http://www.nytimes.com/2003/01/14/health/policy/14VIOL.html?tntemail1
From NY Times 01/15/03. Requires registration for access.
From NY Times 01/15/03. Requires registration for access.
Combining the Scattered Data From Violent Deaths
By DAVID TULLER
What proportion of murders are related to drug trafficking? How often do suicide victims act immediately after a marital split, loss of a job or some other personal crisis? Where are teenagers who shoot others most likely to obtain the weapons they use?
No one, say public health and law enforcement authorities, has accurate answers to these and other critical questions about the 50,000 violent deaths that occur annually in the United States, even though the knowledge could help agencies establish better preventive programs and policies.
To address this information deficit, local and federal officials are collaborating on an effort to develop the nation's first comprehensive system for collecting data about violent deaths.
Each state and local jurisdiction maintains its own system for gathering information about homicides and suicides, and little effort is currently made to link various pieces of data from police and F.B.I. reports, crime labs, death certificates, coroners' exams and other sources. That makes it impossible to compile the kind of useful national statistics that have been standard for years for automobile fatalities.
"It's surprising that there hasn't been a national system, especially when you look at the toll that homicide and suicide take both in costs and in terms of life lost," said Richard Withers, co-director of the Firearm Injury Center at the Medical College of Wisconsin.
Since 1999, the Firearm Injury Center and agencies in nine other states have collected comprehensive data from various law enforcement and public health sources as part of a pilot program coordinated by the Harvard School of Public Health. Now the Centers for Disease Control and Prevention, working closely with the Harvard researchers, has adopted a similar approach to put in place the first phase of what it is calling the National Violent Death Reporting System.
In September, the agency announced awards totaling $7.5 million over five years to six states - New Jersey, Maryland, Massachusetts, Oregon, South Carolina and Virginia - that have agreed to collect more than 100 pieces of information about each violent death.
These factors include, for example, the role played by drugs or alcohol, the relationship between perpetrators and victims, the type and source of the weapons used, whether incidents occurred at home or elsewhere, the mental and physical health of those involved and whether police or social service agencies had received prior warnings of domestic violence or child abuse. In each case, the names of everyone involved will be removed from the data to protect confidentiality.
Dr. Len Paulozzi, director of the new C.D.C. initiative, says he hopes to expand the reporting system, estimating that a national program will cost about $20 million a year.
"We just don't have the information about violent deaths in this country that we need to have, that will allow us to identify trends and risk factors in an adequate way," Dr. Paulozzi said. Suicides and homicides account for, respectively, 57 percent and 33 percent of violent deaths, he noted, with the remaining 10 percent including such categories as "events of undetermined intent," "unintentional firearm fatalities" and people killed during the performance of law enforcement duties.
Dr. Paulozzi and the researchers with the Harvard project cite as an important precedent the system established in the 70's to gather detailed information about every motor vehicle fatality. This wealth of data related to traffic deaths has allowed federal and local agencies to enact measures - like laws on seat belts, air bags, car design and speed limits - that have saved tens of thousands of lives over the years. "When you die in a car crash, there's a tremendous amount of information that's collected, from what type of car you were in, to what the visibility was, to the type of road, so we know a tremendous amount about what works and what doesn't to save lives," said Catherine Barber, co-director of the Harvard-sponsored pilot program.
Combining the Scattered Data From Violent Deaths
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"So you think, wow, we know so much about this car crash area, what do we have going in homicides and suicides, and we've got almost nothing," she added. "It's no good to have the coroner collecting very nicely documented information if it's going into a desk drawer. You want it to go into a standard national database."
One reason it has taken so long to develop such a system, say public health experts, is that law enforcement agencies and medical examiners are, by the nature of their work, more focused on investigating the causes of individual events than on establishing broad social patterns. In addition, the national battle over gun control has led many researchers, especially those receiving government money, to proceed cautiously so as not to be accused of pursuing a backhanded crusade for greater firearm restrictions.
And violent deaths have not generally been regarded as a public health problem in the same way as infectious illnesses, for example.
People understand that collecting information on tuberculosis or sexually transmitted diseases helps officials develop prevention and treatment strategies, says Dr. Lenora Olson, associate director of the Intermountain Injury Control Research Center at the University of Utah, one of the sites participating in the Harvard project. But homicide has more often been treated as a moral and law enforcement issue and suicide as an individual or family-related mental health problem, she said.
"This is part of a paradigm shift that lets us look at violent deaths with an epidemiological approach, not just as accidents that can happen to anyone," she said. "By finding out the who, how, where and why, we realize there are patterns. If we can predict them, then we can intervene."
The federal effort does not expect to generate much data before the end of 2003. But participants in the Harvard program say their efforts have led to some provocative findings that may provide valuable clues to private and public agencies developing law enforcement policies as well as suicide, domestic violence and child abuse prevention programs.
The Medical College of Wisconsin, for example, found that, in 2000, 40 percent of local firearm suicide victims had revealed their plans to another person. In Miami-Dade County in Florida, investigators determined that half of the gun-related deaths of children under the age of 10 occurred in incidents of domestic violence directed at the mother.
And in Pittsburgh, Deborah Friedman, an epidemiologist at the Center for Violence and Injury Control at Allegheny General Hospital, has uncovered a tantalizing piece of information: homicide and suicide rates in the region dropped significantly in the three months after Sept. 11, 2001. She hopes that additional information from other data-collection sites will help illuminate the reason for the decline, although she suspects that it has to do with the bonding effect of the terrorist attacks.
"There's a theory that when traumatic events occur, a type of societal cohesion occurs because they now have a common enemy instead," she said. "And I think in terms of suicide, people become less focused on themselves and more focused on the group."
