Introduction: violent injury is like a chronic disease

Mass casualty shootings push violence to the forefront of the US public's attention. While the events at the Washington Navy Yard, Aurora, Newtown, and Oak Creek were horrific tragedies, many Americans live in communities where violent injury is an everyday event. In 2012, mass casualty shootings resulted in 88 fatal and 102 non-fatal injuries.1 Yet, in the same year, 388 fatal and 8662 non-fatal aggravated assault injuries were reported to the police in Philadelphia alone.2

Nationwide, the Centers for Disease Control and Prevention (CDC) estimate that 1.7 million non-fatal assault injuries were treated at hospitals in 2011.3 The year prior, homicide was responsible for 16259 deaths. The incidence of violent injury is disproportionately high among racial and ethnic minority males in low-income communities. In 2011, African–American men aged 18–27 years were treated in hospitals across the country for an estimated 90 854 non-fatal assault injuries—approximately one injury per 38 individuals in this demographic group, compared with one injury per 86 non-Hispanic white men of the same age. Homicide is the leading cause of death among African–Americans aged 15–34 years, and the second leading cause of death among Hispanics in this age group, but only the fifth cause among non-Hispanic whites.

With violent injury contributing to excess mortality and racial and ethnic health disparities in the USA, many have deemed interpersonal violence to be an ‘epidemic’ that should be treated like an ‘infectious disease.’4 Although this analogy is useful in promoting a public health approach to violence prevention, it also likens violent injury to an acute illness and shapes the design of preventive interventions that treat it as such. Evidence of the recurrent nature of violent injury and its sequelae, however, suggest that violent injury might be more appropriately viewed through the lens of a chronic disease model.5 , …