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Health Aff (Millwood). 2019 Oct;38(10):1638-1645. doi: 10.1377/hlthaff.2019.00642.

Violence And The US Health Care Sector: Burden And Response.

Author information

David C. Grossman ( David. C. Grossman@kp. org ) is senior investigator at the Kaiser Permanente Washington Health Research Institute, in Seattle.
Bechara Choucair is senior vice president and chief community health officer at Kaiser Permanente in Oakland, California.


Violence has significant impacts on the US health care sector, which include the need to care for injured victims and prevent violence to its physicians and employees, as well as the surrounding community. In 2017 violence resulted in about 2.3 million emergency department visits and 376,500 hospitalizations, with an estimated total medical cost of about $8.7 billion. Victims also often need short- and long-term physical and psychological rehabilitation. Health care workers experience the highest rates of violent injuries in the workplace in the US: 7.8 per 1,000 workers per year, compared to rates under 2.0 per 1,000 for other private industry. Treating and preventing injuries to workers in 2016 added an estimated $429 million in direct and indirect costs to US health systems. Health systems and clinicians have embraced screening and interventions in primary care, mental health care, emergency departments, and other clinical settings to prevent violence among high-risk patients, including potential victims of intimate partner violence, victims of youth violence, and suicidal patients. Some interventions include addressing patients' access to firearms, the most lethal method for assaults and suicides. Community health needs assessments help health systems identify violence as a key community health priority and lead to improvements in the delivery of violence prevention programs.


Community health; Depression; Emergency departments; Health policy; Preventive care; Public health; Systems of care; Trauma centers; Violence; Workforce issues


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