The World Health Organization report, prepared by Dr. Desmond Runyan of the University of North Carolina at Chapel Hill, concluded that an estimated 57,000 children die each year from physical abuse. Sexual and psychological abuse also are widespread, are difficult to measure and need to be addressed.
"Whether child abuse is uniquely American or Western is a question that's been raised by a number of people around the world," said Runyan, professor and chief of social medicine at the UNC School of Medicine and professor of pediatrics. "Not long ago, a Chilean physician said to me that clearly it happens more in North America than any other place. 'Just look at Medline (an online search engine for medical information),' he said. 'It is American journals that write about child abuse.'"
But just because doctors and others in other countries haven't paid much attention or written about it, doesn't mean abuse is not universal, the UNC scholar found.
WHO asked Runyan, who had done international research on the topic, to write a chapter for its new book-length "World Health Organization Report on Violence and Health" released in Brussels today (Oct. 3).
"Despite all the differences in cultures and the rules about how we raise children, rates of abuse around the world are remarkably similar in some ways," Runyan said. "Close to 40 percent of the children being beaten by their parents in places as far away as Romania, Hong Kong and Korea. And the risk factors for abuse look remarkably similar in different countries."
Runyan relied not only on extensive online searches for papers about abuse, but also on reports sent to the WHO from organizations that hadn't published them in peer-reviewed medical journals but compiled, in some cases, extensive information anyway.
His review showed major differences between countries in how abuse was defined, not what parents did to their children, he said. In much of the United States, for example, slapping or punching a child in the head would be considered abuse, while in India such actions are as common as spanking on the buttocks and aren't normally considered abusive.
Parents yelling at children appears to be nearly universal, he found. Seriously injuring children physically is uncommon.
"People all around the world basically do value kids, and while they may do things that are stupid or harmful, really serious things like burning or threatening them with a knife or gun or cutting them happens at a relatively low rate," Runyan said. "It's not a zero rate -- we're talking a few percent."
In reviewing the literature and related information, he found more abuse among poor families, and higher levels in families with more children, he said. The youngest children -- those age 4 and younger -- were at greatest risk of serious injuries and death. Not surprisingly, boys suffered more physical abuse, while girls were more likely to be sexually abused. For both sexes, the chief victimizers were men.
Another major observation was that despite reports from a variety of countries around the world, on every continent, no data existed for many nations, he said. The chief questions should no longer center on "Is abuse going on?" but rather how to define, measure and minimize it.
"We haven't found a country yet that, when they seriously looked at the problem, didn't find that they had a problem, but there are many countries that haven't even looked," the physician said. "And so one of our recommendations is that these countries need to start. Another recommendation is that local data should be collected to guide local interventions in every country. National health services, medical schools and social scientists across the globe need to think about measuring abuse to determine what's going on."
Only a minority of countries have provisions for protecting children in terms of mandatory reporting, child protective services and legal systems that are designed to help kids, he said. That needs to change too.
"We think the report will surprise a lot of people because so many have held firmly to the idea that this is a disease of Western society, that it doesn't happen in developing countries," Runyan said. "The data found and reported here make it sound like developing countries have an even greater problem than richer countries, perhaps because of a lack of training and opportunities for parents."
Note: Before Monday, Oct. 7, Runyan can best be reached via email at email@example.com.
By DAVID WILLIAMSON
UNC News Services