GLOSSARY
Violence: a glossary
Alison Rutherford, Anthony B Zwi, Natalie J Grove, Alexander Butchart
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J Epidemiol Community Health 2007;61:676–680. doi: 10.1136/jech.2005.043711
Violence has been explicitly identified as a significant public
health problem. This glossary clarifies widely used definitions
and concepts of violence within the public health field, building
on those promoted through the 2002 World Report on Violence
and Health. We provide definitions and concepts that can be
usefully applied to identify points for public health intervention
to prevent the social and health impacts of violence.
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See end of article for
authors’ affiliations
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Correspondence to:
Professor Anthony Zwi,
School of Public Health and
Community Medicine,
University of New South
Wales, Sydney, Australia;
a.zwi@unsw.edu.au
Accepted 30 October 2006
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I
n 1996, the Forty-Ninth World Health Assembly
declared violence a major and growing global
public health problem.1
The initial and subsequently
updated Global Burden of Disease study,
the World Report on Violence and Health (WRVH)
and the associated Global Campaign on Violence
Prevention have together propelled violence onto
the public health agenda.2–4
So too have recent
debates on terrorism, gender-based violence, firearms
control, youth violence and the upsurge of
armed conflict in the Middle East.
This glossary clarifies widely used definitions
and concepts of violence within the public health
field, building on those promoted through the
WRVH. Definitions of violence depend upon their
purpose. For example, legal definitions of
‘‘assault’’ are more narrowly defined than the use
of ‘‘assault’’ in hospital morbidity data collections,
which is narrower than the meaning of assault in
general parlance. Defining violence in different
ways has implications for policy and practice. We
use definitions and concepts from a range of
sources that can be applied to identify public
health consequences and preventive strategies.
The accompanying paper provides a framework
in which to consider these definitions and con-
cepts.5
DEFINITIONS OF VIOLENCE
An overarching definition
Violence is defined by the World Health
Organization in the WRVH 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 depriva-
tion’’.4
This definition emphasises that a person or
group must intend to use force or power against
another person or group in order for an act to be
classified as violent. Violence is thus distinguished
from injury or harm that results from unintended
actions and incidents. This definition also draws
attention not only to the use of physical force but
also to the use of threatened or actual power. Such
power or force may be used against oneself,
against an individual or against a group or
community, as in gang violence or repression of
ethnic groups. Violence is here defined not only as
resulting in physical injury but as being present
where psychological harm, maldevelopment or
deprivation occurs; acts of omission or neglect,
and not only of commission, can therefore be
categorised as violent.
The WRVH divides violence into three categories
according to who has committed the violence: selfdirected,
interpersonal or collective; and into four
further categories according to the nature of
violence: physical, sexual, psychological or involving
deprivation or neglect (fig 1).
Many forms of violence may occur simultaneously,
so they are not mutually exclusive. For
example, intimate partner violence may involve
psychological, physical and sexual abuse, and
collective violence often includes the use of rape
as a weapon of war.6 7
Self-directed violence
Self-directed violence is a broad term that includes
suicidal thoughts or action and forms of self-harm.
The term ‘‘fatal suicidal behaviour’’ is often used
for suicidal acts that result in death. ‘‘Non-fatal
suicidal behaviour’’, ‘‘attempted suicide’’, ‘‘parasuicide’’
and ‘‘self harm’’ describe suicidal behaviour
that does not result in death. ‘‘Suicidal
ideation’’ is used clinically to describe contemplation
of wilfully ending one’s own life. ‘‘Selfmutilation’’
refers to direct and deliberate destruction
or alteration of parts of the body without
conscious suicidal intent.
Interpersonal violence
Interpersonal violence include acts of violence and
intimidation that occur between family members,
between intimate partners or between individuals,
whether or not they are known to one another,
and where the violence is not specifically intended
to further the aims of any group or cause.8
This
category includes child maltreatment, youth violence,
some forms of sexual violence and abuse of
elders.
The International Classification of Diseases
(ICD) codes, used around the world to code
mortality and morbidity data, include mechanism
of injury codes for assault, sexual assault, neglect,
abandonment and maltreatment.9
These are sometimes
grouped together and reported as ‘‘interpersonal
violence’’.10
ICD codes also exist for selfinflicted
violence and for injuries sustained
through legal interventions or operations of war.
Abbreviations: ICD, International Classification of
Diseases; WRVH, World Report on Violence and Health
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Collective violence
Collective violence has been defined as the ‘‘instrumental use of
violence by people who identify themselves as members of a
group…against another group or set of individuals, in order to
achieve political, economic or social objectives’’.11
Collective
violence includes war, terrorism and violent political conflict
between or within states, violence perpetrated by states
(genocide, torture, systematic abuses of human rights) and
organised violent crime such as gang warfare. It may include all
categories of violence, be these physical, sexual, psychological,
or characterised by neglect or discrimination.
Sexual violence
Sexual violence can occur at an interpersonal or collective level.
Sexual violence incorporates non-consensual sexual contact
and non-consensual non-contact acts of a sexual nature, such
as voyeurism and sexual harassment.12
Acts qualify as sexual
violence if they are committed against someone who is unable
to consent or refuse, for example because of age, disability,
misuse of authority, violence or threats of violence.
Rape is defined as ‘‘physically forced or otherwise coerced
penetration, even if slight, of the vulva or anus, using a penis,
other body parts or an object’’.13
Sexual coercion is defined as
‘‘the act of forcing (or attempting to force) another individual
through violence, threats, verbal insistence, deception, cultural
expectations or economic circumstances to engage in sexual
behaviour against his/her will’’.14
Gender-based violence
Gender-based violence is a term that recognises that violence
occurs within the context of women’s and girl’s subordinate
status in society, and serves to maintain this unequal balance of
power.15
Gender-based violence is sometimes used interchangeably
with ‘‘violence against women’’ although the latter is a
more limited concept. The United Nations defines violence
against women as ‘‘any act of gender-based violence that
results in, or is likely to result in, physical, sexual or
psychological harm or suffering to women, including threats
of such acts, coercion or arbitrary deprivations of liberty,
whether occurring in public or private life’’.16
Gender-based violence therefore includes violence against
women occurring within the family, geographically or culturally
specific forms of abuse such as female genital mutilation,
‘‘honour killings’’ and dowry-related violence as well as various
forms of sexual violence, including rape during warfare,
trafficking of women and forced prostitution.14
As mentioned
earlier, these latter examples may be forms of collective
violence where these abuses are directed not only against
individuals but against entire groups. This is particularly so
when sexual and gender-based violence are perpetrated in
situations of conflict.17–20
Despite considerable attention, the
lack of widely agreed definitions of the different forms of
gender-based violence and violence against women, and the
different ways in which these concepts are operationalised in
the research context, limits the comparability of research
findings.15
Intimate partner violence
‘‘Intimate partner violence’’ refers to physical, sexual or
psychological harm by a current or former partner or spouse.
This type of violence can occur among heterosexual or same-sex
couples and does not require sexual intimacy. Although women
can be violent against their male partners and violence may be
found in male-male and female-female partnerships, it is well
accepted that the overwhelming burden of partner violence
around the world is borne by women at the hands of men.4
Feminist theorists have studied the links between masculinities
and violence, and identified the ways in which violence is used
to bolster masculine identities, particularly in situations of
poverty, and the implications of this for broader understandings
of global violence.21–23
Domestic violence
‘‘Domestic violence’’ is often used interchangeably with
intimate partner violence. Domestic violence includes physical
abuse, verbal abuse, economic abuse and social abuse. Hegarty
et al suggest that ‘‘domestic violence can be better understood
as a chronic syndrome characterised not only by episodes of
physical violence but also by the emotional and psychological
abuse the perpetrators use to maintain control over their
partners’’.24
Family violence
Family violence refers to child maltreatment, sibling violence,
intimate partner violence and elder abuse. The concept of
family violence is increasingly being used to draw attention to
how each of the sub-types of family violence may cause or be a
risk factor for the other subtypes, and how there may be
Figure 1 Typology of violence (from the World Report on Violence and Health4
).
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common underlying risk factors at the levels of the family and
the relationship between the family and the wider community
and society. In turn, this suggests prevention opportunities that
can help reduce the risk of all types of violence within the
family by addressing the family and social systems. The
interconnectedness of family violence, suicide, crime and drug
and alcohol abuse as manifestations of intergenerational
trauma and the importance of understanding historical contexts
that produce family violence have been emphasised in
Australia and in indigenous communities elsewhere.25 26
Child maltreatment
Child maltreatment and child abuse are sometimes used
interchangeably. For example, the WHO Consultation on
Child Abuse Prevention uses the following definition: ‘‘Child
abuse or maltreatment constitutes all forms of physical and/or
emotional ill-treatment, sexual abuse, neglect or negligent
treatment or commercial or other exploitation, resulting in
actual or potential harm to the child’s health, survival,
development or dignity in the context of a relationship of
responsibility, trust or power’’.27
Some definitions consider as abused those children who have
been inadvertently harmed through the actions of a parent or
caregiver, while others require that harm to the child be
intended for ‘‘abuse’’ to have occurred.28
Given that ideas about parenting are culturally contingent,
concepts of what constitutes child maltreatment vary significantly
between cultures. For example, corporal punishment of
children is socially and legally accepted in many countries,
while in others it is outlawed.28
Cultures continuously evolve
and so harmful, culturally sanctioned practices have the
potential to change over time.
Youth violence
Around the world age is a significant risk factor for becoming
both a victim or a perpetrator of violence, with young males
being particularly at risk. The World Health Organization
defines youth violence as ‘‘homicide and non-fatal attacks
perpetrated by or against a person aged 10–29 years of age’’.29
This definition explicitly includes young people as both victims
and perpetrators, emphasising the increased exposure to
violence young people experience as they pass through this life
stage.
Elder abuse
Elder abuse may be an act of commission or omission and may
be intentional or unintentional. As with other forms of abuse, it
may be physical, psychological, financial, sexual or involve
neglect. The International Network for the Prevention of Elder
Abuse uses the following definition: ‘‘a single or repeated act,
or lack of appropriate action, occurring within any relationship
where there is an expectation of trust which causes harm or
distress to an older person’’.30
Workplace violence
Workplace violence has received increased attention around the
world in the last decade. Definitions vary in the emphasis they
place on physical violence versus psychological violence; recent
work emphasises the negative effects of both.
The International Labour Organization uses a definition of
workplace violence adapted from the European Commission:
‘‘Incidents where staff are abused, threatened or assaulted in
circumstances related to their work, including commuting to
and from work, involving an explicit or implicit challenge to
their safety, well being or health’’.31
Bullying lacks a consistent definition but is usually defined
as persistent rather than isolated behaviour. Bullying within a
workplace may involve threats to professional status, threats to
personal standing, isolation, overwork and destabilisation.
Within the health care professions, ambulance workers, nurses
and workers with substantial face-to-face contact are particularly
vulnerable to bullying.32
Harassment at work is any conduct based on age, disability,
HIV status, sex, sexual orientation and other factors that is
unreciprocated and unwanted and affects the dignity of men
and women at work.31
Sexual harassment refers to ‘‘where any
form of unwanted verbal, non-verbal or physical conduct of a
sexual nature occurs, with the purpose or effect of violating the
dignity of a person, in particular when creating an intimidating,
hostile, degrading, humiliating or offensive environment’’.33
Structural violence
‘‘Structural violence’’ refers to the physical and psychological
harm that result from exploitative and unjust social, political
and economic systems. The apartheid system, based on racial
discrimination in South Africa, is a classical case of structural
violence in which the state set in place unjust laws and systems
which disempowered, marginalised and disenfranchised the
majority black population. These and related human rights
violations are significant social determinants of ill health.
Structural violence is, however, often most pervasive because
of its invisibility: ‘‘embedded in ubiquitous social structures
(and) normalized by stable institutions and regular experience…structural
inequities usually seem ordinary’’.34
Farmer,
for example, demonstrated the link between the emergence and
persistence of AIDS and TB in Haiti and their disproportionate
impact on the poor to the enduring effects of European
expansion, slavery and racism; economic dependence on the
United States; and attempts to erase, or forget, this history.35
Forms of structural violence operate globally against women,
children, indigenous peoples and those in poverty.34
Structural
violence may both underlie and be an outcome of modern
armed conflicts.34
Armed conflict
The term ‘‘armed conflict’’ is often used in preference to ‘‘war’’
given legal complexities surrounding definitions of war and the
changing nature of violent political conflict.11
War typically
suggests armed conflict between two states, but we are
increasingly facing internal armed conflicts, wars within states,
and often conflicts involving non-state actors such as private
armies and locally armed militia. Conflicts in the Middle East
have highlighted the immense impact on lives and livelihoods
of both terrorism and massive armed interventions.
New wars
‘‘New wars’’ describe conflicts where the boundaries between
war, organised crime and wide-scale human rights abuse have
blurred.36
A current example is in Darfur, Sudan, where
ongoing collective violence has resulted from a group of militia,
backed by the Sudanese state, using terror and repression to
displace other communities and thereby enrich themselves
through gaining access to key resources. Nearly 4 million
people have been affected by displacement.37
Human rights
abuses abound and the international community has been
limited in its response.
Complex emergencies
A complex emergency is ‘‘a humanitarian crisis in a country,
region or society where there is total or considerable breakdown
of authority resulting from internal or external conflict and
which requires an international response that goes beyond the
mandate or capacity of a single agency and/or the ongoing
United Nations country program’’.38
Complex emergencies
result in dislocation of population, destruction of social
networks and ecosystems, insecurity affecting civilians and
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others not involved in conflict and abuses of human rights.39
Complex emergencies may involve natural or man-made
disasters, but the term is often used to describe violent conflict
with major political implications.11
The health impacts typically
result from both the direct effect of the violence as well as the
additional layer of morbidity and mortality which results from
food insecurity and infectious diseases, as recently seen in the
Democratic Republic of Congo.40 41
Terrorism
Terrorism is a controversial and subjective term with multiple
definitions, one of which relates to use of, or threat of, violence
against civilians and the state, or symbols thereof, in order to
create fear and achieve political, economic, religious or
ideological goals. Concern has focused most recently on issues
of biosecurity and the potential to use biological agents against
the general population. Terrorism has been defined by a high
level United Nations panel as ‘‘any act intended to cause death
or bodily harm to civilians or non-combatants for the purpose
of either intimidating a population or compelling a government
or a government institution to do or not to do something’’.42
The population health effects of terrorism vary considerably.
Particularly important may be the psychological impact of
widespread fear and anxiety and the implications of these for
travel, use of and access to services, and psychosocial wellbeing
more generally.
Genocide
Article 2 of the 1951 Convention on the Prevention and
Punishment of the Crime of Genocide defines genocide as
any of the following acts committed with intent to destroy, in
whole or in part, a national, ethnical, racial or religious
group, as such: (a) killing members of the group; (b) causing
serious bodily or mental harm to members of the group; (c)
deliberately inflicting on the group conditions of life
calculated to bring about its physical destruction in whole
or in part; (d) imposing measures intended to prevent births
within the group; (e) forcibly transferring children of the
group to another group.43
THE PREVENTION OF VIOLENCE
The most important outcome of focusing on violence and
defining it clearly is the potential to more precisely understand
its scale, forms and causes and to enhance the scope to
intervene to prevent its occurrence or to modify its effects.
Prevention activities can be classified by the stage during which
prevention takes place (primary, secondary or tertiary prevention)
as well as by its relationship to the population (universal,
selective or indicated interventions).
Primary prevention
The primary prevention of violence aims to stop violent
incidents occurring. Primary prevention is the most effective
form of prevention but also the most difficult to achieve. Policy
initiatives to address poverty and inequity could be classified as
primary prevention activities in relation to violence, as could
those directed at controlling the availability of firearms.
Primary prevention is often unattractive to politicians
because upstream preventive activities are not visible unless
they are linked with service provision. Sustained nurse homevisiting
of mothers with young children is an evidence-based
primary prevention strategy that does link with service
provision and is widely acknowledged to improve outcomes
for children and reduce their risk of becoming victims or
perpetrators of abuse.44
Secondary prevention
Secondary prevention aims to minimise harm once a violent
incident has occurred, focusing on immediate responses, such
as emergency services or treatment for sexually transmitted
diseases following rape. Secondary prevention could also
include intervening in situations of high risk, such as reducing
the risks of sexual exploitation in refugee camps or internally
displaced person settings through better planning of facilities,
better training of protection forces, and greater calls for
accountability by those charged with the duty to protect
victims of violence.
Tertiary prevention
Tertiary prevention aims to treat and rehabilitate victims and
perpetrators. Approaches focus on long-term care in the wake
of violence, such as rehabilitation and reintegration, and
attempts to lessen trauma or reduce the long-term disability
associated with violence. Examples include psychological
therapies for abused children; screening and support services
for victims of intimate partner, domestic or family violence; and
specific recognition of the needs of survivors of torture.
Universal interventions
Universal interventions addressing violence are aimed at the
general population, or groups within it (for example those of a
certain gender or age bracket) without regard to individual risk.
Examples include developing educational and training programs
against bullying in schools, or reducing population
alcohol consumption by regulating sales and increasing prices
to prevent alcohol-related violence.
Selective (or targeted) interventions
Selective interventions focus on those at heightened risk of
violence. For example, early intervention programs focusing on
low-income single parents.
Indicated interventions
Indicated interventions focus on high-risk individuals who
have detectable problems, such as perpetrators of domestic
violence or sexual offenders. For example, some prisons
conduct mandated programs for violent offenders.
What this paper adds
N This paper provides key definitions of major forms of
violence.
N Common terms used in describing violence are
explained.
N A comprehensive overview of why violence is important
to public health is provided.
Policy implications
N Public health must engage with issues of violence.
N Improved definitions and precise description will aid
surveillance, help determination of burden, and enhance
response.
N Violence can no longer be relegated to some other sector
– public health must engage and help shape a safer
future.
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CONCLUSION
Violence is a significant public health problem and defies
simple analysis. Defining violence in different ways has both
moral and material consequences, such as whether or not a
perpetrator is prosecuted, whether or not a prevention program
is funded, or how a victim understands their situation. It is
most important that public health practitioners understand the
broad scope of violence and are able to identify points for
successful intervention to prevent violence and its health and
social impacts.
Authors’ affiliations
. . . . . . . . . . . . . . . . . . . . . . .
Alison Rutherford, Anthony B Zwi, Natalie J Grove, School of Public
Health and Community Medicine, University of New South Wales, Sydney,
Australia
Alexander Butchart, Department of Injuries and Violence Prevention,
World Health Organization, Geneva, Switzerland
Competing interests: AZ was co-editor of the World Report on Violence
and Health. AB works for the World Health Organization which campaigns
and provides technical advice on violence prevention.
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