Homicide is a long-standing threat to a community's health, although it began to be widely recognized as a public health issue only in the 1990s. Homicide has traditionally been viewed through the lens of crime, though both criminal justice and public health approaches can be useful in efforts to reduce homicide.
Public health descriptions of homicide are based largely upon information provided on death certificates. In the United States, death certificate
Figure 1
information is reported to each county by funeral directors, physicians, and coroners. Each county reports the information to the state, which, in turn, reports it to the National Center for Health Statistics. These data cover every death (regardless of cause of death) for which there is a body. In vital statistics data, and for public health purposes, a homicide is defined as the death of a person at the hands of another.
Law enforcement data about crime are gathered by police and sheriff's officers at the local level, reported to a central agency at each state, and then forwarded on to the Federal Bureau of Investigation. Participating in The Uniform Crime Reports (UCR) is a voluntary process, and about 85 percent of police departments—covering 96 percent of the U.S. population—participated in UCR as of 1991. The data about homicides are reported in the Federal Bureau of Investigation's (FBI) Supplementary Homicide Report. The FBI defines a homicide as murder—the willful (nonnegligent) killing of one human being by another.
In addition to murders, the public health definition of homicide includes legally sanctioned killings (e.g., executions or homicides in self-defense). The law enforcement definition, however, is limited to criminal homicides. Because the
Figure 2
definitions differ, the numbers of homicides reported by each system also differ. The overall patterns of risk, however, are the same.
EXTENT OF THE PROBLEM
Homicide rates in the United States peaked in 1993, dropped substantially, and the homicide rate in 1998 was the same as that in 1968 (see Figure 1). Although people were alarmed at the high homicide rates in the early 1990s, these rates have vacillated throughout the twentieth century. Historians believe that homicide rates were probably even higher in the Middle Ages in Europe.
The United States has a much higher homicide rate than other industrialized countries (see Figure 2). Although not included in the chart, it many be useful to note that among those countries reporting rates to the World Health Organization, Colombia actually has the highest rate by far—146.5 homicides per 100,000 males. The discrepancy appears to be largely due to the much higher number of deaths due to firearms in the United States. Even when compared to other countries where firearms are relatively common, homicide
Figure 3
rates in the United States are higher, possibly because firearms in the United States are much more likely to be handguns, whereas in other countries the guns are most likely to be rifles and shotguns. Handguns are the leading method of homicide in the United States.
HOMICIDE RISK
Some people are at higher risk than others of becoming a homicide victim. Homicide victimization rates are highest for adolescents and young adults. Although the number of young people who are homicide victims has dropped since 1993, as it has for all age groups, adolescents and young adults continue to be the age group at highest risk of homicide. As shown in Figure 3, risk is higher for young men than young women, and risk is highest for young minority men, especially young African-American men.
Homicide is a major cause of mortality among infants and toddlers. In fact, homicide is the third leading cause of death of persons under five years or age. In most of these deaths, the assailant is the primary caretaker of the child—either a parent, stepparent, or partner of one of the parents. The most common method of death is by beating with personal weapons (i.e., hands, fists, or feet).
Although homicide rates are much higher among men than women, the rank of homicide as a cause of death is similar for men and women at all age groups. Firearms are the most common method of homicide for both male and female victims. The assailant and the location of the homicide differ by gender, however. Men are most likely to be killed by a friend or an acquaintance in a public place such as the street or a bar. Despite a general concern about "stranger danger," women are most likely to be killed by a current or former male intimate (i.e., a husband, boyfriend, exhusband, or former boyfriend) in the home. Research using data from the mid-1970s through the mid-1980s found that a woman is more than two and one-half times as likely to be shot by her male intimate as to be shot, stabbed, strangled, bludgeoned, or killed in any other way by a stranger.
Research indicates that having a gun in the home increases the chances that a person will become a victim of a homicide in the home and that a person will become a perpetrator of homicide, though more scientific research is needed before such risks can be assessed with confidence.
HOMICIDE AND PUBLIC HEALTH
Public health approaches to homicide are based largely in one of two frameworks: injury prevention and, for lack of a more specific descriptor, social change. Injury prevention traces its roots to Hugh De Haven, a World War I pilot who, after surviving an airplane crash, spent many years studying the dynamics of traumatic force upon the body. Subsequent work focused on motor vehicle crashes. Researchers found that trying to change human behavior (e.g., trying to get drivers to "drive defensively") did not work very well. In fact, some efforts, such as drivers' training, did not reduce crash or injury rates at all. Strategies that focused on the environment and the vehicle itself proved to be more successful. Roads were designed not just to get from point A to point B, but with injury prevention in mind. For example, rigid signposts and bridge abutments have been modified so that even if a vehicle veers off the roadway, an injury is not inevitable. Vehicles are now equipped with collapsible steering wheels, reinforced side doors, seat belts and airbags, and antilock brakes. In other words, efforts switched from preventing a crash from occurring to preventing an injury if a crash occurred.
Injury prevention practitioners and researchers took this same model from unintentional injury (i.e., car crashes, drownings, and other "accidents") into their work with homicide. They set their sights clearly and specifically on one question: If the violence cannot be stopped, how can the violence be made less lethal? Given that guns (handguns in particular) are used in most homicides, it is not surprising that injury prevention efforts related to homicide focus mainly on handguns. Public health efforts to reduce gun fatalities have focused largely on the manufacture of guns (e.g., "smart guns" that are personalized so that only an authorized user can shoot the weapon). Policies related to the marketing and advertising, sale, possession, and use of guns also are points of intervention.
The social change, or social justice, approach emphasizes the inequalities that might give rise to lethal violence. The epidemiological data presented in the figures document how risk differs across nations and across groups in the United States. The social justice approach tries to understand why these differences might exist, and to identify ways to remedy the situation. For example, why do minorities have a much greater risk than white people of dying of homicide? Areas of investigation include differences in socioeconomic status(e.g., income and education), limited opportunities (e.g., inner-city schools that are more likely to be attended by minorities generally are less well funded than suburban schools), and the effects of institutional racism (e.g., racial profiling by law enforcement).
Social change approaches seek to expand educational, recreational, and employment opportunities, especially for young people. Related approaches have attempted to increase adolescents' problem-solving and anger-management skills so that violence becomes an option, not an inevitability. Evaluations of such programs have produced inconsistent results. Some, such as W. R. Hammond and B. R. Yung, say certain programs are effective, whereas others, including D. W. Webster, find few positive effects.
The injury prevention and social change approaches need not be in competition, although they are sometimes cast that way. Efforts to reduce homicide will likely be more successful if a multifaceted approach, rather than one single strategy, is taken.
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