Forty young Europeans murdered every day: new WHO report shows these deaths can be avoided

Alcohol and other drugs strongly implicated

Violence claims the lives of 40 young people every day in the WHO European Region – over 15,000 each year – according to a new report from WHO Europe* ; 4 out of 10 of these homicides are perpetrated with knives.

The report on preventing violence and knife crime among young people is the first comprehensive report published in Europe on young deaths from violence and stabbings. It highlights the enormous loss to society from youth violence in European countries and the huge benefits of a public health approach, complementing the criminal justice approach. The report was sponsored by the Department of Health in England and the Government of the United Kingdom.

Violence is spread unevenly

Interpersonal violence is the third leading cause of death in Europe among those aged 10–29 years, accounting for 15,000 homicides yearly. This is only the tip of the iceberg, as estimates suggest that for every young person who dies, 20 more are admitted to hospital. Some 40% of homicides, or 6,000 yearly, are carried out with knives and other sharp weapons. Knife-carrying is relatively common in many countries (up to 12% of young people carry them) and increases the likelihood of serious injury or death. Other means of committing homicide include firearms and strangulation.

Wealth and gender influence violence: 9 of 10 homicides occur in low- and middle-income countries in the Region, and there is a 34-fold difference between the countries with the highest and the lowest death rates. In all countries, irrespective of country income, poorer young people are much more at risk of violence than those who are better off. Males bear a heavier burden than females, with 80% of homicide victims being male.

Causes of violence

Many factors – adverse experiences in childhood, exposure to fear of and forms of violence in schools and the community, association with violent or delinquent peers, alcohol and drug use, and freely available weapons in the community – can increase the risk of being involved in violence and carrying weapons in adolescence. Important contributing factors include: low levels of neighbourhood resources, social capital and income; social inequality; and social and cultural norms that tolerate violence.

The report summarises the links between violence and alcohol and other drugs:

Alcohol use and violence among young people are strongly associated. Alcohol use can directly affect cognitive and physical functioning, reducing self-control and awareness of risk and increasing emotional lability and impulsivity. This can make drinkers more likely to resort to violence in confrontation and reduce their ability to recognize warning signs in potentially dangerous situations.

The broader links between alcohol and violence are complex and can be affected by a range of individual, situational and sociocultural factors. However, young people who start drinking at an early age, who drink frequently and who drink large quantities are at increased risk of being both perpetrators and victims of violence. Data from the European School Survey Project on Alcohol and Other Drugs for 15- to 16-yearold schoolchildren found a significantly higher prevalence of alcohol-related aggression in countries in which alcohol intoxication was more common (alcohol-related aggression ranged from 1.2% in Greece to 16.0% in Denmark). Drinking alcohol and getting drunk have also been associated with increased risks of weapon-carrying. In Israel, 11- to 16-year-olds who reported binge drinking (drinking five or more drinks in one sitting in the past 30 days) were more than twice as likely to be perpetrators of bullying (in the current school term), four times as likely to have been injured in a fight (in the past year) and almost five times more likely to have carried weapons (in the past 30 days) than non-binge drinkers.

Young people consume considerable alcohol in pubs, bars and nightclubs. The presence of large numbers of alcoholconsuming young people in such environments can mean that they and their surroundings are key locations for confrontation, and individuals who visit them regularly show increased risks of violence. In such settings, the wide availability of glass drinking vessels means that these can be used, often opportunistically, as weapons in violence.

A study of patients presenting to emergency departments with facial injuries in the United Kingdom found that half of assaults involving the use of glasses or bottles as weapons had occurred in a public house and that 97% were alcohol-related (the victim or perpetrator had consumed alcohol in the four hours before the incident). Increases in alcohol consumption among young women are likely to have contributed to an increase in violent offences within this group.

Other drug use

Young people who smoke tobacco or use illicit drugs have an increased risk of being involved in violence. Smoking tobacco is likely to be a proxy for risk-taking behaviour among young people rather than a cause. Although the same can be true for illicit drug use, the pharmaceutical effects of some illicit drugs may make people more vulnerable to violence. Substances such as cocaine and amphetamines have been particularly linked to violence. A study of 14- to 17-year-olds in Belgium, the Russian Federation and the United States of America found that those who smoked or used marijuana or other illicit drugs were more likely to have been a victim of violence (although associations between marijuana and victimization were not significant in the sample in the United States of America). Illicit drugs and violence can also be linked through other mechanisms, including using violence to gain resources to purchase drugs and to control drug trades.

Smoking, using illicit drugs, trying illicit drugs at an early age and engaging in polydrug use (using more than one type of substance) have also been associated with increased risks of weapon-carrying in adolescents). Among schoolboys aged 11–16 years in Scotland, one fifth (20%) of non-drug users reported having carried weapons versus 63% of drug users Among both sexes, the proportion of students who had carried weapons increased with the number of illicit drugs they had used, from 21% of those who had used one drug to 92% of those who had used five or more illicit drugs.

*European report on preventing violence and knife crime among young people. WHO Europe 2010