Beyond the bruises: Why violence is a health problem

Opinion: There is a misconception that family violence only affects a few people, but the data shows something different, with experience of family violence being shockingly common.
Population-based studies show that over half of New Zealand women experience some form of intimate partner violence in their lifetime, and almost half of people we surveyed have had one or more adverse childhood experiences. 
While this does not mean that half the population are currently living in fear, or are at current risk of violence, it does mean there is a huge burden of trauma we are carrying.  
We need to care, and we need to act because people deserve to be safe, and because the burden of violence and trauma is part of what is crippling our health system. Economic estimates point to an annual cost of between $4 to $7 billion.
Intimate partner violence is a criminal justice issue. But the research is clear that we need to treat it equally as a health issue.
Our studies looking at health consequences associated with these experiences of violence are consistent with international reports. Women and children who experience physical, sexual, and other forms of violence are at increased risk of a whole range of health problems.
The health problems are not just injuries, they are increased risks of cancer, respiratory problems, cardiovascular problems, cancers, digestive disorders, endocrine problems like diabetes, pregnancy complications and a host of mental health problems.
We are also learning a lot about how these health effects occur, for example, through physiological pathways like repeated activation of toxic stress responses which increase inflammation, through increased likelihood of people adopting high-risk behaviours, from abusing alcohol and tobacco to eating disorders. Each can be a way to try to manage the response to violence and trauma.
Men also experience violence, but their patterns are different. Men are more likely to experience violence from other men, which takes a toll in terms of injury. For the majority of men who experience violence by intimate partners, the violence they experience is not as frequent nor severe and is less likely to result in fear.
Internationally, this approach is advocated by the World Health Organization, recommending bedding in actions like routine enquiry by health professionals about their patients’ experiences of violence and trauma, in order to understand how these experiences contribute to people’s health problems. Enquiry needs to be followed up with appropriate actions and referral pathways to help people get the help they need. This can range from help with acute safety concerns to linking patients to services that help with long-term recovery from trauma.
In Aotearoa, we have built an evidence-backed framework – the Violence Intervention Programme – to support the health response to people who have experienced violence. Like any initiative it needs leadership, investment and sustained action to see it through.  
These efforts need to be supported by our educational institutions, like universities, who also need to step up and make sure our health professionals have a solid understanding of violence and trauma, and how these experiences influence health before they start clinical practice.  
If we are willing to step up and recognise that violence is a health issue that requires a serious response, we could get a catalytic change in the overall health burden for the country.