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From Public Health to Personal Health: Violence against Women across the Life Span
- Anne Flitcraft, MD
- University of Connecticut Health Center New Haven, CT 06511 Requests for Reprints: Anne Flitcraft, MD, DVTP, 900 State Street, New Haven, CT 06511.
One hundred years ago, 90% of childhood deaths were caused by natural causes; this figure has steadily decreased. By 1985, only 36% of all childhood deaths were due to natural causes, and only 25% of all urban children died of natural causes. Do these percentages represent a victory for modern medicine or a profound failure? Perhaps these numbers are a testament to the success of efforts to provide clean water, improved nutrition, enhanced access to prenatal care, and prevention of infectious disease—a victory for modern medicine. But if children are not dying of natural causes, they are dying of an “unnatural” cause—that is, trauma—and we have not made parallel progress in stemming its toll. Our general failure to affect trauma can be traced to insufficient efforts to broaden the medical response to include primary, secondary, and tertiary injury prevention. As a bumper sticker on my bulletin board notes, “Injuries are not accidents.”
That simple assertion reflects the beginning of a serious consideration of the epidemiology of trauma. As the data come in, it is clear that a disturbing—and increasing—proportion of trauma cases are caused by interpersonal violence. In the mid-1980s, a public health surveillance approach to violence was implemented to establish the extent of the problem, identify risk groups and risk factors, and support program development [1]. Patterns of violence among different groups have been identified and are now beginning to inform intervention efforts. For instance, improved surveillance shows that violence against women is epidemic.
Females of every age face the threat of violence. Current estimates indicate that 1 in 5 girls is sexually abused and that the peak ages of such abuse are 8 to 12 years. The prevalence of rape in the United States is estimated to be 1 in every 4 women, with the peak incidence …
