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An important function of public health is to prevent injuries or to lessen their impact when they occur. An estimated 251,000 people worldwide die each year from a firearm-related death and many more suffer nonfatal injuries with consequences that can last a lifetime. Firearm injuries, which include those that are intentionally self-inflicted, unintentional, or from an act of interpersonal violence, are heavily concentrated in the Americas, driven largely by firearm homicides. Firearm-related deaths and injuries disproportionately impact males and younger populations and are associated with factors such as access, substance use, adverse childhood experiences, involvement in high-risk social networks, drug trafficking, density of alcohol outlets, and neighborhood and social disadvantage. While progress is being made to understand firearm injuries and how to effectively prevent them, much more needs to be done to improve the availability and timeliness of data; apply the knowledge that is generated to effectively reduce firearm-related injuries, deaths, and costs; strengthen the scientific infrastructure; and move countries closer to achieving the violence-related targets in the 2030 Sustainable Development Goals.

Background In the 6 months following our estimates from March 1, 2020, to April 30, 2021, the proliferation of new coronavirus variants, updated mortality data, and disparities in vaccine access increased the amount of children experiencing COVID-19-associated orphanhood. To inform responses, we aimed to model the increases in numbers of children affected by COVID-19-associated orphanhood and caregiver death, as well as the cumulative orphanhood age-group distribution and circumstance (maternal or paternal orphanhood).Methods We used updated excess mortality and fertility data to model increases in minimum estimates of COVID-19-associated orphanhood and caregiver deaths from our original study period of March 1, 2020-April 30, 2021, to include the new period of May 1-Oct 31, 2021, for 21 countries. Orphanhood was defined as the death of one or both parents; primary caregiver loss included parental death or the death of one or both custodial grandparents; and secondary caregiver loss included co-residing grandparents or kin. We used logistic regression and further incorporated a fixed effect for western European countries into our previous model to avoid over-predicting caregiver loss in that region. For the entire 20-month period, we grouped children by age (0-4 years, 5-9 years, and 10-17 years) and maternal or paternal orphanhood, using fertility contributions, and we modelled global and regional extrapolations of numbers of orphans. 95% credible intervals (CrIs) are given for all estimates.Findings The number of children affected by COVID-19-associated orphanhood and caregiver death is estimated to have increased by 90middot0% (95% CrI 89middot7-90middot4) from April 30 to Oct 31, 2021, from 2 737 300 (95% CrI 1 976 100-2 987 000) to 5 200 300 (3 619 400-5 731 400). Between March 1, 2020, and Oct 31, 2021, 491 300 (95% CrI 485 100-497 900) children aged 0-4 years, 736 800 (726 900-746 500) children aged 5-9 years, and 2 146 700 (2 120 900-2 174 200) children aged 10-17 years are estimated to have experienced COVID-19-associated orphanhood. Globally, 76middot5% (95% CrI 76middot3-76middot7) of children were paternal orphans, whereas 23middot5% (23middot3-23middot7) were maternal orphans. In each age group and region, the prevalence of paternal orphanhood exceeded that of maternal orphanhood.Interpretation Our findings show that numbers of children affected by COVID-19-associated orphanhood and caregiver death almost doubled in 6 months compared with the amount after the first 14 months of the pandemic. Over the entire 20-month period, 5middot0 million COVID-19 deaths meant that 5middot2 million children lost a parent or caregiver. Our data on children's ages and circumstances should support pandemic response planning for children globally.Funding UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, and Medical Research Council), Oak Foundation, UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.Copyright (c) 2022 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY NC ND 3.0 IGO license which permits users to download and share the article for non-commercial purposes, so long as the article is reproduced in the whole without changes, and provided the original source is properly cited. This article shall not be used or reproduced in association with the promotion of commercial products, services or any entity.There should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Violence is a major public health problem and in recent years has become increasingly important on the global public health agenda. This article provides an overview of the history and significance of interpersonal violence – including child maltreatment, youth violence, intimate partner violence and elder abuse – in global health and development policy, and illustrates the public health approach to violence prevention.

Summary Background The COVID-19 pandemic priorities have focused on prevention, detection, and response. Beyond morbidity and mortality, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, and institutionalisation. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Methods We used mortality and fertility data to model minimum estimates and rates of COVID-19-associated deaths of primary or secondary caregivers for children younger than 18 years in 21 countries. We considered parents and custodial grandparents as primary caregivers, and co-residing grandparents or older kin (aged 60–84 years) as secondary caregivers. To avoid overcounting, we adjusted for possible clustering of deaths using an estimated secondary attack rate and age-specific infection–fatality ratios for SARS-CoV-2. We used these estimates to model global extrapolations for the number of children who have experienced COVID-19-associated deaths of primary and secondary caregivers. Findings Globally, from March 1, 2020, to April 30, 2021, we estimate 1 134 000 children (95% credible interval 884 000–1 185 000) experienced the death of primary caregivers, including at least one parent or custodial grandparent. 1 562 000 children (1 299 000–1 683 000) experienced the death of at least one primary or secondary caregiver. Countries in our study set with primary caregiver death rates of at least one per 1000 children included Peru (10·2 per 1000 children), South Africa (5·1), Mexico (3·5), Brazil (2·4), Colombia (2·3), Iran (1·7), the USA (1·5), Argentina (1·1), and Russia (1·0). Numbers of children orphaned exceeded numbers of deaths among those aged 15–50 years. Between two and five times more children had deceased fathers than deceased mothers. Interpretation Orphanhood and caregiver deaths are a hidden pandemic resulting from COVID-19-associated deaths. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families to nurture children bereft of caregivers and help to ensure that institutionalisation is avoided. These data show the need for an additional pillar of our response: prevent, detect, respond, and care for children. Funding UK Research and Innovation (Global Challenges Research Fund, Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, US National Institutes of Health, and Imperial College London.

Ending all violence against children by 2030 is a core part of Sustainable Development Goals 5 and 16. A number of promising violence reduction strategies have been identified in research studies. However, we lack an understanding of the implementation and impact of these programs in respect to their delivery at a large scale or within existing service systems, particularly in low- and middle-income countries (LMICs). We advocate for greater collaboration between researchers, policymakers, donors, governments, non-governmental organizations, and program managers and staff to study how violence prevention programs operate on a large scale. We describe a new initiative aiming to foster such collaborations in the field of family strengthening programs.

Background: The global COVID-19 pandemic and response has focused on prevention, detection, and response. Beyond morbidity and mortality of those infected, pandemics carry secondary impacts, such as children orphaned or bereft of their caregivers. Such children often face adverse consequences, including poverty, abuse, delayed development, and institutionalization. We provide estimates for the magnitude of this problem resulting from COVID-19 and describe the need for resource allocation. Methods: We use mortality and fertility data to model rates of COVID-19-associated orphanhood and caregiver deaths for 18 countries in Africa, Asia, Europe, and the Americas, and extrapolate global estimates of COVID-associated deaths of parents and grandparent caregivers. Results: We estimate that globally, >1 million children were orphaned or lost a caregiver due to COVID-19-associated deaths during March–December 2020. Countries with higher rates of caregiver deaths included Peru, South Africa, Mexico, Russian Federation, Colombia, Brazil, Islamic Republic of Iran, Argentina, U.S.A., and Spain (range, 1·1–9·8/1000). For most countries, numbers of children orphaned were greater than deaths among those aged 15–44 years; 2–5 times more children had deceased fathers than deceased mothers. Conclusions: Orphanhood and caregiver deaths are a shadow pandemic resulting from COVID-19-associated deaths: we find that over one million children worldwide have lost a parent or caregiver in just ten months. Accelerating equitable vaccine delivery is key to prevention. Psychosocial and economic support can help families nurture children bereft of caregivers and promote their recovery. Strengthening family-based care can help ensure that institutionalization of these children is avoided. These data demonstrate the need for an additional pillar of our response: prevent, detect, respond, and care for children. Funding: UK Research and Innovation (Global Challenges Research Fund (GCR), Engineering and Physical Sciences Research Council, Medical Research Council), UK National Institute for Health Research, U.S. National Institutes of Health, Imperial College. Declaration of Interests: Dr. Donnelly reports grants from UK Medical Research Council and grants from NIHR during the conduct of the study. Dr. Cluver reports grants from UK Research and Innovation (UKRI) Global Challenges Research Fund, during the conduct of the study. All other authors report nothing to disclose. Ethics: We used modeled aggregate data and publicly available de-identified survey metadata.

CITATION: Cluver, L. et al. 2020. Parenting in a time of COVID-19. Lancet, 395:e64, doi:10.1016/S0140-6736(20)30736-4.

Interpersonal violence affects millions of people worldwide, often has lifelong consequences, and is gaining recognition as an important global public health problem. There has been no assessment of measures countries are taking to address it. This report aims to assess such measures and provide a baseline against which to track future progress.In each country, with help from a government-appointed National Data Coordinator, representatives from six to ten sectors completed a questionnaire before convening in a consensus meeting to decide on final country data; 133 of 194 (69%) WHO Member States participated. The questionnaire covered data, plans, prevention measures, and victim services. Data were collected between November 2012 and June 2014, and analyzed between June and October 2014. Global and country-level homicides for 2000-2012 were also calculated for all 194 Members.Worldwide, 475,000 people were homicide victims in 2012 and homicide rates declined by 16% from 2000 to 2012. Data on fatal and, in particular, non-fatal forms of violence are lacking in many countries. Each of the 18 types of surveyed prevention programs was reported to be implemented in a third of the 133 participating countries; each law was reported to exist in 80% of countries, but fully enforced in just 57%; and each victim service was reported to be in place in just more than half of the countries.Although many countries have begun to tackle violence, serious gaps remain, and public health researchers have a critical role to play in addressing them.

The 2030 Sustainable Development Agenda aims to "ensure that all human beings can fulfil their potential in dignity and equality". Violence against children and adolescents has devastating health and social consequences, and undermines the possibility of achieving this goal. This chapter presents the INSPIRE technical package as the path forward for ending violence against children. Most INSPIRE strategies have shown preventive effects across several types of violence, and benefits in areas such as mental health, education and crime reduction. Seven strategies for ending violence against children is a global technical package for addressing violence against children. Each letter of the INSPIRE stands for one of the strategies: Implementation and enforcement of laws; Norms and values; Safe environments; Parent and caregiver support; Income and economic strengthening; Response and support services and Education and life skills. The INSPIRE technical package represents a means of revitalizing, directing and expanding existing multisectoral efforts to prevent and respond to violence against children.

This chapter describes the global magnitude of violence against children around the world and reviews the life-long health consequences of exposure to violence as a child, as well as the associated biologic underpinnings and economic costs. It highlights promising solutions, based on the best available evidence, for strengthening the prevention of violence for all children in all countries. Documenting the magnitude of violence against children is and will continue to be essential for targeting prevention and driving the urgent investment in action endorsed in the UN 2030 Sustainable Development Agenda. Violence against children is an endemic public health and human rights problem, with potentially devastating and costly consequences. Consistent evidence confirms that exposure to violence during childhood increases the risks of injury, mental health problems, reproductive health problems, non-communicable diseases, and infectious diseases. Beyond chronic health consequences, serious psychosocial effects that are highly detrimental to quality of life persist decades after childhood violence occurs.

© 2014 The Authors. Published by Elsevier Ltd. Through a global review, we identified gaps in the geographical distribution of violence prevention evidence outcome evaluation studies and the types of violence addressed. Systematic literature searches identified 355 articles published between 2007 and 2013 that evaluated programs to prevent interpersonal or self-directed violence; focused on universal or selected populations; and reported outcomes measuring violence or closely related risk factors. The number of studies identified increased annually from 2008 (n = 37), reaching 64 in 2013. Over half (n = 203) of all studies focused on youth violence yet only one on elder maltreatment. Study characteristics varied by year and violence type. Only 9.3% of all studies had been conducted in LMICs. These studies were less likely than those in high income countries (HICs) to have tested established interventions yet more likely to involve international collaboration. Evaluation studies successfully established in LMIC had often capitalized on other major regional priorities (e.g. HIV). Relationships between violence and social determinants, communicable and non-communicable diseases, and even economic prosperity should be explored as mechanisms to increase the global reach of violence prevention research. Results should inform future research strategies and provide a baseline for measuring progress in developing the violence prevention evidence-base, especially in LMICs.

Editors’ Note: We invited a sample of AJPM’s Editorial Board, supplement guest editors, and longtime colleagues and contributors to share their experiences and impressions of the impact of AJPM on their respective domains. We were particularly fond of Ken Powell’s analogy to being “tenders of the planted seed”—as planters, weeders, and harvesters—watching and nurturing the growth of AJPM, and have elected to lead with his commentary. In the mid-1940s my brothers and I helped our father tend our victory garden. We were suburbanites and our small garden shared a vacant lot with the concrete foundation of a home abandoned in mid-construction during the Depression. We helped plant, weed, and harvest the crops. I especially liked the tall stalks of sweet corn that grew taller than I was. Many years later, in the mid-1990s, I met a couple of other gardeners: Kevin Patrick and Doug Scutchfield visited the Centers for Disease Control (now the Centers for Disease Control and Prevention) to discuss their plans as the editors of the American Journal of Preventive Medicine. I was working in a Branch that was trying to understand the public health importance of regular physical activity, and they had the foresight to know we were planting some seeds in an important new area. I’m not sure that I had even heard of AJPM before their visit. A few years later, while the field of physical activity and public health continued to grow, I shifted my focus to violence and injury prevention. Once again, the team of Patrick and Scutchfield recognized the importance of this topic to the field of preventive medicine. By the turn of the century my work had shifted from the national to the state level. I tried to keep up with the literature by reading or scanning articles as I rode the subway to and from work. The Georgia Division of Public Health had no access to a library so I circulated my personal copy of the American Journal of Preventive Medicine to my team in the Chronic Disease and Injury Epidemiology Section because it contained by far the most articles of interest and practical application for us. Isn’t it interesting to watch things grow. Gardens, journals, and the fields of public health and preventive medicine.

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

Globally interpersonal violence kills more than 520 000 people each year. The impact of nonfatal violence is also enormous and has grave long-term physical, psychological, economic, and social consequences. The burden is unequally distributed, with 90% of deaths from violence borne by low- and middle-income countries, and within countries the socioeconomically disadvantaged are the more susceptible. Traditionally, interpersonal violence has been perceived as an unavoidable occurrence and a science-based approach to prevention has only been promoted in the last few decades. There is a growing evidence base regarding primary prevention, thereby preventing violence, which is often cyclical in nature. One of the challenges facing society is mobilizing the political support needed to tackle the current levels and norms of violence, and risk factors such as poverty and alcohol consumption, which perpetuate interpersonal violence in all its pervasive forms.

There is thus an increased awareness of the problem of child maltreatment and growing pressure on governments to take preventive action. At the same time the paucity of evidence for the effectiveness of interventions raises concerns that scarce resources may be wasted through investment in well-intentioned but unsystematic prevention efforts whose effectiveness is unproven and which may never be proven. For this reason the main aim of this guide is to provide technical advice for setting up policies and programmes for child maltreatment prevention and victim services that take into full account existing evidence on the effectiveness of interventions and that use the scientific principles of the public health approach. This will encourage the implementation of scientifically testable interventions and their evaluation. It is hoped that in this way the guide will contribute to a geographical expansion of the evidence base to include more evaluations of interventions from low-income and middle-income countries and a greater variety of evaluated interventions. The long-term aim is to be able to prepare evidence-based guidelines on interventions for child maltreatment. (excerpt)

Injury and violence rank among the leading causes of death worldwide, with more than 5 million deaths annually, representing a significant portion of the global burden of disease. This article examines how injury and violence relate to global health using recent global burden of disease data and selected key studies and databases, and further explores risk factors and intervention initiatives that address unintentional and intentional injuries. The article serves as a call to action to enhance understanding of the growing burden of injury and violence, especially in low-income and middle-income countries, where more than 90% of injuries occur.

The study's aim was to develop a multidimensional model for the assessment of child maltreatment prevention readiness in low- and middle-income countries. The model was developed based on a conceptual review of relevant existing models and approaches, an international expert consultation, and focus groups in six countries. The final model comprises 10 dimensions: key country conditions; problem assessment; legislation, mandates, policies, and plans; will to address the problem; institutional links and intersectoral collaboration; institutional resources and efficiency; material resources; human and technical resources; informal social resources; and program implementation and evaluation. This model and the instrument being developed on the basis of it address an unmet need in the field of child maltreatment prevention and will help identify those dimensions of readiness that need to be increased to ensure the successful implementation of child maltreatment prevention programs. © 2011 Wiley Periodicals, Inc.

n May 2009, the WHO and the National Center for Chronic Disease Prevention and Health Promotion (CDC, Atlanta GA) met in Geneva, Switzerland, to egin a collaborative effort to build a framework for pubic health surveillance that can be used to define the global ealth burden of adverse childhood experiences (ACEs). n addition toWHO andCDC staff, meeting participants ncluded people working in the fields of public health and arly child development from Canada, China, the former ugoslav Republic ofMacedonia, Philippines, Saudi Araia, SouthAfrica, Switzerland, andThailand. Participants rticulated their goal of forming a network aimed at adancing global understanding andmeasurement of ACEs hrough the exchange of information and the provision of echnical expertise and support. Viewing childmaltreatment and related experiences as set of exposures that have broad implications for human evelopment and prevention of public health problems is relatively new concept. Only since 2004 has child sexual buse been included in the global burden of disease estiates of death and disability attributable to particular voidable risk factors, and medical journals have reently begun to acknowledge the concept of abuse and elated it as a major public health issue by raising awareess of the body of literature that supports this concept.

Objective To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. Methods A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. Findings The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven – home-visiting, parent education, abusive head trauma prevention and multi-component interventions – show promise in preventing actual child maltreatment. Three of them – home visiting, parent education and child sexual abuse prevention – appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. Conclusion Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.

Violence is an enormous global public health problem that increases the risk of injury, disease and poor mental health while also impeding economic and social development. This paper articulates a framework for violence prevention in developing countries that is grounded in the knowledge gained from research and programmatic efforts in rich and in poor countries over several decades. This framework can be used by countries and funding agencies as a guide to building strong foundations for ongoing violence prevention efforts and for identifying violence prevention strategies most likely to be effective. The world has learned a lot about preventing violence and, without a doubt, there is a great deal more to learn. As a global community, however, it is not possible to wait for perfect solutions to these problems to act. The obligation is to act now to use the valuable knowledge that has been gained about violence prevention to improve the world.

More than 90% of violence-related deaths occur in low- to middle-income countries (LMICs), where the mortality rate due to violence is almost 2.5 times greater than in high-income countries. Over and above the substantial contribution of violence as a cause of death and physical injuries, victims of violence are also more vulnerable to a range of mental and physical health problems. Several studies describe the deleterious impact of different types of violence on a range of health outcomes, but no review has yet been undertaken that presents a composite overview of the current state of knowledge in LMICs. This paper reviews the scientific literature describing the nature, magnitude and impact of violence on health, describing the current state of violence-prevention policy developments within the global health agenda and highlighting the health consequences, disease burden and economic costs of violence. Although data are limited, the review indicates that costs relating to violence deplete health care budgets considerably and that scarce resources could be better used to address other health threats that hamper development.

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. System- atic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child mal- treatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region’s per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US $151 billion, accounting for 1.88% of the region’s GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child mal- treatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally.

The Global status report on violence prevention 2014,1 jointly published by WHO, UNDP, and the UN Office on Drugs and Crime, was launched on Dec 11, 2014. For the first time, it assesses national efforts to address interpersonal violence, which includes child maltreatment, youth violence, intimate partner violence, sexual violence, and elder abuse. It identifies gaps in violence prevention and suggests how to fill them. It does so by describing the extent to which 133 participating countries covering 88% of the world's population are collecting data on interpersonal violence, implementing violence-prevention programmes, enacting and enforcing relevant laws, and providing victim services.

As with other diseases, citizen perceptions of injury causes and solutions are important determinants of their response to the problem. This study explores qualitative responses to questions about the causes and solutions for injuries due to violence, transport, and unintentional burns, falls and other causes from 1,075 residents in six neighbourhoods of a low-income area in Johannesburg, South Africa. These included council houses, council apartment blocks and informal settlements. Data were analysed using content analytic procedures. Perceived causes of injury varied sharply between neighbourhoods. Violence was seen as an outcome of unemployment, socialisation, drug abuse and drug dealing in the formal housing areas, while in the informal settlements it was attributed to unemployment, poor housing and environmental conditions, and excessive alcohol consumption. In the formal housing areas, suggested solutions for violence emphasised increased policing and other repressive measures that contradicted the attribution of causes to environmental factors. In the informal areas, solutions were more congruent with perceived causes, emphasising housing development, education and employment. Perceived causes and solutions for transport injuries reflected the specific context of each neighbourhood, and indicated strong support for the implementation of environmental modifications to reduce the speed of motor vehicles and thus the number of pedestrian injuries. Where perceived causes and solutions for violence and transport-related injuries were located beyond the community in the broader environment, unintentional injuries due to other causes were seen as more in the sphere of potential personal control, except in the informal areas where electrification and formal housing provision were the most commonly suggested solutions. Popular constructions of the causes and solutions for major categories of injury are important in shaping injury prevention responses, and their careful assessment can increase the likelihood that safety promotion programmes will succeed.

A survey of medical superintendents revealed that an estimated 1.5 million trauma cases presented to South Africa's 356 secondary and tertiary level hospitals in 1999. Injury rates for traffic, violence and other injuries showed considerable inter-provincial variation, with violence accounting for more than half of the trauma caseload. This type of survey is a simple low cost alternative for monitoring injury patterns and supplementing burden of disease and injury costing studies.

Despite being freely available in English language translation since the late 1970s, the writings of Michel Foucault have only faintly imprinted themselves within the work of South African socio-medical scientists. Where references to Foucault do stray beyond mere name dropping, they frequently distort the lines of his thought by pressing it into precisely the liberal-humanist and Marxist analyses Foucault himself was so concerned to dispel. How is this possible, and what is being done by this failure to accurately understand and apply Foucault? Deploying a Foucaultian methodology of strategic questioning, this paper explores the phenomenon to conclude that the failure of Foucault in South African socio-medical discourse is only apparent, the very impermeability of these disciplines to his ideas itself confirmation for the Foucaultian thesis that while sovereignty is the preserve of an elite, discipline is within the grasp of us all.

This paper is about power, medicine andthe identity of the African as a patient of westernmedicine. From a conventional perspective and asencoded in the current ’’quest for wholeness‘‘ thatcharacterises South African biomedical discourse, theAfrican patient – like any other patient – has alwaysexisted as an authentic and subjectified being, whosetrue attributes and experiences have been denied bythe ’’mechanistic,‘‘ ’’reductionistic‘‘ and ’’ethnocentric‘‘practices of clinical medicine. Against this liberalhumanist perspective on the body as ontologicallyindependent of power, this paper offers a Foucaultianreading of the African patient as – like any otherpatient – contingent upon the force relations immanentwithin and relayed through the clinical practices ofbiomedicine. A quintessential form of disciplinarymicro-power, these fabricate the most intimaterecesses of the human body as manageable objects ofmedical knowledge and social consciousness to makepossible the great control strategies of repression,segmentation and liberation that are the usual focusof conventional investigations into the place andfunction of medicine in society. Since the 1930s whenthe African body first emerged as a discrete object ofa secular clinical knowledge, these have repeatedlytransformed the attributes and identity of the Africanpatient, and the paper traces this archaeology ofSouth African clinical perception from then until the1990s to show how its “quest for wholeness” is not anend point of “discovery” or “liberation,” but merelyanother ephemeral crystallization of socio-medicalknowledge in a constantly changing force field ofdisciplinary power.

Developments in the global violence prevention field and the surrounding international policy context over the last four to five years have created new windows of opportunity to strengthen science-based approaches to understanding and preventing violence. With a focus on interpersonal violence (i.e. child maltreatment, youth violence, intimate partner violence, sexual violence and elder abuse), this presentation explores the new horizons for global violence prevention that these developments represent. Within the global violence prevention field, there has been a substantial increase in the number and geographical distribution of nationally representative surveys that document the prevalence, risk factors, and consequences of interpersonal violence, and in particular violence against children and women. Research too has increased, both concerning how exposure to violence can lead to lifelong behavioural, physical and mental health consequences, and by way of outcome evaluation studies into the effectiveness of prevention programmes and victim services. Together, this has resulted in strong convergence between the violence prevention recommendations made by key international and national violence prevention players, and more powerful arguments for investment in evidence-based prevention and response. Key developments in the international policy context include inclusion in the Sustainable Development Goals of several targets that directly aim at violence prevention, and others that address many of the major underlying causes of violence. Within the health sector, adoption by the May 2016 World Health Assembly of a resolution endorsing the first ever WHO Global plan of action to strengthen the role of the health system in addressing interpersonal violence provides a powerful new incentive for increased health sector involvement in preventing and responding to violence. In combination, these developments suggest that the next big advances in global violence prevention will entail a stronger emphasis on implementing evidence-based prevention programming and policy at the national and local levels, coupled with a new drive to better measure the nature, reach and quality of evidence-based policies and programmes at national and local levels. Recent examples of initiatives to move global violence prevention efforts in this new direction include the development by WHO and other international agencies of the INSPIRE technical package for ending violence against children, and the new Global Partnership to End Violence Against Children. While welcome, these new violence prevention opportunities do not come without threats, in particular the danger that violence among and against men and boys may risk being marginalised unless better efforts are made to balance the current focus on women and girls with an equally strong focus on males of all ages.

The almost exclusive media focus on political violence in South Africa has deflected attention from the high levels of interpersonal violence in areas of socioeconomic deprivation. In order to explore the tension between an at-risk community's perspective and the current reality of violence against women, imaginary constructions of their own violent death produced by 45 African female interview respondents were examined in conjunction with forensic data relating to 73 African female homicide victims in Cape Town, South Africa. The prototypical account of an imagined homicide involved a female commuter being approached by a group of men, taunted and assaulted, raped and then killed. The majority of actual homicides occurred at or in the vicinity of the residence of the victim, with the attacker being known to the deceased. Whilst only 1 of the imagined homicide narratives depicted the use of alcohol by the victim, over half the actual homicides had elevated postmortem blood alcohol levels. These and other disjunctions and convergencies between lay and forensic constructions of violent female death should be viewed in the wider context of enmeshment in social circumstance, and could provide some understanding of how at-risk communities perceive violence against women, thereby providing a foundation for appropriate prevention programmes.