Healthy People 2030 organizes the social determinants of health into 5 domains:
- Economic Stability
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood and Built Environment
- Social and Community Context
Crime and Violence are key issues in the Neighborhood and Built Environment domain.
Crime and violence experienced by individuals living in a community is an important public health issue. People can be exposed to violence in many ways. They may be victimized directly, witness violence or property crimes in their community, or hear about crime and violence from other residents.1
Violence can lead to premature death or cause non-fatal injuries.2 People who survive violent crime endure physical pain and suffering3 and may also experience mental distress and reduced quality of life.3 Repeated exposure to crime and violence may be linked to an increase in negative health outcomes.4 For example, people who fear crime in their communities may engage in less physical activity.5 As a result, they may report poorer self-rated physical and mental health.5 One study found that people who perceive their environment to be less safe from crime may also have higher body mass index scores and higher levels of obesity due to reduced physical activity.6
Exposure to violence in a community can be experienced at various levels, including victimization, directly witnessing acts of violence, or hearing about events from other community members. It can also include property crimes that result in damage to the built environment.7 Crime rates vary by neighborhood characteristics. Low-income neighborhoods are more likely to be affected by crime and property crime than high-income neighborhoods.8
Children and adolescents exposed to violence are at risk for poor long-term behavioral and mental health outcomes regardless of whether they are victims, direct witnesses, or hear about the crime.9 For example, children exposed to violence may experience behavioral problems, depression, anxiety, and post-traumatic stress disorder.10 Children exposed to violence may also show increased signs of aggression starting in upper-elementary school.11 Children exposed to several types of violence over long periods of time are more likely to experience anxiety, depression, and behavioral problems compared to children with only moderate exposure to violence.12
The effects of exposure to violence in childhood may be seen in adulthood and can result in greater risk for substance use, risky sexual behavior, and unsafe driving behavior.13 Individuals exposed to violence at any age are more likely to engage in and experience intimate partner violence.14, 15 Women exposed to intimate partner violence have an increased risk of physical health issues such as injuries, and mental health disorders such as disordered eating, depression and suicidal ideation.16
There are serious short- and long-term health effects from exposure to crime and violence in one’s community. Addressing exposure to crime and violence as a public health issue may help prevent and reduce the harms to individual and community health and well-being. Additional research is needed to increase the evidence base for what works to reduce the effects of crime and violence on health outcomes and disparities. This additional evidence will facilitate public health efforts to address crime and violence as a social determinant of health.
Disclaimer: This summary of the literature on crime and violence as a social determinant of health is a narrowly defined review that may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges or as additional research is conducted.
i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.
ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.
Hartinger-Saunders RM, Rine CM, Nochajski T, Wieczorek W. Neighborhood crime and perception of safety as predictors of victimization and offending among youth: A call for macro-level prevention and intervention models. Child Youth Serv Rev. 2012;34(9):1966-73.
Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. 2002;360(9339):1083-8.
McCollister KE, French MT, Fang H. The cost of crime to society: New crime-specific estimates for policy and program evaluation. Drug Alcohol Depend. 2010;108(1-2):98-109. doi: 10.1016/j.drugalcdep.2009.12.002.
Margolin G, Vickerman KA, Oliver PH, Gordis EB. Violence exposure in multiple interpersonal domains: Cumulative and differential effects. J Adolesc Health. 2010;47(2):198-205. doi: 10.1016/j.jadohealth.2010.01.020.
Meyer OL, Castro-Schilo L, Aguilar-Gaxiola S. Determinants of mental health and self-rated health: A model of socioeconomic status, neighborhood safety, and physical activity. Am J Public Health. 2014 Sep;104(9):1734-41.
Brown BB, Werner CM, Smith KR, Tribby CP, Miller HJ. Physical activity mediates the relationship between perceived crime safety and obesity. Prev Med. 2014;66:140-144.
Buka SL, Stichick TL, Birdthistle I, Earls FJ. Youth exposure to violence: Prevalence, risks, and consequences. Am J Orthopsychiatry. 2001;71(3): 298-310.
Kang S. Inequality and crime revisited: Effects of local inequality and economic segregation on crime. J Popul Econ. 2016;29(2):593-626.
Jones-Webb R, Wall M. Neighborhood racial/ethnic concentration, social disadvantage, and homicide risk: An ecological analysis of 10 U.S. cities. J Urban Health. 2008;85(5):662-76. doi: 10.1007/s11524-008-9302-y.
Fowler PJ, Tompsett CJ, Braciszewski JM, Jacques-Tiura AJ, Baltes BB. Community violence: A meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Dev Psychopathol. 2009;21(01):227-59.
Guerra NG, Huesmann LR, Spindler A. Community violence exposure, social cognition, and aggression among urban elementary school children. Child Dev. 2003;74(5):1561-76.
Margolin G, Vickerman KA, Oliver PH, Gordis EB. Violence exposure in multiple interpersonal domains: Cumulative and differential effects. J Adolesc Health. 2010;47(2):198-205.
Brady SS. Lifetime community violence exposure and health risk behavior among young adults in college. J Adolesc Health. 2006;39(4):610-13.
Beyer K, Wallis AB, Hamberger LK. Neighborhood environment and intimate partner violence a systematic review. Trauma Violence Abuse. 2013;16(1):16-47.
Raghavan C, Mennerich A, Sexton E, James SE. Community violence and its direct, indirect, and mediating effects on intimate partner violence. Violence Against Women. 2006;12(12):1132-49.
Stockman JK, Hayashi H, Campbell JC. Intimate partner violence and its health impact on ethnic minority women. J Womens Health. 2015;24(1):62-79.