Family violence

In Victoria, family violence is the biggest cause of early death, disability and illness in women between the ages of 15 and 44.

It is also the main contributor to depression and anxiety in women. It can affect your social situation, your friendships, your ability to work and be involved in your community, and your financial circumstances.

On this page:

• What is family violence
• Describing violence
• Family violence is a crime
• What are the health impacts of family violence
• Why do men commit family violence
• Issues for women from other cultures
• Women in Aboriginal and Torres Strait Islander communities
• Women from immigrant and refugee communities

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What is family violence

Family violence, intimate partner violence or domestic violence all describe relationships where women are threatened, isolated, punished or controlled. While the vast majority of this violence comes from men, violence occurs in relationships across all communities, including in same sex relationships.

Women who have experienced or witnessed violence as children are more likely be subject to violence and abuse in their adult relationships.

As well as being physically attacked, women in controlling relationships may be threatened, intimidated and abused. Ways used to undermine women's self-confidence might include:

• criticism, public humiliation and putdowns
• manipulative mind games
• controlling her access to money; isolating her from family and friends; demanding to know where she is; accusations of being unfaithful
• rape.

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Describing violence

Violence is any behaviour that makes you feel scared, sad, isolated, worthless or disconnected from your family, community or your mob. Violence is also behaviour that threatens the safety, security and wellbeing of your children.

Violence can be:

• physical – hitting, punching, slapping, pushing and yelling
• sexual – rape or forcing you to have sex, forcing you to do sexual acts you don’t want to do, unwanted sexual comments or touching
• emotional or psychological – putting you down, making you feel stupid, swearing at you and calling you names
• controlling – stopping you from being with your family or friends, or participating in community or religious and cultural events.
• economic – keeping money from you, not allowing you to have money of your own
• coercive – using power over you to get you to do things you don’t want to do.

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Family violence is a crime

Until quite recently family violence was seen as private and police often turned a blind eye to men who were violent towards their partners. The law is now clear:

• women do not lose their rights because they marry or are in a relationship
• family violence is a crime.

All states and territories have laws to protect women and children from family violence and governments fund services to provide resources and support.

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What are the health impacts of family violence

Intimate partner violence is responsible for more ill health and premature death in Victorian women under the age of 45 than any other known risk factor.

Women with a history of intimate partner violence are more likely to:

• smoke and have alcohol or drug problems
• have an abnormal Pap test or have contracted a sexually transmitted infection
• be diagnosed with a mental illness
• suffer from a chronic lung condition, heart disease, hypertension, stroke or bowel problems
• experience chronic pain and fatigue.

The impacts of violence on health may vary according to the different stages of life:

• Children have an increased risk of mental health problems, behavioural difficulties and developmental delays.
• Young women are at increased risk of having an unplanned pregnancy, an abortion or a miscarriage.
• Many women are assaulted when they are pregnant, increasing the risk of complications in their pregnancy and on their baby’s health.
• In midlife, women who have lived with a violent partner are more likely to experience depression and anxiety.
• Older women who have experienced violence use health services more frequently than other women, even after they are no longer exposed to violence.

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Why do men commit family violence

Men’s violence towards women is aimed at controlling or punishing their partner, and is supported by a sense of entitlement.

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Issues for women from other cultures

Young women, Aboriginal and Torres Strait Islander women, women from culturally and linguistically diverse backgrounds and women with disabilities are at greater risk of male violence than women in the general population.

If you're a victim of family violence you might not want to talk about what is happening to you. This might be because you:

• don’t want to believe it is happening to you
• believe talking about it might lead to frightening life changes
• are scared of what your partner/family member (the perpetrator) will do
• want to protect your family and community.

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Women in Aboriginal and Torres Strait Islander communities

Aboriginal and Torres Strait Islander women don’t often use the term ‘family violence’. You might say “we had an argument” or “he was acting up”. You might still have been really frightened, or felt abused or forced to do things you didn’t want to do.

In Aboriginal and Torres Strait Islander communities it is hard to single out one particular cause of family violence because the reasons are very complex.

Aboriginal and Torres Strait Islander women also have additional concerns about reporting violence to authorities or seeking help from health services. These concerns are deeply rooted in history and the fact that hospitals were once involved in removing babies from Aboriginal families. Aboriginal and Torres Strait Islander women will still encounter racism and disbelief from individual staff in hospitals, and there will always be a risk that the perpetrator will not be adequately punished or child protection will be contacted about the welfare of your children.

Remember

Health workers are bound by the rules of privacy and confidentiality. Anything you tell the doctor or midwife about your past experiences of violence will be confidential. However, if you or your children are in immediate danger health professionals have to, by law, discuss your safety with other professionals; this will be done with your involvement where possible.

For a full list of resource and support services download the fact sheet Family violence - information for Aboriginal and Torres Strait Islander women

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Women from immigrant and refugee communities

Family violence is illegal in Australia. However, immigrant or refugee woman may face obstacles to getting help. In addition to language being a barrier, you may:

• not know of services that can help you, such as health and welfare services, legal services and social support services
• be socially isolated and dependent on the person who is causing the violence
• find it difficult to trust authorities
• have found services were insensitive to your culture
• feel that it is your duty as a wife and a mother to tolerate your husband’s behaviour 
• be uncertain whether what you are experiencing is violence (this can be particularly difficult with non-physical violence)
• be concerned about being sent back to your country of origin
• be worried about the welfare of your children
• fear being judged by other people in your community.

Seeking support requires courage and determination but it may also be a first step to feeling safe.

For a full list of resource and support services download the fact sheet Family violence - information for women. This fact sheet has been translated into a number of community languages.

Rabies

Rabies

Key facts

• Rabies is a vaccine-preventable viral disease which occurs in more than 150 countries and territories.
• Dogs are the source of the vast majority of human rabies deaths.
• Rabies elimination is feasible by vaccinating dogs.
• Infection causes tens of thousands of deaths every year, mostly in Asia and Africa.
• 40% of people who are bitten by suspect rabid animals are children under 15 years of age.
• Immediate wound cleansing with soap and water after contact with a suspect rabid animal can be life-saving.
• Every year, more than 15 million people worldwide receive a post-bite vaccination to prevent the disease; this is estimated to prevent hundreds of thousands of rabies deaths annually.

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Rabies is an infectious viral disease that is almost always fatal following the onset of clinical signs. In more than 99% of human cases, the rabies virus is transmitted by domestic dogs. Rabies affects domestic and wild animals, and is spread to people through bites or scratches, usually via saliva.

Rabies is present on all continents with the exception of Antarctica, but more than 95% of human deaths occur in Asia and Africa.

Rabies is a neglected disease of poor and vulnerable populations whose deaths are rarely reported and where human vaccines and immunoglobulin are not readily available or accessible. It occurs mainly in remote rural communities where children between the age of 5–14 years are the most frequent victims.

The average cost of rabies post-exposure prophylaxis (PEP) can be the cost of catastrophic expenses for poor populations, since a course of PEP can cost US$ 40 in Africa and US$ 49 in Asia, where the average daily income is about US$ 1–2 per person.

Prevention

Eliminating rabies in dogs

Rabies is a vaccine-preventable disease. Vaccinating dogs is the most cost-effective strategy for preventing rabies in people. Dog vaccination will drive down not only the deaths attributable to rabies but also the need for PEP as a part of dogbite patient care.

Preventive immunization in people

The same safe and effective vaccines can be used for pre-exposure immunization. This is recommended for travellers spending a lot of time outdoors, especially in rural areas, involved in activities such as bicycling, camping, or hiking as well as for long-term travellers and expatriates living in areas with a significant risk of exposure.

Pre-exposure immunization is also recommended for people in certain high-risk occupations such as laboratory workers dealing with live rabies virus and other rabies-related viruses (lyssaviruses), and people involved in any activities that might bring them professionally or otherwise into direct contact with bats, carnivores, and other mammals in rabies-affected areas. As children are considered at higher risk because they tend to play with animals, may receive more severe bites, or may not report bites, their immunization could be considered if living in or visiting high-risk areas.

Symptoms

The incubation period for rabies is typically 1–3 months, but may vary from <1 week to >1 year. The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling, pricking or burning sensation (paraesthesia) at the wound site. As the virus spreads through the central nervous system, progressive, fatal inflammation of the brain and spinal cord develops.

Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity, excited behaviour, hydrophobia and sometimes aerophobia. After a few days, death occurs by cardiorespiratory arrest.

Paralytic rabies accounts for about 30% of the total number of human cases. This form of rabies runs a less dramatic and usually longer course than the furious form. The muscles gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.

Diagnosis

No tests are available to diagnose rabies infection in humans before the onset of clinical disease, and unless the rabies-specific signs of hydrophobia or aerophobia are present, the clinical diagnosis may be difficult. Human rabies can be confirmedintra-vitam and post mortem by various diagnostic techniques aimed at detecting whole virus, viral antigens or nucleic acids in infected tissues (brain, skin, urine or saliva).

Transmission

People are usually infected following a deep bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. They are the cause of human rabies deaths in Asia and Africa.

Bats are the source of most human rabies deaths in the Americas. Bat rabies has also recently emerged as a public health threat in Australia and western Europe. Human deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and other wild carnivore host species are very rare.

Transmission can also occur when infectious material – usually saliva – comes into direct contact with human mucosa or fresh skin wounds. Human-to-human transmission by bite is theoretically possible but has never been confirmed.

Rarely, rabies may be contracted by inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of raw meat or other tissues from animals infected with rabies is not a source of human infection.

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis (PEP) means the treatment of a bite victim that is started immediately after exposure to rabies in order to prevent rabies infection. This consists of:

• local treatment of the wound, initiated as soon as possible after exposure;
• a course of potent and effective rabies vaccine that meets WHO standards; and
• the administration of rabies immunoglobulin, if indicated.

Effective treatment soon after exposure to rabies can prevent the onset of symptoms and death.

Local treatment of the wound

This involves first-aid of the wound that includes immediate and thorough flushing and washing of the wound for a minimum of 15 minutes with soap and water, detergent, povidone iodine or other substances that kill the rabies virus.

Recommended PEP

Depending on the severity of the contact administering with the suspected rabid animal, administration of PEP is recommended as follows (see table):

Table: Categories of contact and recommended post-exposure prophylaxis (PEP)
Categories of contact with suspect rabid animal	Post-exposure prophylaxis measures
Category I – touching or feeding animals, licks on intact skin	None
Category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding	Immediate vaccination and local treatment of the wound
Category III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, contacts with bats.	Immediate vaccination and administration of rabies immunoglobulin; local treatment of the wound

All category II and III exposures assessed as carrying a risk of developing rabies require PEP. This risk is increased if:

• the biting mammal is a known rabies reservoir or vector species;
• the animal looks sick or displays an abnormal behaviour;
• a wound or mucous membrane was contaminated by the animal’s saliva;
• the bite was unprovoked; and
• the animal has not been vaccinated.

In developing countries, the vaccination status of the suspected animal alone should not be considered when deciding whether to initiate prophylaxis or not.

The Organization continues to promote human rabies prevention through the elimination of rabies in dogs as well as a wider use of the intradermal route for PEP which reduces volume and thereby the cost of cell-cultured vaccine by 60% to 80%.

WHO response

WHO, in close collaboration with the Food and Agriculture Organization of the United Nations (FAO), the World Organisation for Animal Health (OIE) and the Global Alliance for Rabies Control, is raising awareness of and commitment to overcoming this persistent zoonosis in endemic countries.

Great strides have been made in the Philippines, South Africa and Tanzania where a project is underway as part of a Bill & Melinda Gates Foundation project led by WHO. The key towards sustaining and expanding the rabies programmes to new territories and countries has been to start small, demonstrate success and cost-effectiveness, and ensure community engagement.

Stockpiles of dog and human rabies vaccine have had a catalytic effect on rabies elimination efforts in countries.

Rabies transmitted by dogs has been eliminated in many Latin American countries, including Chile, Costa Rica, Panama, Uruguay, most of Argentina, the states of São Paulo and Rio de Janeiro in Brazil, and large parts of Mexico and Peru.

Many countries in the WHO South-East Asia Region have embarked on elimination campaigns in line with the target of regional elimination by 2020. Bangladesh launched an elimination programme in 2010 and, through the management of dog bites, mass dog vaccination and increased availability of vaccines free of charge, human rabies deaths decreased by 50% during 2010–2013.

Alcohol

Alcohol

In many parts of the world, drinking alcoholic beverages is a common feature of social gatherings. Nevertheless, the consumption of alcohol carries a risk of adverse health and social consequences related to its intoxicating, toxic and dependence-producing properties.

In addition to the chronic diseases that may develop in those who drink large amounts of alcohol over a number of years, alcohol use is also associated with an increased risk of acute health conditions, such as injuries, including from traffic accidents.

Key facts 1

• Worldwide, 3.3 million deaths every year result from harmful use of alcohol,2 this represent 5.9 % of all deaths.
• The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions.
• Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability- adjusted life years (DALYs).3
• Alcohol consumption causes death and disability relatively early in life. In the age group 20 – 39 years approximately 25 % of the total deaths are alcohol-attributable.
• There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other noncommunicable conditions as well as injuries.
• The latest causal relationships have been established between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS.
• Beyond health consequences, the harmful use of alcohol brings significant social and economic losses to individuals and society at large.

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Alcohol is a psychoactive substance with dependence-producing properties that has been widely used in many cultures for centuries. The harmful use of alcohol causes a large disease, social and economic burden in societies.

Alcohol impacts people and societies in many ways and it is determined by the volume of alcohol consumed, the pattern of drinking, and, on rare occasions, the quality of alcohol consumed. In 2012, about 3.3 million deaths, or 5.9 % of all global deaths, were attributable to alcohol consumption.

The harmful use of alcohol can also result in harm to other people, such as family members, friends, co-workers and strangers. Moreover, the harmful use of alcohol results in a significant health, social and economic burden on society at large.

Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioural disorders, including alcohol dependence, major noncommunicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions.

A significant proportion of the disease burden attributable to alcohol consumption arises from unintentional and intentional injuries, including those due to road traffic crashes, violence, and suicides, and fatal alcohol-related injuries tend to occur in relatively younger age groups.

The latest causal relationships are those between harmful drinking and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS. Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications.

Factors affecting alcohol consumption and alcohol-related harm

A variety of factors have been identified at the individual and the societal level, which affect the levels and patterns of alcohol consumption and the magnitude of alcohol-related problems in populations.

Environmental factors include economic development, culture, availability of alcohol, and the comprehensiveness and levels of implementation and enforcement of alcohol policies. For a given level or pattern of drinking, vulnerabilities within a society are likely to have similar differential effects as those between societies. Although there is no single risk factor that is dominant, the more vulnerabilities a person has, the more likely the person is to develop alcohol-related problems as a result of alcohol consumption.

Conceptual causal model of alcohol consumption and health outcomes

The impact of alcohol consumption on chronic and acute health outcomes in populations is largely determined by 2 separate but related dimensions of drinking:

• the total volume of alcohol consumed, and
• the pattern of drinking.

The context of drinking plays an important role in occurrence of alcohol-related harm, particularly associated with health effects of alcohol intoxication, and, on rare occasions, also the quality of alcohol consumed. Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes in individuals.

There are gender differences in alcohol-related mortality, morbidity, as well as levels and patterns of alcohol consumption. The percentage of alcohol-attributable deaths among men amount to 7.6 % of all global deaths compared to 4.0 % of all deaths among women. Total alcohol per capita consumption in 2010 among male and female drinkers worldwide was on average 21.2 litres for males and 8.9 litres of pure alcohol for females.

Ways to reduce the burden from harmful use of alcohol

The health, safety and socioeconomic problems attributable to alcohol can be effectively reduced and requires actions on the levels, patterns and contexts of alcohol consumption and the wider social determinants of health.

Countries have a responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. Substantial scientific knowledge exists for policy-makers on the effectiveness and cost–effectiveness of the following strategies:

• regulating the marketing of alcoholic beverages (in particular to younger people);
• regulating and restricting availability of alcohol;
• enacting appropriate drink-driving policies;
• reducing demand through taxation and pricing mechanisms;
• raising awareness of public health problems caused by harmful use of alcohol and ensuring support for effective alcohol policies;
• providing accessible and affordable treatment for people with alcohol-use disorders; and
• implementing screening and brief interventions programmes for hazardous and harmful drinking in health services.

WHO response

WHO aims to reduce the health burden caused by the harmful use of alcohol and, thereby, to save lives, prevent injuries and diseases and improve the well-being of individuals, communities and society at large.

WHO emphasizes the development, implementation and evaluation of cost-effective interventions for harmful use of alcohol as well as creating, compiling and disseminating scientific information on alcohol use and dependence, and related health and social consequences.

In 2010, the World Health Assembly approved a resolution endorsing a global strategy to reduce the harmful use of alcohol. The resolution urges countries to strengthen national responses to public health problems caused by the harmful use of alcohol.

The global strategy to reduce the harmful use of alcohol represents a collective commitment by WHO Member States to reduce the global burden of disease caused by harmful use of alcohol. The strategy includes evidence-based policies and interventions that can protect health and save lives if adopted, implemented and enforced. The strategy also contains a set of principles to guide the development and implementation of policies; it sets priority areas for global action, recommends target areas for national action and gives a strong mandate to WHO to strengthen action at all levels.

The policy options and interventions available for national action can be grouped into 10 recommended target areas, which are mutually supportive and complementary. The 10 areas are:

• leadership, awareness and commitment
• health services’ response
• community action
• drink–driving policies and countermeasures
• availability of alcohol
• marketing of alcoholic beverages
• pricing policies
• reducing the negative consequences of drinking and alcohol intoxication
• reducing the public health impact of illicit alcohol and informally produced alcohol
• monitoring and surveillance.

The Global Information System on Alcohol and Health (GISAH) has been developed by WHO to dynamically present data on levels and patterns of alcohol consumption, alcohol-attributable health and social consequences and policy responses at all levels.

Successful implementation of the strategy will require action by countries, effective global governance and appropriate engagement of all relevant stakeholders. By effectively working together, the negative health and social consequences of alcohol can be reduced.

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Footnotes

• Based on the Global status report on alcohol and health 2014.
• The Global strategy refers only to public-health effects of alcohol consumption, without prejudice to religious beliefs and cultural norms in any way. The concept of “harmful use of alcohol” in this context is different from “harmful use of alcohol” as a diagnostic category in the ICD-10 Classification of Mental and Behavioural Disorders (WHO, 1992).
• The disability-adjusted life year (DALY) extends the concept of potential years of life lost due to premature death to include equivalent years of "healthy" life lost by virtue of being in states of poor health or disability.