Mapping Strategy to Stop Violence Before It Starts : Education: Treat violence as a public health problem, one official says, and teach people the techniques they need to cope with their anger without acting on it.

When Deborah Prothrow-Stith was a medical student 13 years ago, a young man went into a Boston hospital emergency room covered with blood from a knife-slash over his eye. He had been injured, she said, after an argument at a party where he had had “quite a lot to drink. . . . An inch lower and he would have lost his eye.”

When she finished bandaging the wound, “he told me with a swagger, ‘Don’t go to sleep because the guy who did this to me is going to be in here in about an hour, and you’ll get all the practice stitching you need.’ ”

Thinking it over later that night, she realized that “there was no prescribed treatment for anger that might explode into violence.”

Prothrow-Stith is now an assistant dean at the Harvard University School of Public Health; from 1987 to 1989 she was the Massachusetts commissioner of public health. She has written a book on violence called “Deadly Consequences,” which will be published soon.

Since that night 13 years ago, she has been thinking about violence and what to do about it.

She has concluded, she said, that a tough criminal justice system, which punishes after the fact, is not sufficient. “As a physician, I wanted to find ways to intervene before blame was necessary--before a homicide was committed.”

Violence, she said, must be treated partly as a public health problem, handled with the same techniques used to combat smoking, drinking and other behaviors that cause ill health.

“Standard strategies to modify behavior” could include the removal of excessive violence from television, efforts by respected public figures to make violence unfashionable and school programs to discuss violence and explain why people resort to violence.

In addition, strategies need to be developed to identify violence-prone individuals and to channel them into appropriate counseling and other services.

Among statistics that led her to that conclusion, she said: “In 1980, homicide and assault were responsible for over 23,000 deaths . . . 350,000 hospitalizations, 1.5 million hospital days and $640 million in health-care costs. Fatalities from violence represent only the tip of the iceberg; non-fatal intentional injuries occur as much as 100 times more frequently.”

“Poverty rather than race (seems to be) the major risk factor,” she added.

In about 20% of killings, the victims and suspects are members of the same family; in 30%, they are acquaintances, she said.

In maybe half the killings, she said, alcohol plays a role. In about half, handguns play a role; in 13%, other firearms are involved.

Her recommendations are based on the assumption that “violence is a learned behavior.” She believes that parents, public institutions and the community can take steps to ensure that such behavior is not learned or to modify it later in life.

“Parents have daily opportunities to teach their children how to handle anger, such as encouraging verbal rather than physical expression,” she said. They also can regulate TV time and guide children who fight with siblings.

As children grow older, she said, doctors and health workers “have the opportunity to raise the subject of anger and violence directly with them. Raising awareness of the risks of fighting and factors that can lead to violent situations can open the opportunity to discuss the issue in more depth,” she said.

And screening of youths “for a history of family or peer violence, substance abuse, depression and low self-esteem” can help channel violence-prone youth into counseling, she said.

Because guns and drinking often go together, Prothrow-Stith said she favors restrictions on weapons.