Category Archives: Violence and Trauma
A new study funded by Public Health Law Research, a program of the Robert Wood Johnson Foundation at Temple University, addresses the consequences of weak penalties for domestic violence offenders in the U.S.
Domestic violence, also known as intimate partner violence, accounts for an estimated 1,200 deaths and two million injuries among women each year. The new study, authored by Frank Sloan, PhD, professor of health policy and management at Duke University, and published in the journal Risk and Uncertainty, reviewed data from the North Carolina administrative courts and found that there are often repeat offenses for men arrested for domestic violence and that penalties don’t seem to significantly reduce repeat arrests or convictions.
Sloan points to low prosecution rates and minimal fines as reasons behind many repeat offenses. The study did find, however, that defendants who hired a private lawyer are less likely to be arrested or convicted during the follow-up period because the added costs may be a deterrent.
Shortly after the shooting of 20 children and six adults in Newtown, Ct., a large group of Hollywood stars released a video asking viewers to “demand a plan” on action to be taken to prevent future mass shootings. Since then several videos have popped up on YouTube that show almost all of the actors in the video wielding weapons in films and television shows.
Another video also demands a plan on gun violence, with a compelling set of spokespeople. This one stars and was developed with minority teens in California and produced by the California Endowment, a private health foundation. At last check, the teens’ video had gotten close to 750,000 hits on YouTube.
NewPublicHealth spoke with Barbara Raymond, director of youth opportunity at the California Endowment about how the video came to be and what the next steps are for taking action on gun violence.
NewPublicHealth: How did this video come to be?
Barbara Raymond: The Endowment looks at health very broadly, including things that happen in our schools and happen in our neighborhoods. We started work a couple of years ago in 14 communities across California, and through the process we’ve worked with over 20,000 residents and they came back so strongly saying safety and my own health prevention are our number one issues. And they drilled down further to issues including school safety and school climate and the epidemic of suspensions and extreme school discipline policies.
We have been able to engage a whole set of young people and they have really identified these issues as well. It’s especially the young people saying that working on these issues is urgent, including violence in the community and on the streets of our neighborhoods, fixing issues in our schools and what the kids call the school-to-prison pipeline. These issues have just come up so strongly so when the Newtown tragedy happened, young people wanted to say something and react to that.
As staff, we talked about how the tragedy would open up a whole public conversation around mental health and school safety practices and staff members suggested we reach out to the kids with the video idea.
NPH: How were the kids involved in the development of the video?
Tuesday, January 8, from 12:30 to 1:30 p.m. EST, the Harvard School of Public Health, in collaboration with Reuters, will present an hour long live webcast on gun violence, in response to the too many recent gun massacres.
The webcast is part of the school’s ongoing “Forum” series, whose aim is to provide a platform to discuss policy choices and scientific controversies by leveraging participants' collective knowledge. Tomorrow’s forum on gun violence will look at the legal, political, and public health factors that could influence efforts to prevent gun massacres.
Participants include Laurence Tribe, professor of Constitutional Law at Harvard Law School; Felton Earls, MD, professor of child psychiatry at Harvard Medical School; David King, senior lecturer in public policy at the John F. Kennedy School of Government at Harvard, and chair of Harvard’s Bipartisan Program for Newly Elected Members of Congress; and David Hemenway, PhD, Director of the Harvard Injury Control Research Center.
In advance of tomorrow’s Forum, NewPublicHealth spoke with Dr. Hemenway about ongoing research efforts aimed at preventing gun violence and gun massacres. Dr. Hemenway is the author of Private Guns, Public Health, which demonstrates how a public-health approach—historically applied to reducing the rates of injury and death from infectious disease, car accidents, and tobacco consumption—can also be applied to preventing gun violence. Dr. Hemenway’s book was supported by a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
NewPublicHealth: What is the overall goal of the Forum?
Dr. Hemenway: The Forum series focuses on how public health can help impact many major issues in the U.S. We are able to gather experts at Harvard who are working on these issues to provide information about what we know and to share ideas on approaches to help address these problems.
NPH: On tomorrow’s panel, you’ll be discussing the issue from a public health approach. What are some of the concepts you’ll be sharing?
Mental health has become a more prominent topic since the recent shooting in Newtown, Conn., that claimed 26 lives, 20 of them children. The Alliance for Health Reform, a non-profit group based in Washington, D.C., that provides information to journalists and Congressional staff on health reform issues, released some key numbers on mental health issues recently that can be useful in moving the discussion forward:
- An estimated 45.9 million adults in the United States age 18 or older had any mental illness in 2010 (one out of five people in this age group).
- In 2010, an estimated 31.3 million adults received any kind of mental health service during the past year.
- Among adults with severe mental illness, 60.8 percent received mental health services during the past year.
- An estimated 11.1 million adults reported an unmet need for mental health care in the past year. Of those, 5.2 million had not received any mental health care at all in the past year.
- People who are out of work are four times as likely as those with jobs to report symptoms consistent with severe mental illness.
- The cost of care is the reason most often given by people who recognize that they need mental health treatment but don’t get it.
According to research by the Alliance, mental illnesses range from occasionally troubling to life-consuming. To cope with temporary problems, such as depression following illness or a traumatic event, many people need only a short-term intervention. But others experience more debilitating and long-lasting conditions that interfere with routine activities such as work, school and family, and can require lifelong treatment.
Effective, well-documented treatments for mental illness and substance abuse have been developed and widely disseminated, including psychotherapy, psychosocial treatment and prescription medications. But a significant number of Americans do not have adequate access to mental health treatment or do not take advantage of available help.
The Institute of Medicine and the Avon Foundation for Women issued the “Ending Violence @ Home App Challenge” to encourage powerful communication through technologies such as social media and mobile apps to help end worldwide suffering caused by domestic violence. Four winners of the App challenge were chosen from 19 submissions that came in from across nine countries. The four were chosen based on their innovation, design, potential impact, and ability to integrate evidence-based information and usability in different settings. IOM President Harvey Fineberg stated in a release, “I am very impressed with the level of creativity demonstrated by the winning products, which can make a real difference to abused individuals.”
The top prize of $10,000 was awarded to Wisdom of the Children (Çocuktan Al Haberi), a Turkish group that developed a website to encourage individuals to see that change can start with a simple shift in how we talk to each other. The website encourages families to take old Turkish expressions that condone violence and reinforce traditional gender norms, and turn them into more positive sayings. For example, the traditional saying from the region, “don't spare a baby from your wife's belly and rod from her back,” was changed to “don't spare soup from a women's belly and sunscreen from her back.” Web visitors are encouraged to create their own new, positive, health-reinforcing sayings with their children.
>>Read more about the app challenge.
Last week at the American Public Health Association (APHA) annual meeting, a number of presenters took on an important, but often overlooked topic in the public health world: violence. Violence is often primarily considered a criminal justice or public safety issue, but there is a growing movement of public health practitioners that recognize that the health of vulnerable communities cannot be improved without first stopping shootings and killings.
When violence is present in a community, it impacts the physical, mental and emotional health of all residents. Violence also often prevents other positive changes from taking place. According to Greta Massetti from the Centers for Disease Control and Prevention, the current economic impact of youth violence is an estimated $14.1 billion in combined costs from medical care and work loss.
Treating violence as a disease
For many vulnerable communities, violence is the most pressing health issue. For children growing up in violent communities, the health impact is more than just the physical threat. As Benita Tsao from Urban Networks to Increase Thriving Youth (UNITY) pointed out, growing up in a community plagued by violence can often feel like being in a war zone. That constant fear results in real health consequences, as evidenced by the increasing number of children who have grown up surrounded by violence and are now showing signs of chronic traumatic stress disorder. Experiencing ongoing trauma impacts young people’s physical, mental and emotional development, and has the ripple effect of making it harder to focus and succeed in school.
>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.
Sheila Regan manages hospital partnerships for Cure Violence, formerly CeaseFire, an organization based in Chicago that has pioneered a public health approach to stopping shootings and killings. A grantee of the Robert Wood Johnson Foundation, Cure Violence has been successful at reducing violence in cities across America.
This week at APHA, Cure Violence shared how violence presents all the same characteristics of an infectious disease. Like tuberculosis or cholera, violence appears in clusters; it spreads and can be transmitted. By changing the frame on violence, Cure Violence is able to use proven public health strategies from other epidemics to stop shootings and killings. Hospital partnerships are a key part in stopping the spread and transmission of violence.
NewPublicHealth: Can you explain how Cure Violence’s hospital partnerships work?
Sheila Regan: We have a number of partnerships with level I trauma centers that are committed to the public health approach to violence prevention. We serve patients who are violently injured, typically shootings, stabbings or beatings and work to prevent further violence, retaliation or re-injury, which are seen as normal in our culture. There are the doctors, police, nurses, social workers, and everybody you’d expect to see in the hospital. What we’re trying to do is introduce a third party—our workers—who can impact behavior and mindset around violence at an opportune moment.
NPH: When someone has been injured, what is the goal of Cure Violence working with them in the hospital?
Debbie Lee, senior vice president at Futures Without Violence and deputy director of Start Strong: Building Healthy Teen Relationships’ national program office, will speak Tuesday, October 30 about lessons learned from the Start Strong initiative at an APHA session on preventing teen dating violence.
Start Strong is a national program of the Robert Wood Johnson Foundation in collaboration with Futures Without Violence. The Robert Wood Johnson Foundation and the Blue Shield of California Foundation have invested in 11 communities across the country to identify and evaluate the most promising pathways to stop dating violence and abuse before it starts. This initiative uses a comprehensive community health model to prevent teen dating violence and promote the development of healthy relationships among 11 to 14 year olds.
NewPublicHealth spoke with Debbie Lee before her APHA session to find out more about the unique approach Start Strong is taking to building healthy relationships skills in youth and tackling teen dating violence before it begins.
NewPublicHealth: First tell us a bit more about the comprehensive approach that Start Strong uses.
Debbie Lee: Start Strong uses a multifaceted approach to promote healthy relationship behaviors among young adolescents in order to stop relationship violence before it starts. Its four key components include: educating and engaging youth in and out of school; engaging the people that influence teens; addressing policy change in schools and environmental factors that affect adolescent development; and then implementing communications and social marketing strategies to create and reinforce positive social norms.
NPH: This year’s theme at APHA is “Prevention and Wellness Across the Lifespan.” How does Start Strong fit into this theme?
Martin Fenstersheib, MD, MPH, director of the Santa Clara County Public Health Department in California led a session on safe outdoor activity for kids and adults at the 2012 Public Health Law Conference. NewPublicHealth spoke to Dr. Fenstersheib about what is keeping our communities from safely getting outside to play—violence, blight and communities built for cars—and solutions grounded in evidence-based public health law.
NewPublicHealth: You presented at a key session on making outdoor physical activity opportunities safer. What makes this an important issue for you?
Dr. Fentersheib: Often when we talk about physical activity, we hear people say that all we need to do is convince kids to go outdoors. A lot of us then say, “when we were kids, our parents let us out of the house in the morning and we came back at nighttime and all was well.” There wasn’t any problem with that. But, of course, we’ve all become aware of safety as a barrier to outdoor physical activity. And the issue has to do with not only criminal or violence safety, but safe streets generally. Do cars in an area make it less safe for example? And, is our environment built in a way that it is safe for kids to walk to school? My presentation will be an overview of the benefits of physical activity, and what some of the barriers are.
We’ll also look at the legal side of the issue, including a study on mixed use land zoning. I think the bottom line is that safer neighborhoods will have more of a mixed use flavor so that you don’t have to go far to get to work or play or to recreational areas. In such neighborhoods, there are stores and other places for you to go, and you’re closer to public transportation. The data to be presented will show that the crime rates in those areas are lower than in pure industrial areas or areas where there isn’t mixed use. Mixed use is helping to improve the built environment in the communities in which we live by having more eyes on the street, by having people basically looking out for one another and be more of a community.
NPH: What are examples in Santa Clara of new plans to create safer outdoor spaces for children and adults?
In the wake of yet one more high-profile shooting this week, at Texas A&M University, the Associated Press profiled the Violence Prevention Research Program at the University of California, Davis, which is calling for a public health approach to reducing gun violence, in the same way that public health has tackled such issues as motor vehicle deaths, tobacco and alcohol. "The greater toll is not from these clusters but from endemic violence, the stuff that occurs every day and doesn't make the headlines," says Garen J. Wintemute, MD, MPH, the program’s director.
According to information in the article from the Centers for Disease Control and Prevention, there were more than 73,000 emergency room visits in 2010 for firearm-related injuries.
Critical factors being addressed by the Violence Prevention Research Program include:
- What makes someone more likely to shoot?
- Which firearms are most dangerous and why?
- What conditions allow or contribute to shootings?
>>Bonus Link: Public Health Law Research, a program of the Robert Wood Johnson Foundation and Temple University Beasley School of Law are co-sponsoring LEPH 2012: The First International Conference on Law Enforcement and Public Health to be held in Melbourne, Australia, November 11-13, 2012.
Among the sessions will be case studies of successful collaborations between police and public health across a wide range of issues.