Violence and abuse are problems as significant as cancer or diabetes and must be addressed

The news media remind Americans daily that tragedy is all around. Whether it is the drowning of children, the murder of a pregnant spouse, or classroom or workplace shootings, we are made aware of the fragile nature of our existence and our sense of security. We worry about strangers who may attack, rape or rob us, or death from unknown viruses or bacteria without cures. Yet, studies repeatedly show that the greatest dangers come from among those we know, from within our families and circle of acquaintances. Each year more than 900,000 children are abused or neglected and more than 1,300 of these children die; an estimated 1.8 million women are victimized by an intimate partner and more than 1,300 of these women die; more than 450,000 elderly persons experience abuse or neglect in domestic settings.

Violence and abuse affect the health care system in many ways. Victims of abuse suffer both physical and psychological consequences. The direct costs of violence and abuse are counted in billions of health care dollars. An even greater financial impact comes from long-term consequences of abuse. Adverse childhood experiences, including exposure to violence and abuse, lead to high-risk behavior, significant increases in chronic illness, and early death. This is a health care problem as significant as cancer, diabetes, or heart disease when measured by the number of people affected or by the dollars spent. As such, it demands the unwavering attention of the medical community and a financial commitment on the same order of magnitude as that given to other major chronic health issues.

Now that medicine is aware of the impact of violence and abuse on health, we are ethically obliged to act. As physicians, we have a professional responsibility to ensure that the prevention and management of violence and abuse among our patients remains a top priority. Improving our patients' health through the elimination of violence and abuse is a challenge that can only be met through broad participation. If your state medical society or national specialty association is not currently a member of the AMA National Advisory Council on Violence and Abuse, please urge them to consider joining this work.

David McCollum, MD, AMA Advisory Council on Violence and Abuse, Chicago

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/01/26/edlt0126.htm.