With the homicide rate still rising, especially in many large cities, murder is viewed increasingly as a public health threat similar to smoking or infant mortality or heart disease.
As with most health problems, homicide afflicts all segments of the population but puts particular groups at disproportionate risk. It is now the leading cause of death in American black males between the ages of 15 and 24. The homicide rate among young black men rose by two thirds between 1984 and 1988, the federal Centers for Disease Control reported last month. Almost the entire increase was accounted for by deaths from gunshot wounds.
In black male teenagers, the rise was even more dramatic, nearly doubling during the five-year study. The homicide rate in this group had been relatively low before the mid-1980s.
"Unfortunately, we expect this trend to continue," said Robert G. Froehlke, a medical epidemiologist in the CDC's Division of Injury Control and chief author of the CDC homicide report.
In some urban neighborhoods, the homicide rate among young black men approaches the casualty rate among soldiers in Vietnam, Froehlke said.
In the District and five states --
California, Florida, Michigan, Missouri and New York -- the homicide rate for young black men exceeded 100 per 100,000, the CDC found. That means that in those areas, at least one of every 1,000 young black males is murdered each year.
The District set a record for homicides in 1990 for the third straight year, reaching a total of 483 killings. More than 80 percent of the victims were black men, the police department said.
More than a dozen other large U.S. cities -- including New York, Dallas, San Antonio, Phoenix, Memphis, Milwaukee and Boston -- also marked all-time high homicide totals in 1990.
The soaring homicide rate, CDC and other public health officials said, is the result of a complicated set of overlapping factors that include alcohol and drug abuse, drug trafficking, poverty, racism, cultural acceptance of violent behavior and access to firearms. Reducing the toll will take an all-out attack on these problems, they said.
A substantial but declining percentage of killings in the District is classified by police as drug-related, down from 66 percent in 1988 to 39 percent last year. Officials find some cause for hope in a National Institute on Drug Abuse survey showing sharp declines in use of cocaine over the past five years.
Just as heart disease is seen increasingly as a lifestyle problem, with major risks from smoking, diet, stress and lack of exercise, violence is considered largely behavioral, said Deborah Prothrow-Stith, a physician, former Massachusetts health commissioner and assistant dean of the Harvard School of Public Health. Public health officials are beginning to target high-risk groups with preventive strategies designed to change attitudes and behavior as directly as anti-smoking campaigns do.
"It's become more similar, not less," she said, "to other illnesses we treat."