Violence as a Public Health Issue for Children
Elders, Joycelyn, Childhood Education
The Surgeon General's primary role is to make the people of the United States aware of serious health threats. One does not have to look far into the home, school or community to realize that a major threat to our health is violence. I would like to share with Childhood Education readers my views on the public health consequences of violence, and to discuss prevention efforts and the implications for health and child care professionals.
The problem of violence in this country has increased markedly in recent years, including extraordinary increases in homicide and suicide rates among our young people. Since the 1950s, suicide rates among our youth have almost quadrupled. Homicide rates among young men are 20 times as high as most other industrialized countries. Concurrently, the average age of perpetrators and victims has fallen. We now have the problem of children killing children. On the day you read this, 14 children in America under the age of 19 will die in suicides, homicides or accidental shootings and many more will be injured.
The violence has spilled over into the schools. In increasing numbers and proportions, kids are carrying guns to school. In 1989, an estimated 430,000 students took a weapon to school to protect themselves from attack or harm at least once during a six-month period.
Also, much of today's violence occurs in the home. In 1990, there were over 500,000 reported and confirmed cases of child abuse (physical and sexual) in the U.S. Evidence suggests that this figure may be only one-third the actual incidence--much of which results from drug and alcohol abuse. Furthermore, research shows that approximately 30 percent of the adult population experiences some form of spousal violence. Twenty to 30 percent of emergency room visits by women are the result of domestic violence.
Our children are learning to use violence to solve problems. Violent behavior is being modeled in our homes, schools, neighborhoods and in the media. If we are to have confidence in health care reform, we must restore security in our homes, our schools, our streets and our nation. It is time for us to roll up our sleeves and rid this country of the hideous, highly infectious, yet preventable problem of violence.
Public Health Consequences
The costs of violence to this country are clearly too great to ignore:
* Firearm injuries represent nearly $3 billion a year. The cost of firearm injuries alone to our health care system is nearly $3 billion a year.
* The vast majority (85 percent) of the hospital costs for treatment of firearm injuries is unreimbursed care.
* In the District of Columbia, the cost to hospitals of criminal violence totaled $20.4 million in 1989.
* The total medical cost of all violence in the U.S. was $13.5 billion in 1992--$3 billion due to suicides and suicide attempts and $10.5 billion due to interpersonal violence.
* In 1988, one out of six pediatricians nationwide treated a young gunshot victim.
The public health toll, however, is not just financial. We can clearly document the immediate adverse psychological and physical consequences of violence, including family violence and rape. The long-term effects of such violence include trauma-related disorders (including post-traumatic stress disorder, especially for rape victims), personality disorders, addictive disorders and even physical disorders. We also know that many violent individuals were victims themselves of child abuse.
Drug use is a leading cause of America's crime and violence. Research suggests that 40 percent of all homicides are related to drugs. In Washington, D.C., 80 percent of homicide victims had evidence of cocaine in their bodies. Likewise, in 65 percent of all homicides, the perpetrator and/or the victims had been drinking. Alcohol is a factor in at least 55 percent of all domestic disputes.
An estimated 1.2 million elementary-age children have access to guns in their homes. …