If you are interested in gun violence, then sooner or later you have to pay some attention to the issue of violence in general, if only because you really can’t have one without the other.  In that respect, it’s worthwhile to read a new article on violence that is based on a two-year study of ER-admitted patients between the ages of 14 and 24 in Flint, Michigan – that’s right – the same Flint made famous by Michael Moore in his Roger and Me 1989 documentary that made both the filmmaker and the city famous.  When Moore made his film the city was in the throes of a virtual collapse given the closing of its GM plant and the collapse of related industries; now the city’s poverty rate is 40% so you can’t say that things have improved very much, right?

On the other hand, what comes out in this study is that poverty and related social ills does not, in and of itself, necessarily account for recurring, violent injuries in the group selected for this study.  In fact, what seems to be the overwhelming factor in promoting recurring violence is the outbreak of violence in the first place.  And this finding is demonstrated brilliantly in this study because the researchers had the good sense to not only look closely at 349 subjects who sought ED medical care for violent injury over a two-year period, but to compare this population to 250 persons in the same age cohort who came in initially for non-violent injury during the same two-year period.

violence                Guess what?  Both groups had a fairly similar public assistance profile (78% and 70%), a very similar racial profile (African-Americans were 63% and 56% respectively),the exact same marijuana use (nearly 100% in both groups) and virtually identical criminal records (13%-12%.)  In other words, being underprivileged, prone to using drugs and having contact with criminal justice doesn’t necessarily lead to violent behavior, at least not of the type that results in continuous visits to an ER for serious injuries, up to and including death.

I should mention one brief corrective, namely, the authors’ comments about the cost of such behavior.  They quote a study published by the Urban Institute in 2013 which found that firearm injuries alone cost $630 million, most of which has to absorbed by the publicly-funded medical system.  On the other hand, Jarone Lee and others recently published an article in Surgery which might place those costs much higher, although they defined the problem in a somewhat different context than what was used by the authors who wrote for the urban Institute.  But this is a minor squabble and shouldn’t take away from the remarkable study on recurrent injury that needs to be read and circulated for the following reason.

What the researchers on recurrent violence found was not only that multiple ER visits for violent injury was segmented between the two groups whereas both groups shared demographic and social conditions in common, but the most frequent rate of recurrence was in the first six months following discharge from the initial visit for violent injury.  This clearly indicates that recurring violence is, as the research team says, a chronic disease and should be treated as such.  But, in contrast to other chronic diseases like asthma and diabetes, there is no management plan for recurring violence that could be used to cut ED costs, never mind reduce the social impact of the disease on its victims.

If a consensus ever emerged on how to deal with tis chronic illness called recurring violence, it would have to include a sub-plan for dealing with guns.  The FBI tells us that more than 80% of all homicides involve people who knew each other before the murder took place.  Take a chronic perpetrator or victim of violent injury, put a gun in his hand and it will go off.  This study strongly suggests that immediate, post-discharge intervention might cut down the rate of violent injury.  Which means that such interventions must include keeping this population away from guns.