Cost-Effectiveness of Interventions
Studies show that implementing preventive interventions costs less than dealing with the outcomes of violence, in some cases by several orders of magnitude.
Examples of Cost-Saving Interventions
To date, most evaluations of preventive interventions measure cost and effects in high-income countries. Although cost savings may not be comparable in LMICs, effects may be greater.
Legislation and Shelter for Abused Women
The 1994 Violence against Women Act in the United States has resulted in an estimated net benefit of US$16.4 billion, including US$14.8 billion in averted victims' costs (Clark, Biddle, and Martin 2002). This wide-ranging legislation introduced programs aimed at deterring crimes against women and providing assistance to female victims of crimes. Interventions include penalties for repeat offenders, use of sexual history in criminal and civil cases, programs for victims of child abuse, safe homes for women, confidentiality of the abused person's address, and pretrial detention in sex offense cases. Chanley, Chanley, and Campbell's (2001) analysis shows that providing shelters for victims of domestic violence results in an estimated cost-benefit ratio of 18.4 to 6.8.
Parent Training and Home Visitation
Caldwell (1992) estimates that the costs of child abuse and neglect in Michigan are US$1 billion a year, including the costs of crimes committed by the victims of child abuse later in life and the costs of their incarceration. The study estimates that prevention costs, including a home visitor program for every family and a comprehensive parent education program, are just one-nineteenth of the cost of child abuse. Armstrong's (1983) cost-benefit analysis of a child abuse prevention program in Yeardon, Pennsylvania, finds net savings of US$647,000 per year and a cost-benefit ratio of 1.86.
Registering Firearms
Chapdelaine and Maurice (1996) quantify the costs and benefits of a Canadian law that required gun owners to register their firearms by January 1, 2001. Implementing a universal licensing and registration system cost approximately US$70 million (2001 U.S. dollars), including a significant one-time expense, compared with annual direct health care costs of gun-related violence of US$50 million. When the indirect costs of gun violence are included, the economic benefits of the law are much clearer. Miller (1995) estimates the total costs of firearm-related injuries in Canada at US$5.6 billion, including lost productivity and psychological costs, equivalent to 1 percent of Canada's GDP.
Youth Intervention
Greenwood and others (1996) compare interventions to reduce youth crime in the United States and find that providing high school students with incentives to graduate, which costs US$14,100 per program participant, is the most cost-effective intervention, resulting in an estimated 258 serious crimes prevented per US$1 million spent. Parent training prevents an estimated 157 serious crimes per US$1 million, compared with 72 for delinquent supervision programs and 11 for home visits and day care. All those interventions (excluding home visits) are more cost-effective than California's "three strikes" law, which incarcerates for life those individuals convicted of three serious crimes.
Need for LMIC Cost-Benefit Data
Though violence disproportionately affects LMICs, studies of the economic effects of violence in those countries are scarce. Comparisons with high-income countries are complicated by the tendency to undervalue economic losses related to productivity in lower-income countries, because such losses are typically based on forgone wages and income. Thus, when the costs of violent homicides are calculated, the estimates range from US$15,319 per homicide in South Africa, to US$829,000 in New Zealand, to more than US$2 million in the United States. Given the existing methodological differences and widespread gaps in the literature, systematic research into the costs of violence and the costs versus benefits of prevention efforts is urgently needed.
