Violence is a health problem as well as a public order and social one. At a cost of £400m a year to the NHS, it was the rising level of violent attacks which formed the centrepiece of the discussion on the annual report of Scotland's chief medical officer, Dr Harry Burns, with Holyrood's health committee.

Violence is a health problem as well as a public order and social one. At a cost of £400m a year to the NHS, it was the rising level of violent attacks which formed the centrepiece of the discussion on the annual report of Scotland's chief medical officer, Dr Harry Burns, with Holyrood's health committee.

However the real shock in Dr Burns's remarks is that he believes that the growing incidence of violence among young people, particularly boys, is at least partly due to foetal alcohol syndrome (FAS). In other words, some of the teenagers involved in gang violence and knife crime are suffering from the effects of their mothers' heavy drinking in pregnancy.

The evidence from Accident and Emergency Units and official crime statistics of rising numbers of assaults is given further weight by a new survey of young people which reveals that they expect to encounter violence: 63% get involved with guns and knives to protect themselves. We have long known that life chances, including future health, are determined to a significant degree by early childhood experiences. We must now face the possibility that the seemingly inexorable tide of violence sweeping up too many young people may not be attributable only to external factors such as poor parenting, poor diet and violent computer games, but result from physical damage before birth.

This requires urgent action on several fronts. Foetal alcohol syndrome causes learning difficulties and social and behavioural problems as well as physical defects. Research in other countries points to a link between levels of drinking which may not cause the full-blown syndrome but predispose to violence. We need to find out exactly what is happening in Scotland, as Dr Burns suggests.

We must also continue to identify, at an early age, children in danger of falling into a violent lifestyle, and intervene before they get caught up in gang fights and cause injury to others or go on to damage their own health with alcohol and drugs. Dr Burns' praise for the Violence Reduction Unit is recognition that this is a problem which falls across the criminal justice, health and social work and requires different agencies to work together. Health visitors and nursery teachers are likely to be the key workers with the greatest influence on the parents of young children, yet both professions are under threat. There is no substitute for the direct, practical expertise they offer.

There must also be informed guidance on safe levels of alcohol during pregnancy. The current advice is confused, but at a time when young women are drinking more than previous generations, it must be clear.

Dr Burns is right to identify violence as a public health issue because our best hope of reducing the shockingly high level, which is particularly acute in Glasgow, is with both education and practical intervention.