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Community and Family Safety
Homicide deaths and occupational fatalities are lower than 35 years ago. However, in recent years, the homicide rate has risen alongside an increase in firearm deaths. Public health funding increased during the pandemic but is returning to pre-pandemic levels.
Homicide
Losing a loved one or community member through violent means can have significant psychological implications; survivors are more likely to experience post-traumatic stress disorder (PTSD), depression and substance abuse issues. Furthermore, homicide events create feelings of fear and vulnerability that can negatively impact health and quality of life, damaging a sense of security that is important to individual and community well-being. According to the Organization for Economic Co-operation and Development (OECD), the U.S. has a homicide rate more than double the average for OECD member countries. About 8 in 10 homicides in the U.S. involved a firearm in 2021.
Changes over time. Nationally, the homicide rate decreased 25% from 10.1 to 7.6 deaths due to injuries inflicted by another person with intent to injure or kill per 100,000 population between 1990-1991 and 2021-2022. The rate decreased 50% between 1990-1991 and 2013-2014, reaching a national low (5.0). However, the homicide rate has been increasing steadily since then, including a 15% increase between 2019-2020 (6.6) and 2021-2022, although the 2020-2021 rate (7.7) was slightly higher than the 2021-2022 rate. In 2021-2022, nearly 50,900 homicides occurred, an increase of almost 7,200 deaths compared with 2019-2020. The current rate does not meet the Healthy People 2030 target of 5.5 deaths per 100,000 population.
Between 1990-1991 and 2021-2022, homicide significantly decreased 33% among females (4.3 to 2.9 deaths per 100,000 population) and 23% among males (16.3 to 12.5). The rate decreased in 14 states and the District of Columbia, led by: 69% in New York (14.3 to 4.5), 56% in the District of Columbia (67.0 to 29.2) and 53% in California (12.9 to 6.1). However, during the same period, homicide also increased in 10 states. The largest increases were: 87% in South Dakota (3.0 to 5.6), 40% in New Mexico (10.1 to 14.1), 38% in Mississippi (15.1 to 20.9) and 37% in Indiana (6.3 to 8.6).
Between 1999-2000 and 2021-2022, homicide significantly increased: 56% among those ages 35-44 (7.1 to 11.1 deaths per 100,000 population), 50% among those ages 25-34 (10.5 to 15.7), 48% among those ages 45-54 (4.6 to 6.8), 43% among those ages 55-64 (3.0 to 4.3) and 16% among those ages 15-24 (12.8 to 14.8).
Between 2019-2020 and 2021-2022, the homicide rate significantly increased:
- 23% among multiracial (3.5 to 4.3 deaths per 100,000 population), 22% among Hispanic (5.8 to 7.1), 15% among Black (28.4 to 32.8) and 7% among white (2.9 to 3.1) populations.
- 19% among those ages 45-54 (5.7 to 6.8), 18% among those ages 65-74 (2.2 to 2.6), 17% among those ages 35-44 (9.5 to 11.1), 16% among those ages 25-34 (13.5 to 15.7), 12% among those ages 15-24 (13.2 to 14.8) and 10% among those ages 55-64 (3.9 to 4.3).
- 16% among females (2.5 to 2.9) and 15% among males (10.9 to 12.5).
During this time frame, homicide increased in 22 states and the District of Columbia; the largest increases were: 48% in Oregon (3.3 to 4.9), 35% in Washington (3.7 to 5.0) and 33% in New Mexico (10.6 to 14.1).
Disparities. Homicide varied significantly by race/ethnicity, geography, age and gender in 2021-2022. The rate was:
- 20.5 times higher among Black (32.8 deaths per 100,000 population) compared with Asian (1.6) populations.
- 4.3 times higher among males (12.5) than females (2.9).
Note: The values for those age 85 and older and those ages 75-84 (2.1) may not differ significantly based on overlapping 95% confidence intervals.
Related Measure: Firearm Deaths
Gun violence continues to be a significant public health issue in the United States. In addition to being responsible for 80% of homicides, in 2022, firearms were responsible for more than half (56.1%) of all suicide deaths nationally. Furthermore, the U.S. has a significantly higher rate of firearm deaths than other comparable nations: In a data set comparing 31 populous, high-income countries, the U.S. made up 83.7% of all firearm deaths and 96.7% of children younger than age 5 killed by guns.
Changes over time. Nationally, the firearm death rate stabilized at 14.5 deaths due to firearm injury of any intent (unintentional, suicide, homicide or undetermined) per 100,000 in 2022. The current rate does not meet the Healthy People 2030 target of 10.7 deaths per 100,000 population and is 20% higher than in 2018 (12.1). In 2022, there were 48,200 deaths by firearm.
Occupational Fatalities
Occupational fatalities, or workplace fatalities, represent unsafe working conditions and personal risks faced by workers. In 2022, there were nearly 5,490 fatal workplace injuries in the United States. Transportation incidents accounted for the majority of fatalities (37.7%). Per capita, farming, fishing and forestry occupations had the highest rates of workplace fatalities in 2022, followed by transportation and material-moving occupations.
Changes over time. Nationally, occupational fatalities decreased 45% from 7.6 to 4.2 fatal occupational injuries in construction, manufacturing, trade, transportation and utility industries, as well as in professional and business services per 100,000 workers between 1989-1991 and 2020-2022. Healthy People 2030 has a related target to reduce deaths from work-related injuries across all industries to 2.9 deaths per 100,000 full-time workers. Between 2017-2019 and 2020-2022, the national rate of occupational fatalities remained the same at 4.2 deaths per 100,000 workers.
Disparities. The occupational fatality rate was 2.7 times higher in New Mexico (7.6 deaths per 100,000 workers) than Washington (2.8) in 2020-2022.
Public Health Funding
The U.S. public health system aims to keep Americans safe and healthy through health promotion, preparedness and surveillance programs, and serves as the first line of defense against epidemics. Community-based health programs can reduce health care spending. One study shows that investing in school-based substance misuse programs can return up to $20 in benefits for every $1 spent. Governmental public health activities accounted for less than 5% of U.S. health care spending in 2022.
Changes over time. Nationally, public health funding — state dollars dedicated to public health per person, including federal grants directed to states from the Centers for Disease Control and Prevention and the Health Resources and Services Administration — decreased 36%, from $194 to $124 between 2020-2021 and 2022-2023. Public health funding decreased more than the national average in 37 states during this time. The largest were 57% in Wyoming ($286 to $123 per person), 55% in Nevada ($148 to $66) and 54% in Hawaii ($338 to $156).
Disparities. Public health funding varied significantly by geography in 2022-2023. The amount was 5.1 times higher in Alaska ($334 per person) than Nevada ($66).
Economic Resources
Food insecurity, poverty and unemployment have decreased over the past decade. However, the pandemic challenged these successes. In recent years, food insecurity has increased, while poverty and unemployment have returned to pre-pandemic levels.
Food Insecurity
Food insecurity is a complex problem and does not exist in isolation for low-income families. It has broad effects on health due to the mental and physical stress it places on the body and is associated with an increased risk of many chronic conditions, including diabetes and heart disease.
Changes over time. Nationally, food insecurity — the percentage of households unable to provide adequate food for one or more household members due to lack of resources — decreased 27%, from 14.6% to 10.7% between 2011-2013 and 2018-2020, and recently increased 14% from 10.7% to 12.2% between 2018-2020 and 2021-2023. During this period, the rate significantly increased: 50% in Arkansas (12.6% to 18.9%), 35% in Illinois (9.2% to 12.4%) and 27% in Texas (13.3% to 16.9%). Healthy People 2030 has a target to reduce household food insecurity and hunger to 6.0% of households.
Between 2011-2013 and 2021-2023, the prevalence significantly decreased in seven states and the District of Columbia. The largest decreases were: 37% in North Carolina (17.3% to 10.9%), 34% in the District of Columbia (13.4% to 8.8%) and Washington (14.3% to 9.5%), and 33% in Rhode Island (14.4% to 9.7%) and Tennessee (17.4% to 11.7%).
Disparities. Food insecurity varied significantly by geography in 2021-2023 and was 2.6 times higher in Arkansas (18.9%) than New Hampshire (7.4%).
Poverty
Poverty is a social determinant of health with intergenerational impacts. It is associated with poorer environmental conditions and health outcomes, as well as increased risk of mortality and chronic disease. Those with incomes below the federal poverty level may need help to consistently meet basic needs such as stable housing, food and health care.
Changes over time. Nationally, the percentage of households living below the federal poverty level decreased 14% from 14.7% to 12.7% of households between 2013 and 2023. This rate is above the Healthy People 2030 target of reducing the proportion of people living in poverty to 8.0%. In 2023, approximately 16.7 million households lived in poverty, about 384,000 fewer than in 2013.
Between 2013 and 2023, poverty significantly decreased in 30 states and the District of Columbia, led by: 31% in Idaho (14.7% to 10.1%), 23% in Utah (11.9% to 9.2%), and 22% in Maine (14.2% to 11.1%) and Montana (15.6% to 12.2%). However, poverty increased 30% in Alaska (8.0% to 10.4%) during this period.
Disparities. Poverty varied significantly by geography in 2023 and was 2.3 times higher in Mississippi (19.5%) than New Hampshire (8.3%).
Unemployment
There is a strong relationship between employment status and mental and physical health. A stable, safe and well-paying job makes it easier for people to live in healthier neighborhoods, access health insurance benefits and afford quality child care, education and nutritious food. These are all critical factors to maintaining good health that unemployment can jeopardize. Unemployment is associated with a higher risk of all-cause mortality.
Changes over time. Nationally, the percentage of the civilian workforce ages 16-64 that is unemployed decreased 49% from 8.4% to 4.3% of the civilian workforce between 2013 and 2023. In 2023, nearly 7.4 million civilians in the workforce were unemployed, almost 6.0 million fewer than in 2013.
Between 2013 and 2023, unemployment significantly decreased 52% among the Black population (15.5% to 7.4%), 49% among the white population (6.9% to 3.5%) and 48% among the Hispanic population (10.1% to 5.3%). The rate also decreased in all states and the District of Columbia except North Dakota, led by: 59% in both Delaware (8.6% to 3.5%) and North Carolina (9.7% to 4.0%), and 58% in Alabama (9.6% to 4.0%), Florida (9.7% to 4.1%), Montana (6.5% to 2.7%) and Nevada (11.0% to 4.6%).
Disparities. Unemployment varied significantly by geography and race/ethnicity in 2023. The rate was:
- 2.1 times higher among Black (7.4%) than white (3.5%) workforce civilians.
Education
High school graduation has increased over the past decade. However, geographic and racial/ethnic disparities persist.
High School Graduation
The connection between education and health is well documented. Higher educational attainment is associated with higher earnings, increased health literacy and better self-reported health. Individuals with lower educational attainment are at a greater risk of adverse health outcomes such as cardiovascular disease and premature death.
Changes over time. Nationally, the percentage of high school students graduating with a regular high school diploma within four years of starting ninth grade increased 8% from 80.0% to 86.6% between 2011-2012 and 2021-2022. The current rate falls short of the Healthy People 2030 target to increase the proportion of high school students who graduate in four years to 90.7% of students attending public schools.
Between 2011-2012 and 2021-2022, high school graduation increased: 17% among Black students (69.0% to 81.0%), 13% among Hispanic students (73.0% to 82.8%), 10% among American Indian/Alaska Native students (67.0% to 73.9%), 6% among Asian/Pacific Islander students (88.0% to 93.7%) and 4% among white students (86.0% to 89.8%).
During this time frame, high school graduation increased the same as or more than the national change in 18 states and the District of Columbia, led by: 30% in Nevada (63.0% to 81.7%), 29% in the District of Columbia (59.0% to 76.4%), and 20% in both Oregon (68.0% to 81.3%) and Georgia (70.0% to 84.1%).
Disparities. High school graduation varied by geography and race/ethnicity in 2021-2022. The prevalence was:
- 1.3 times higher among Asian/Pacific Islander students (93.7%) than American Indian/Alaska Native students (73.9%).
Social Support and Engagement
High-speed internet access has increased overall and across all racial/ethnic groups, with the disparity between the highest and lowest groups narrowing.
High-Speed Internet
High-speed internet is a social driver of health. Lack of access to high-speed internet can restrict access to educational and economic opportunities, accessible health care through telemedicine, as well as avenues for social connectedness and community ties.
Changes over time. Nationally, the percentage of households with a broadband internet subscription and a computer, smartphone or tablet increased 16% from 80.8% to 93.8% between 2015 and 2023. In 2023, 306.3 million households had high-speed internet, nearly 53.2 million more households than in 2015.
Between 2015 and 2023, high-speed internet significantly increased: 37% among American Indian/Alaska Native households (65.3% to 89.5%), 31% among Black households (69.7% to 91.5%), 26% among both Hispanic households (74.5% to 93.7%) and households that identify as other race (73.5% to 92.5%), 16% among Hawaiian/Pacific Islander households (80.1% to 93.1%), 12% among both multiracial households (85.0% to 94.8%) and white households (83.9% to 93.9%) and 6% among Asian households (91.3% to 96.6%).
During this time frame, high-speed internet significantly increased in all 50 states and the District of Columbia, led by: 36% in Mississippi (65.6% to 88.9%), 34% in Arkansas (68.2% to 91.1%) and 28% in New Mexico (70.8% to 90.3%).
Disparities. High-speed internet access varied significantly by geography and race/ethnicity in 2023. The prevalence was:
- 1.1 times higher among Asian (96.6%) than American Indian/Alaska Native (89.5%) households.