Homicide Health Article

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.

SUSAN B. SORENSON

(SEE ALSO: Domestic Violence; Public Health and the Law; Violence)