Social and Economic Costs of Violence Workshop Summary (2012) / Chapter Skim
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6 Direct and Indirect Costs of Violence
6 Direct and Indirect Costs of Violence
Pages 33-83
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From page 33... ...
Direct costs are more readily quantifiable and tend to fall into traditional categories of medical and nonmedical costs and productivity costs. Indirect costs indicate impact beyond direct victims and perpetrators and also include indirect victims and often society at large.
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Interpersonal violence is defined to include violence between family members and intimate partners, as well as violence between acquaintances and strangers that is not intended to further the aims of any formally defined group or cause. Although these types of violence disproportionately affect poorer countries, there is a scarcity of studies of their economic impact in those countries.
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. Indirect costs include the long-term effects of acts of violence on perpetrators and victims, such as lost wages and psychological costs, also referred to as pain and suffering (Hornick et al., 2002)
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reported estimated direct costs of violent crime to victims resulting from short-term medical expenses and work loss. These estimates were based on responses to the National Crime Victimization Survey (NCVS)
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The Australian Institute of Criminology (2003) reported national annual costs for assault of $159 million, an estimate that did not include indirect costs and was based largely on the costs of incarcerating offenders.
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calculated the costs of child abuse and maltreatment in Colorado to be $468 million -- of which indirect costs represent 53 percent. There is a considerable range of estimates of individual-level treatment costs for child abuse, depending on the types of costs included.
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child HHS, 2001 United States, Colorado, Direct medical, legal $17.4 million 1995 services, incarceration, workers' productivity, lost earnings, and opportunity cost of lost time Irazuzta et al., United States, West Virginia, Direct medical $0.6 million; 1997 1991-1994, pediatric ICU $42,518 per admissions (n 5 13) child Libby et al., Head trauma patients from Direct medical Mean charges of 2003 Colorado hospital discharge $4,232 more database, 1993-2000 than those with unintentional head trauma New and United States, Washington Direct medical $1.2 million; Berliner, 2000 State, 1994, mental $1,891 per child health treatment costs compensated by crime victims compensation program (n 5 608 children)
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Forjuoh (2000) , working with discharge data from acute care hospitals in Pennsylvania, calculated a mean hospitalization cost of $18,103 per child abuse victim -- comparable to a cost $19,266 per discharge found by Rovi (2004)
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IPV and no-IPV women of $1,064 Day, 1995 Canada, data drawn Direct medical costs $1.2 billion from surveys (dental costs also) , lost earnings and opportunity cost of time, other monetary costs, psychological costs Mansingh Jamaica, Kingston public Costs for treating $454,000 and hospital, 1991 victims of intimate Ramphal, partner violence, 1993 direct medical costs New and United States, Direct medical costs $3,087 per patient Berliner, Washington State, (mental health (median 15 2000 1994, 318 women; treatment costs)
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calculated the economic losses of rape as $33 million, based on reported direct medical costs and lost earnings, though this estimate did not include psychological costs. For costs at the level of individual rape victims, Miller et al.
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, 1987-1990 employment and workers' productivity, psychological costs, lost earnings, and opportunity costs of time U.S. Department United States, NCVS Direct medical costs, Cost of rape, of Justice, lost earnings, and $33 million 1994 opportunity cost of time and are hampered by measurement difficulties and nonstandardized methodologies.
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surveillance system 1980-1997 Hashemi United States, 600 Direct medical costs, Costs per and nonfatal workplace lost earnings and workplace Webster, violence claims, opportunity cost of compensation 1998 randomly selected time employment and claim, $3,694 workers' productivity psychological costs, other nonmonetary costs McCall and United States, 2,028 Direct medical costs, $6,200 average Horwitz, workers' claims of lost earnings and per claim 2004 workplace violence in opportunity cost of Oregon 1990-1997 time, employment and workers' productivity claim. McCall and Horwitz (2004)
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lost earnings and life of crime, opportunity costs of $1.9 million to time, employment and $2.6 million workers' productivity, psychological costs Miller et al., United States, violent Direct medical costs, Costs per 2001 juvenile crimes lost earnings and workplace committed in opportunity cost of compensation Pennsylvania in 1993 time, employment and claim, $3,694 (n 5 93,000) workers' productivity, psychological costs, other nonmonetary costs
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calculate that gun violence cost $100 billion a year, including indirect costs such as increased security and psychological effects. Hospital-based studies have also found a heavy economic toll related to gun violence.
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They found 272 cases of gang-related gunshot injuries over a 29-month period from 1992 to 1994. These injuries resulted in an average of $21,200 in direct medical charges.
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. Similarly, 80 percent of the direct medical costs for gunshot wounds, stab wounds, and injuries from assault at the San Francisco General Hospital in the mid-1980s were paid for with public funds (Sumner et al., 1987)
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We used the following keywords, representing types of violent behavior and factors associated with violent behavior combined with economic variables: • Violence: interpersonal violence, family violence, partner violence, domestic violence • Abuse: child abuse, domestic abuse, partner abuse, girl abuse • Assault benefits • Homicide investments • Injury and intentional injury • Human capital • Firearms expenses • Costs: cost-effectiveness, cost-benefit • Economics: economic policy The following databases and websites were searched: • Australian Institute of Criminology • CIAO -- Columbia International Affairs Online • CINAHL -- Cumulative Index to Nursing and Allied Health Literature • Cochrane Library • Contemporary Women's Issues • EconLit • General Sciences database • Gun Control Alliance (South Africa) • Health Canada
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(USA) • World Bank • World Health Organization After the initial database and Internet literature searches, additional sources were identified through the reference lists of collected articles and through consultation with the following resource experts, gratefully acknowledged below: • David Ball, Middlesex University, United Kingdom • David Bishai, Johns Hopkins Bloomberg School of Public Health • Nancy Cardia, Centre for the Study of Violence, University of São Paulo, Brazil • Phillip Cook, Duke University • Phaedro Corso, Centers for Disease Control and Prevention • Elizabeth Eckermann, Deakin University, Australia • Rune Elvik, Norwegian Center for Transport Research • Adam Graycar, Australian Institute of Criminology • Rodney Hammond, Centers for Disease Control and Prevention • Patricia Hernandez, World Health Organization • Michael Koenig, Johns Hopkins Bloomberg School of Public Health • Daniel Lederman, The World Bank • Pat Mayhew, Australian Institute of Criminology • Katherine McKenna, Centre for Women's Studies and Feminist Research, University of Western Ontario
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. Despite the accessibility of adult protective services and nursing home regulations in all 50 states, as well as mandatory reporting laws for elder abuse and neglect in most states, an overwhelming number of abused and neglected elderly pass through our healthcare system undetected and untreated.
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. The direct medical costs associated with these violent injuries are estimated to add more than $5.3 billion to the nation's annual health expenditures (Mouton et al., 2004)
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Fear and Social Isolation Access to the abused and neglected elderly can be difficult for healthcare providers, in part because the perpetrator may block efforts to intervene and further induce isolation of the victim. As a reaction to the abuse and neglect, most victims will react with anger, disappointment, fear, or grief.
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In a recent study, Chinese Americans were less likely to seek help and further induce social isolation (Dong et al., 2011a)
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. Morbidity and Mortality Healthcare System Utilization Elder abuse and neglect are recently recognized forms of family violence, but much less is known compared to child or spousal abuse, with respect to how elder abuse victims interact with the healthcare system.
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Elderly referred to protective services represent some of the most frail, isolated, and medically and psychiatrically ill older members of society. Nursing home placement is a drastic, restrictive, and costly intervention, and it is one of the most difficult decisions that adult protective services workers and elder abuse field workers face.
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From page 57... ...
The cohort had been previously linked with a long-term care data registry in the State of Connecticut, permitting the certainty of nursing home placement records for all cohort members. This study found that the number of abused and neglected elderly referred to adult protective services is a compelling predictor of nursing home placement, even after adjusting for other variables known to be associated with institutionalization in the older population (Lachs et al., 2002)
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Policy Implication for Elder Abuse The field of elder abuse is estimated to be 40 years behind the field of child abuse and 20 years behind the field of domestic violence. While there have been strong national policies dealing with child abuse and violence against women, there has been a great paucity of national policy to prevent elder abuse and to protect victims of elder abuse.
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The EJA will also be responsible for issuing human subjects protections guidelines to assist researchers and for establishing elder abuse forensic centers. The EJA will provide grants and incentives for long-term care staffing and electronic medical records technology grants programs and will collect and disseminate annual data related to elder abuse from adult protective services.
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As child abuse and domestic violence training are mandatory parts of health professional education, so should elder abuse training be. Training and resources for the APS and other frontline workforce will be critical to alleviate factors exacerbating the abusive situation and to prevent elder abuse recidivism of an already vulnerable population.
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In addition, there are the costs to the community associated with criminal law enforcement, including the costs of police, district attorneys, judges, parole officers, and prisons. There are also large psychological costs caused by street violence.
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Finally, attempts by young people to protect themselves by acquiring guns and joining gangs exacerbate the problem. Using medical costs and productivity losses to estimate the societal cost of injury is a common, if somewhat controversial, economic approach.
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Institute for Social Research, University of Michigan One of best-established findings in the psychological literature on aggressive and violent behavior is that violence begets violence. This contagion of violence appears to be a universal phenomenon.
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and behavior problems (e.g., violent behavior)
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For example, as shown in Figure 6-2, Palestinian kids and Israeli Jewish kids who fall in the top 25 percent on the amount of war violence they have seen in 1 year are 15 percent more likely to punch or beat a peer than kids who fall in the lowest 25 percent on violence exposure, and Arab Israeli youth in the highest quartile on exposure are about 30 percent more likely to punch or beat a peer during the year. These youth have not been victimized by their peers; yet they attack their peers.
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No, the direction of the effect is clearly that exposure to violence stimulates later increases in aggression even after we control for initial differences in aggression. For example, for 8- and 11-year-olds the causal path coefficients from exposure to Figure 6-2 violence in year 1 of the study to change in R02080 aggression from year 1 to year 3 are about .30, while the causal path coef vector editable ficients from aggression in wave 1 to increases in exposure to war violence between wave 1 and wave 3 are about 0.
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These generally are scripts that are most strongly primed by the social situation and have been most strongly learned from past experiences. Thus, a boy who has grown up observing violence around him almost every day (whether war violence, neighborhood violence, gang violence, school violence, or family violence)
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about behaving aggressively in year 2 (that is, they rehearse aggressive scripts more) , held stronger beliefs that aggressive behavior toward others is okay in year 2, and showed higher levels of emotional distress in year 2.
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The authors wish to advise that the article was originally adapted from the following publication: National Scientific Council on the Developing Child (2010)
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In 2006, the United Nations Secretary-General's Study on Violence against Children reported that more than 130 million children have witnessed intimate partner violence in the home, and more than 200 million have suffered some form of sexual abuse. For children living in such circumstances, frequent and repetitive threats create the potential for heightened fear and chronic anxiety.
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Elevated stress hormones such as cortisol have been shown to affect the growth and performance of the hippocampus and the activity of the amygdala in rodents and nonhuman primates, and early and persistent activation of the stress response system adversely affects brain architecture in these critical regions. Beyond its impact on these two brain structures, heightened stress has also been shown in animals to impair the development of the prefrontal cortex, the brain region that, in humans, is critical for the emergence of executive functions -- a cluster of abilities such as making, following, and altering plans; controlling and focusing attention; inhibiting impulsive behaviors; and developing the ability to remember and incorporate new information in decision making.
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For example, a child who is physically abused by an adult may become anxious in response to both the person and the place where the fear learning occurred. Over time, the fear elicited and the consequent anxiety can become generalized, and subsequent fear responses may be elicited by other people and places that bear sometimes only small resemblances to the original conditions of trauma.
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Persistent fear can distort how a child perceives and responds to threat. Fear learning typically takes place in specific contexts and results in those fears' becoming associated with the places where the learning occurred.
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Young children can perceive threat in their environment, but un like adults, they do not have the cognitive or physical capacities to regulate their psychological response, reduce the threat, or remove themselves from the threatening situation. As a result, serious fear-triggering events such as family violence can have significant and long-lasting impacts on the developing child, beginning in infancy.
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. Programs focused on the reduction of domestic violence, substance abuse, neighborhood violence, and poverty are examples of the kinds of community-based services whose impacts could be enhanced by incorporating targeted interventions to explicitly address the emotional needs of young children living under these conditions.
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2008. Adverse health conditions and health risk behaviors associated with intimate partner violence.
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Child Abuse & Neglect 23(10)
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Child Abuse & Neglect 24(8)
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1997. Outcome and cost of child abuse.
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1999. Social and economic costs of domestic violence: Chile and Nicaragua.
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1999. Using benefit-cost analysis to assess child abuse pre vention and intervention programs.
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2004. The economic burden of hospitalizations as sociated with child abuse and neglect.
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1999. Intimate partner vio lence against women -- Do victims cost health plans more?
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