RAND Corporation also mentioned that various types of indirect costs exist and specified the difference between a cost incurred in the provision of care that is not part of the care protocol itself and the cost of an indirect effect. Speakers Gary Milante from the World Bank and Theresa Betancourt from Harvard University and the François-Xavier Bagnoud Center for Health and Human Rights also named another important indirect cost— the cost of inaction. Both cautioned against waiting too long for the full picture of costs at the risk of waiting too long to act and prevent violence from escalating. Dr. Milante also pointed out that determining the cost-effectiveness of a program is important, but reducing the cost of inaction could have greater impact than ensuring that a preventive intervention is the most effective.

Along with the cost of inaction, several speakers suggested that opportunity costs be considered as well. Dr. Waters noted that certain costs will be incurred by certain sectors regardless of whether violence occurs. For example, medical and social services providers and infrastructure costs will be paid. However, when resources are spent to address the effects of violence, fewer resources are available to be allocated toward other issues. Speaker Aslihan Kes from the International Center for Research on Women pointed out that women who are victims of violence lose opportunities to complete household or income-generating activities. Dr. Corso suggested that productivity costs are often calculated in terms of opportunity costs.

The identification of noneconomic effects and the ability to place dollar values on such effects was also a major discussion at the workshop. Some participants strongly felt that such costs lie at the heart of the massive burden of violence but are currently difficult to enumerate. Finally, the need to place costs within a larger context was an important element of discussions; as Dr. Shonkoff highlighted, the issue is not simply about saving money, but also about ensuring a higher quality of life.

REFERENCES

Yang, B., and D. Lester. 2007. Recalculating the economic cost of suicide. Death Studies 31(4):351-361.



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