What mur­der statis­tics don’t say

Calgary Herald - - NEWS - Colby Cosh Na­tional Post [email protected]­tion­al­post.com

The city of Toronto has bro­ken its record for homi­cides in a sin­gle year after a Sun­day af­ter­noon shoot­ing in an apart­ment build­ing in Scar­bor­ough. Ninety peo­ple were by then killed in the city (and an­other since), a scary num­ber that will nat­u­rally cre­ate un­ease in Toronto and at­tract na­tional at­ten­tion.

So I sup­pose it falls to me, an Ed­mon­to­nian who is a stu­dent of mor­bid statis­tics, to point out that this record­shat­ter­ing num­ber is still not so aw­ful.

Toronto has 2.7 mil­lion peo­ple: it’s al­most three times larger than Ed­mon­ton. Out here we are en­joy­ing a quiet year, by our stan­dards, and have had 26 homi­cides to date, so Toronto’s rate of vi­o­lent death is slightly higher.

But this is very un­usual. Our homi­cide to­tal last year was 45, or 47 if you count po­lice killings (which we should); the lo­cal record (set in 2011) is 48. When Toronto gets closer to three times those to­tals, we’ll start get­ting ner­vous on your be­half.

What, if any­thing, should we re­ally make of homi­cide counts like these? Homi­cides are in the­ory use­ful as a bench­mark for over­all crim­i­nal­ity: they rep­re­sent the hard, in­escapable edge of a wedge of so­cial vi­o­lence, or even of gen­eral dis­or­der. It is enor­mously dif­fi­cult, and pre­sum­ably very rare, to kill a per­son with­out hav­ing any­body at all no­tice. Vir­tu­ally all homi­cides are thus recorded in of­fi­cial statis­tics, and most of them make the news­pa­per as a mat­ter of course.

But the num­bers of homi­cides for any Cana­dian city are so pal­try from year to year that they are eas­ily in­flu­enced by chance. There is an ob­vi­ous ex­am­ple, a rea­son Toronto has smashed through its pre­vi­ous record for deadly vi­o­lence: we count deaths rather than acts of lethal vi­o­lence, and so the ter­ri­ble van car­nage that oc­curred in North York City Cen­tre in April counts as 10, rather than one or even zero.

The per­pe­tra­tor of the van at­tack was a lone nut who chose a risky method of in­flict­ing mass death. When a ter­ror­ist used the same modus operandi in down­town Ed­mon­ton last fall, crash­ing a rented ve­hi­cle into a crowded side­walk, he man­aged to not even hurt any­one es­pe­cially badly. The dif­fer­ence is just dumb luck.

But there is an­other in­flu­ence that is hardly ever dis­cussed in Canada. Toronto’s old record year for homi­cide was 1991. That is al­most a gen­er­a­tion ago. Sur­gi­cal trauma care is con­tin­u­ously evolv­ing — or one as­sumes, and hopes, that it is.

Mil­i­tary statis­tics, which are even more care­ful and com­plete than the ones po­lice agen­cies keep in cities, sug­gest that doc­tors have learned a lot about keep­ing vic­tims of vi­o­lence alive.

As the med­i­cal writer Atul Gawande ob­served in a 2004 jour­nal ar­ti­cle, Amer­i­can physi­cians made lit­tle progress in keep­ing wounded sol­diers alive be­tween the Revo­lu­tion­ary War and the end of Viet­nam. Deaths from “com­bat in­jury” as a frac­tion of suf­fer­ers went only from per­haps one in three to maybe one in four over all that his­tory. But in the U.S.’s post-2001 wars, the fig­ure was more like one in 10.

This should prob­a­bly af­fect how we re­gard homi­cide as an in­di­ca­tor of se­ri­ous vi­o­lence. In this year’s an­nals of Toronto blood­shed, the flip side of the dread­ful North York van at­tack was the Dan­forth shoot­ing in July. A dis­turbed man walked down a crowded Greek­town street ran­domly shoot­ing passersby and restau­rant pa­trons: he wounded 15 peo­ple in all. Be­cause of out­stand­ing sur­gi­cal care given at three dif­fer­ent Toronto hos­pi­tals, 13 of these in­di­vid­u­als were saved.

What would that fig­ure have been in 1991? In­deed, if Toronto had the same qual­ity of trauma care in 2018 that it did in “record-set­ting” 1991, and emer­gency-room doc­tors had learned noth­ing use­ful in the mean­time, how high would the city’s year-to­date homi­cide to­tal now be? Over 100? 120?

There is no telling — but there are rea­sons to be skep­ti­cal about the as­sump­tion of con­stant progress in trauma care. The ques­tion of im­proved medicine “mask­ing” a more vi­o­lent ur­ban en­vi­ron­ment is an ac­tive is­sue in the United States, with its high-stakes de­bate over firearms in the cul­ture and the con­sti­tu­tion.

More­over, the U.S. has cities like Chicago, where the all-time an­nual homi­cide record is a sick­en­ing 943 (1992). In a place like that, the po­lice are mighty quick to be judged on a bad year for mur­ders, and they are equally quick to take credit for a good one, even if some should be go­ing to doc­tors and paramedics.

It seems clear that there was some “mask­ing” be­fore the year 2000. But if it has ex­isted since — if there has been fur­ther uni­form progress in the per­for­mance of the trauma-care sys­tem — it is harder to find sta­tis­ti­cally.

There was a bit of a clam­our in 2012 when the U.S.’s Na­tional Elec­tronic In­jury Sur­veil­lance Sys­tem seem­ingly re­vealed a re­duc­tion in the case-fa­tal­ity rate for in­ten­tional shoot­ings; the brute fig­ures showed that over a decade or so (20032012) it had been cut from 25 per cent to 18 per cent.

Un­for­tu­nately, statis­ti­cians were (in 2017) able to show that these fig­ures were af­fected by poor sam­pling, and that the rate had ac­tu­ally held steady, at 22 per cent.



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