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Tuesday, November 22, 2011

What does violence cost us?

In a most fascinating group of studies, the National Academies Press has published Social and Economic Costs of Violence: Workshop Summary. Of particular interest is a series of papers that consider the direct and indirect costs of violence. Clearly, as a society, we are putting out very significant amounts of money as a result of violence. In the first of these papers, Waters et al., identify that in the USA, the cost of interpersonal violence equals about 3.3% of that country's GDP. The majority of costs are born by publicly funded services. Consider the GDP figures (US Dollars):

Canada - 1.57 trillion - 2010

Australia - 954 billion - 2009

Germany - 3.3 trillion - 2010

South Africa - 363 billion - 2010

Switzerland - 523 billion - 2010

UK - 2.246 trillion - 2010

USA - 14.5 trillion - 2010

One immediately gets the sense that, even with variations in rates of inter personal violence (IPV), the costs are extraordinary. The study considered various forms of IPV including child abuse and neglect, violence in intimate relationships, elder abuse, sexual violence, violence in the workplace and youth violence. The study authors are from John Hopkins University, the World Bank and the World Heath Organization.

A second study by Dong looking at elder abuse raises the challenge that many forms of abuse are likely underreported. Perhaps only 1:14 cases come to the attention of authorities suggesting that some costs are being borne by society without society knowing that is what is being paid for. It also suggests that the victims are not being identified. As Deng notes, "Elder abuse includes physical abuse, sexual abuse, emotional abuse, neglect (both caregiver and self-neglect), and financial abuse. Available prevalence data suggest that at least 10 percent (or 5 million) of the U.S. elderly persons experience abuse each year, and many of them experience it in multiple forms " (p.6-16). The implications for morbidity and mortality are significant.

As Hemenway notes in his brief paper, the costs can be difficult to fully quantify because the nature of many costs can be intangible. Take the costs related to street violence. He states:

"There are also large psychological costs caused by street violence. Exposure to violence (e.g., witnessing violence) increases the risk for psychiatric, emotional, behavioral, and health problems. Psychiatric problems include posttraumatic stress disorder (PTSD), depression, anxiety, intrusive thoughts, sleep problems, and personality change. Emotional problems include anger, nervousness, withdrawal, loneliness, and despair. Behavioral problems include low academic performance, risky sexual behavior, substance abuse, delinquency, and violence. Finally, exposure to violence has been linked to such health problems as asthma, heart disease, and low birth weight babies.

There are also high community costs of street crime that accrue when people and institutions try to avoid the shootings and protect themselves. Commercial and residential locations can be affected. Businesses do not want to locate in areas of high crime, tourists do not want to go there, and people do not want to live there. This leads to fewer jobs and to flight from the neighborhood of higher-income people who can afford to leave (e.g., “white flight”). The loss of jobs, good stores, community social capital, and positive role models leads to neighborhood deterioration.

To avoid being shot, residents also change their behavior concerning recreation, shopping, leisure, and other activities. Children are not allowed to play outside, residents are less likely to go out at night, and they are less likely to accept evening work. People live behind locked doors. Having fewer people on the street further reduces the safety of being on the street". (p.6-24).

Another paper by Huesmann from the University of Michigan, reports that violence is highly contagious. He states:

"One of best-established findings in the psychological literature on aggressive and violent behavior is that violence begets violence. This contagion of violence appears to be a universal phenomenon. The contagion of violence occurs within families. Violence between partners increases the risk of violence directed at children and increases the risk of the children behaving violently themselves. Having one violent individual in a family makes it more likely there will be others. It is true within peer groups. Violence by some peers increases the risk of violence by others. Violence by peers directed outward not only stimulates violence by others that is directed outward, but stimulates violence between peers within the group. This is true in neighborhoods and communities. Violent communities and neighborhoods breed violence in those who join the community or neighborhood. Introducing violence into a community increases the risk of greater violence throughout the community. It even appears to be true within nations and cultures, and it is true across generations. Children “catch” it from their parents, and parents can catch it from their children.

Violence is highly contagious. Not only is it spread from the perpetrators of violence to the victims, but it is spread to onlookers and observers. It is not surprising that violent victimization leads to violent retaliation within and between families, peer groups, schools, communities, ethnic groups, cultures, and countries. What may be more surprising to some is that simply the observation of violence also leads to increased violence within and between all of these groups". (p. 6-25).

A final paper in this section looks at the implications of fear on children and their development. There are long term implications for the developing brain which impacts learning, family life, work productivity and other economic inputs. In their paper Fox and Shonkoff note:

"The scientific knowledge around fear and anxiety points to three important implications:

1. Young children can perceive threat in their environment, but unlike adults, they do not have the cognitive or physical capacities to regulate their psychological response, reduce the threat, or remove themselves from the threatening situation. As a result, serious fear- triggering events such as family violence can have significant and long-lasting impacts on the developing child, beginning in infancy.

2. Children do not naturally outgrow early learned fear responses over time. If young children are exposed to persistent fear and excessive threat during particularly sensitive periods in the developmental process, they may not develop healthy patterns of threat or stress regulation. When they occur, these disruptions do not naturally disappear.

3. Simply removing a child from a dangerous environment will not by itself undo the serious consequences or reverse the negative impacts of early fear learning. Children who have been traumatized need to be in responsive and secure environments that restore their sense of safety, control, and predictability—and supportive interventions are needed to ensure the provision of these environments". (p.6-34).

This data has very significant implications for child protection. Clearly, children left in violent and fear inducing homes are harmed and the impact is long term. Child protection should not dither in helping those families. Getting the right interventions in place quickly is vital. Removing children needs to be done when parents are unable or unwilling to change. Failing to act is a direct price that a child pays and that price is not included in the cost of violence.


Patel, D.M. & Taylor, R.M. (eds) (2011). Social and Economic Costs of Violence: Workshop Summary. Washington DC: National Academies Press.

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