Notwithstanding some of the braying from elected officials and aspiring political candidates, violent crime rates in the United States, especially murder, have declined materially since the early days of the pandemic when homicide rates spiked to 7.8 per 100k. As a point of comparison, Jamaica sadly suffered with 61 murders per 100k in 2023 while Bahrain only had 0.07 per 100k. Fortunately of all the ways to die, murder is estimated to be only 0.7% of all deaths globally, but the amount of resources dedicated to preventing and then prosecuting a homicide is extraordinary. According to the Bureau of Justice Statistics data, the U.S. justice system employs 2.17 million people and costs $255 billion annually to operate. As a point of comparison, the digital health sector saw $78 billion invested in nearly 2,300 companies over the last five years, perhaps framing a debate about best allocation of resources.
According to a 2010 study at Iowa State University, the cost per murder is $17.25 million ($24.15 million in 2024 dollars) which includes the costs incurred by the criminal justice system, direct victim costs, the lost productivity for both victim and murderer, and arguably the hardest to estimate, the public’s cost to prevent future violence. The last category includes training, public awareness programs, and other social services focused on early intervention before a violent crime is committed.
The World Health Organization (WHO) estimated that there were 475k murders globally in 2019 (the latest year for comprehensive data, so pre-pandemic) or 6.2 murders per 100k. Homicide by gender diverged significantly with 9.8 males per 100k versus only 2.4 for women. Perhaps not surprising, those aged between 15-29 experienced the greatest homicide rate at 9.8 per 100k as compared to those between 0-14 years old and over 60 years of age at 1.2 and 5.0, respectively. As a majority of those murdered are young males, the WHO observed that societies that experience a profound political transition and displacement, coupled with absence of foundational societal structures, tend to experience elevated homicidal rates.
The Centers for Disease Control and Prevention most recent data show that there were 24,849 murders in 2022. Obviously, the onset of the pandemic had a dramatic impact on overall murder rates; there were “only” 18,830 murders in 2018. Stresses induced by the pandemic, proliferation of firearms, and social tensions clearly contributed to the heightened incidence. The data underscore that much of the increase in violent crime was centered around cities, often times accompanied by spectacular headlines.
Notably, violent crimes have declined 2.6% in 2023 in major cities in the U.S. with the murder rate dropping 10.4%. According to AH Datalytics, a criminal justice consulting firm, year-to-date 2024 violent crime across the 263 largest American cities has declined a further 18.7% when compared to the similar period in 2023 (although notably, firearm industry advocates strongly suggest that there is a fundamental data reporting issue as many precincts are not submitting data). Should this pace be maintained over the balance of this year, the murder rate will return to 2014 levels, which was a 30-year low. Perhaps not surprising, not every city saw declines as five of the top 20 cities experienced increased ratee (Atlanta, Charlotte, Los Angeles, Louisville, St. Louis). Fortunately, for those of us living in Boston, this has been a relatively quiet year. This storyline will continue to play a prominent role in the 2024 elections.
Source: AH Datalytics, Axios.
Framing violent crime as a public health crisis has sought to emphasize prevention over prosecution. Prevention and intervention prioritize initiatives around more responsive family and social services, workforce training and development, removing vacant buildings, improving public spaces, coupled with more visible and responsive police forces in the communities they serve.
Causation or correlation? States that tend to underinvest in public safety net healthcare programs, such as Medicaid, tend to exhibit higher homicide rates. Obviously, the factors that contribute to this relationship are nuanced, multi-factorial, and complex. Simply investing more resources in public health may not be enough to meaningfully lower homicide rates, but the phenomenon is real and provocative.
Source: KFF analysis of T-MIS Research Identifiable Files (Health Tech Nerds).
According to Federal Bureau of Investigation data, homicide rates by 100k are elevated along the swath of southern states arching into the mid-Atlantic region. Quite clearly, at least for Medicaid spending per enrollee, the Southeast is significantly lower than most other regions of the country, almost by 50+%.
Given the consequences of homicide are so profound and destabilizing for the surviving family and impacted community, increased issues of anxiety, aggression, sense of heightened vulnerability, depression, and post-traumatic stress disorder are observed, which further increases the costs borne by society. Even more acute are the impacts on those who survive an attempted murder or have been shot, particularly among the youth who likely will suffer a lifetime of related conditions.
A study published in Health Affairs in 2023 looked at 2k young shooting survivors and saw a 144% increase in substance use disorders, 117% increase in pain disorders, and 68% increase in psychiatric disorders. Given those issues, annual healthcare costs for those victims increased 17-fold to $35k.
Source: Health Affairs (November 2023).
If there is a silver lining to all of these data, it is that humans appear to be less barbaric to one another over the arc of history. While of no comfort to those who are suffering collateral damage from homicide today, advances in technology, specifically healthcare technology, may continue to chip away at this scourge. Unfortunately, it does not appear that sensible gun policies will be our reality any time soon. And keep in mind as tragic and devasting as the nearly 25k murders in 2022 are, 480k people died from smoking last year, 178k died from alcohol abuse, 108k died from drug overdose, and 43k from car accidents.
The question in front of all of us is do we have the collective fortitude to direct resources to address what is in our immediate control.
Homicide Rates Over Time (per 100k)
Source: World Health Organization Mortality Database (2022).
On the Flying Bridge 
Mike,
Your friends at Uncornered have amazing statistics on their impact in Boston and Kansas City. However, the individuals involved are too modest by half! Bill Darling
really well said!!