Caring in the face of violence is peacemaking. Violence is sin on full display, a flagrant disruption of God’s loving design for His creation. Violence is as ancient as our first family—one brother rising up against another east of Eden. Violent injury is our first health threat, our first “disease,” our first cause of death (Genesis 4:8). Violent injury is the only health condition that we know Jesus bore in His own body. Violence is Jesus’ cause of death. Violence vandalizes the image of God in our neighbor (Genesis 9:5-6), amplifies oppression (Psalm 72:13-14), marks a godless life (Romans 1:28-32) and offends God (Psalm 11:4-5).

While violence is not original to our times, it is certainly true of our times. It takes numerous different forms, all of them ugly: child abuse, intimate partner violence, gang violence, “random” violence, political violence, hate crime, elder abuse, workplace violence and countless other manifestations. As Christian healthcare professionals, we have the privilege to care for people affected by violence. While it is not wrong to conceptualize peace in its most narrow context—the absence of conflict—we understand the biblical concept of peace to be far more expansive. Peace, shalom, is the complete flourishing of a person in all aspects of health (spiritual, mental, physical, moral) and in all human relationships, foundationally in right relationship to God. As we grow in our understanding of this expansive view of peace, we understand, by contrast, an expansive view of its antithesis, violence.

Violence is a life issue. In 2023, more than 22,000 people in the U.S. died from homicide.¹ Of these homicide victims, 2,729 were children age 1-18, making homicide the second leading cause of death in U.S. children.² Life is a gift from God, and it is not for human beings to give or take away. We do not know the particularities of each of these lost lives, but God does. Because these deaths were at the hand of another person, they were all preventable.

Violence is a health issue. Beyond the loss of life, the U.S. had 1.8 million emergency department visits because of assault.³ Approximately 200,000 people are hospitalized every year for treatment of violent injuries, with the estimated total cost of violence to U.S. hospitals of $18.27 billion in 2023.⁴ Exposure to violence is associated with a number of adverse health outcomes, especially when this exposure occurs during childhood. Violence is associated with subsequent increases in depression, suicidality, substance abuse, disability, risky sexual activity, gastrointestinal disorders, headaches, chronic pain, perpetration of violence, future violent injury and subsequent violent death.⁵ The health reach of violence extends far beyond the doors of the emergency department. Healthcare professionals from a wide range of specialties, in a wide range of settings, care for patients who bear the health effects of violence.

Violence is a complex issue. A number of interlocking risk factors are associated with violence. Looking at the specific category of youth violence, the 2001 U.S. Surgeon General’s Report  on youth violence identified risk factors and protective factors for subsequent violence in 15-year-olds to 18-year-olds.⁶ This report identified risk factors at the individual, family, school, peer group and community level that associate with youth violence: “No single risk factor or set of risk factors is powerful enough to predict with certainty that youths will become violent…Most individual youths identified by existing risk factors for violence, even youths facing accumulated risks, never become violent.”⁶ Individual-level risk factors for violence include ADHD, substance use, high emotional distress, antisocial beliefs and previous violent victimization. Family and school risk factors include parental substance use, exposure to violence in the family, lax or authoritarian parenting, poor monitoring and supervision, association with delinquent peers, social rejection, low commitment to school and poor academic performance. Community risk factors include diminished economic opportunity, high poverty, unstable housing and socially disorganized neighborhoods. Protective factors against youth violence include high educational aspirations, highly developed social competencies, religious beliefs, positive affective relationships at school, frequent shared activities with parents, ability to discuss problems with parents and increased parental presence.^6-10

Violence is a sin issue. Sin against. Sinned against. Sin within communities. Sins toward communities. Surely a Christian healthcare response to violence includes a multifaced response to a multifaceted problem. It is certainly not less than injury care, but more than that, it includes substance abuse treatment, health counseling, mental healthcare, trauma-informed primary care, screening for violence at home and more. As Christians in healthcare, so many of our patients have health problems that are mediated through behavior and lifestyle. The love of Christ empowers us to offer hope, encouragement, repentance, confession and compassion to our patients. Hospital-based violence intervention programs provide care to patients injured by violence, offer them acute therapeutic support and provide intensive case management services after discharge. They connect patients to crisis intervention services and refer them to community-based organizations, including religious organizations, for ongoing support. Churches can serve as communities of encouragement and support for people recovering from violent injury. Likewise, worship, connection, belonging and family support are protective factors arising from participation in the body of Christ.

If the health effects of violence point to their sin source, acts of healthcare for these effects point to the God who saves. When Jesus said, “You have heard that it was said to the people long ago, ‘You shall not murder, and anyone who murders will be subject to judgment.’ But I tell you that anyone who is angry with a brother or sister will be subject to judgment,” He was speaking to our hearts (Matthew 5:21-22, NIV). He connected the act of murder with the heart of murder. Understood this way, violence is a me issue. Violence is a gospel issue. God did not spare His own Son from lethal violence in His body, so He could make a way to release us from the violence in our hearts. God makes peace in our violent hearts and empowers us to make His peace in a violent world.

“Blessed are the peacemakers, for they will be called children of God” (Matthew 5:9, NIV).

References

1. Centers for Disease Control, Wide-ranging Online Data for Epidemiologic Research (WONDER) database. https://wonder.cdc.gov/controller/datarequest/D158;jsessionid=6C881CE56948427166B86E069036. Accessed November 14, 2025.
2. Centers for Disease Control, Web-based Injury Statistics Query and Reporting System (WISQARS) database. https://wisqars.cdc.gov/lcd/?o=LCD&y1=2023&y2=2023&ct=10&cc=ALL&g=00&s=0&r=0&ry=2&e=0&ar=lcd1age&at=custom&ag=lcd1age&a1=1&a2=18. Accessed November 14, 2025.
3. Cairns C, Kang K. National Hospital Ambulatory Medical Care Survey: 2022 emergency department summary tables. Available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NHAMCS/doc22-ed-508.pdf.
4. Graves JM, Moore M, Avery A, Wolff C, St. Vil C, Jackson E, Vrablik M, Wong A, Qiu Q, de Leon A, Faustino I, Kumar A. The Burden of Violence to US Hospitals: A comprehensive assessment of financial costs and other impacts of workplace and community violence. Report. Harborview Injury Prevention and Research Center, University of Washington; March 2025.
5. Rivara F, Adhia A, Lyons V, Massey A, Mills B, Morgan E, Simckes M, Rowhani-Rahbar A. The Effects Of Violence On Health. Health Aff (Millwood). 2019 Oct;38(10):1622-1629. doi: 10.1377/hlthaff.2019.00480. PMID: 31589529.
6. Office of the Surgeon General (US); National Center for Injury Prevention and Control (US); National Institute of Mental Health (US); Center for Mental Health Services (US). Youth Violence: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2001. Chapter 4 — Risk Factors for Youth Violence. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44293/
7. Resnick, M. D., Ireland, M., & Borowsky, I. (2004). Youth violence perpetration: What protects? What predicts? Findings from the National Longitudinal Study of Adolescent Health. Journal of Adolescent Health, 35(5), 424.e1-424.e10.
8. Dahlberg, L. L., & Simon, T. R. (2006). Predicting and preventing youth violence: Developmental pathways and risk. In J. R. Lutzker (Ed.), Preventing violence: Research and evidence-based intervention strategies (pp. 97-124). Washington, DC: American Psychological Association.
9. Sampson, R. J., Morenoff, J. D., & Gannon-Rowley, T. (2002). Assessing “neighborhood effects”: Social processes and new directions in research. Annual Review of Sociology, 28, 443-478.
10. Ttofi, M. M., Farrington, D. P., Piquero, A. R., & DeLisi, M. (2016). Protective factors against offending and violence: Results from prospective longitudinal studies. Journal of Criminal Justice, 45, 1-3.