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Measuring the cost of injury: underestimating the costs of street violence
  1. David Hemenway
  1. Correspondence to Professor David Hemenway, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 2115, USA; hemenway{at}hsph.harvard.edu

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The Centers for Disease Control and Prevention (CDC) website (http://wisqars.cdc.gov:8080/costT/) provides precise estimates of the cost of injuries. For example, one can quickly find the cost in 2005 for unintentional poisoning deaths ($22.018239 billion) and homicides ($20.002002 billion). The CDC cost estimates come from adding the medical costs to the productivity losses, with productivity costs for these deaths accounting for well over 99% of the total estimated cost.

A prime reason for making these cost estimates is to inform policy decisions concerning the proper allocation of scarce resources. Unfortunately, if the relative estimates are misleading, they can lead to inefficient decisions.1 The CDC relative cost estimates are particularly misleading for homicides.

The cost burden of injury might be divided into three components—the cost to: (1) the individuals directly involved; (2) family and friends; and (3) the community at large.2 The cost estimates available on the CDC website are only costs to the individuals directly involved (and then only for the victim). In addition, the costs are only for a narrowly-defined cost of physical injury—the estimates exclude pain, suffering, lost quality of life and psychological costs such as post-traumatic stress disorder (PTSD). In addition, the cost estimates are only for the injury itself, not the injury incident. In other …

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