be as good as it would have been had you gotten things right in the first place, and the cost of getting to a better place is going to be higher than the cost of getting it done right the first time.”

However, some speakers cautioned against overreliance on economic data because the complexity of violence does not always lend itself to quantifiable impact. Some outcomes, such as pain and suffering, cannot be reduced to calculated costs, and relying solely on numbers would potentially miss larger effects of prevention. Also, some outcomes of violence, when calculated in terms of medical costs, suggest potential financial benefits from preventing violence-related mortality. For example, speaker and Forum member Michael Phillips of the Shanghai Jiao Tong University School of Medicine pointed out that survivors of suicide attempts often have ongoing psychological illnesses that require medical attention and can pose a burden on the social welfare system through requiring subsidized health care or disability. He referenced a study in which researchers determined that $5 billion was saved in 1990 due to just over 30,000 suicides, which did not take into account the costs of psychological and physical pain and suffering, suggesting that suicide prevention should not be assessed solely in terms of monetary cost (Yang and Lester, 2007).

Still, most speakers felt that determining the economic costs of violence held some value and developing a framework for doing this would be useful in showing the importance of primary prevention. The framework would allow for comparisons across types of violence, types of impact, and types of context. These speakers also noted that such a framework would be most effective through accounting for social costs and that research into developing a methodology for calculating costs of pain, suffering, and other nontangible effects was important.

A number of factors that would be useful in thinking about a broader process for calculating costs were discussed. Participants discussed ways of categorizing costs, criteria for inclusion in cost calculations, noneconomic effects, and placement of costs in a larger context.

In terms of categorizing costs, participants began with a matrix that broke out costs by traditional economic categories and by ecological elements (see Table 2-1 and Box 2-1). For example, traditional cost categories include health services, social services, workforce, community development, and criminal justice. Ecological elements include individual, family, community, and societal. Thus, speakers were able to consider costs at various intersections of these two axes, as well as the relative ease or difficulty of obtaining such figures.

Dr. Corso further simplified the categories of costs into three: medical, nonmedical, and productivity. Medical costs include medical claims and other acute costs, as well as the costs of long-term sequelae. At various levels, these could include out-of-pocket expenses (individual), effects



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