Is Violence a Disease?

Yes, according to the World Health Organization's new World Report on Violence and Health. None of the major news outlets that covered the release of the report—including The New York Times, The Washington Post, the BBC, and The Washington Times—displayed any skepticism about the idea that violence is a disease.

First, what did WHO discover about the global scale of violence? About 1.65 million people died violently in 2000, accounting for about 3 percent of the world's annual death toll. Most people will probably be surprised to learn that suicide is the world's leading cause of violent deaths. Forty-nine percent of violent deaths were suicides, while 32 percent were murders, and 19 percent were the result of war. In the United States in 1999, the number of people who died of suicide was nearly double the number of those who were murdered: 29,199 suicides versus 15,533 murders.

WHO estimated that 191 million people died in conflicts over the past century; well over half were civilians. The WHO report also notes that poorer countries are about twice as violent as wealthier countries. Taking population differences into account, 1.5 million people died of violence in low and middle-income countries, while 150,000 died in high-income countries.

Strangely, while the WHO report notes that, in all societies, males initiate most violence, it resolutely draws no conclusions about why that might be. The most obvious first thought might be that male violence has a biological basis. Instead, cleaving to old-fashioned social science, WHO looks chiefly for social and cultural roots of violence. What is most interesting is that violence rates are way down from the rates registered in earlier societies. For example, the murder rate in medieval England was at least twice as high as the current murder rate in the United States. Murder among primitive non-state societies is also quite high. In other words, culture does matter, but in the sense that it reins in male tendencies toward violence. The advance of civilization has lowered the "background" rate of interpersonal violence, but 191 million dead in the past century are stark testimony that collective violence remains all too prevalent.

The WHO's public health model of violence prevention can help address some sources of violence. Hotlines for the prevention of suicide and domestic violence clearly have a place. But with regard to interpersonal violence within societies, one of the best strategies for preventing violence is to make it clear to violence-prone individuals that they are unlikely to get away with it. More pro-active law enforcement, not public health interventions, is responsible in large measure for the steep decline in the violent crime rate in the United States over the past decade.

Finally, the public health rationale simply becomes incoherent in the face of civil or international wars. They are not epidemics. The best way to prevent them may still be summed up in Teddy Roosevelt's advice, "Walk softly, but carry a big stick."