"Encouraging safe, stable, and nurturing relationships between children and their parents or caregivers is like a vaccine against maltreatment, and its long-term consequences." - Dr. Linda C. Degutis, DrPH, MSN

Imagine the call – “5 Bravo 12 is coming in with an infant who has been shot.” Just when you think you’ve seen it all in the emergency department (ED), something else happens – something that you could not have imagined.   

The infant arrived at the ED in the arms of the paramedic who had responded to the scene, and who was trying to give him CPR, despite the bleeding from his wounds and the lack of any signs of life.  But, how else can you respond when you find an innocent 7-month-old child who is a victim of shots fired through a window?  The infant was killed, and his grandmother, who was also shot, was paralyzed. While this happened over two decades ago, I still vividly recall the reactions of the ED staff and the paramedics, much as I recall so many other cases in the ED and trauma unit that were the end result of violence.  One spring, we saw a 6-year-old who died on a school bus that was caught in the crossfire of a gang fight.  Another particularly violent summer, we cared for several young men who had been shot and were paralyzed.  We also saw the victims of retaliations – some dead, some injured, but all young men under the age of 25.  Another time, a 14-year-old boy who had been living in the streets arrived at the ED after being shot in his abdomen.  After spending 2 weeks with us in the hospital while his wounds healed and he adjusted to his colostomy, he was taken to jail for his role in gang violence that had recently occurred.   

To try and figure out how to put a stop to the killing and maiming, many of us met with several of the gang leaders and community organizations.  Ironically, the next morning, one of the gang leaders who was at the meeting was arrested and jailed for ordering the killings of three men in cold blood.  

Twenty years ago, violence had skyrocketed nation-wide, and everyone in my community was feeling its tragic results. Homicide rates among 15–19 year-old boys had increased one-and-a-half times between 1985 and 1991—a dramatic departure from rates in the previous 20 years.  And, suicide rates among young people ages 15–24 had almost tripled between 1950 and 1990.   

While we have come a long way since then, we have such a long way to go.  Violence is still one of the leading causes of death of young people; with homicide the 2^nd leading cause of death for people in the U.S. ages 15-24 and the leading cause of death for black males.  Clearly, we need to do more to stem the tide of violence and increase the potential for young people to have healthy futures.   

During the past 20 years, the CDC Injury Center has identified specific factors that either protect our children or put them at risk—not only for homicide and suicide, but also for other types of violence, including intimate partner violence, sexual violence, and child maltreatment.  We have established programs in schools, neighborhoods, cities, and states that build their knowledge, skills, and capacity to stop violence before it starts.   

We know that violence affects people everywhere, and that the long-term consequences are great. CDC research has shown that:  

• In the United States, on average, 24 people per minute, or 12 million people per year, are victims of rape, physical violence, or stalking by an intimate partner. And, victims of violence are more likely to experience long-term physical and mental health issues.
• The total lifetime cost of child maltreatment in just one year of confirmed cases (physical, sexual, and psychological abuse, and neglect) is about $124 billion. Each death due to child maltreatment had a lifetime cost of about $1.3 million, almost all of it in money that the child would have earned over a lifetime if he or she had lived. The lifetime cost for each victim of child maltreatment who lived was $210,012, which is comparable to other costly health conditions, such as stroke or type 2 diabetes.
• Exposure to violence early in life is linked to many emotional, behavioral, and physical health problems.  But we also know safe, stable, and nurturing relationships between children and their parents or caregivers are like a vaccine against maltreatment, and its long-term consequences. Healthy relationships are fundamental to the development of the brain and to physical, emotional, social, behavioral, and intellectual abilities.   

And what about bystanders? Our recent study on gang violence shows that between 2003 and 2008, bystander victims were rare among gang homicides. But while bystanders may not be showing up in the ED, young boys still are.   More than 90 percent of gang homicide victims were male and were more likely to be younger than non-gang homicide victims; 92–96 percent of gang homicides involved firearms. This underscores the need to protect our youth by helping them learn how to diffuse and resolve conflict without resorting to violence and to identify ways to prevent them from becoming involved in gangs in the first place.  

Every child deserves to be safe and healthy and to grow up and live a full and productive life. No child should ever be the victim of violence—nor do they have to be. We can prevent violence, and give children and youth health and hope for the future.