Citation

Prothrow-Stith DB. Public Health Rep. (1974) 1987; 102(6): 615-616.

Copyright

(Copyright © 1987, Association of Schools of Public Health)

DOI

unavailable

PMID

unavailable

Abstract

Intentional and unintentional injuries are different and require different prevention strategies. Environmental manipulations may lessen the impact of intentional injuries but can be predicted to be less effective than they have been with unintentional injuries. Why should we apply the public health model or public health strategies to intentional injuries if they are so different?

Let us begin by examining the characteristics of the problem. Over half of homicide victims know their assailant, and most homicides begin with an argument-not with the commission of another crime. Furthermore, alcohol and handguns frequently play a role in homicides. In terms of a preventive appproach, law enforcement strategies have little or no control over such intentional injuries.

With its emphasis on education and prevention, the public health model offers an opportunity to change attitudes and behavior, as demonstrated in efforts to reduce smoking, heart disease, and drunk driving.

One of the major benefits of viewing interpersonal violence as a public health problem relates to the new resources and strategies that can be applied to this problem. The traditional law enforcement approach sorely lacks the prevention strategies that are present in the public health model. It is at best secondary prevention focusing on the identification of the perpetrator and the description of the victim in traditional terms.

What resources can the public health model bring to this problem? First, there is the education-public awareness campaign, which is a large part of the public health model. Media campaigns often provide a successful conduit for such efforts. Community agencies (for example, churches, tenants' organizations, police organizations) provide successful vehicles for launching public education campaigns.

School-based efforts (that is, health education) are a second resource for conducting education campaigns. Perhaps every elementary school ought to have a curriculum on handling anger and how to avoid fights.

Health institutions are a third resource available through the public health model. Four times as many cases of nonfatal assault are seen in the emergency room as are reported to the police. Given these figures, the emergency room cannot be ignored as a source for prevention and intervention strategies. As a medical student in one of Boston's emergency rooms, I treated a man with a laceration above his eyebrow, which had resulted from a fight. After treatment, he was released; but before leaving the hospital, he advised us that he intended to find the man who injured him and send him to the emergency room, in turn. We did not take him seriously, and he left. However, if he had attempted suicide and indicated the intention to try again, the response of the health care team would have been different.

Hospitalized patients represent an additional opportunity for intervention and secondary prevention. For instance, an initiative in Boston identifies adolescents admitted to the hospital as victims of interpersonal violence and offers limited specialized counseling. It is hoped that eventually this initiative will be expanded to offer such teenagers not only traditional medical care, but expanded psychological and social interventions as well. A Boston pediatrician, Dr. Peter Stringham, has developed a series of protocols for screening infants, toddlers, young children, early adolescents, and their families for their exposure to and use of violence.

Clearly, there are many resources that can be applied to this new concept of interpersonal violence as a public health problem. Environmental manipulations are perhaps going to be less effective in reducing interpersonal violence; rather, the focus should be on changing human behavior. The success of any intervention strategy in this area necessitates a multidisciplinary approach. Although the public health model is accustomed to the involvement of epidemiologists, emergency room personnel, health educators, and community outreach people, it has not often embraced the criminal justice or the mental health communities as part of that model. However, these two communities must be incorporated into this multidisciplinary model to effectively address intentional injury.