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By Nikki Meredith
Publich health officials are setting out to conquer violence in American as though it were a virus.
ONE AMERICAN kills another every 23 minutes. Homicide has doubled in this country in the past 20 years and is now claiming more than 20,000 lives a year. Many of our law enforcement agents have given up trying to figure out why. According to a recent FBI report, “Murder is primarily a societal problem over which law enforcement has little or no control.” Public health officials say it’s time they had a crack at reducing the devastation.
“Violence is every bit a public health issue for me and my successors in this century as smallpox, tuberculosis, and syphilis were for my predecessors in the last two centuries,” says U.S. Surgeon General C. Everett Koop. “Violence in American public and private life has in deed assumed the proportions of an epidemic.”
An epidemic is defined as a condition occurring at a rate exceeding its natural occurrence. American homicide qualifies because it has increased so dramatically since the 1960s. At least 80 percent of the countries that report homicide statistics to the United Nations have rates lower than the U.S. rate of almost 10 for every 100,000 citizens. The few countries with higher rates include South Africa, Nicaragua and Mexico. Mexico, at 17 per 100,000 population, has one of the highest in the world, whereas Canada has a mere two per population 100,000.
One manifestation of the recent public health interest in homicide is the formation of the Violence Epidemiology Branch at the federal Centers for Disease Control in Atlanta. “One of the main missions of the CDC is to prevent premature and unnecessary death,” says Mark Rosenberg, chief of the newly formed unit. “Contrary to the hopelessness that currently exists among the public, a significant number of homicides can be prevented.”
This optimism derives, in part, from past triumphs over many of the world’s most pernicious afflictions and a belief that the comprehensive approach of the public health discipline will lead to solutions that previous, more circumscribed efforts haven’t.
To date, much of the work on homicide has focused on individual behavior. “Because of this concentration on the individual, we haven’t gotten anywhere,” says Garen Wintemute, assistant professor at the University of California at Davis Medical School. “Epidemiology is not just a science of people. When we look at the occurrence of disease in a population, we look at the host, the disease agent, and we look at the environment. There isn’t any other science that does that.”
As applied to homicide research, the duo of the murderer and the victim could be considered the host, the weapon is considered the disease agent and the circumstances surrounding the homicide fall into the environment category. However, because existing data on homicide are so limited, the CDC and other health agencies have a long way to go before filling in the necessary data of the public health model. “It is impossible to overestimate how little we know,” says Franklin E. Zimring, director of the University of Chicago’s Center for Studies Criminal Justice and one of only a few people who have done systematic homicide research over the past two decades. “If we think of the causes and variations of the homicide rate as a jigsaw puzzle, then a third of that puzzle is now assembled into subassembled pieces, and those subassembled pieces do not fit with each other, and there are 700 loose ends.”
Zimring says that most of the previous research was too general. “Getting specific is tremendously important. We spend millions of dollars each year trying to find out which flu we ought to vaccinate against—A or B or Hong Kong or Philippine—and that’s very much the approach that I think we ought to be taking to the varieties of life-threatening criminal violence.”
Homicides have typically been separated into three categories: about one third are between intimates—family members or lovers; one-third are between acquaintances; and one-third are between strangers. In recent years, the rate in the last category has risen dramatically while the other two have remained relatively stable. Zimring says the classification needs to be examined much more carefully. “What the hell is stranger-to-stranger violence? If you ask a man who he had lunch with on a certain day and he replies, ‘I had lunch with someone, not my wife,’ would you be satisfied with that answer? That’s as specific as police agencies get with that category, and it’s not enough. We need to know who these strangers are and why the rate is going up.”
One result of poor research is the oft-sounded alarm over the large number of children under 16 now committing murder. Zimring recently completed a study on youth homicide in New York which revealed that not to be true. “We found that only two to four percent of all the killings in New York City are attributable to kids under 16. They’re not even doing their share—but no one had before done the basic homework to find out that age is an important predictor of homicide. Our study found that a 13-year-old is one-seventh as likely to kill you during a robbery as a 19-year-old.
In an effort to identify people who are at risk of being killed and the factors that put them at risk, the CDC has begun to sponsor detailed studies in various cities around the country. In Los Angeles, Nancy Allen at UCLA’s Neuropsychiatric Institute and colleagues recently analyzed every homicide that occurred in that city from 1970 through 1979—a total of 4,950 cases. They classified each homicide by age, sex, and race of the victim and the offender, when the offender was known; location of the event; method; motive; and relationship between victim and suspect.
The data are still being processed, but according to CDC sociologist James Mercy, early results indicate that as the homicide rate remained somewhat stable in the rest of the nation, it was increasing by 84 percent in Los Angeles. “Something is happening in Los Angeles that isn’t happening in the rest of the country. The task now is to find out why.”
Zimring says that unexpected and quirky patterns make the work of a homicide buff exciting these days. “In the ’60s all you could see were tremendous increases in the homicide rate. Everything went up everywhere. But now all kinds of crazy things are happening. It’s up in one city, down in another, stabilized in another. There are an awful lot of interesting tea leaves to be read out there.”
One of the shifts that is being examined carefully is the pattern of homicide among black men. As a group, American blacks consistently kill far more often than whites, and since most of their victims are black, the homicide rate for blacks is significantly higher than for whites. Nationally, it is 10 times higher for black men than white men and five times higher for black women than white women. In Oakland, California, black men between the ages of 25 and 35 suffer a gun homicide victimization rate of 120 per 100,000 (Oakland is located in Alameda County, which has an overall rate of 7.4 per 100,000). By some estimates, homicide is currently the number one killer of black men aged 15 to 39.
(It is important to note that blacks were not carriers of the homicide disease when they were brought from Africa. When last studied, the homicide rate in some sections of black Africa was about the same as the homicide rate in Western Europe and well below the rate in either white or black America. Indeed, the black American homicide rate was three to five times that of some black African tribes.)
Throughout the years various explanations for the extraordinarily high numbers of killings among blacks have been proposed, the most prominent one being the existence of a subculture that not only tolerates violent behavior but expects and promotes it as the residue of a history of slavery, lynchings, and other forms of violent racism combined with the effects of discrimination, unemployment, and poverty.
In view of this explanation, researchers have been surprised to find that homicide victimization among young black men aged 15 to 24, while still much higher than the rate for all people in the same age group, actually decreased more than 25 percent in the 1970s. Certainly the rate of unemployment and poverty among blacks has not improved during this period.
“If we can identify the factors responsible for the decrease, then we are on to something,” says Rosenberg, who speculates that some of the factors for the decline have to do with better integration of blacks into the mainstream and the maturing of the baby boom generation, which has resulted in a decrease in the numbers of young men—the group most prone to violence.
But the baby boom factor has also affected white males, for whom homicide victimization in the same age group has increased. In 1965, the homicide rate for young white males was 4.9 per 100,000 By 1980, it had tripled to 15.5 per 100,000. So far, no one can satisfactorily explain this dramatic increase.
In South Carolina, public health researcher Greg Alexander examined homicide and violence victimization in that state from 1970 to 1979 and was surprised to find not only a decrease in the homicide rates for black men, but a point in the late 1970s where the violence rates for white men and black men were equal. Alexander says he’s not sure to what extent his findings can be generalized to the national population.
Murder rates in the South are significantly higher than in the North among both blacks and whites. Recent research, however, indicates that geography is not the reason. When sociologist Colin Loftin, who is currently at the University of Maryland, analyzed the homicide rates for both populations, he found that once he accounted for educational levels and annual incomes, the geographical differences were no longer significant. “The homicide rate for people in the South is highest among people well below the poverty level and with less than five years of education. The homicide rate among people in the northern states who are in the same circumstances is just as high there. There are just are more poor people in the South. The majority of the more than 20,000 people in this country who are victims of homicide are dirt poor people who have been killed by dirt poor people.”
But neither is poverty alone a sufficient condition for high homicide rates. The extreme poverty of Haiti may drive its desperate natives to flee the country; it does not, however, seem to cause them to kill each other in great numbers.
Homicide researchers emphasize that contradictions such as these that underscore how little is known about the causes of homicide and they point to the need for more systematic and detailed research.
Rosenberg and others talk vaguely about improving social and cultural factors. These goals sound uncomfortably like some of those of Lyndon Johnson’s war on poverty—noble in purpose but less than impressive in effecting significant social change. For example, Rosenberg says: “Some people have suggested that young black men have little to live for and that consequently their lives or the lives of their friends may not be worth much to them. Maybe starting with very young kids in schools and the message churches are giving them that they are worth something might make a difference.
Some researchers claim that although the concept is out of fashion, the only way to reduce homicide appreciably is to “do something” about unemployment and poverty.
CDC Director James Mason resists this sort of global approach. He points out that other public health measures have been successful with poverty-related problems—such as venereal disease lead poisoning, and tuberculosis—without trying to alleviate the social problems related to them. “In the same way, I think we can do something about violence without first having to come up with the solution to poverty. In three to four years, there will still be poverty, but we will have to reduce violence.”
When it comes to preventive medicine, public health people are champions of what they call environmental risk reduction. The model for the effectiveness of the approach is the dramatic gain made in highway safety. For years, the National Safety Council campaigns focused on the behavior of the driver. But it wasn’t until modifications in the environment were instituted—such as breakaway lampposts, center dividers, collapsible steering wheels, padded dashboards, and 55-mile-per-hour speed limits—that there was a significant reduction in highway deaths.
Most public health professionals say a similar environmental shift must be made in the area of homicide, and that translates to control of handguns. The degree to which handguns contribute to the homicide rate may be debated, but most who have studied the issue seriously—at least those with no financial or emotional ties to the National Rifle Association—agree that guns play a central role in elevated homicide rates.” Anyone who believes that cigarettes contribute to lung cancer will, after reviewing the evidence, be convinced that firearms—particularly handguns—increase the risk associated with criminal assault,” says Ziering.
Two-thirds of all homicides in the United States are committed with guns; 75 percent of these are with handguns. And while our rate of homicide with other weapons is three times higher than that of England, Germany, Denmark, or Japan, our gun homicide rate is 50 times that of those countries.
Advocates of gun ownership say those statistics are meaningless because people who kill are going to kill with whatever means is available. Most homicides, however, are not planned but seem to result from a dispute in which the most readily available weapon is used. When that happens to be a knife — the second most common weapon used in homicides — the victim has a much better chance for survival: the death rate for all victims assaulted with guns is five times that for those assaulted with knives.
Detroit psychiatrist Emanuel Tanay says impulsive homicide is the result of three circumstances: a relationship that is creating tension; a sudden explosion that disrupts a person’s usual control; and having a suitable tool available. “A baseball bat will do, but if it’s a baseball bat, the result probably won’t be homicide,” he says. “First of a it’s difficult to kill someone with a baseball bat, and since the act of lifting it discharges aggression, it’s possible the individual using it will be back to normal before anyone is hurt.”
There are some researchers who claim that guns are more psychologically accessible than other weapons. “The distance that usually exists between the assailant and the victim permits a feeling of detachment and a blurring of personal responsibility,” says Richard Seiden, former professor at the University of California at Berkeley School of Public Health.
Tanay, who is a long-time advocate of gun control legislation, says handguns are what converts homicidal urges—urges that everyone feels—into homicide. “Murderous wishes, murderous rage, and murderous fantasies occur in every human being.” He says the gun proponent bumper sticker that proclaims, “Guns don’t kill people, people kill people,” is absolutely right. “That,” Tanay says, “leads to the option of eliminating people or guns. To change people into creatures incapable of aggressive impulses would be like trying to cure prostitution by eliminating the sexual drive.”
Most people who buy guns have no they intention of becoming murderers—they buy them to protect themselves and their families. Consequently, as the rate of violent crime goes up, so does the public’s fear and so do gun sales. The result in the 1960s was a domestic arms proliferation as intractable as the international arms race. Americans own more guns per capita than any other people in the world: It is estimated that there are between 30 million and 50 million handguns currently on the streets and 2.5 million manufactured annually.
Guns purchased for protection are rarely used for that purpose. Many are stolen in home burglaries and used to kill people in the commission of crimes. Others are used by family members against each other. One study found that accidental firearm deaths are six times as frequent as purposeful killings of residential intruders.
It is unlikely, however, that the CDC will address the handgun issue in the near future. “Because of the Reagan administration’s anti-gun-control stance, the CDC has tiptoed around the issue of gun control,” says one CDC staff member who insists on anonymity. “The violence branch is in a fledgling state. If it steps too hard on the gun issue, it would be squashed in a heartbeat.”
Although the ban on gun research is not an official policy of the CDC, researchers both within the agency and on the outside suspect that gun-related research will not be funded soon. Many frustrated researchers liken this restriction to studying lung cancer without being able to consider cigarettes. “Studying the agent is a major and well-validated approach to studying health problems,” says Wintemute, the University of California, Davis researcher who recently finished a comprehensive gun-related death study in California. “You can’t study violence without studying firearms and without studying the other means by which violence is perpetrated.”
Zimring, who has done extensive gun research, says it’s impossible to ignore the gun issue. He says his life would be simpler if he researched homicide without including handguns, but it would be like going to Tibet and not seeing Mount Everest.
Short of taking on the Reagan administration and the powerful gun lobby, some believe much can be done in the area of education. “I think it is scandalous that when people purchase a gun to protect themselves from a robbery, they are not informed of their statistical chance of being killed or having some one in their family killed with that gun,” says Ziering.
Zimring is hopeful that once data on patterns of homicide are assembled, key people who are not yet involved in the gun ownership issue might speak out. Minority group leaders, for example. “Even though blacks are disproportionately victimized by homicide, Jesse Jackson has not gotten up and yelled, ‘Get the goddamn guns out of your house.’ That’s public health education.”
The problem, of course, is that regardless of the fact that guns endanger the families of their owners, they do offer a sense of security. Gun owners are guided by emotional, not actuarial, considerations. According to Maryland sociologist Colin Loftin, people will buy guns as long as they feel threatened, and the only way to stop them from doing so is to build confidence in law enforcement. “When people do not have collective trust, they arm themselves, and that escalates the violence.”
From that point of view, neighborhood crime watch programs are helpful because they make people feel safer and, perhaps, less likely to purchase guns. Also, public health programs have had some success in reducing victimization among particularly vulnerable groups. In San Francisco’s Tenderloin district—a high crime area where the elderly are frequent victims of assailants—a series of “safehouses” has been created. Forty two stores, bars, and hotels display the figure of a dove in a birdhouse to indicate that senior citizens can enter whenever they are afraid.
Instituting the safehouses, along with increased policing, has resulted in a 17 percent reduction in crime in the area, but the perception of safety has been increased by much more. Senior citizens interviewed about the program say they feel at least 50 percent safer. “The attitude in this neighborhood several years ago was, ‘I have to take care of myself,'” says safehouse
cofounder Robin Wechsler. “Now we’re a family. We’re a neighborhood.”
Zimring believes people also should be informed about patterns of victimization. “People want to know if someone apprehends them in the street, should they resist or should they cooperate?” In an effort to answer some of these questions, Zimring and James Zuehl of the University of Chicago recently conducted a study in which they compared nonfatal robberies to fatal ones in Chicago. The results demonstrated clearly that cooperation is safer: Resistance occurred in only eight percent of the total robberies but produced 51 percent of the deaths. “The evidence is overwhelming. Somebody sticks a gun in your ribs and wants your purse, give them your purse.”
In another effort to control a specific piece of the violence epidemic, the CDC is evaluating the effectiveness of existing programs aimed at reducing conflict particularly between family members, friends, and acquaintances. In public health parlance, dispute-related homicides are considered primary homicides—that is, they are not connected with other crimes (as are secondary homicides). The CDC considers the two types “epidemiologically dissimilar” because the motivations and circumstances are so different. Other public health agencies, however, do not make this distinction. James Mercy, a sociologist with the Violence Epidemiology Branch, says the agency is examining programs that teach people in high-risk groups how to handle conflicts in nonviolent ways.
In its search for techniques aimed at conflict reduction, the CDC has taken particular interest in an approach developed by Arnold P. Goldstein, a psychologist who teaches aggressive people alternatives to aggressive behavior. For example, he works with prisoners, teaching them how to negotiate, in hopes of reducing violent interactions in prison. “I teach a guy how not to punch someone in the face who comes up and demands a cigarette.”
Although Goldstein says he has successfully applied his approach to groups outside the controlled prison environment, he has found that there are many for whom his approach is too late. “We have to give up on some people and concentrate on individuals for whom there is still hope,” he says. Consequently, he is eager to teach nonaggressive styles of behavior to kids in school, before they come into contact with the criminal justice system.
In fact, the frontier of intervention research is prescriptive work—that is, matching diagnosis with optimal treatment and acknowledging that all “treatment” is not effective with all groups. Because of this, the CDC says not enough data are available to recommend intervention on a large scale.
Although both the causes of homicide and the solutions remain elusive, public health’s enthusiasm and nascent commitment offer hope in what has been an otherwise hopeless situation. “Public health people are bringing a whole new mindset to the problem,” says Wintemute, who is sanguine about the ability of those in his field to get results despite the obstacles. “We examine more of the variables, and we don’t insist that we have to change the fundamental nature of people in order to do something about a health problem. And unlike other disciplines, we take the results of our scientific work to the public and into the legislative arena.
To those who doubt the ability of public health measures to change behavior, researchers point to the campaign against smoking. “The reduction of smoking in this country was the result of the cumulative effect of many changes,” says Lawrence Wallack at the University of California School of Public Health in Berkeley. “There was the Surgeon General’s report on smoking and lung cancer in 1964; then there were the magazine and newspaper articles, which were followed by the changes in advertising and the warning labels on the cigarette packages; then came the politicization of the nonsmokers and their increased courage to demand nonsmoking areas. All of this was accompanied by a new interest in physical fitness.
“Each of these steps may be a small and insignificant event in it’s own right, and we probably overestimate the importance of any one event while underestimating the importance of all of them taken together,” says Wallack. “And yet, it is estimated that cigarette consumption is about one-third lower now than it would have been had none of these things taken place.
In his book The Exploits of the Incomparable Mulla Nasrudin, Sufiwer Idries Shah, in a parable about fate, writes about the many culprits of murder:
“‘What is Fate?’ Nasrudin was asked by a scholar.
‘An endless succession of intertwined events, each influencing the other.’
‘That is hardly a satisfactory answer. I believe in cause and effect.’
‘Very well,’ said the Mulla, ‘look at that.’ He pointed to a procession passing in the street.
‘That man is being taken to be hanged. Is that because someone gave him a silver piece and enabled him to buy the knife with which he committed the murder: or because someone saw him do it; or because nobody stopped him?'”