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SSUE UBLICEALTH AS , is the Associate Director for Science in the Division of Vio-for Disease Control and Prevention (CDC) in Atlanta. In addition to serving as a senior science and policy advisor, she coordinates international research and programmatic ac-James A. Mercy, PhD, is the Special Advisor for Strategic Directions of the Division of Violence Prevention in the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention (CDC). He received his doctorate in sociol-ogy from Emory University in Atlanta. His research focuses on understanding the health Reprinted from: Dahlberg LL, Mercy JA. History of violence as a public health issue. AMA Virtual Mentor, February 2009. Volume 11, No. 2: 167-172. Available on-line at http://virtualmentor.ama-assn.org/2009/02/mhst1-0902.html. The History of Violence When and how violence was recognized as a matter for 9LROHQFHLVQRZFOHDUO\UHFRJQL]HGDVDSXEOLFKHDOWKSUREOHPEXWMXVW\HDUVDJRWKHRIFDXVHVRIGHDWK7XEHUFXORVLVDQGSQHXPRQLDZHUHWKHWZROHDGLQJFDXVHVRIGHDWKDWWKHturn of the 20th century. By mid-century, the incidence and mortality from these infectious public health. The risk of homicide and suicide reached epidemic Similarly, from 1985 to 1991 homicide rates among 15- to 19-year-old males increased 154 percent, 7KLVLQFUHDVHZDVSDUWLFXODUO\DFXWHDPRQJ\RXQJ$IULFDQAmerican males. These trends raised concerns and provoked calls for UHVWVODUJHO\RQEHKDYLRUDOPRGL¿FDWLRQV 1 smoking cessation. Successes in these areas encouraged public health professionals to be violence and suicidal behavior. Finally, the emergence of child maltreatment and intimate of violence. In 1979, the Surgeon General’s Report, the American people during the previous century and identi$PRQJWKHZDVFRQWURORIVWUHVVDQGYLROHQWEHKDYLRU7KLVthe consequences of violent behavior in an effort to improve the health of children, adolescents, and young adults. The goals for Promoting Health/Preventing These objectives called for Report of the Secretary’s Task Fority in death rate and illness experienced by African Americans Violence Prevention Timeline A report from the Surgeon General Healthy peo-ple: The Surgeon General’s report on health promotion and disease preventionthe nation. The report states that should not be ignored in the effort to improve the nation’s health. Promoting Health/Preventing Disease: Objec-WKH¿UVWFROODERUDWLYHHIIRUWVZLWKseries of child murders in Georgia. CDC establishes the Violence public health efforts in violence 2 Report of the Secretary’s Task Force on Youth SuicideResponse to the Call The emergence of violence as a legitimate issue on the national health agenda spurred a variWKH9LROHQFH(SLGHPLRORJ\%UDQFKZKLFKZDVLQWHJUDWHGLQWRWKH'LYLVLRQRI,QMXU\(SLGHPLRORJ\DQG&RQWURO',(&WKUHH\HDUVODWHUin America: A Continuing Public Health PrFRQWULEXWHGWRDJUDGXDOLQFUHDVHLQWKHQXPEHURIVWDIIDQGWKHVL]HRIWKHEXGJHWGHYRWHGWRZDVSURYLGHGE\WKH6XUJHRQ*HQHUDO¶V:RUNVKRSRQ9LROHQFHDQG3XEOLF+HDOWKLQ7KLVZRUNVKRSZDVWKH¿UVWWLPHWKDWWKH6XUJHRQ*HQHUDOFOHDUO\UHFRJQL]HGYLROHQFHDVDApplying the Tools of looking into a series of child murders in Atlanta and a suicide cluster in Plano, Texas.10, 11 gations helped to demonstrate that epidemiologic research methods could successfully be applied to in- 7KH6XUJHRQ*HQHUDO¶V:RUNVKRSon Violence and Public Health FLGHVLQ7H[DVWKH¿UVWGHPRQVWUDWHG The Report of the Secretary’s Task Force on Black and Minority Report of the Secretary’s TForce on Youth Suicide is released. 3 DEOHULVNIDFWRUV,QSDUWLFXODUHIIRUWVZHUHPDGHWRGHVFULEHWKHSUREOHPRIKRPLFLGHH[DPLQHHSLGHPLRORJLFFKDUDFWHULVWLFVRIGLIIHUHQWW\SHVRIKRPLFLGHFKDUDFWHUL]H Determining What Works WKHSUREOHPWRXQGHUVWDQGLQJZKDWZRUNHGLQSUHYHQWLQJLW7KHVHHIIRUWVZHUHEROVWHUHGE\WLRQDLPHGDWFXUELQJWKHKLJKUDWHVRIKRPLFLGHDPRQJ\RXWK7KHIROORZLQJ\HDUWKH&'&The Prevention of Youth Violence: A Framework for Community Actionthe more common prevention approaches Violence Prevention Timeline 1990 ³9LROHQWDQG$EXVLYH%HKDYLRU´LVHJ\,WFDOOVIRU³FRRSHUDWLRQDQGThe Youth Risk 4 Youth Violence: A Report of the Surgeon GeneralNQRZQDERXWWKHGLIIHUHQWSDWWHUQVRIRIIHQGLQJULVNDQGpeer, family, school, and community), and about the effeclighted the cost effectiveness of prevention over incarceration and set forth a vision for the 21st century. PDOWUHDWPHQW(IIRUWVZHUHPDGHWRGRFXPHQWHDFKSURE A special issue of Health Affairs 9LROHQFH3UHYHQWLRQZLWKLQWKHInjury Prevention and Control. The Division leads CDC’s efforts to prevent injuries and The Prevention of Youth Violence: A Framework for Community Action communities to effectively address 5 YLROHQFHDJDLQVWZRPHQVXUYH\&RQGXFWHGRYHUWKHQH[WWZR\HDUVWKHVXUYH\SURGXFHG In 1994, Congress passed the Violence Against :RPHQ$FW7LWOH,9RIWKH9LROHQW&ULPH&RQWURODQG/DZ(QIRUFHPHQW$FW²ODQGPDUNGLQDWHWKHLQWHUYHQWLRQDQGSUHYHQWLRQRIGRPHVWLFYLROHQFH7KH&'&ZDVJLYHQWKHIHGHUDOresponsibility to administer both efforts. The appropriations for these programs and their Moving Forward in a Global Context As public health efforts to understand and prevent violence gained momentum in the United 6WDWHVWKH\JDUQHUHGDWWHQWLRQDEURDG9LROHQFHZDVSODFHGRQWKHLQWHUQDWLRQDODJHQGDLQZKHQWKH:RUOG+HDOWK$VVHPEO\DGRSWHG5HVROXWLRQKHDOWKSUREOHP´7KHUHVROXWLRQUHTXHVWHGWKH:+2WRLQLWLDWHSXEYLROHQFHDVVHVVWKHHIIHFWLYHQHVVRISURJUDPVZLWKSDUWLFXODUand Violence Prevention to increase the global visibility of unintentional injury and violence and to facilitate public health action. The JDQL]DWLRQ¶VWorld Report on V Violence Prevention Timeline 9LROHQFHDJDLQVW:RPHQ6XUYH\The survey, conducted in 1995-data on the incidence and preva-Congress passes the Violence :RPHQ$FW7LWOH,9RIWKH9LROHQW&ULPH&RQWURODQG/DZ(QIRUFHPHQW$FWZKLFKLQFOXGHV:RUOG+HDOWK$VVHPEO\SDVVHV 6 Next Steps $VZHPRYHLQWRWKHVWFHQWXU\SXEOLFKHDOWKLVSODFLQJJUHDWHUHPSKDVLVRQGLVVHPLQDWing and implementing effective violence-prevention programs and policies. The need to document and monitor the problem and identify effective programs and policies through foundation has been laid for future success. Youth Violence Prevention: A Sour-cebook for Community ActionThe U.S. Surgeon General releases Call to Action to Prevent Sui- Injuries and Violence Prevention. for Youth Violence Prevention. The U.S. Surgeon General releases Preventionpropriations for child maltreatment 7 ReferencesZZZFGFJRYQFKVGDWDGYVOHDGBSGI$FFHVVHG1RYHPEHU:HEEDVHG,QMXU\6WDWLVWLFV4XHU\DQG5HSRUWLQJ6\VWHP:,64$56KWWSZZZFGFJRYQFLSFZLVTDUV$FFHVVHG1RYHPEHU$OFRKRO'UXJ$EXVHDQG0HQWDO+HDOWK$GPLQLVWUDWLRQ5HSRUWRIWKH6HFUHWDU\¶V7DVN)RUFHRQ