An Epidemiologist Looks at Violence


November 30, 1992|By GEORGE F. WILL

ATLANTA — Atlanta.-- Few noticed, but in 1990 America passed a gri milestone. In at least two states, Texas and Louisiana, the leading cause of death by injury was not motor vehicles but guns.

Mark Rosenberg noticed. He is a doctor at the Centers for Disease Control, specializing in injury prevention, particularly the prevention of violence. Violence is epidemic and epidemiologists' skills are relevant to rendering violence a treatable public-health problem.

Throughout mankind's history, the leading causes of premature death have been infectious diseases and injuries. Control of infectious diseases began accelerating in 1796, when Edward Jenner developed the first vaccine, for smallpox. Since then, improved sanitation, hygiene, housing, food handling, pesticides and education have joined the inventory of disease controls.

The contrast with the failure to apply scientific intelligence to the preventing of violence -- self-inflicted (suicides) and assaultive -- is marked. Violence is not a disease, but neither is it something simply to be endured. It is a problem susceptible to ameliorative policies.

Consider two analogies. Smoking is not a disease, it is socially costly addictive behavior, and it is demonstrably combatable. If the motor- vehicle fatality rate of 1952 had been the same in 1989, 155,075 Americans would have died in vehicular accidents. But only 45,555 did, because the problem was treatable (with improved vehicle and highway design, licensing requirements, motorcycle-helmet laws and other measures).

About one-third of the 150,000 deaths per year from injuries are from suicide or assaultive violence. The U.S. homicide rate for black males 15-24 is 17 to 283 times greater than the male homicide rates in 17 other industrial nations. Homicide is the second-leading cause of death by injury among ages 1-19 and the leading cause of deaths for blacks, male and female, 15-34. Furthermore, 2.2 million Americans suffer non-fatal injuries from violent and abusive behavior.

Epidemiology looks for patterns in large numbers, and for predictive and diagnostic implications for at-risk individuals and groups, and for risky behavior. For example, Dr. Rosenberg says, in 30 years the suicide rate in ages 15-24 has tripled. The prototypical suicide casualty is no longer an older, depressed male. The rate is rising most rapidly among younger males (five times more numerous than female suicides) who are not usually depressed but are angry, frustrated, resentful, often using drugs and unable to communicate their distress.

Another example: Many people think the way to avoid being a homicide victim is to stay at home at night. But most homicides occur in the home, among acquaintances, in connection with drinking, in the context of an argument and in proximity to a gun.

The idea of government ''treating'' violence has occasionally aroused resistance on the right, which fears the rise of a therapeutic state staffed by what C.S. Lewis called ''official straighteners,'' coercive utopians trying to make something straight from the crooked timber of humanity. On the left, the suspicion is that government's focus on violence masks an attempt to control the disadvantaged by targeting racial and ethnic minorities, thereby diverting attention from social injustices.

The fiction that violence research is a racist plot was fueled recently by misguided proposals for research on ''genetic factors in crime.'' There is no behavior for which any single gene has been identified as the cause. Granted, there are interesting avenues of biological research, such as possible linkages between nutrition, brain chemistry and behavior. However, the CDC's objective, Dr. Rosenberg says, is not to find a pacifying drug or any other strategy of biological intervention. The objective, he says, is the empowerment of communities, so they will not be passive victims.

Practical measures against violence are many: conflict-resolution skills, for individuals and adolescents' gangs; improved public lighting; bullet-proof barriers for cab drivers; reduced alcohol and drug consumption; gun control; family-life education; condemnation of entertain- ment that fosters cultural acceptance violence as a response to grievances; metal detectors to deter the one in 20 high school students who today carries a gun, and so on.

Today, in ages 1-19, more people die of injuries than from all diseases combined. Up to age 44 injury is the leading cause of death. Because the young are so often victims of fatal injuries, injury is the leading cause of loss of potential life -- more than heart disease, cancer and stroke combined.

To the staggering -- scores of billions of dollars -- monetary costs of assaultive violence must be added the costs of psychological and social dysfunction. These include fear, anxiety, isolation, restricted mobility and activity and, especially among the young, fatalistic despair -- the feeling that prudent behavior is unavailing because the odds of one's situation are against longevity.

Clearly the criminal-justice system is inadequate to the task of turning the tide of violence. So as a sound investment in improving the quality of American life, no federal funds are spent better than those that fund the CDC's research.

George F. Will is a syndicated columnist.

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