Perspectives on Violence and Public Health – Injury Prevention, Violence Prevention, and Trauma Care: Building the Scientific Base

I anticipated focusing on the Haddon Matrix for this week’s BLOG post.  However, I felt that this week’s entry was better suited to build the foundation for the Haddon Matrix.  Developed by William Haddon in 1970, the matrix looks at factors related to personal attributes, vector or agent attributes, and environmental attributes before, during and after an injury or death.  By utilizing this framework, one can then think about evaluating the relative importance of different factors and design and interventions.

So, let’s look back to the societal context at the time of the origination of the Haddon Matrix…

The CDC published Injury Prevention, Violence Prevention, and Trauma Care:  Building the Scientific Base on October 7, 2011 / 60(04);78-85.  The article authors were David A. Sleet, PhD, Linda L. Dahlberg, PhD, Sridhar V. Basavaraju, MD, James A. Mercy, PhD, Lisa C. McGuire, PhD & Arlene Greenspan, DrPH.

The following section was found within that article under the subheading:  Perspectives on Violence and Public Health.  This section provides the context for the Haddon Matrix (which I will address in a future BLOG post) and also serves to remind us that we’ve made significant strides forward in applying an epidemiological epistemology to the study of such events as attacks on schools.  While still in its infancy, this “new” perspective offers much promise to eventually designing effective interventions as we view attacks on schools as a public health issue – and the Haddon Matrix will be an important tool in the study methodology of that topic.

“Thirty years ago, the words “violence” and “health” were rarely used in the same sentence.  Today, violence is recognized as a major public health problem. Violence is defined as the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community that either results in, or has a high likelihood of resulting in, injury, death, psychological harm, maldevelopment, or deprivation.  This definition encompasses three broad types of violence: interpersonal violence (e.g., intimate partner violence, sexual violence, child maltreatment, elder maltreatment, and youth violence), self-directed violence (e.g., suicidal behavior), and collective violence (e.g., war, armed conflict, terrorism, and state-sponsored violence).

Several trends contributed to increased recognition and acceptance that violence could be addressed from a public health perspective:

Homicide and suicide rose in the rankings of causes of death as the United States became more successful in preventing and treating infectious diseases.  Since 1965, homicide and suicide have consistently been among the 15 leading causes of death in the United States.

The risk for homicide and suicide reached epidemic proportions during the 1980s. Suicide rates among persons aged 15-24 years almost tripled during 1950-1990.  Similarly, during 1985-1991, homicide rates among 15- to 19-year-old males increased 154%. This increase was particularly acute among young African-American males.

The importance of behavioral factors was recognized in the etiology and prevention of disease. Successes in applying behavioral strategies to changing other health risks encouraged public health professionals to apply these strategies to prevent interpersonal violence and suicidal behavior .

Child maltreatment and intimate partner violence were recognized as social problems in the 1960s and 1970s, demonstrating the need to move beyond sole reliance on the criminal justice sector in solving these problems.”