New Look at Preventing Violence

Health professionals examine scientific approach to curbing murders in inner city

RESPONSES to the Los Angeles riots have mostly taken two familiar forms - calls for better law enforcement and for improving social and economic conditions in central cities.

But a new approach to violence is gaining interest and adherents among people concerned with urban crime. It comes from an unlikely quarter: physicians.

Medicine itself is not necessarily involved. Instead public-health specialists are bringing a relentlessly practical mind-set to analyzing the patterns of where and how violence occurs, then exploring how it can be prevented.

Health professionals have noted that violence is one of urban America's gravest health problems, that in fact murder is the leading cause of death among young black men. "We're teaching black youths nutrition - `Eat an apple a day,' " - laments Mark Rosenberg, an official at the Centers for Disease Control (CDC) in Atlanta, when about one in 27 is being murdered.

The conventional American response to violence is dominated by the legal profession through the criminal-justice system. At bottom, it is moralistic - seeking to assert right by punishing wrong.

Medical researchers are not concerned with making moral judgments about violence, just reducing it. They apply the same broad scientific approach they use to track the spread of epidemics and search out ways to intervene. They range over nearly every discipline and science tracking the factors that appear to govern the spread of violence.

Their attention has focused on matters such as the presence of guns, how disagreements escalate into violence, and the role of alcohol and drugs. Goal: prevent violence

"The criminal-justice approach focuses resources on crime after violence and injuries occur," says James Mercy, Dr. Rosenberg's colleague at CDC. The two run a division there that has become the leading center for research and promotion of public health concern over violence.

Few policies or programs have yet emerged that public-health scholars can claim as the offspring of their ideas. There are some early stirrings. A handful of schools and consultants around the country are developing and using courses in conflict resolution to try to break the patterns that lead to violence. Many public-health departments are beginning to consider violence prevention in their work.

But through the 1980s articles on subjects such as the incidence of gun ownership have begun appearing in prestigious medical journals and public-health professionals have entered the professional networks of criminologists.

"The major ferment in the research community in the 1980s was the entry of the public health people," says Frank Zimring, a leading scholar of crime and violence at the University of California at Berkeley.

"It's great because it depoliticizes some of this stuff," says Jim Lynch, a sociologist at American University here in Washington. "We'll get good information and pragmatic, instead of ideological, policy."

He calls the public-health perspective a value change in how to look at crime. It is not the search for the larger social causes of violence associated with the 1960s. It is looking for more immediately useful ways to intervene.

Not everyone is comfortable with everything about treating violence as a public health problem. Dr. Lynch notes, "Health people don't understand crime as well as justice people do." They tend to see the damage violence does as what ends up in the emergency rooms. But it also harms the social fabric in many less obvious ways, Lynch says.

Others who study crime find the public-health newcomers to be innocents abroad in crime research, and not without political agendas of their own.

Public-health specialists tend heavily toward gun control, for example. Some of the studies of gun ownership and health published in the venerable New England Journal of Medicine, for example, had glaring weaknesses, according to Gary Kleck, a Florida State University expert on gun crime and ownership.

"It's done by physicians who apparently have had no training in research methods," he says.

Their professional bias toward gun control comes from treating the victims of gunshot wounds, he says. Such wounds are more often fatal than from violence without gunshots. What they don't see is that the presence of a gun - even when a criminal has it - makes it less likely that violence will actually occur than in a crime with less firepower, according to Mr. Kleck.

Whoever wins that debate, some new debaters are on the stage these days. If they are learning some things that criminal justice professionals already now, says Alfred Blumstein, dean of sociology at Carnegie Mellon University, "that is a small price to get approaches that previous paradigms have failed on." Victims know slayers

When most people think of homicide, says Dr. Rosenberg, they think of something like a bystander caught in the crossfire during a convenience store robbery.

But in most murders, the victim and killer know each other and no other crime is involved. Frequently an argument escalates between young men, alcohol is involved, and a weapon is accessible. The public health approach might be able to find ways to interrupt that script, but the police can't do much, says Rosenberg.

Even Kleck admits: "Anything that will move the approach away from ideology - from how to deal with evil - will help with these problems."

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