More than 18 million children aged under 18 years suffer from maltreatment (1) in the WHO European Region. Published in a new report from the WHO Regional Office for Europe, European report on preventing child maltreatment, these figures are a concern for any policy-maker implementing Health 2020, the new European health policy framework.
The abuse can be fatal, leading to 852 deaths of children under 15 years every year. Deaths are only the tip of the iceberg. The report, released at the sixty-third session of the WHO Regional Committee for Europe, estimates that the prevalence of maltreatment is much higher, ranging from 29.1% for emotional abuse, 22.9% for physical abuse, to 13.4% for sexual abuse in girls and 5.7% in boys.
“It is time to recognize child maltreatment as a public health concern, and not solely a criminal justice and social issue.Child abuse is preventable through a mainstreamed public health approach, an opportunity that we cannot afford to miss. In the coming months, we will prepare a set of measures that countries can take to address this, and we are ready to assist with the implementation,” said Zsuzsanna Jakab, WHO Regional Director for Europe.
What are the consequences?
As well as having a devastating impact on young people’s lives, child maltreatment has far-reaching social and economic costs, running into tens of billions of Euros. The evidence linking maltreatment to the development of mental ill health is indisputable. Child maltreatment may be responsible for a quarter of the burden of mental disorders such as depression, anxiety, eating disorders, behaviour problems, suicide attempts, self-harm and illicit drug use. It affects schooling, leading to lower educational achievement and poorer employment prospects. There is also a strong association with risky sexual behaviour and emerging evidence of an association with the development of obesity and other noncommunicable diseases. Violent behaviour is known to pass from generation to generation, fostering a cycle of violence.
Who is most at risk?
Young, single and poor parents with low education levels living in deprived communities may be more likely to maltreat their children. The social and cultural acceptability of physical punishment of children, inequality, economic stress and legislation all affect rates of child maltreatment. A strong association also exists between child maltreatment and alcohol and drug abuse in the family, parenting stress and domestic violence. Poor children are hit the most: rates of fatal maltreatment are more than twice as high in low- and middle-income countries and, within countries, the fatality of children of less-well-off parents is several times higher that of children from wealthier parts of society.
What can be done?
Prevention is more cost-effective than dealing with the consequences of maltreatment. A public health approach is required with the sustained implementation of evidence-based measures such as the following.
- Targeting at-risk families with programmes that intervene in the first few years, such as home visiting to provide parenting support, parenting programmes and pre-school education, reduces maltreatment.
- Programmes to prevent abusive head trauma (shaken baby syndrome), reducing the availability of alcohol, and intensive social and medical support to high-risk families are effective.
- Interventions such as mass media campaigns, social norms programmes and measures to alleviate poverty are promising, but more research is needed in Europe.