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Putting a price on violence

There are some who argue that human beings are violent by nature. What can't be argued is that violence has costs – culturally, surely, but also in dollars and cents, and one of the industries where the cost impact is huge is healthcare.
In 2005, an estimated $406 billion in medical and work loss costs were attributed to injury – classified as stemming from violent and nonviolent incidences – according to the Center for Disease Control and Prevention. Violence-related deaths cost about $47 billion a year in medical and work loss costs, with the average medical costs per violence-related death at $4,196 for men and $4,231 for women.
"What we've done is we've taken an attitude as a society, and particularly in medicine, that violence is inevitable and that we can't do anything about it. I think that is just as lethal as the violent act itself," said Edward Barksdale Jr., MD, medical director for trauma and chief of pediatric surgery at University Hospitals Rainbow Babies and Children's Hospital in Cleveland.
Barksdale believes a multipronged approach – combining research and community collaboration and outreach – is the best way to attack the problem of violence. "We need to take (a) public health approach to violence and treat it like it is an infectious disease that is out of control," he said. "It is our business (to address violence) because we take care of the ravages of social problems."
A new website tool offered by the Centers for Disease Control may help by allowing people to see what needs attention. The Web-based Injury Statistics Query and Reporting System (WISQARS) Cost of Injury module enables people to generate reports on estimated costs (based on 2005 dollars) associated with fatal or nonfatal injuries classified by intent and mechanism of injury or by body region and nature of injury. Reports for specific regions, genders and ages may also be created and statistics may be expressed at national, regional or state prices and broken into medical and/or work loss costs.
Violence experts say healthcare systems can make an impact on violence by instituting some internal policies.
For example, Baltimore-based Clinical psychologist Michael Heitt says, urban hospitals can reach out to communities by hiring people from their neighborhoods and offering work training, job coaches, mentoring programs and social services.
"Those are all modes of community outreach that benefit the hospital and benefit the community," he said.
Screening for partner violence and child mistreatment in the emergency department is a good way to curb the costs of violence, said Phaedra Corso, head of the Department of Health Policy and Management at the University of Georgia and an author of violence-related studies. For exampled, a woman who is not identified as a victim of partner violence will return to the ED repeatedly.
"So our healthcare system can do itself a favor by screening for violence," Corso said, and by getting the victim into a safe environment. "The utilization of the healthcare stops because the abuse stops."