Murder & Medicine: The Transformation of Homicide to Assault

Despite the proliferation of increasingly dangerous weapons and the very large increase in rates of serious criminal assault, since 1960 the lethality of such assault in the United States has dropped dramatically. This paradox has barely been studied and needs to be examined using national time-series data. Starting from the basic view that homicides are aggravated assaults with the outcome of the victim’s death we assemble evidence from national data sources to show that the principal explanation of the downward trend in lethality involves parallel developments in medical technology and related medical support services that have suppressed the homicide rate compared to what it would be had such progress not been made. Against a baseline of 1960, we estimate that without this technology the U.S. would presently be experiencing 45,000 to 70,000 homicides a year instead of an actual 15,000 to 20,000. We estimate urban/rural-specific drops in lethality from 1964 to 1999 at between 54% to 76%, and annual weapon-specific drops in lethality at between 2.5% and 4.5%. We conclude with two county-level crosssectional analyses covering two time periods (1976 to 1989 and 1994 to 1997) that show a strong relationship between lethality and a set of medical variables, including presence of a hospital, presence of a trauma center, and countywide membership within a coordinated regional trauma system. We argue that research into the causes and deterrability of homicide would benefit from a “lethality perspective” that focuses on serious assaults, only a small proportion of which end in death