Last year, the board of directors of the newly formed California Wellness Foundation set out to find a health-related cause worthy of $30 million.
They passed over prenatal care. They rejected vaccination. Instead, startling the research community, the board announced its first major grant program for a subject that the public only recently began to link to public health: violence prevention.
The program, launched by the foundation created by Health Net as part of a state-brokered deal that allowed the HMO to drop its nonprofit status, was by far the largest private contribution ever made to the public heath approach to violence prevention.
The foundation is funding violence research by nine fellows into topics such as why some people are repeat victims of violence, and which programs best curb aggression in children. But rather than wait for results, the foundation is also funding dozens of grass-roots violence prevention programs, and has created an organization to lobby for less violence in movies and television.
Its approach mirrors new research being done across the country in the area of violence prevention. Investigators say their research is distinct from medical research into what some think may be genetic explanations for violent behavior--criticized as overly deterministic by some public health experts.
Instead, Wellness Foundation researchers and other public health investigators are focusing on social causes, and education programs and government policies to prevent violence.
Researchers seek to prevent violence in the same ways they would seek to prevent any epidemic--by applying the standard tools of the disease scientist's trade. The method is no different whether the disease in question is violence, yellow fever or dysentery, researchers say. Only the solutions vary--what washing hands and building sewers are to digestive parasites, job programs and anger-management training may be to violence.
Using this model, epidemiologists map the progress of the so-called violence epidemic, identify vulnerable "host populations" and risk factors, and seek vectors or transmitters that help it spread. Then they identify policy changes that might prevent it, and educate people about behaviors that promote the disease.
Public health researchers first began attempting to frame shootings, stabbings and assaults as manifestations of disease more than a decade ago. Today, it appears that efforts to instill this approach in the public consciousness have gone a long way toward success. Newspapers casually refer to the "epidemic of violence." Aspects of the public health approach are found everywhere, from presidential speeches to television sitcoms.
And money has followed. Where violence, the social problem, was long too political for mainstream foundations, violence, the public health problem, is a magnet for corporate grants.
Not just the Wellness Foundation, but the Carnegie Corp. of New York, the Joyce Foundation and the Ford Foundation in recent years have announced new grant programs for violence prevention.
Advocates say the change is a result, in part, of a concerted campaign to reframe age-old arguments about gun control and media violence in terms of public health.
"Once it becomes a public health problem, people from all ends of the political spectrum can own the issue," explained Howard Kahn, Wellness Foundation president.
"Before, it was just 'Build more prisons,' " said Susan B. Sorenson, an associate research epidemiologist at UCLA's School of Public Health, who has received a Wellness Foundation grant. Now, she said, public health researchers have succeeded in getting physicians, and even police, to look at the economic and social context in which violence occurs.
The Wellness Foundation's research grants will further advance incursions of epidemiology--the study of disease--into the area of violent crime.
"Instead of a virus, think of a bullet," said Andrew McGuire, executive director of the San Francisco-based Pacific Center for Violence Prevention, which is funded by the Wellness Foundation.
Not all supporters take the disease model so literally. But they see clear benefits in defining violence in terms of disease rather than criminality.
They point to widespread changes in national attitudes and policies brought about by public health campaigns to limit smoking and drunk driving, and argue that the same changes can occur in the area of violence once it comes to be seen as a matter of public health.
The Wellness Foundation will provide about $5 million in grants over six years. This year's initial awards total nearly $1 million to five California universities and the state Department of Health Services to pay for research by nine academic fellows, including psychologists, epidemiologists and surgeons.
Dozens of grants will also go to community leaders who organize grass-roots programs to prevent violence, organizers of programs to teach violence prevention in schools, and conferences for violence prevention.
In addition, Wellness Foundation grants established the $1.2-million Pacific Center for Violence Prevention, which will provide technical assistance to policy-makers and training to fellows and community leaders. Also, $300,000 will be provided over three years to Mediascope, a San Fernando Valley-based group that advocates changes in the way violence is depicted in movies and television.
The foundation was formed by order of the state corporations commissioner as part of an agreement that allowed Health Net, California's second-largest HMO, to become a for-profit company.
With a total of $300 million in assets, and 80% ownership of Health Net shares, the newly formed foundation is typical of many of the nation's largest, corporate-style mega-endowments.
Such organizations don't usually launch major initiatives for fringe causes. Observers say the Wellness Foundation's embrace is a sign of the new legitimacy of the violence-prevention movement.
Geno Tellez, a trauma surgeon at San Francisco General Hospital, is one of the foundation's new academic fellows.
He will use his new research money to investigate "recidivistic" trauma victims--patients who return to hospitals over and over again with violent injuries.
Tellez said about 30% of trauma victims have been treated for trauma before. He wants to identify these people, who appear particularly prone to violent injuries, and develop interventions to prevent their constant reappearance in emergency rooms.
"People think violence is an acceptable complication of our society," he said. "But from a medical standpoint, this complication is not acceptable. Death is not acceptable."
The crusading tone should not come as a surprise, said Jim Whorton, a professor of medical history at the University of Washington.
The idea that public health could cure society's deepest ills is rooted deep in the history of the discipline. Early English sanitary reformers thought of disease as tightly correlated to the poverty, prostitution, crime and filth that plagued 19th-Century urban slums, he said.
"They believed by preventing disease, they could prevent violence. They envisioned a future with no disease and no problems and no poverty--socially and medically purified cities," Whorton said.
Later reformers dropped the idea that a little soap and hygiene could cure a plethora of social ills. Scientists studying epidemics shifted their focus to germs. But today, Whorton said, researchers are harking back to a broader vision.
"The question is, can epidemiology, which has succeeded so well against environmental problems and disease agents, work as well in the area of violence?" Whorton said.
Kahn, the Wellness Foundation president, said it is not realistic to pretend that recasting violence as a disease will solve the problem. But he defends the effort as a response to a problem that affects nearly everyone.
"It absolutely is not as easy as a vaccination," he said. "But what is the alternative? Not to address the problem?"