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Abstract
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This correspondence responds to Gary Slutkin et al.’s “How the Health Sector Can Reduce Violence by Treating It as a Contagion,” which appeared in the January 2018 issue, 20(1), of the AMA Journal of Ethics.
Slutkin, Ransford, and Zvetina argue that violence is an epidemic that is efficaciously treated as a contagious disease. The tradition of framing violence as a preventable public health issue, dating from the 1979 Surgeon General’s report [1], certainly has proven invaluable in developing violence prevention strategies and has helped in our understanding of the multiple and reciprocal links among violent victimization and health and behavioral health problems. For example, the American Academy of Pediatrics issued a protocol in 1996 to respond to adolescent assault victims and outlined the dangers of a treat-and-release approach [2]. We have also learned much about the nature and treatment of the psychological trauma that arises from exposure to violence as a witness and as a victim. These advances are certainly highlighted and endorsed in this article. Nevertheless, to approach violence with a “disease” model is misleading at best, and could be harmful.
First, the authors describe violence—more particularly, homicide—as an epidemic. However, for a “disease” to be categorized as an epidemic, the observed prevalence rate must increase over the expected prevalence rate. Thus we need to be careful about which baseline we choose for the expected prevalence. If, for example, we choose the late 1980s and early 1990s as our base—a period in which homicide rates spiked across the country [3]—we would conclude that current levels of violence represent a substantial reduction in violence perpetration and victimization. Moreover, the homicide rate in the United States has generally declined since the mid-1990s [4]. This is not to suggest that current homicide rates are acceptable but rather that we need to be careful in the terminology we use to describe these rates.
More importantly, we need to be clear that there are no “violence bacteria” or “violence viruses,” no violence parasites or pathogens. Violence is not airborne or contagious by touch or breath. There is no violence “germ” within individuals that can be suppressed. Certainly, as acknowledged by the authors, there are neighborhoods and communities in which violence is substantially concentrated. However, this geographic concentration of violence is driven not by contagion from person to person. Rather, geographic concentration of violence, as documented in a large literature on the structural covariates of homicide and related topics, is driven by known ...
Language: en |