COMBINING THE SCATTERED DATA FROM VIOLENT DEATHS

What proportion of murders are related to drug trafficking? How often do
suicide victims act immediately after a marital split, loss of a job or
some other personal crisis? Where are teenagers who shoot others most
likely to obtain the weapons they use?

No one, say public health and law enforcement authorities, has accurate
answers to these and other critical questions about the 50,000 violent
deaths that occur annually in the United States, even though the knowledge
could help agencies establish better preventive programs and policies.

To address this information deficit, local and federal officials are
collaborating on an effort to develop the nation's first comprehensive
system for collecting data about violent deaths.

Each state and local jurisdiction maintains its own system for gathering
information about homicides and suicides, and little effort is currently
made to link various pieces of data from police and F.B.I. reports, crime
labs, death certificates, coroners' exams and other sources. That makes it
impossible to compile the kind of useful national statistics that have been
standard for years for automobile fatalities.

"It's surprising that there hasn't been a national system, especially when
you look at the toll that homicide and suicide take both in costs and in
terms of life lost," said Richard Withers, co-director of the Firearm
Injury Center at the Medical College of Wisconsin.

Since 1999, the Firearm Injury Center and agencies in nine other states
have collected comprehensive data from various law enforcement and public
health sources as part of a pilot program coordinated by the Harvard School
of Public Health. Now the Centers for Disease Control and Prevention,
working closely with the Harvard researchers, has adopted a similar
approach to put in place the first phase of what it is calling the National
Violent Death Reporting System.

In September, the agency announced awards totaling $7.5 million over five
years to six states - New Jersey, Maryland, Massachusetts, Oregon, South
Carolina and Virginia - that have agreed to collect more than 100 pieces of
information about each violent death.

These factors include, for example, the role played by drugs or alcohol,
the relationship between perpetrators and victims, the type and source of
the weapons used, whether incidents occurred at home or elsewhere, the
mental and physical health of those involved and whether police or social
service agencies had received prior warnings of domestic violence or child
abuse. In each case, the names of everyone involved will be removed from
the data to protect confidentiality.

Dr. Len Paulozzi, director of the new C.D.C. initiative, says he hopes to
expand the reporting system, estimating that a national program will cost
about $20 million a year.

"We just don't have the information about violent deaths in this country
that we need to have, that will allow us to identify trends and risk
factors in an adequate way," Dr. Paulozzi said. Suicides and homicides
account for, respectively, 57 percent and 33 percent of violent deaths, he
noted, with the remaining 10 percent including such categories as "events
of undetermined intent," "unintentional firearm fatalities" and people
killed during the performance of law enforcement duties.

Dr. Paulozzi and the researchers with the Harvard project cite as an
important precedent the system established in the 70's to gather detailed
information about every motor vehicle fatality. This wealth of data related
to traffic deaths has allowed federal and local agencies to enact measures
- - like laws on seat belts, air bags, car design and speed limits - that
have saved tens of thousands of lives over the years.

"When you die in a car crash, there's a tremendous amount of information
that's collected, from what type of car you were in, to what the visibility
was, to the type of road, so we know a tremendous amount about what works
and what doesn't to save lives," said Catherine Barber, co-director of the
Harvard-sponsored pilot program.

"So you think, wow, we know so much about this car crash area, what do we
have going in homicides and suicides, and we've got almost nothing," she
added. "It's no good to have the coroner collecting very nicely documented
information if it's going into a desk drawer. You want it to go into a
standard national database."

One reason it has taken so long to develop such a system, say public health
experts, is that law enforcement agencies and medical examiners are, by the
nature of their work, more focused on investigating the causes of
individual events than on establishing broad social patterns. In addition,
the national battle over gun control has led many researchers, especially
those receiving government money, to proceed cautiously so as not to be
accused of pursuing a backhanded crusade for greater firearm restrictions.

And violent deaths have not generally been regarded as a public health
problem in the same way as infectious illnesses, for example.

People understand that collecting information on tuberculosis or sexually
transmitted diseases helps officials develop prevention and treatment
strategies, says Dr. Lenora Olson, associate director of the Intermountain
Injury Control Research Center at the University of Utah, one of the sites
participating in the Harvard project. But homicide has more often been
treated as a moral and law enforcement issue and suicide as an individual
or family-related mental health problem, she said.

"This is part of a paradigm shift that lets us look at violent deaths with
an epidemiological approach, not just as accidents that can happen to
anyone," she said. "By finding out the who, how, where and why, we realize
there are patterns. If we can predict them, then we can intervene."

The federal effort does not expect to generate much data before the end of
2003. But participants in the Harvard program say their efforts have led to
some provocative findings that may provide valuable clues to private and
public agencies developing law enforcement policies as well as suicide,
domestic violence and child abuse prevention programs.

The Medical College of Wisconsin, for example, found that, in 2000, 40
percent of local firearm suicide victims had revealed their plans to
another person. In Miami-Dade County in Florida, investigators determined
that half of the gun-related deaths of children under the age of 10
occurred in incidents of domestic violence directed at the mother.

And in Pittsburgh, Deborah Friedman, an epidemiologist at the Center for
Violence and Injury Control at Allegheny General Hospital, has uncovered a
tantalizing piece of information: homicide and suicide rates in the region
dropped significantly in the three months after Sept. 11, 2001. She hopes
that additional information from other data-collection sites will help
illuminate the reason for the decline, although she suspects that it has to
do with the bonding effect of the terrorist attacks.

"There's a theory that when traumatic events occur, a type of societal
cohesion occurs because they now have a common enemy instead," she said.
"And I think in terms of suicide, people become less focused on themselves
and more focused on the group."