11th World Congress on Public Health 8th Brazilian Congress on Collective Health Rio de Janeiro, Brazil August 21st – August 25th 2006

When the Victim is a Child: A Global Public Health Tragedy Presented by Joyce N. Thomas, RN, MPH, PNP President/ CEO and Co-Founder Center for Child Protection and Family Support, Inc. Washington, DC

Purpose of Presentation To increase understanding about child violence and the challenges it poses for public health practice across the globe.

Overview/ Introduction Dynamics of the Problem Public Health Approach Challenges Incidence and Prevalence Types of Child Violence Global Implication for Public Health Practice and Policies

Bound, beaten, starved, killed: “NB’s tragic life of unimaginable physical and emotional agony ended at 4:30 a.m. when the 7-year-old’s battered body was found in her “house of horrors.” The second-grader had been bound to a chair, tortured, sexually molested and starved for weeks before being killed by a savage blow to the head– even after child welfare authorities dismissed charges of abuse” Source: Dillion, N., Fenner, A., and Gendar,A: New York Daily Newspaper, January 11, 2006

Public Health Approach Scope of the problem Population to be served Risk and protective factors Program interventions Measure Outcomes

Challenges to Addressing Child Violence Across the Globe: Complex and subtle scientific issues involved in gathering data about abused children. The definitions of abuse used by public agencies are usually based on legal definitions, which vary across jurisdictions. Most abused and neglected children never come to the attention of public agencies, thus, official government statistics do not capture the full extent of the problem. Bias and personal values influence decisions and judgments.

Challenges in measuring the impact of child violence are influenced by: What is the age and development stage of the abused child? What is the relationship of the perpetrator to the child? How was the abuse is discovered, or disclosed? What is the level of severity of the abuse? What is the duration of violent experience? What is the frequency of the problem? What are the cultural factors of the child and family?

Global Challenges that Influence Child Violence Poverty War Family disruptions Family Violence Abandonment of Children HIV/AIDS Health disparities Human trafficking Commercial sexual exploitation Neighborhood crime Institutional Racism Political Oppression

Statistics Tell Us An estimated 3 million children were alleged victims of abuse and neglect. Over 872,000 children were identified to be abused. Children ages 0-3 years had the highest rate of victimization at 16.1 per 1,000 children. 56% of reports are made by persons who work with children. An estimated1,490 children died due to child abuse. About 79% of perpetrators were parents, 7% were other relatives, 4% were unmarried partner of the child’s parent, and 5% other. Girls are slightly more likely to be victims than boys. Source: 2004 Child Maltreatment, from the National Child Abuse and Neglect Data System (NCANDS) Department of Heath and Human Services, Administration on Children and Families.

Substantiated Reports 60 % are incidents of child neglect 18% are cases involving physical abuse 10% are cases of sexual abuse 7% were related emotional maltreatment 15% other based on specific State laws (A child could be a victim of more than one type of maltreatment) Source: 2004 Child Maltreatment, NCANDS

Global Issues of Sexual Violence 33% of adolescent females reported being forced to participate in sexual initiations. Mass rape of women and girls is used as a weapon of war. Young boys are also victims of sexual violence in many areas of the world. The number of children involved in commercial sexual exploitation is widely under-reported and therefore, largely unknown. Source: (2002) World Report on Violence and Health, NSVRC.

Current systems for detecting and reporting incidents of child prostitution, commercial sexual exploitation, and pornography across the globe are not sufficiently sensitive in measuring the true magnitude of the problem.

Parental: Risk Factors Low self-esteem Abused as a child Depression Substance abuse Character disorder/mental illness Poor parenting skills Unrealistic expectations

Implication for Public Health Practice and Policies Funding levels must be expanded to address the global problem of child violence. Public health research must continue to examine the elements of violence against children. Public health programs must be comprehensive, developmentally appropriate and culturally competent. Disparities in child violence must be examined using a public health approach.

Continuation…. Public health practitioners must be trained to screen for child violence and to intervene appropriately. Curriculum materials must be comprehensive to address risk factors, intervention techniques and long-term planning. Child victim are not easily visible, we must continue expand public awareness efforts.