Evidence shows that violence is not inevitable, but rather can be prevented through approaches that have demonstrated measurable impacts in the reduction of violence. Successful and promising violence prevention programs exist that target different types of violence, including self-directed, interpersonal, and collective violence; however, the existing evidence base does not necessarily inform practice or policy making. Furthermore, gaps in the evidence base exist, particularly in the context of interventions in low- and middle-income countries (LMICs).
Knowing how to access and apply evidence in ways that ensure programs are culturally appropriate and acceptable and implemented with high fidelity can help practitioners and policy makers apply it effectively. Furthermore, if stakeholder groups, including decision makers, practitioners, and affected communities, know the value of violence prevention programs that are grounded in evidence, they may more likely support the implementation and continued improvement of such programs.
On January 23-24, 2013, the Institute of Medicine and National Research Council’s (IOM and NRC’s) Forum on Global Violence Prevention convened a 2-day workshop to explore the value and application of the
1 The planning committee’s role was limited to planning the workshop. The workshop summary was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the Forum, the Institute of Medicine, or the National Research Council, and they should not be construed as reflecting any group consensus.
evidence for violence prevention across the lifespan and around the world. Part of the Forum’s mandate is to engage in multisectoral, multidirectional dialogue that explores crosscutting approaches to violence prevention. The Forum’s orientation is through the public health approach, which focuses on prevention, particularly primary prevention, and is multidisciplinary in nature. To these ends, this workshop examined how existing evidence for violence prevention can continue to be expanded, disseminated, and implemented in ways that further the ultimate aims of improved individual well-being and safer communities. Many effective and promising violence prevention programs that contribute to the evidence base have been discussed in the context of previous Forum workshops.2 This workshop was an opportunity to engage in a more comprehensive discussion of the value of the evidence base and its applicability across contexts.
Broadly speaking, violence is a form of intentional injury, and is defined by the World Health Organization (WHO) 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.” Of the 5 million deaths attributed to injury worldwide, 1.6 million are a direct result of violence. However, the greater burden of violence lies not in mortality, but in morbidity and disability (WHO, 2002).
In 1996, WHO adopted Resolution WHA49.25, declaring violence “a major and growing public health problem across the world,” and calling on its member states to address this issue both individually and collectively. WHO recognized violence not only as a visible problem to be confronted on national and state levels, but also a pervasive problem on both the local and interpersonal levels. This paradigm shift toward recognition of violence as an insidious public health problem has significant implications: Violence as a public health problem has empirical and quantifiable risk factors and intervention points and, most importantly, can be prevented.
Violence prevention is a global issue, with the majority of the burden of violence-related mortality and morbidity occurring in LMICs (WHO, 2002). As a global health issue, as defined by Kaplan and colleagues (2009), violence prevention efforts need to be highly multidisciplinary and
2 Previous Forum on Global Violence Prevention workshop summaries include Preventing Violence Against Women and Children (IOM and NRC, 2011); Social and Economic Costs of Violence (IOM and NRC, 2012a); Communications and Technology for Violence Prevention (IOM and NRC, 2012b); and Contagion of Violence (IOM and NRC, 2013). All Forum workshop summaries and additional information on previous workshops are available at http://www.iom.edu/globalviolenceprevention.
inclusive beyond the traditional health fields; focus on both individual- and population-based prevention; promote equity across and within populations; and employ partnership and global cooperation.
Despite the global nature of violence and the burden borne by LMICs, the majority of evidence for violence prevention exists within the context of high-income countries, where resources are greater for both program implementation and evaluation. As several speakers noted during the workshop, implementation of evidence-based programs across cultural contexts often requires multiple considerations in adaptation to help ensure programs will be culturally appropriate and acceptable, implemented with fidelity, and effective. Effective adaptation and implementation can be particularly critical in resource-constrained settings.
The terms “evidence” and “evidence-based” are used throughout this report; however, there is recognition that agreement in the field over the definition of such terms is lacking. Broadly speaking, evidence concerns facts (actual or asserted) that are known through experience or observation and intended for use in support of a conclusion and can inform decision making (WHO, 2013). The strength of evidence is considered to vary depending on the type of methods employed and how well the study was designed and executed. Some determinations that have been applied to defining the strength of evidence are included in Chapter 2. “Evidence-based” frequently describes the use or application of known evidence, such as evidence-based programs or evidence-based decision making.
Programs that have been shown to have evidence supporting their success in reducing violence-related outcomes often are labeled as “effective” or “promising.” Evidence-based registries, such as Blueprints for Healthy Youth Development and CrimeSolutions.gov, have specific defined criteria for labeling of programs but, in general, effective programs are those that are “based on sound theory, have been evaluated in at least two, well-conducted studies, and have demonstrated significant, short-term and/or long-term preventive effects, depending on intent and design” (Purdy and Wilkens, 2011, p. 12). Effective programs are sometimes also referred to as “model” or “exemplar” programs. The categorization of “promising” is designated to programs that are deemed to have potential, but do not meet the “effective” categorization criteria for reasons such as limited evaluation to date or evaluations that have been conducted using methods that do not meet rigorous standards.
This report recognizes the lack of clear agreement within the field over the definitions of these terms and does not attempt to resolve them. Rather, as a summary report, terminology is applied based on the language used
by the individual speakers and participants and the context that is most appropriate to the workshop discussions.
ORGANIZATION OF THE REPORT
This summary provides an account of the presentations given at the workshop. Opinions expressed within this summary are not those of the IOM, the NRC, the Forum on Global Violence Prevention, or their agents, but rather of the presenters themselves. As such, they do not reflect conclusions or recommendations of a formally appointed committee. This summary was authored by designated rapporteurs based on the workshop presentations and discussions and does not represent the views of the institution, nor does it constitute a full or exhaustive overview of the field.
To operationalize the Workshop Statement of Task (see Box 1-1), the planning committee applied a paradigm of knowledge management that served as the framework for the workshop. The workshop summary has
Workshop Statement of Task
Evidence-based approaches show that violence is not inevitable, and that it can be prevented. Successful violence prevention programs exist around the world, but a comprehensive framework is needed to systematically structure proven approaches to this problem. As the global community recognizes the connection between violence and failure to achieve health and development goals, a resource such as an evidence-based framework could more effectively inform policies and funding priorities locally, nationally, and globally.
The Institute of Medicine will convene a 2-day workshop to explore the evidentiary basis for violence prevention across the lifespan and around the world. The public workshop will be organized and conducted by an ad hoc committee to examine (1) What violence prevention interventions have been proven to reduce different types of violence (e.g., child and elder abuse, intimate partner and sexual violence, youth and collective violence, and self-directed violence)? (2) What are the outcomes indicative of success? (3) What are common approaches most lacking in evidentiary support? (4) How can proven effective interventions be integrated or otherwise linked with other prevention programs, especially those related to achieving the Millennium Development Goals?
The committee will develop the workshop agenda, select and invite speakers and discussants, and moderate the discussions. Experts will be drawn from the public and private sectors as well as from academic organizations to allow for multilateral, evidence-based discussions. Following the conclusion of the workshop, an individually authored summary of the event will be prepared by a designated rapporteur.
been organized thematically to reflect this framing paradigm. The first part of this report consists of an introduction and four chapters, which provide a summary of the workshop. Chapter 2 summarizes the workshop presentations and discussions on the types of evidence and what can be learned from them. Chapter 3 focuses on efforts to and best practices in generating and integrating evidence. Chapter 4 covers the workshop discussions on the dissemination of evidence to different stakeholder communities; while Chapter 5 focuses on translating evidence into effective action, particularly across cultural contexts. The second part of this report consists of submitted papers from speakers regarding the substance of the work they presented. These papers were solicited from speakers in order to offer further information about their work and the field; not all speakers contributed papers. The appendixes contain additional information regarding the agenda and participants. Videos of all workshop presentations and discussions are available on the Forum on Global Violence Prevention’s website (www.iom.edu/globalviolenceprevention).
IOM (Institute of Medicine) and NRC (National Research Council). 2011. Preventing violence against women and children: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2012a. Social and economic costs of violence: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2012b. Communications and technology for violence prevention: Workshop summary. Washington, DC: The National Academies Press.
IOM and NRC. 2013. Contagion of violence: Workshop summary. Washington, DC: The National Academies Press.
Kaplan, J. P., T. C. Bond, M. H. Merson, K. S. Reddy, M. H. Rodriguez, N. K. Sewankambo, and J. N. Wasserheit. 2009. Towards a common definition of global health. Lancet 373:1993-1995.
Purdy, R. W., and N. Wilkins. 2011. Understanding evidence part 1: Best available research evidence. A guide to the continuum of evidence of effectiveness. Atlanta, GA: Centers for Disease Control and Prevention.
WHO (World Health Organization). 2002. World report on violence and health. Geneva, Switzerland: WHO.
WHO. 2013. Evidence-informed policy-making: Finding evidence: What is evidence? http://www.who.int/evidence/library/en (accessed September 26, 2013).