Urban violence: a health care issue
Authors: J. L. Uva
Journal: JAMA (1990)

VioLit summary: OBJECTIVE: The aim of this article by Uva was to advocate that the problem of violence was also a health care issue, and that with a few recommendations, it could be approached as a public health problem in addition to primarily a law enforcement problem. METHODOLOGY: A non-experimental review of the relevant literature was employed. FINDINGS/DISCUSSION: The author began by describing the problem of violence. It was noted that over four million Americans are victims of violence each year. In 1980, violence accounted for $640 million dollars in health care costs. Homicide, accidents, and suicide were noted to be the leading causes of premature death. The author noted that advocates suggest that preventative medicine techniques may be effectively applied to decrease mortality and morbidity due to violence, specifically for domestic sexual abuse, physical abuse of spouses, children, and the elderly. The rates of violent interactions in 1985 between children and their parents was 620 per 1,000; and 113 violent interactions per 1,000 married couples. The urban minority community was noted to have the highest rate of devastation by violence. Homicide was noted to be the leading cause of death for black males aged 15-45. A black man's chance of dying by homicide was noted to be 1 in 3, whereas for a white man it was 1 in 22. The rates are higher in all regions of the country and are especially higher in the larger cities. Most of the homicides among black men were found to be attributed to interpersonal violence. Urban minority violence was found to be associated with low per capita income, welfare dependency, disrupted families, lack of social supports, low educational levels, lack of vocational skills, overcrowding, deteriorated buildings, and single-parent families. In addition to the social and economic issues underlying the problem of violence, was a popular culture that appears to accept violence as a normal means of solving problems and of expressing anger or frustration. Other contributors of violence include racism, sexism, and ageism. The medical community, based on two advantages, was seen as a viable contributor to the prevention of violence. The first advantage was that emergency rooms of community hospitals are generally located in the heart of the problem, the inner cities, and second, health care workers spend a large amount of time with victims. Prevention would come in the form of developing a protocol for the early identification of domestic and external violence. Suggestions toward that end included: 1) during patient interviews, physicians should routinely ask questions that would elicit word to violent acts, 2) physicians should become accustomed to nonaccusatory language, 3) they should be informed about referral service for victims of violence and have immediate access to shelters for both adult and child victims, and 4) physicians need to improve medical record keeping for victims of violence for improvements in medical and research data. While physicians were noted to be in a good position to contribute to the prevention of violence, the authors also noted the obstacles. First, physicians tend to be economically advantaged whites who lack personal experience with urban violence or the social forces that produce it. This would make it difficult to relate to both victims and perpetrators of violence. The author concluded with several recommendations which would facilitate violence prevention on the part of medical community. AUTHOR'S RECOMMENDATIONS: The author recommended that current staff physicians and house officers need to be educated on how to identify, assess, refer, report, and intervene in cases of violence. Medical schools should also incorporate curricula on the treatment and management of victims, as well as the socioeconomic causes of urban violence. Medical expertise that has influenced social policy such as with smoking cigarette could also be used to act against violence in the same manner. Lastly, the author recommended that the ultimate approach would be a multidisciplinary one, which would include physicians, nurses, other health care professionals, social workers, educators, counselors, legislators, and law enforcement. (CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado) Violence Prevention Urban Violence Violence Effects Public Health Services Public Health Approach Prevention Recommendations Public Health Personnel Elder Adult Victim Adult Victim Juvenile Victim Child Victim Violence Intervention Public Health Assessment Domestic Violence Assessment Child Abuse Assessment Elder Abuse Assessment Spouse Abuse Assessment