Violent Injury as a Preventable Condition.

Abstract

H omicide and suicide together claim more than 50,000 lives in the United States each year. The broader base of victims of violence includes 1.2 million people seen in the emergency department annually as a result of assault, according to the National Vital Statistics System. An estimated 10 million Americans suffer physical violence at the hands of an intimate partner.1 For US children, more than 1 in 7 experience and more than 1 in 4 witness violence annually.2 Yet effective responses to violence by the public health and health care systems remain few, far between, and—if they exist at all— underfunded. A decade ago, when I was the health commissioner of Baltimore, I addressed a group of about 40 Catholic priests. The city was in the midst of a spate of shootings and the priests were, understandably, alarmed. I told them: “You see violence as a moral failure. The police see violence as crime. In public health, we see violence as a contagious but preventable behavior.” At the time, I was raising funds for an antiviolence program developed by a global public health expert with experience stopping outbreaks of infectious disease. The program hires community members to work late at night to interrupt the cycle of retaliation. The workers mediate disputes, establish community norms against guns, and connect high-risk youth to education, health care, and jobs. An independent evaluation has found that in the initiative’s focus areas, there is markedly less interest in using guns to settle arguments—and there are fewer shootings.3 Despite a track record of results, the program is still struggling for sustainable funding and is operating at a far smaller scale than necessary. So too are successful hospital-based violence intervention programs, which, in a form of secondary prevention, provide a range of services to patients who suffer injuries from violence. These initiatives may reduce the chances of revictimization by as much as fourfold.4 Given that half of certain victims of violence experience violence again, and as many as