Executive Summary

The Corporate Response To Violence

Richard A. Norling
President & CEO of Fairview Health System

January 1996

The Fairview Health System is committed to improving the health of the communities we serve. To achieve that end, Fairview practices continuous quality improvement (CQI). This means systematically measuring and improving health care delivery processes. Our goal: The highest quality care efficiently delivered in a respectful manner. But our CQI orientation is changing.

While still dedicated to improving care in our clinics and hospitals, our CQI efforts must move upstream if community health is to improve. In other words, we must do what we can to keep people from needing our acute services in the first place.

Asked recently to define a healthy community, a cross section of American adults identified four characteristics: low crime rate, a good place to raise children, low levels of child abuse, and a place where people are unafraid to walk alone at night. Significantly, more people used those terms than medical measures like low rates of infant mortality, cancer or heart disease.

Violence is one of the upstream causes having a major impact on health care costs. Recently, Dr. Leroy Schwartz, president of Health Policy International, Princeton, New Jersey, published alarming data on the impact of socio-behavioral problems on healthcare in the U.S. He argues that these problems inflate America's healthcare bill well beyond what other industrialized countries spend.

Direct medical costs associated with violence are one major factor. The direct medical costs of gunshot injuries exceeded $4 billion in 1995. The average cost of a hospital admission resulting from a firearm injury exceeds $53,000. Assaults outpace auto accidents as causes of fatal injuries in nine states. The U.S. homicide rate among those under age 25 is 800 percent higher than in the next closest country in the world!

This grim picture led the American Medical Association to call violence a public health emergency. The Fairview Health System takes very seriously our community health responsibility to address upstream causes and our commitment to address the problem of violence.

As one of the nation's largest providers of mental health and chemical dependency services, Fairview treats both victims and perpetrators. Increasingly however, we are involved with initiatives to prevent violence. Womankind, a Fairview program, is regarded nationally as a model for effective healthcare intervention in domestic abuse. The Fairview Foundation collaborated with the Department of Health to launch different ABC projects, Actions Benefiting Children. Each of our hospitals has active community health programs, many targeting violence reduction. Currently, we are developing an initiative to reduce media violence, which contributes to the overall problem. One of our employees, psychologist David Walsh, has emerged as a national leader on the issue.

Fairview alone cannot stop the scourge of violence. We do believe it is our responsibility to do what we can, and we believe it is incumbent upon all businesses to do the same. Whether considered from a quality of life or a bottom line perspective, violence affects all companies. Violence increases the cost of doing business: higher health care premiums, increased security, increased taxes, higher absenteeism, and lost productivity.

A deep strain of disrespect and violence infects our culture. There is no quick fix, no one solution. The good news is we can change cultural norms when we realize it is in our best interest. Changed attitudes toward tobacco and drunk driving are two examples. Those public health problems have not been eliminated, but we can take satisfaction in having made significant progress. Working together, we can - and must - do the same to reduce violence in our community.

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