ReviewThe costs of interpersonal violence—an international review
Section snippets
Introduction and methods
This article systematically reviews peer-reviewed literature related to the economic consequences of interpersonal violence internationally. Although much of the available literature concerns high-income countries, violence disproportionately affects low- and middle-income countries, where an estimated 90% of all violence-related deaths occur [1].1
Findings
There are widely varying estimates of the cost of violence internationally, depending on the definitions used, the types of costs included, and the methodologies used. In U.S., the Department of justice [3] reported estimated direct costs of violent crime to victims resulting from short-term medical expenses and work loss. These estimates were based on responses to the National Crime Victimization Survey (NCVS), an annual survey based on 100,000 interviews with crime victims. These costs
Child abuse and neglect
The extent of child abuse and neglect is difficult to gauge since much if not most of it is unreported. The 2002 World Report on Violence and Health estimates that the rates of homicide of children under 5 years of age were 2.2 per 100,000 for boys and 1.8 per 100,000 for girls in high-income countries. In low- and middle-income countries, the corresponding rates are 6.1 and 5.1 per 100,000 for boys and girls, respectively. In Africa, the rates are 17.9 per 100,000 for boys and 12.7 per 100,000
Intimate partner violence
The true extent of intimate partner violence is unknown. Surveys suggest there is a wide range in prevalence, but the results are difficult to compare given cultural differences and social taboos in responding to questions (Table 4). In Paraguay and the Philippines, 10% of women surveyed reported being assaulted by an intimate partner (see in Ref. [22]), compared to 22% in the U.S. (see in Ref. [23]), 29% in Canada, and 34% in Egypt (see in Ref. [24]). Other studies have shown that 3.0% or less
Sexual violence
As with intimate partner violence, the costs of sexual assault are difficult to document systematically—given that many such assaults go unreported. As a result, most documented calculations are likely to be underestimates. Many of the published studies are based in the US, and are listed in Table 5. The estimates range widely, depending on the cost categories and included and methods used. For example, Cohen [28], using pain and suffering awards from more than 100,000 jury decisions in the
Workplace violence
Violence at or related to the workplace extracts a significant economic toll (Table 6), but studies of its magnitude are not well developed and are hampered by measurement difficulties and non-standardized methodologies. McCall and Horwitz [29] found that in Oregon in the U.S. the rate of reported incidents of workplace violence was 1.86 per 10,000 employees annually, with female workers and those under age 35 experiencing the most violence (Table 7).
There is a wide range of estimates of how
Youth violence
Youth violence is defined as violence committed by or against individuals between the ages of 10 and 29. In 2000, an estimated 199,000 youth homicides were committed globally—9.2 per 100,000 people. This rate varied from 0.9 per 100,000 in high-income countries to 17.6 in Africa and 36.4 in Latin America. Based on studies of non-fatal violence, it was further estimated that for every youth homicide there are 20–40 victims of non-fatal youth violence receiving hospital treatment (see in Ref. [1]
Violence facilitators—Guns, alcohol, drugs, and gangs
Guns, gangs, alcohol, and drugs all show up in the literature as major facilitators for interpersonal violence. Access to guns is without question a leading facilitating factor. Most estimates of the economic impact of gun violence include suicide. In the United States, there is clear evidence to show that the overall toll of gun violence is very high. More than 30,000 people die annually from firearms injuries in the U.S.; these injuries are the second leading cause of death for individuals
Methodological variation across studies
This review shows clearly that there is a wide range of methodologies used to calculate the costs of violence, and that researchers’ choice of methodologies and approaches can have an important effect on their ultimate results. The most evident methodological difference among studies of the economic effects of interpersonal violence is the broad range of categories of costs employed. Many of the differences in economic estimates are due to the inclusion or exclusion of specific categories of
Conclusion
Given the wide range of methodological differences and extensive gaps in the existing literature on the economics of interpersonal violence, there is a clear need for systematic future research into the costs of violence. Such research should follow rigorous methodological guidelines, include both direct and indirect cost categories, and perhaps most importantly permit comparisons across countries and settings. There is also a need for standardized research on the indirect costs of violence.
Acknowledgements
This research was funded by the World Health Organization. Several individuals have played important roles in identifying documentation and reviewing earlier versions of this work—they are identified in Appendix B.
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