A few weeks ago, I attended a lecture at Harvard Medical School regarding youth violence as it relates to healthcare disparities. The lecturer, Edward Barksdale, is a graduate of Harvard Medical School and now is Chief of Pediatric Surgery at Rainbow Babies & Children’s Hospital in Cleveland, OH. He spoke of his first weekend on call in Cleveland when his first patient, a teenager who looked like his own son, was brought in after suffering multiple gunshot wounds. The teen died before he even reached the hospital. His second patient was a child brought in due to his injuries from the ongoing child abuse occurring at home. This child subsequently died as well. Within hours, a 2 year-old was brought in after suffering gunshot wounds, clearly as an innocent bystander. And this was just his first night on call….
Dr. Barksdale likes to think of youth violence as a virus—it can spread among individuals (and communities), as well as be passed down through generations. I have heard other experts in this field use the quote,“Hurt people hurt people.” Such analogies shed a somewhat hopeful perspective on an otherwise grim picture. Viruses can be “treated”, or at the very least, transmission of viruses to others can often be prevented. In the same way, identifying perpetrators of violent crime as “hurt” implies an injury of sorts. Injuries, if tended to, can often heal with time.
For over a decade now, youth violence has increasingly been recognized as a public health issue rather than merely a criminal justice problem. The CDC tracks national rates of youth violence and the statistics are sobering: In 2010, 4,828 young people ages 10 to 24 were victims of homicide—an average of 13 each day. Among 10 to 24 year-olds, homicide is the leading cause of death for African Americans and the second leading cause of death for Hispanics. (1)
The CDC tracks national rates of youth violence and the statistics are sobering: In 2010, 4,828 young people ages 10 to 24 were victims of homicide—an average of 13 each day.
Clearly this problem, like many other public health issues, disproportionately affects youth of color and underrepresented minorities. Just as living in a poor neighborhood limits an individual’s access to affordable healthy food or top-notch education, it also increases one’s chances of becoming a victim of violence.
One of the benefits of shifting the focus on youth violence from a purely criminal to more of a public health concern is that this naturally leads to research and literature examining the causes of youth violence which may shed light on opportunities for prevention and early intervention. For example, recent research has shown that the reasons for adolescents and young adults violent behavior is not always as apparent as it may seem. There are often assumptions that young gang members are simply “thugs” who are lazy, choosing not to engage in any legitimate type of education or work. A study published this year in the American Journal of Public Health gave a voice to young inner-city men of color who were in prison for serious violent crimes.
One of the common pathways to early violent death that thematically emerged in this study was the concept of violence as a form of labor. With few to no prospects for employment, inner-city young males were often forced to rely on crime and violence as work and a means of financial support, which included selling drugs, robbery, drive-by shootings, and burglary. (2) I don’t cite this analysis as a way of making excuses for violent offenders, but as a suggestion that we reconsider our assumptions that such individuals are choosing the wrong path in spite of a smorgasbord of viable options (including education, employment, etc.) Such research suggests that part of violence prevention ought to focus on seemingly unrelated factors such as education reform, skills training, and job growth in specific neighborhoods.
By defining youth violence as a public health concern, we can also employ tactics which have been successful in championing other issues within public health. For example, gunshot wounds have a relatively lower incidence rate compared to injuries suffered from motor vehicle accidents. However, the latter carry a much lower injury burden despite occurring more often. This results from years of intensive research and injury prevention efforts to improve child motor vehicle safety (e.g., booster seats, rear-facing car seats, seatbelt safety). In addition to scientifically investigating causes of child motor vehicle injuries, pediatricians and public health advocates partnered with national organizations (such as the National Highway Traffic Safety Administration), the automotive industry, and local governments to achieve the significant drop in childhood motor vehicle deaths (3). There is no reason why reducing the mortality of gunshot wounds and other violent injuries will not require the same broad-based, interdisciplinary partnerships.
By defining youth violence as a public health concern, we can also employ tactics which have been successful in championing other issues within public health.
To this end, the CDC’s Division of Violence Prevention is leading an evidence-based national initiative: Striving To Reduce Youth Violence Everywhere (STRYVE). Utilizing information from the available data, STRYVE guides communities affected by violence to facilitate comprehensive, integrated activities to address youth violence. My own city of Boston was awarded funds through STRYVE to increase the capacity of the local public health department to employ youth violence prevention strategies which are based on the best available evidence. Unfortunately, such endeavors reveal the paucity of rigorous, evidence-based research in this area. Hindsight from previous public health efforts remind us that research-driven data is crucial to “best support the scale-up of evidence-based approaches, and build prevention infrastructure and capacity in communities to allow sustainability” (4). This will not only require public health investigators to evaluate the issues at hand but ongoing financial backing from public-private partnerships, buy-in from the affected communities, as well as support from the general public.
Christin Price is a physician completing her training as a clinical and research fellow in Infectious Diseases at Brigham and Women’s Hospitals and Massachusetts General Hospital. Prior to this, Christin went to Weill Cornell Medical College for medical school followed by an internship and residency in Internal Medicine at Brigham and Women’s Hospital where she will return next year as a Chief Resident. Her clinical interests include caring for patients with HIV and hepatitis C. Her main research interests include prevention/intervention among patients who have HIV and/or hepatitis C in the setting of substance use/addiction.
 Richardson JB et al. Pathways to early violent death: the voices of serious violent youth offenders. Am J Pub Health 2013; 103: e5-e16.
 Newguard CD. Gunshot injuries in children served by emergency services. Pediatrics 2013; 132(5):862-70.
 Haegerich TM et al. Advancing research in youth violence prevention to inform evidence-based policy and practice. Injury Prevention 2010; 16(5): 358.