youth, the family, or the elderly, while maintaining only tangential contact with the other areas of violence. This report gives them a comprehensive overview of the field and in doing so sheds new light on their work. In Latin America attention has been focused mainly on violence in youth and intimate partners, and child abuse. Violence against oneself and against the elderly receives much less attention, but the report shows how these too are extremely serious problems in many societies. That the number of suicides annually exceeds that of homicides by nearly 50% is a troubling fact, as is the increase in violence and abuse against the elderly. Such phenomena raise very hard questions about the true nature of the civilizing process in any society. The chapter on collective forms of violence is perhaps the only one that could have done with a more extensive treatment. Issues of the utmost importance such as genocide, extrajudi- cial killings promoted by governments, mob killings and crimes of hatred need specific sections devoted to them. That they are not examined in more depth may reflect the fact that although these phenomena have become more common in recent years, their occurrence in their present forms is more recent and there is relatively little literature on them. They are pressing issues, as the numbers of people who fall victim to these forms of violence seem to be growing. This points to another need: for more accurate monitoring systems. Most of what is known about these events comes from qualitative research and monitoring by human rights organizations rather than official data. Governments can and should be pressured to account for such violence within their territories. The report is a valuable resource for researchers and practitioners in the field. It will also be useful for civil servants involved in designing, selecting and implementing public policies, for the media, and for nongovernmental organizations. As a resource, let us hope it will become a regular document perhaps along the same lines as the Human Development Report. n Nancy Cardia1 1 Research Coordinator, Center for the Study of Violence at the University of Sa˜o Paulo, Av. Prof. Lu´cio Martins Rodrigues, travessa 4, bloco 2, Sa˜o Paulo, SP Brazil 05508-900 (email: ncardia@usp.br). 915Bulletin of the World Health Organization 2002, 80 (11) Drinking water and infectious disease — establishing the links Edited by Paul Raymond Hunter, Mike Waite & Elettra Ronchi Published by CRC Press & IWA Publishing, London, England ISBN 1-84339-027-2, price US$ 129.95 In 1998, a workshop on safe drinking- water recommended ‘‘international coordination for improved surveillance and outbreak investigation’’. To start putting this into effect, the UK Govern- ment hosted an OECD expert group meeting in July 2000, entitled ‘‘Approaches for Establishing Links between Drinking Water and Infectious Disease’’. The book reviewed here is a product of that meeting. In the Foreword, the authors say that it complements a WHO book on guide- lines and standards for drinking-water, waste-water reuse, and recreational water. In fact, however, the present book is not about guidelines; it is about how the link between drinking-water and infectious disease can be demonstrated. The 18 chapters, by authors from a range of institutions in industrialized countries, are organized into three sections: surveillance; investigation and management of outbreaks of disease that may be linked to drinking-water; and methods for determining the contribution of drinking-water to sporadic disease incidence. Plentiful figures, tables and maps give life to the pages and will help readers who find visual information easier to take in than words. Some chapters are better written than others with regard to clarity and logical flow, and nearly all have a conclusion section. Throughout the book, the authors use numerous examples to show what they mean, but these are limited mostly to three countries: the US, the UK and Sweden. Information on a country’s situation occasionally overlaps with that provided in the WHO book. A number of local, national and international surveillance systems currently in use are described, and their strengths and weaknesses are discussed. Their limitations include low probability of detecting waterborne outbreaks be- cause of shared clinical syndromes and underreporting, and lack of a system for submitting specimens for diagnostic microscopy. A general solution the authors suggest is to develop an inte- grated system for technical data on both health and water. This approach would be facilitated by the water industry’s large and currently underutilized database. Although the discussions on local and national surveillance do provide a general understanding of how important a functional surveillance system is for preventing and reducing infectious diseases, not enough attention is given to surveillance of waterborne diseases in the developing world. ‘‘If we are to improve the quality of water-related surveillance,’’ say the authors of Chapter 6, ‘‘it is increasingly obvious that computers and sophisticated analytical algorithmswill be needed to flag unusual events and supplement human judge- ment. It may also be useful to reconsider the choice of measures to be regularly collected and analysed, going beyond the traditional dependence on laboratory isolates.’’ This may be feasible in most industrialized countries but not in many developing ones. There is a chapter on international surveillance, which might eventually provide the beginning of a solution, but it is rather thin, perhaps because this level of surveillance is underdeveloped. All together, the generic title of the book is misleading, as the focus is on problems of OECD countries, where the prevalence of diarrhoeal diseases, for example, is incomparably lower than in developing countries. The realities in developing countries are quite different with regard to surveillance systems, water sources and many of the other water-related diseases as well. For prac- titioners and decision-makers involved in public health and water utility sectors in industrialized countries, however, the book is readable and useful. Readers without specialized knowledge of the topic would have benefited from an introductory para- graph or two on enteric pathogens (bacteria, viruses and protozoa), the routes of exposure, and their similarities and differences. Also, a few words on other water contaminants such as chemicals would have placed water in its broader context. The authors of the last chapter say that ‘‘In many ways, the methods described earlier in this book are all applicable in the setting of the develop- ing world’’, but this is not self-evident. In the developing world, problems of public and personal hygiene contribute to high rates of mortality and are associated with incidence of diarrhoeal diseases. For example, the incidence of cholera is positively associated with poor housing and lack of clean water and sanitation. Therefore, in developing countries, actions to improve hygiene and sanitation, in addition to surveillance and investigation of waterborne infec- tions, are needed to reduce infections from enteric pathogens. To reduce the global burden of diarrhoeal diseases, we have to tackle the whole set of under- lying causes of the disease. This is of course, a complex issue which requires a wide range of collective efforts on the part of all sectors involved, and at each level of planning and policy-making. In public health a vast body of knowledge already exists on the links between drinking-water and infectious diseases. The evidence has been accu- mulating at least since 1848, when John Snow deduced that infection was spread by the water supply, and helped to stop a cholera epidemic in London by famously recommending the removal of the handle of the Broad Street pump. Yet these authors strive to prove the link as if it were still debatable. Evidently, decision-makers in other sectors such as industry and agriculture need more and more irrefutable evidence if they are to be convinced that they are damaging public health when they contaminate the water supply, and so must share the cost of protecting it. Lack of coordination and collaboration between the health and other sectors then seems to be a major underlying problem. The global burden of disease caused by water, sanitation, and hygiene pro- blems has recently been estimated with regard to various disease outcomes, principally diarrhoeal diseases. The dis- ability-adjusted life years (DALY) formula was used to combine numbers of deaths and amounts of disability in a single index. This made it possible to compare the burden attributable to water, sanitation and hygiene problems with those caused by other risk factors or diseases. The estimates were reported as summary measures of population health combining mortality and mor- bidity, expressed as DALYs. The results provide a useful contribution to the design and evaluation of multisectorial policies. They also help to put the links between water and infectious disease in their global context. n Ramesh Shademani1 1 Papers Editor, Bulletin of the World Health Organization, Geneva, Switzerland. 916 Bulletin of the World Health Organization 2002, 80 (11) Books & Electronic Media