Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.9 Violence
A.9 Violence
Pages 345-359
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From page 345... ...
The violent death rate (including both homicide and suicide) in the United States exceeds that of all other industrialized nations and constitutes the fourth leading cause of years of potential life lost prior to age 65 in the United States.
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From page 346... ...
Social factors associated with violence include concentration of poor families in geographic areas, income inequality, population turnover, community transition, family disruption, housing density and other aspects of social disruption, and opportunities for violence such as illegal markets in drugs and firearms (NRC, 1993)
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From page 347... ...
Thus, it is possible to measure many dimensions of violence, its consequences, and its risk factors that shed light on the efforts of various community entities to address it. Health and Function, Disease The direct effects of violence include physical injury, death, and psychological problems.
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From page 348... ...
This measure, which appears in Healthy People 2000, can be ascertained from police records, program data from rape crisis centers and shelters for victims of domestic violence, or population surveys. Well-Being Well-being can depend directly on the physical or psychological consequences of violence, but these dimensions are probably best measured directly.
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From page 349... ...
The three measures reflect the most common forms of domestic or family violence. Although there are mandatory reporting requirements for child abuse in most states, actual reports of domestic violence to police and child protective services probably reflect only a small portion of the events that take place.
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From page 350... ...
Violent behavior is more common among youth than at older or younger ages, so some of the measures of individual response ought to focus on youth violence. Substance abuse is a major contributor to violent behavior in a community, and can be measured through school-based as well as population surveys.
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From page 351... ...
These measures suggest actions that the health sector can take to respond to violence and contribute to its prevention. Social Environment As indicated above, the social factors associated with violence include concentration of poor families in geographic areas, income inequality, population turnover, community transition, family disruption, housing density and other measures of social disruption, and opportunities for violence such as illegal markets in drugs and firearms (NRC, 1993)
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From page 352... ...
Gangs, illegal markets, and firearms are typical of the situations in a community's social environment that provide opportunities for violence. Although the presence of such situations is difficult to represent in statistical terms, the use of focus groups and other observational techniques for documenting the existence of contributors to violence in a community would be an important measure of the performance of the police and criminal justice system and of local policymakers concerned with housing, economic development, and so on.
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From page 353... ...
Prosperity As indicated above, a community's prosperity both depends on and affects violence. Violence carries high economic costs, not only in treating its direct effects, but in terms of pain and suffering, psychological damage, and reduced quality of life.
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From page 354... ...
Data for this indicator should be available from hospital discharge data, police records, and population surveys. Each source is likely to be incomplete, but together they should yield an accu
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From page 355... ...
This indicator, for which data must be obtained from a population survey, measures adverse effects on well-being that are not captured in health-related data. Although not now generally available, population surveys could include questions either to determine whether people fear violence enough to change their behavior or to measure specific activity restrictions (e.g., not going out at night or alone, not going to certain neighborhoods)
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From page 356... ...
The effect of gun control laws on the actual possession or use of guns will be difficult to measure, but their effect might be seen, for instance, in the proportion of homicides or robberies in which guns were involved. Rather than a statistical measure, an analysis of the strength of national, state, and local gun control laws and their implementation would be an appropriate indicator for the law enforcement sector.
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From page 357... ...
1991. Healthy People 2000: National Health Promotion and Disease Prevention Objectives.
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From page 358... ...
358 TABLE A.9-1 Field Model Mapping for Sample Indicator Set: Violence Field Model Domain Construct Sample Indicators Data Sources Health and Violence-related Firearm-related deaths per 100,000 people Vital statistics Function, mortality and morbidity Disease Number of assault injuries among people Police records, program aged 12 and over data, population surveys Individual Frequency of sexual Number of rapes and attempted rapes Police records, surveys Response violence Frequency of domestic Prevalence of physical abuse of women by State health department; violence male partners police records Number of confirmed child abuse cases Child protective services reported to authorities; percentage of confirmed data cases receiving protective services and appropriate medical care Prevalence of self- Number of suicide attempts by adolescents State health department, directed violence aged 14–19 program data, hospital discharge databases Well-being General impact of Restriction of activities due to fear of violence Survey required violence in personal activities IMPROVING HEALTH IN THE COMMUNITY
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From page 359... ...
Social Atmosphere that Number of hours of violence-related Television industry Environment supports violence programming on television most watched by voluntary classifi children and youth cation system Law enforcement Use of community policing techniques Police department A.9 VIOLENCE prevention activities Legislative changes to Gun control laws Police department, state decrease violence and local statutes Health Care Professional awareness Existence of protocols for health care Surveys and support for victims professionals to identify, treat, and properly of violence refer individuals who attempt suicide; victims of sexual assault; victims of spouse, elder, and child abuse Physical Environmental hazards Percentage of youth reporting carrying State health department Environment weapons to school (Healthy People 2000 indicator data) , surveys, education department, school districts 359
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