A/HRC/29/33 100. The issue of shared responsibility is as a crucial one. Representatives of professional health-care groups, including psychiatry, should agree that it is in the interest of all to demonopolize the decision-making process and to develop mechanisms for sharing competences and responsibilities between actors, including providers and users of services, policymakers and civil society. F. Violence as a major obstacle for the realization of the right to health 101. Protection from all forms of violence is considered by the Special Rapporteur as a cross-cutting issue present in all key elements of the realization of the right to health. As the United Nations High Commissioner for Human Rights has recently underlined, violence and human rights violations are often rooted in the deprivation and discrimination of individuals and communities. Such violations are not generated spontaneously but “result from policy choices which limit freedoms and participation, and create obstacles to the fair sharing of resources and opportunities”. 9 Violence needs to be addressed in a comprehensive and proactive way, not only as a cause of serious violations of human rights, but also as a consequence of a lack of political will to effectively invest in human rights, including the right to health. 102. It was not until the end of the twentieth century that the close link between violence and health began to be sufficiently understood. Interestingly, as health and human rights came closer, a similar tendency could be observed by the turn of century when violence was finally seen as a public health concern. In 1996, the World Health Assembly declared violence as “a leading worldwide public health problem”.10 Since then, the burden of violence has been documented and the effectiveness of programmes, with particular attention devoted to women and children and community-based initiatives, has been assessed. 103. Evidence has shown that, when violence is addressed proactively as a public health issue, there are more opportunities to break the cycle of violence, poverty and helplessness and, in the longer run, to significantly reduce the prevalence of all forms of violence, including collective violence.11 104. All forms of violence are harmful and detrimental to the health and development of human beings, starting from the youngest children. Early childhood adversities, including all forms of violence against children, such as physical and emotional abuse and chronic neglect, if they are not timely addressed by healthy public policies, can result in chronic diseases in the adult affecting both physical and mental health. 105. The human rights approach, together with the modern understanding of public health, warns against typifying violence into severe forms and those forms which are considered to be “milder” and thus perceived as not harmful. That can lead to the proliferation of practices which are justified as being “mild” forms of violence and thus tolerated or even recommended, such as domestic violence against women, female genital mutilation or the institutional care of young children. 106. From the public health perspective, the cumulative effect of a large number of “mild cases” generates a heavier burden for the health of population than a smaller number of 9 10 11 United Nations High Commissioner for Human Rights, opening speech to the high-level segment of the twenty-eighth session of the Human Rights Council, 2 March 2015. World Health Assembly resolution 49.25 (1996). See Etienne G. Krug et al. (eds.), “World report on health and violence” (WHO, Geneva, 2002). Available from www.who.int/violence_injury_prevention/violence/world_report/en/. 17