The first healthcare instrument in Italy for the recognition and comprehensive care of violence as a clinical and public health phenomenon. The document originates from the collaboration between the University of Padua and the Padua University Hospital
Abstract: Gender-based violence is a cross-cutting phenomenon that must be addressed on multiple fronts: judicial, social, political, regulatory, educational, cultural, economic, and healthcare. The Padova Charter 2026, presented on January 16 at Palazzo del Bo of the University of Padua, aims to address gender-based violence as a public health issue through an integrated, scientific, and structured approach.
Keywords #violence #genderbasedviolence #healthcare #padovacharter2026 #unipd #paduahospital #silviazaghi #ethicasocietas #ethicasocietasjournal #scientificjournal #law #ethicasocietasupli
THE PREMISE
The World Health Organization has recognized for over two decades violence as a major public health issue, due to its structural impact on individual health, healthcare systems, and the balance of communities.[1] From this perspective, violence does not constitute an isolated or episodic event, but rather a complex and multifactorial phenomenon, capable of profoundly and enduringly affecting the biological, psychological, relational, and developmental processes of the individual.
Healthcare facilities frequently represent the first institutional point of contact for people who have experienced violence. However, many victims access healthcare services presenting symptoms that are not immediately recognized as expressions of a traumatic experience. Physical injuries are not always associated with episodes of violence, often because such experiences are concealed, minimized, or not disclosed.
Children, adults, and older persons present to healthcare services with aspecific clinical presentations: recurrent injuries, physical deterioration, developmental delays, mood disorders, anxiety, depression, or other psychopathological manifestations.[2] These conditions may conceal situations of maltreatment, abuse, or neglect, with documented consequences on neurobiological, endocrine, and immune systems, as well as on epigenetic mechanisms, with effects that may persist throughout the lifespan.[3]
The clinical approach to individuals who have experienced violence therefore requires a comprehensive set of specialized competencies, cultural and relational knowledge, and a thorough understanding of the legal procedures for protection and safeguarding provided by national and international legal frameworks. The Padova Charter 2026 aims to provide physicians, nurses, and healthcare professionals with conceptual and operational tools to identify, behind apparently ordinary clinical presentations, the signals of violence, promoting interventions oriented toward the protection of dignity, safety, and health of those receiving care.
THE PROPOSAL
The Charter identifies a common foundation underlying the various clinical presentations attributable to violence, allowing their recognition as a complex nosological entity, not reducible to isolated sector-specific diagnoses. This entity is characterized by the presence of individual, familial, community, and social risk factors, by its impact on biological, genetic, physical, psychological, and developmental processes, and by the occurrence of short- and long-term harm, sometimes irreversible and potentially fatal.[4]
Clinical onset is often insidious, associated with non-specific signs and symptoms, making early, personalized, and precision diagnosis essential. Within this framework, healthcare professionals play a central role in identifying situations of maltreatment concealed behind apparently common clinical pictures, which must instead be assessed in their bio-psycho-social complexity, thereby enabling timely and comprehensive care of the victim.
Such care cannot be episodic or fragmented. It requires dedicated organizational and structural solutions, integrated according to age, sex, and gender, capable of ensuring continuity of care between hospital and community settings, between pediatric and adult services, and between healthcare and social services. This responsibility must be entrusted to dedicated multidisciplinary and multiprofessional teams operating within public and/or accredited private healthcare institutions.
Of particular importance is the structured coordination with forensic medicine, law enforcement agencies, the judiciary, and territorial psychosocial services, in full respect of institutional competencies and legal safeguards, in order to ensure protection, safety, and continuity of interventions.
The document highlights that violence, as a public health phenomenon, requires a systemic and interdisciplinary approach, grounded in scientific research, reliable epidemiological data, specialized training of healthcare professionals, hospital reference centers, dedicated organizational models, educational programs, and coherent health policies.
NECESSARY ACTIONS
The Charter does not merely constitute a declaration of intent, but identifies concrete actions aimed at implementing an integrated healthcare approach to violence, requiring a collective and medium- to long-term commitment from all institutional stakeholders involved.
At the academic level, efforts should focus on the introduction of dedicated training modules on the integrated healthcare approach to violence within undergraduate programs in Medicine and Surgery and Health Professions, as well as within medical residency curricula and postgraduate Master’s programs.
At the institutional level, violence should be formally included as a structural public health issue within National and Regional Health Plans, permanent observatories for systematic data collection should be established, tools for monitoring and evaluating policy impact should be defined, and resources proportionate to the magnitude of the phenomenon should be allocated.
At the operational level, it is necessary to establish dedicated intra- and extra-hospital services, create multidisciplinary teams, develop shared diagnostic, therapeutic, and rehabilitative pathways between hospital and community services, and activate programs for safe social reintegration and continuous professional training.
In the field of research and dissemination, funding bodies are encouraged to support studies on the impact of violence on human health and healthcare systems. Universities and research institutes should promote such activities in synergy with institutions, while healthcare systems should act as promoters of information, awareness, education, and prevention campaigns, with particular attention to younger populations.
PURPOSES
In line with the guidance of the World Health Organization, the Padova Charter 2026 stands as a tool of scientific, ethical, and institutional guidance, as well as an appeal to collective responsibility across the entire system, from healthcare to education, from research to public planning. Its objective is to contribute to the development of an integrated and sustainable model for the prevention, recognition, and care of violence, alongside other civil society actors committed to the protection of fundamental rights, human dignity, and health of every individual.
NOTES
[1] World Health Organization, World Report on Violence and Health, WHO, Geneva, 2002.
[2] World Health Organization, Global Plan of Action to Strengthen the Role of the Health System within a National Multisectoral Response to Address Interpersonal Violence, WHO, Geneva, 2016.
[3] Krug, E.G. et al., “The Global Burden of Violence”, Bulletin of the World Health Organization, vol. 80, no. 5, 2002.
[4] Felitti, V.J., Anda, R.F. et al., “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults (ACE Study)”, American Journal of Preventive Medicine, 1998.
Italian sources – healthcare and public policies
- Italian Ministry of Health, National Guidelines for the Assistance of Victims of Violence, Rome, Ministry of Health, latest available edition.
- Italian National Institute of Health (Istituto Superiore di Sanità),
- ISTAT – Italian National Institute of Statistics.
- State–Regions Conference, Agreement on the Implementation of National Guidelines for Emergency Care and Socio-Healthcare Assistance to Women Victims of Violence, Rome.
Legal and regulatory sources
- Council of Europe, Convention on Preventing and Combating Violence against Women and Domestic Violence (Istanbul Convention), ratified by Italy through Law No. 77/2013.
- Charter of Fundamental Rights of the European Union, 2000.
- Legislative Decree No. 502/1992, as amended,
Clinical and psychosocial sources (Italian and international)
- Herman, J.L., Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, Basic Books (Italian edition published by Raffaello Cortina Editore).
- Di Blasio, P., Interpersonal Trauma and Violence: Models of Clinical Intervention, Il Mulino.
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National Center for Disease Prevention and Control (CCM), Programs for the Prevention and Response to Gender-Based Violence in Healthcare Settings, Italian Ministry of Health.
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