For most of the twentieth century, violence between intimate partners was a private matter handled, when it was handled at all, by police and courts. The framing was criminal: a perpetrator, a victim, a charge, a verdict. In 1985 the U.S. Surgeon General held a workshop on violence and public health, and the field began a slow, contested migration. By the early 1990s the Centers for Disease Control had a division dedicated to violence prevention. By 2000 the World Health Organization had named violence a leading public health problem worldwide. The reframe was not cosmetic. It changed what counted as data, what counted as success, and who was responsible for acting.
The criminal framing asks: did a crime occur, and who pays? The public health framing asks: what is the incidence, what are the risk factors, what interventions reduce the rate, and how do we know? The first is retrospective and individual. The second is prospective and populational. They are not mutually exclusive—courts still matter, perpetrators still need to be held accountable—but the public health frame insists that waiting until after the violence to act is a strategy guaranteed to produce a steady stream of beaten and dead women.
James Mercy, one of the architects of the CDC's approach, framed it through the four-step model adapted from injury prevention: define the problem, identify risk and protective factors, develop and test interventions, implement at scale. The first step alone was a revolution. Linda Saltzman's 1999 publication of uniform definitions for intimate partner violence surveillance gave the field something it had never had: a way to count consistently across jurisdictions. Before that, every state's data was incomparable, and the national picture was a blur.
The Law 4 dimension is structural. Planning at scale requires shared definitions, shared measurement, and shared targets. The public health frame supplies all three. The Law 2 dimension—think clearly—is methodological. Public health refuses the moralized vocabulary that dominates criminal framings (evil men, broken women) in favor of distributions, risk factors, and dose-response relationships. The Law 3 dimension—connect—is the recognition that intimate partner violence is not isolated from child abuse, community violence, suicide, or substance use; they cluster, they share risk factors, and they can sometimes be addressed by overlapping interventions.
The romantic lens forces a particular question. Public health is good at populations and weak at meanings. A woman who is beaten by her husband is not a unit in a surveillance system; she is a person in a relationship she once chose, in a story that has gone wrong. The public health frame can name her injury but not what was lost. This is not a refutation of the frame—it is a limit on what the frame can do. Criminal justice cannot do that work either. Neither can policy. The work of meaning belongs to her, to her community, and to whatever spiritual or relational resources she has access to. The collective's job is to keep her alive long enough to do it.
The frame has produced real wins. Cardiff's model of sharing emergency department data with police, without identifying victims, reduced violent injuries by forty percent over a decade by directing patrols to the streets and bars producing the most cases. The CDC's Dating Matters program, tested in four cities, reduced teen dating violence perpetration by roughly fifteen percent in treated middle schools. These are not transformations, but they are measurable improvements that the criminal frame had no mechanism to produce.
It has also produced characteristic failures. The public health frame tends to elevate intermediate metrics—knowledge, attitudes, intentions—because they are easier to measure than behavior change at population scale. Programs declare success on attitude surveys while the underlying rates of violence drift sideways. The frame also struggles with severe violence, which is rare enough that population studies are statistically underpowered to detect changes. Most public health DV interventions show effects on common forms of aggression but no detectable effect on femicide.
Jacquelyn Campbell's danger assessment work bridges the gap. By identifying the specific risk factors most predictive of homicide—access to a gun, threats to kill, escalation of frequency, choking—the field can focus intensive intervention on the highest-risk cases without abandoning the population-level work. This is Law 4 done well: a tiered plan that does not pretend one intervention fits all.
The deepest move the public health frame has made is treating the perpetrator as a person whose behavior can be changed rather than as a moral fact. Programs based on this premise have modest but real effects. The criminal frame is allergic to it because the language of public health applied to abusers sounds like excuses. The public health frame is allergic to the criminal frame because moralization gets in the way of measurement. The collective needs both, sequenced correctly: protect the victim first, then ask what changes the perpetrator. Most jurisdictions still get the sequence wrong.