Violence and Public Health: To suture and to rupture

PURPOSE: To explore how and why violence became a public health issue, to investigate the field's definition of violence, and to consider the possibilities and limitations of this definition for public health practitioners and researchers who seek to address the social conditions and inequities that inform violence. METHODS: Content analysis of the public health literature on violence. The research design utilized emergent coding based on three major U.S. Surgeon General reports on violence, and key word searches for “violence” and “violence and public health” on MEDLINE and American Journal of Public Health (AJPH) databases (N=1024). Random sampling of the AJPH literature was conducted to perform the content analysis (ss=194; 95% CI; 10% CL). OUTCOMES: a substantial increase in the propensity of public health literature on violence between 1979 and 2006, from 22% to 60% respectively; identification and focus on violence as interpersonal, intentional, and physical; an increase, over time, in attention to the social determinants and inequities that influence violence; and a constant emphasis on interventions that target individual behavior change, with the focus of such change directed primarily at structurally vulnerable communities. CONCLUSION: A chasm exists between the field's increasing recognition of the upstream determinants of violence and the downstream interventions that focus on changing the behaviors of individuals that bear the burden of these determinants. Reconsideration of the field's conceptualization of violence (from interpersonal to structural) will help researchers and practitioners close this chasm, more effectively aligning research and intervention efforts to address the upstream factors of violence.