Pubdate: Tue, 14 Jan 2003
Source: New York Times (NY)
Copyright: 2003 The New York Times Company
Contact:  http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: David Tuller

COMBINING THE SCATTERED DATA FROM VIOLENT DEATHS

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.

"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."
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