Two heavily armed young men stormed a suburban Denver high school at midday today, and in a shooting rampage on a scale unprecedented in American schools, killed as many as 25 students and faculty members. The gunmen, whom police and fellow students described as disaffected outcasts, were found dead this afternoon in the library after what police described as their “suicide mission.” The killings brought the country face to face once again with the tragic spectacle of a seemingly senseless murder in the schools, renewing a horrific chain that since 1997 has included two killed in a school in Pearl, Mississippi; three at a school in West Paducah, Kentucky; five at a school in Jonesboro, Arkansas; and two at a school in Springfield, Oregon.<sup>8 Kenworthy, Washington Post, April 21, 1999.

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A tragedy such as this can be seen as an isolated act of aggression and relatively removed from most Americans, but it is not. As violence becomes commoner, it begins to affect the health of everyone in this country. Neither the violent acts themselves, nor the repercussive effects of these tragedies, are limited to one geographic or social setting, and it is not just the frequency of actions that threatens the health of the nation. It is the ripple effect that occurs from each of these incidents that affects everyone. What was the effect on the town of Littleton and the Denver community at large? How many students nationwide missed school from the anxiety provoked by this attack? What are the lasting effects to the psyche of the nation after an incident such as this? Without question, violence is a public health problem. Violence threatens or denies not only the health of those who are directly affected but diminishes the whole human process.<sup>5 Franco Aguledo S. Violence and health: Preliminary elements for thought and action Int J Health Serv 1992 ;  22 : 365-376

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