Suicide is the greatest single cause of violent death around the globe and almost equalled deaths from homicide and war combined in 2000, according to the World Health Organisation.
In its first report on violence and health, published today, the WHO called on countries to tackle violence as a public health problem similar to Aids or smoking. It said 1.6 million people were killed in acts of violence in 2000 and millions more were injured and suffered physical, sexual and mental problems.
Suicides claimed 815,000 lives in that year, of which 250,000 were among men aged between 15 and 44. Suicide rates were a third higher among men than women and twice as high among men over 60. The highest suicide rates were to be found in eastern Europe, with Lithuania, Belarus and Estonia having rates more than four times that of Britain. In 1999, 4,448 people killed themselves in the UK.
There were 520,000 homicides, most in Africa and North and South America, where the homicide rate was more than double the suicide rate. In Europe, Australia and the Far East, suicides were more than twice as common as homicides.
An estimated 310,000 people died in wars and conflicts around the globe in 2000 but this figure is dwarfed by the 191 million people estimated to have lost their lives in wars and conflicts during the 20th century, more than half of them civilians.
The vast majority of the 1.6 million deaths in 2000 occurred in developing countries with fewer than 10 per cent in the developed world.
In a foreword to the report, Nelson Mandela, the former South African president, says there is an assumption by those who live with violence that it is an intrinsic part of the human condition. "But this is not so. Violence can be prevented. Violent cultures can be turned around. In my own country and around the world we have shining examples of how violence has been countered. Governments, communities and individuals can make a difference," he says.
The 350-page report seeks to replace pessimism about violence with optimism by suggesting that public health measures can reduce it in the same way as they have reduced infectious diseases and injuries at work.
It says youth homicide rates have increased in many parts of the world and for every young person killed, between 20 and 40 are injured severely enough to require treatment. Evidence on child abuse from certain countries suggests one in five women and up to 10 per cent of men suffered sexual abuse as children. In the home, women are at greatest risk with half of those who die due to homicide killed by husbands or boyfriends. Nearly one in four women will experience sexual violence during their lifetime.
The roots of violence lie in low educational attainment and substance abuse at the individual level while friends, partners and family members wield important influence at the domestic level. Violence is more likely in areas with highly mobile and diverse populations which lack the social glue that binds communities together.
Social factors that influence rates of violence include norms that entrench male dominance over women and children, give priority to parental rights over child welfare, and support the use of excessive force by police against citizens.
Research shows that biological factors may explain some of the predisposition to aggression in individuals, but these interact with family, community and cultural factors. Understanding these factors would help policy-makers intervene at an early stage.
Recommendations made in the report include social development programmes for children and adolescents, parental training and support, and measures to reduce injuries caused by firearms.
Gro Harlem Brundtland, director general of WHO, said: "The report forces us to reach beyond our notions of what is acceptable and comfortable – to challenge notions that acts of violence are simply matters of family privacy, individual choice or inevitable facts of life."
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