MotherJones MJ93: A social disease

Dr. Mark Rosenberg thinks violence, like smallpox, can be prevented. But reactions to his idea have been, well, violent.

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A bright red “A” rests on the windowsill in Dr. Mark Rosenberg’s modest office at the Centers for Disease Control in Atlanta. The symbol is as powerful for Rosenberg, an epidemiologist, as it was for Nathaniel Hawthorne 150 years ago, although it has a rather more modern meaning. It stands for “accident,” as in “three people died in a boating accident today,” and visitors are forbidden to speak it. Rosenberg fines anyone who does twenty-five cents.

“The word implies that this is something that can’t be prevented,” says Rosenberg, associate director of the CDC’s National Center for Injury Control. “But I’ll make the blanket statement: There is no such thing as an accident.”

Instead, he explains, there are injuries, which he divides into two categories: intentional injuries (violence that people inflict upon themselves and others) and unintentional injuries (most car crashes, burns, drownings, poisonings, falls, etc.). None of these injuries, Rosenberg insists, are “accidents.” If a window-washer falls to his death, that death is the result of inadequate safety gear. Not only is the fatality statistically predictable, it is preventable. So is a child’s overdose from good-tasting aspirin that comes in bottles of a hundred rather than thirty. And, if Rosenberg is right, that same predictability applies to violence.

Unlike traditional social thinkers, Rosenberg doesn’t see violence as a matter for the courts, prisons, and police. He instead thinks of violence as a public-health problem–metaphorically, a social illness–best addressed by the tools of preventive medicine. Just as other epidemiologists try to prevent outbreaks of disease, Mark Rosenberg is trying to prevent eruptions of violence.

Acts of violence are the most frightening source of injuries, and America is the most violent country in the industrialized world. Every year approximately fifty-two thousand Americans are killed or kill themselves. Hundreds of thousands more are injured in violent incidents.

Most doctors don’t concern themselves with preventing violence, only with healing its wounds. Rosenberg, a forty-seven-year-old with an intelligent, youthful face, is starting to change that. Working thirteen-hour days that start at 4:30 a.m., he has pushed violence prevention to the top of the public-health agenda.

Rosenberg grew up in Montclair, New Jersey, and went to Harvard, where he concurrently earned a medical degree and a master’s degree in public policy. He then worked for the CDC in India before returning to pursue a degree in psychiatry. He first became involved in violence prevention in 1983, when the CDC asked him to create a new program in the field.

The CDC had launched other efforts to reduce unintentional injuries– in particular a campaign for auto safety dating to the late 1950s–but people were still skeptical of Rosenberg’s program. Many doctors “felt [violence prevention] was a law-enforcement problem,” says Dr. George Lundberg, editor of the Journal of the American Medical Association.

Rosenberg agrees that the criminal justice system is necessary, but he believes that its flaws make it inadequate: Police respond to injuries only after they occur. The courts punish offenders but don’t benefit victims. And, judging by the rising crime rates, the entire system does little to deter violence.

“The older methods of law enforcement have simply not worked,” Lundberg says. “In fact, things are getting worse steadily, at least in certain populations and certain areas. So when you’re a physician and you keep seeing dead patients, you have to ask yourself, ‘Might there not be a better way to do this?'”

Rosenberg’s crusade was to find the better way, to win over the skeptics by applying the tools of injury control to violence prevention. “The conception was that we would look at suicide and homicide and assault,” Rosenberg says, “and by analyzing large numbers of cases, we would identify the patterns behind them, and the patterns would suggest how we might intervene to prevent these problems.”

Rosenberg’s statistical analysis painted a revealing picture of violence in America. It showed that violence transpires overwhelmingly between people who know each other, are drinking, and have gotten into an argument. And it showed that if there was a gun around, there was a good chance that someone would get killed.

The statistics also revealed which groups are hardest hit by violence. Before Rosenberg investigated it, “If you had said to someone, ‘Homicide is the leading cause of death among young black men,’ they would have said, ‘Oh, I don’t think so,'” says Mark Moore, a professor of criminal justice at Harvard’s Kennedy School.

The National Center for Injury Control, working on a relatively paltry budget of $32 million, is dispensing initial violence-prevention grants to try to save those in the greatest danger. A study they funded in Durham, North Carolina, is testing whether youths with jobs are less prone to violence than those without. And a Houston, Texas, program teaches conflict-resolution skills in schools. “The bottom line,” Rosenberg says, “is that you have to convince kids that it’s better to be a chicken for one minute than to be dead for the rest of their lives.”

These deliberately modest programs combine aspects of traditional social work with scientific methods. Rosenberg evaluates and quantifies the results, taking nothing for granted. “Before you invest $2 billion in a national program, it would be nice to know if it worked,” Rosenberg says. “You have to test it.” In the meantime, he strongly supports proven intermediate steps, like placing metal detectors in schools.

Rosenberg’s efforts have met with surprising opposition. “The very notion of violence as a public-health problem undercuts the true causes of violence in the inner city and the most fundamental cause of all, white racism,” says Peter Breggin, a Maryland psychiatrist (himself white) who is concerned with questions of race. “All this stuff is a waste of time, it’s misleading, and it fattens white people.”

Breggin’s opinion of Rosenberg’s work is shared by the Washington, D.C.-based Committee to Stop the Federal Violence Initiative. The committee, most of whose members are black, fears that behavioral modification programs will be discriminatorily targeted at minorities. The group wants more attention paid to poverty, unemployment, and racism, arguing that if these were eradicated, the problem of violence would ebb.

Rosenberg agrees that the United States needs to address social injustice. During Senate testimony on gun control, he made a point of remarking that “public health is not enough–we also have to address underlying causes.” But he is concerned that the committee will jeopardize community support and federal funding for anti-violence programs.

“Some people charge that this public-health approach is really an attempt to pacify people,” Rosenberg says. “We’re trying to do exactly the opposite–to get people to believe that they can change things and that they have much more power when they don’t give up.”

Rosenberg admits that preventing violence won’t make a perfect world. It won’t banish the sting of racism or the hunger of poverty. “But maybe,” he says hopefully, “while you’re working on ways to do that, there are other things you can do to save lives.”

Some of those other things have the National Rifle Association up in arms. One of the most powerful lobbies in the country, the NRA has become Rosenberg’s greatest opponent because of his repeated assertion of the link between firearms and injury.

Rosenberg doesn’t claim that firearms cause violence, just that when violence erupts and firearms are around, the toll is much higher. In 1986 and 1987, the most recent years for which statistics are available, 66,182 Americans died from gun wounds, more than died in nearly nine years of fighting in Vietnam. One in twenty children are now estimated to have carried a handgun to school at some point.

The NRA questions both Rosenberg’s motives and his methods, claiming that he has a knee-jerk hostility to guns and supports only research that reinforces his bias. “Essentially, the CDC is a gun-control organization,” says Dr. Paul Blackman, an NRA researcher who monitors the health agency. “They want a ban on handguns, and, failing that, they want all sorts of other gimmicks regulating handguns.” (Rosenberg’s ideas for decreasing gun injuries include banning certain sizes of bullets, mandating rubber bullets, and requiring that all new guns have “loaded indicators.”)

Blackman keeps the pressure on by filing Freedom of Information requests for CDC grant information, arguing that “tax dollars are being wasted by Rosenberg and his friends.” He also writes papers with titles such as, “Children and Firearms: Lies the CDC Loves,” which he delivered at the American Society of Criminology’s annual meeting.

Rosenberg knows that the NRA can create major headaches for him on Capitol Hill, and so, on the subject of gun control, he is wary. If he longs for a ban on handguns, he won’t admit it. Instead, he says that he aims not necessarily to ban such weapons, but to keep guns from killing people.

“You can make the best progress in government by being scientific and objective,” he says. “And if you’re supposed to be scientific and objective, you can’t really advocate.”

But it’s clear Rosenberg is an advocate, if only because of the humanity of his work. An expert photographer since college, Rosenberg has published two books of photography that contrast the coldness and sterility of medical technology with the inspiring warmth and humanity of the ill and injured. In the more recent book, Just Being Vi, he documents the life of Viola Harwell, a Tennessee woman permanently crippled when her state trooper husband shot her in the neck. Author and subject are now close friends, but it took time for Rosenberg to gain her trust. “I didn’t want to be bothered and would treat him very nasty,” Harwell recalls. “But he would always come back. Mark would not give up.”

Rosenberg’s perseverance–and his empathy for the individuals behind the statistics–might prove enough to convince his medical colleagues that violence prevention falls under the public-health agenda. If that were to happen, Rosenberg believes, the world would be a safer place.

Richard Blow is a free-lance writer living in Washington, D.C. His articles have appeared in the Washington Post, the New York Times, the New Republic, and Rolling Stone.


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