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Abstract
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Injury resulting from interpersonal violence is now recognized as an important public health problem. Consequently, the public health community is applying its perspectives and strategies to the goal of preventing violence. The public health approach emphasizes preventing injuries due to interpersonal violence from occurring or recurring, rather than treating the health consequences of these injuries. Four interrelated steps are used to develop information to guide the development of prevention strategies: public health surveillance, risk group identification, risk factor exploration, and program implementation/evaluation. The ability to predict which people are at greatest risk of injury (or producing injury) and the relative effectiveness and costs of alternative prevention strategies are central to decisions influencing the nature and focus of public health prevention strategies. In order to improve the information base on which decisions concerning violence prevention strategies are founded, the following activities should be given priority: (a) developing surveillance systems for morbidity associated with interpersonal violence; (b) precisely identifying risk groups for nonfatal violent events; (c) applying case-control methods to the exploration of potentially modifiable risk factors for injuries and violent behaviors; and (d) rigorously evaluating extant programs that are intended to prevent interpersonal violence or modify a suspected risk factor for violence.
VioLit summary:
OBJECTIVE:
The aim of this article by Mercy and O'Carroll was to describe violence approaches as a public health issue. More specifically, the emergence of violence as a public health problem, the public health approach to prevention of violence, and an agenda and applications of this approach were discussed.
METHODOLOGY:
A non-experimental literature review of the public health literature was used in this study. Key features of the public health approach were discussed and then applied to the phenomenon of violence.
FINDINGS/DISCUSSION:
The authors reported that interpersonal violence has been gaining more attention from the public health field. This has been both because homicide is becoming a more prominent cause of death in proportion of total mortality and because the actual risk of victimization has increased in the last decade. Acceptance of the role of behavioral change to decrease mortality for such diseases as cancer and heart disease was argued to have an effect on the attention to violence as a public health problem. National plans for disease prevention and health promotion of goals and objectives for the prevention of violence-related morbidity and mortality were developed, and the public health sector has responded with several violence prevention programs. The public health perspective on violence rests on the public health goal of preserving, promoting, and improving health. The authors stated that important aspects of this goal are prevention, intervention with those at highest risk, and ongoing evaluation of the efficacy of preventive interventions. Multidisciplinary approaches, the authors argued, can inform these activities. There were four steps identified as the public health approach to the development of information for decision-making. These were public health surveillance, risk group identification, risk factor exploration, and program implementation/evaluation. Public health surveillance is research-based in the collection, analysis, and interpretation of health data which inform programs and their evaluation as well as inform the public. The status of data on violent crimes have benefitted from the FBI's Uniform Crime Reports, the Bureau of Justice's National Crime Survey, and data collected by state and local officials as well as public health data collected through public health agencies and centers. Risk group identification, as discussed by the authors, involves identifying those populations, times, or places that are most likely to be exposed to the disease. In violent behavior, this risk group can include perpetrators as well as victims. The authors reported that identifying risk groups can enhance the predictive ability of public health decision-makers in at least two ways; it provides information for the most effective targeting programs, and provides background information that is useful for generating causal hypotheses. This is an area that both criminology and public health has contributed to. Risk factor exploration refers to the use of analytical techniques to explore potential causes of disease or injury which provides a basis for intervention strategies and/or can explain why certain populations are at risk. Cohort studies, case-control studies, and cross-sectional studies were reported as the three most used methodologies epidemiologists have used. The contributions of epidemiological homicide study are argued to be potentially helpful but may suffer from definitions of homicide that are too broad and which obliterate distinctions between kinds of homicide. Program implementation and evaluation was seen to depend largely on risk group and risk factor identification. Programs must also include good evaluation procedures to determine effectiveness. Some of the programs implemented in the criminal justice sector have been gun control legislation and evaluation of arrest as a strategy to deter new incidents of wife battery. The public health model, the authors argued, provides a foundation for activities that should be emphasized. Specifically, the authors saw two major priorities. These were development of surveillance systems for morbidity associated with interpersonal violence which must allow for the identification of different types of violence. Improved quantity and quality of data on violence were seen as a must to assess the magnitude of the problem, identify and better define risk groups, and do adequate evaluations of programs. This research should focus on factors that can be implemented in preventive public health approaches, according to the authors. Risk factors such as poverty and accessibility of firearms need to be better understood in their contribution to the violence problem. Additionally, the authors argued that the impact of some governmental policies (such as the raising of the drinking age) and preventive programs must be evaluated.
AUTHORS' RECOMMENDATIONS:
The authors clearly advocated a public health approach to combatting the incidence of violence. The implicit goal of prevention of injury in a public health approach was argued to be critical to decision-making. These efforts should, the authors stated, require decision-makers to make predictions and then act upon them. A public health strategy, as outlined, could assist them in providing quantitative information and understanding of violence which would assist in effective and best directed interventions and assistance as well as evaluating the effectiveness of prevention strategies. Systematic biases could be minimized through increased reliability and validity in research and the evaluation of model systems. Expanded knowledge of the causes of violent behavior can lead to better decisions, and information about effectiveness of present programs can also lead to better strategies for distribution of resources.
EVALUATION:
The authors carefully lay out a detailed approach to decreasing the damage that violence is doing to society. From the viewpoint of the use of public funds for intervention programs, these suggestions could be invaluable to better expenditures of government money. However, the implicit assumption in this approach is that there is a causal relationship between some factor(s) and violent crime that can be discovered and attacked. Criminological research has yet been unable to uncover this clear-cut causal link. Perhaps, if data were improved, we could see this relationship, but as of yet it looks like a difficult, if not impossible, discovery. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
KW - Public Health Approach
KW - Violence Intervention
KW - Violence Prevention
KW - Prevention Recommendations
KW - Adult Violence
KW - Juvenile Violence
KW - Violence Prediction
KW - Violence Risk Factors |