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Violence against children: Physical child abuse in the United states
Sm. Sci. & Med. 1972, Vol. 6, pp. 527-531. Pergamon Press. Printed in Great Britain
BOOK REVIEWS Child Care in a Developing Community by K. S. GOKULANATHANand K. P. VERGHESE,Vantage Press, 1969. 78 pp. $2.95.
Violence Against Children: Physical Child Abuse in the United States by DAVID G. GIL, Harvard Univ. Press, Cambridge, Mass., 1970,204 pp. $6.50.
THEPURPOSE of the book is to illustrate how a combined sociocultural and medical approach may enable one to arrive at an accurate recognition of the problems of child care in a developing community. The authors chose as their site of study the town in southern India where they were born and raised and which had been a traditional agrarian community with a limited production of cash crops until a recent influx of industry and peoples of different socio-economic levels. The study is focused on young children who were members of families of high and middle socioeconomic status. The parents often disliked and sometimes misunderstood traditional forms of child care practices in the community and were interested in modem ways and ideas. Modern and traditional systems of medical practice were available in the area and some parents switched back and forth during the wurse of an illness. The authors report their experience in dealing with problems of infant feeding, immunization, infant clothing and associated problems, and personal hygiene. They illustrate the need for a combined sociocultural and medical approach in which knowledge of traditional beliefs and practices in the community is used in introducing modern medical methods. For example, the authors describe how some of the children of well-to-do families suffer from dysnutrition as the result of heavy dependence upon local tinned foods which the parents mistakenly believe are equivalent to baby and junior foods available in western industrial society. The parents also use extensively expensive and socially prestigeous foods such as ice cream, candy bars and aerated sweetened drinks. Inappropriate feedings of children with minor gastrointestinal disturbance or mild febrile illness often aggravates rather than alleviates the disturbance. The 62 pages of text provide useful understanding and insights into parental beliefs and practices in a society during a period of rapid change in which traditional patterns of child rearing are being partially deserted by well-to-do parents. These parents emulate, but have little knowledge of western industrial patterns of child care.
THE STATED approach of the studies reported in the book is to provide a macroscopic and epidemiologic approach to child abuse in contradistinction to clinical studies. Physical abuse of children is de6ned as ‘I. . . intentional, nonaccidental use of physical force, or intentional, nonaccidental acts of omission, on the part of a parent or other caretaker interacting with a child in his care, aimed at hurting, injuring, or destroying the child”. The first study deals with the opinions and attitudes of Americans toward physical abuse of children. An area probability sample was obtained of people over 21 in the U.S. Over half the respondents felt that “almost anybody could at some time injure a child in his care”, one-fifth felt they could at sometime injure a child and 16 per cent reported that at one time they could hardly refrain from injuring a child in his care. The author interprets these finding as supporting his position that “a certain measure of physical abuse of children tends to be condoned by American culture as a ‘normal’ aspect of rearing children”. Respondents were asked whether they personally knew families involved in incidents of child abuse resulting in physical injury during the 12 months preceding the interview.Threepercentreportedsuchpersonalknowledge. From this Gill estimates, given the margin of error of the samule, that 2.3-3.7 per cent of adults in the U.S. would personally know of incidents of child abuse. He suggests these figures would be an upper limit on the basis that some of the families involved in abusing children are likely to be known personally by more than one person. The author may wish to provide a conservative estimate but it is just as likely that there are a sizeable number of cases of child abuse which are unknown to the families and that the 2.3-3.7 per cent may be a low rather than a high estimate of incidence of child abuse. The second study reported is a nationwide epidemiological survey of children whose physical abuse was reported through legal channels of the States and U.S. territories during 1967. The reason given for the study was to obtain information about as many types of child abuse as possible. The author points out some of the shortcomings of only obtaining cases known through legal channels, as for example, different States using different reporting laws. Reported rates per 100.000 children range from 31.2 in Texas to 0.0 in Rhode Island and So. Dakota with a rate of 8.4 and 9.3 for the entire U.S. during the years 1967-68. The wide range in State reports underlines the shortcomings outlined by the author. The characteristics of abused children, their families and the perpetrators are reported. The results show that abused children are found most frequently in the 3-9 year age groups, an older age than reported in previous
STEPHEN A. RICHARDSON, Ph.D. Albert Einstein ColIege of Medicine, Dept. of Pediatrics, Bronx, New York, 10461
527
528
Boon REVIEWS
studies. Non-whites are over-represented, as were children in special classes for retarded children. Although no data is given for comparative families where child abuse is absent there appears to be an overrepresentation of families without father or father substitute and in homes where the mother was not living with the child. These are only illustrative of many findings reported. It is very difticult to interpret the findings because of the unknown biases derived from using legal reporting channels. The higher frequency of older children may be because abuse of children may more likely be brought to legal notice by school authorities than by other representatives of the community prior to school age. The overrepresentation of perpetrators of abuse having little education and low socio economic status may be because these families have fewer ways of hiding their behavior from legal authorities than well educated well-to-do families. It is always easier to judge a study after than before it is carried out, but it seems a pity that the author chose a nationwide study with so many unknowns in what cases of child abuse were and were not included as a function of legal reporting. A preferred and perhaps more useful strategy would have been to conduct an intensive epidemiological inquiry within one or more restricted and well deflned geographical areas and for these areas use a variety of methods for identifying as many cases of child abuse as possible. Perhaps the strongest and most valuable part of the book is the conceptual framework given in the opening and closing chapters. The author argues that a sociocultural frame of reference may be used to supplement a psychodynamic conceptualization of child abuse. Based on the survey he conducted and other sources the author believes that approval of a certain measure of physical force as a legitimate and appropriate educational and socializing agent seems endemic to American culture and that there are no clear criteria concerning what quantity and quality of physical force used against a child is considered excessive. STEPHEN A. RICHARDSON,Ph.D
Albert Einstein College of Medicine, Dept. of Pediatrics, Bronx, New York, 10461
Financing Medical Education, by RASHIFEINand GERALD I. WEBER.McGraw-Hill, 279 pp. $6.95. THIS IS an excellent monograph. The interested reader, particularly one who has been deeply concerned with the problems of health manpower in his own country, will find in Fein and Weber’s work one of the few available sources of sound information. The authors have used all available data with caution and skill, calling attention to the need for much sounder data than are now being produced. There is no country which has been educating physicians which cannot benefit from the material presented in the
monograph. It is, however, of special relevance to tb problems of the United States. The authors have stuck to the facts in describing tb general characteristics of medical schools and thei funding problems, the expenses and opportunities fo medical students and house officers, and the nature o public expenditures which support medical education They have remained faithful to their own disciplines a economists but with high sensitivity to the social issue created by our current health delivery system. Perhaps the greatest contribution is the way in whit the monograph focuses on the multiple outputs of medics education by identifying the iniluences exerted by variou types of funding allocations. They have distinguishe’ between the public and private medical schools, hav identified the ways in which these differences affect studer admissions and outputs, and have provided a base fo better understanding of the future financing needs of bot institutions and students. This reviewer is convinced that future investments i medical education, whether through state or feder: mechanisms, will be relatively non-productive if decisior are made in the absence of the kind of thinking whit has gone into this monograph. It provides the solid has for deliberations which could conceivably lead us to rational system to replace the present hodgepodge c wasteful mixed support for the nation’s medical school: The authors do not insist that their recommendations 1: accepted but they are correct in suggesting that far greats public benefit could be derived if this kind of log: dominated future public decisions which affect 5 financing of medical education. HAROLDMARGULIES,M.I
Department of Health, Education, and Welfare PHS, HSMHA, Regional Medical Programs Service
Anthropology and the Behavioural and Health Sciences Edited by OTTO VON MERING and LEONARDKASDAI University of Pittsburg. 340 pp., Cloth $12.95. Ecce Homo Universalis! Come back, polymath! This hoc is a product of the protest movement against the frighten ing growth rate in specialization. It is essentially ar inevitably in the nature of an hors d’oeuvre. It could I seen as a starter for some main banquet of generalizatic to come and it introduces the reader to some centr hypotheses as to what we have lost in allowing tl specialisms to become too isolated from each othe Typical of the book is sociologist Wax’s arresting phra “the precision/accuracy hoax” as it applies to meth’ dology in the behavioural sciences. This may be no mo than a tarting up of the old Validity-Reliability classic 1 undergraduate instruction, but in fact these fundament ideas may well be in danger of growing irrelevant throut sheer familiarity. Wax updates them, makes them see contemporary, modernizes their relevance for curre research.
BOOK REVIEWS Child Care in a Developing Community by K. S. GOKULANATHANand K. P. VERGHESE,Vantage Press, 1969. 78 pp. $2.95.
Violence Against Children: Physical Child Abuse in the United States by DAVID G. GIL, Harvard Univ. Press, Cambridge, Mass., 1970,204 pp. $6.50.
THEPURPOSE of the book is to illustrate how a combined sociocultural and medical approach may enable one to arrive at an accurate recognition of the problems of child care in a developing community. The authors chose as their site of study the town in southern India where they were born and raised and which had been a traditional agrarian community with a limited production of cash crops until a recent influx of industry and peoples of different socio-economic levels. The study is focused on young children who were members of families of high and middle socioeconomic status. The parents often disliked and sometimes misunderstood traditional forms of child care practices in the community and were interested in modem ways and ideas. Modern and traditional systems of medical practice were available in the area and some parents switched back and forth during the wurse of an illness. The authors report their experience in dealing with problems of infant feeding, immunization, infant clothing and associated problems, and personal hygiene. They illustrate the need for a combined sociocultural and medical approach in which knowledge of traditional beliefs and practices in the community is used in introducing modern medical methods. For example, the authors describe how some of the children of well-to-do families suffer from dysnutrition as the result of heavy dependence upon local tinned foods which the parents mistakenly believe are equivalent to baby and junior foods available in western industrial society. The parents also use extensively expensive and socially prestigeous foods such as ice cream, candy bars and aerated sweetened drinks. Inappropriate feedings of children with minor gastrointestinal disturbance or mild febrile illness often aggravates rather than alleviates the disturbance. The 62 pages of text provide useful understanding and insights into parental beliefs and practices in a society during a period of rapid change in which traditional patterns of child rearing are being partially deserted by well-to-do parents. These parents emulate, but have little knowledge of western industrial patterns of child care.
THE STATED approach of the studies reported in the book is to provide a macroscopic and epidemiologic approach to child abuse in contradistinction to clinical studies. Physical abuse of children is de6ned as ‘I. . . intentional, nonaccidental use of physical force, or intentional, nonaccidental acts of omission, on the part of a parent or other caretaker interacting with a child in his care, aimed at hurting, injuring, or destroying the child”. The first study deals with the opinions and attitudes of Americans toward physical abuse of children. An area probability sample was obtained of people over 21 in the U.S. Over half the respondents felt that “almost anybody could at some time injure a child in his care”, one-fifth felt they could at sometime injure a child and 16 per cent reported that at one time they could hardly refrain from injuring a child in his care. The author interprets these finding as supporting his position that “a certain measure of physical abuse of children tends to be condoned by American culture as a ‘normal’ aspect of rearing children”. Respondents were asked whether they personally knew families involved in incidents of child abuse resulting in physical injury during the 12 months preceding the interview.Threepercentreportedsuchpersonalknowledge. From this Gill estimates, given the margin of error of the samule, that 2.3-3.7 per cent of adults in the U.S. would personally know of incidents of child abuse. He suggests these figures would be an upper limit on the basis that some of the families involved in abusing children are likely to be known personally by more than one person. The author may wish to provide a conservative estimate but it is just as likely that there are a sizeable number of cases of child abuse which are unknown to the families and that the 2.3-3.7 per cent may be a low rather than a high estimate of incidence of child abuse. The second study reported is a nationwide epidemiological survey of children whose physical abuse was reported through legal channels of the States and U.S. territories during 1967. The reason given for the study was to obtain information about as many types of child abuse as possible. The author points out some of the shortcomings of only obtaining cases known through legal channels, as for example, different States using different reporting laws. Reported rates per 100.000 children range from 31.2 in Texas to 0.0 in Rhode Island and So. Dakota with a rate of 8.4 and 9.3 for the entire U.S. during the years 1967-68. The wide range in State reports underlines the shortcomings outlined by the author. The characteristics of abused children, their families and the perpetrators are reported. The results show that abused children are found most frequently in the 3-9 year age groups, an older age than reported in previous
STEPHEN A. RICHARDSON, Ph.D. Albert Einstein ColIege of Medicine, Dept. of Pediatrics, Bronx, New York, 10461
527
528
Boon REVIEWS
studies. Non-whites are over-represented, as were children in special classes for retarded children. Although no data is given for comparative families where child abuse is absent there appears to be an overrepresentation of families without father or father substitute and in homes where the mother was not living with the child. These are only illustrative of many findings reported. It is very difticult to interpret the findings because of the unknown biases derived from using legal reporting channels. The higher frequency of older children may be because abuse of children may more likely be brought to legal notice by school authorities than by other representatives of the community prior to school age. The overrepresentation of perpetrators of abuse having little education and low socio economic status may be because these families have fewer ways of hiding their behavior from legal authorities than well educated well-to-do families. It is always easier to judge a study after than before it is carried out, but it seems a pity that the author chose a nationwide study with so many unknowns in what cases of child abuse were and were not included as a function of legal reporting. A preferred and perhaps more useful strategy would have been to conduct an intensive epidemiological inquiry within one or more restricted and well deflned geographical areas and for these areas use a variety of methods for identifying as many cases of child abuse as possible. Perhaps the strongest and most valuable part of the book is the conceptual framework given in the opening and closing chapters. The author argues that a sociocultural frame of reference may be used to supplement a psychodynamic conceptualization of child abuse. Based on the survey he conducted and other sources the author believes that approval of a certain measure of physical force as a legitimate and appropriate educational and socializing agent seems endemic to American culture and that there are no clear criteria concerning what quantity and quality of physical force used against a child is considered excessive. STEPHEN A. RICHARDSON,Ph.D
Albert Einstein College of Medicine, Dept. of Pediatrics, Bronx, New York, 10461
Financing Medical Education, by RASHIFEINand GERALD I. WEBER.McGraw-Hill, 279 pp. $6.95. THIS IS an excellent monograph. The interested reader, particularly one who has been deeply concerned with the problems of health manpower in his own country, will find in Fein and Weber’s work one of the few available sources of sound information. The authors have used all available data with caution and skill, calling attention to the need for much sounder data than are now being produced. There is no country which has been educating physicians which cannot benefit from the material presented in the
monograph. It is, however, of special relevance to tb problems of the United States. The authors have stuck to the facts in describing tb general characteristics of medical schools and thei funding problems, the expenses and opportunities fo medical students and house officers, and the nature o public expenditures which support medical education They have remained faithful to their own disciplines a economists but with high sensitivity to the social issue created by our current health delivery system. Perhaps the greatest contribution is the way in whit the monograph focuses on the multiple outputs of medics education by identifying the iniluences exerted by variou types of funding allocations. They have distinguishe’ between the public and private medical schools, hav identified the ways in which these differences affect studer admissions and outputs, and have provided a base fo better understanding of the future financing needs of bot institutions and students. This reviewer is convinced that future investments i medical education, whether through state or feder: mechanisms, will be relatively non-productive if decisior are made in the absence of the kind of thinking whit has gone into this monograph. It provides the solid has for deliberations which could conceivably lead us to rational system to replace the present hodgepodge c wasteful mixed support for the nation’s medical school: The authors do not insist that their recommendations 1: accepted but they are correct in suggesting that far greats public benefit could be derived if this kind of log: dominated future public decisions which affect 5 financing of medical education. HAROLDMARGULIES,M.I
Department of Health, Education, and Welfare PHS, HSMHA, Regional Medical Programs Service
Anthropology and the Behavioural and Health Sciences Edited by OTTO VON MERING and LEONARDKASDAI University of Pittsburg. 340 pp., Cloth $12.95. Ecce Homo Universalis! Come back, polymath! This hoc is a product of the protest movement against the frighten ing growth rate in specialization. It is essentially ar inevitably in the nature of an hors d’oeuvre. It could I seen as a starter for some main banquet of generalizatic to come and it introduces the reader to some centr hypotheses as to what we have lost in allowing tl specialisms to become too isolated from each othe Typical of the book is sociologist Wax’s arresting phra “the precision/accuracy hoax” as it applies to meth’ dology in the behavioural sciences. This may be no mo than a tarting up of the old Validity-Reliability classic 1 undergraduate instruction, but in fact these fundament ideas may well be in danger of growing irrelevant throut sheer familiarity. Wax updates them, makes them see contemporary, modernizes their relevance for curre research.