Nov 21 2011
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Preventing Violence: A NewPublicHealth Q&A with Kristin Schubert

Kristin Schubert, Robert Wood Johnson Foundation

>>EDITOR'S NOTE: On 9/13/2012 CeaseFire changed its name to Cure Violence.

Violence is preventable. It's a simple statement, but one that has sparked considerable dialogue in the field of public health and beyond. Groups like Start Strong, which works on preventing teen dating abuse by educating pre-teens on healthy relationships, and CeaseFire, which helps prevent the spread of gun shootings and killings by tracking and containing it like an infectious disease, are some of those leading this critical discourse. These programs focus on changing behavioral norms and community conditions so that violence does not spread from act to act, person to person.

NewPublicHealth caught up with Kristin Schubert, MPH, a director at the Robert Wood Johnson Foundation (RWJF) and a specialist within RWJF on violence prevention, about the Foundation’s approach to the issue and strategies in the field that are working to create change.

NewPublicHealth: What makes violence a public health issue?

Kristin Schubert: When people think of violence, they often think of extreme forms of violence—war, gunshots, gangs. They often don’t think about it in its most holistic forms—intimate partner violence, verbal violence, child maltreatment and neglect, date rape, stalking, bullying—anything that makes a person feel unsafe. When we look at violence in the fullest way, it very much is an issue that affects everybody.

NPH: Tell us more about that. How does violence affect all populations?

Kristin Schubert: You take an issue like intimate partner violence or sexual violence. These are issues that cut across socioeconomic status, all racial and ethnic lines. No one is immune.

Violence is an issue that affects everyone. You might not be the direct recipient, but chances are you know someone who has been affected. Intimate partner violence affects one in four women in this country and one in three women worldwide. And we know that is probably a significant underestimate because of the nature of intimate partner violence—it’s something that has been kept hidden and private, and we’re trying to change that. Just using that statistic alone, you can see this is something that is commonplace and very much, a public health issue.

NPH: Why is violence so pervasive?

Kristin Schubert: There are many factors that influence violence. You have to look at the culture around us, and the shift in our values as a society—the increased shift in seeing violence as an acceptable way of dealing with problems.

There is of course an economic dimension. The more a community feels the stress of not having adequate resources, the more that stress is going to need an outlet. When we see the economy start to decline, you start to see an uptick in intimate partner violence, for example. When you dig a little bit deeper, you start to see common factors that are very much contextual—housing, jobs, social isolation.

We know that the child who was abused is that much more likely to be a victim or perpetrator of bullying a few years down the line, and then is that much more likely to be a victim or perpetrator of dating violence a few years later in high school, and then is much more likely to be a part of more family violence later on. There’s no form of violence that stands alone. It’s a multigenerational phenomenon that is passed down.

This context is so essential—in considering why someone engages in violent behavior, it’s important to recognize that it’s not just the “bad apple,” it’s not the person. It’s the behavior. As Gary Slutkin of CeaseFire says, “Violence is a learned behavior.”

One study called the Adverse Childhood Experiences Study, showed in a cohort of older adults that the more adverse events they experienced as a child—maltreatment, neglect, abuse, witnessing violence—the greater their health problems later on, including hypertension, diabetes and heart disease. We’re learning about what happens when you do not feel safe inside your home or in your neighborhood, or in your school, and the effects on your mind and body. That kind of exposure to trauma and toxic stress affects you physically and mentally. It changes your brain, it changes your perspective, and it changes your behaviors. Picture that at a community level, where there are high rates of violence. Now you have people who are responding the same way, have the same norms about violence and reinforce this kind of behavior among one another within a school, within a community. That kind of science is helping us understand the transmission of violence.

NPH: Many view violence, poverty and inadequate housing as intractable problems. What is the Robert Wood Johnson Foundation's approach to tackling them?

Kristin Schubert: A lot of our work early on was to give supports to individuals. For example, the Nurse-Family Partnership can be seen as a violence prevention program, among other things. You’re teaching moms, giving them resources and human capital, to use positive disciplinary techniques—giving them supports, helping them connect with others so that they can be better parents.

A few years ago, we started funding CeaseFire—it focuses more on secondary prevention by trying to anticipate and interrupt violent acts before they happen, but as it succeeds in changing norms around interpersonal violence, starts to have a primary prevention effect in communities.

>>Read our Q&A with Tio Hardiman from CeaseFire Chicago.

And then with Start Strong, we are asking the question: is there a way to prevent intimate partner violence before it starts? By focusing on prevention instead of treatment, we are expanding the conversation to the whole community (public health, schools, health care, businesses) and engaging all stakeholders in promoting healthy relationships with young people.

>>Read our Q&A with Start Strong Atlanta.

NPH: Are there interesting collaborations happening across sectors and beyond public health to help prevent violence?

Kristin Schubert: The power of prevention is that you can bring in a much bigger variety of stakeholders, and that is so important. For so long with domestic violence, people would say, “That’s not my issue. That’s the police’s issue, that’s the court’s issue, and that’s that woman’s issue. It’s not my issue.” With prevention, we’re able to bring teachers, parents, coaches, business owners, and schools in to deliver a message of healthy relationships, model healthy relationships and have a stake in making real change. We just co-hosted a meeting at the CDC to talk about how we actually define and measure healthy relationships. Just having the dialogue is important. It’s a new way of framing things. We’re going to help a new generation of kids, parents and schools talk about these issues in an open way and set the stage for making progress in stopping this problem.

NPH: What are some of the changes happening at a policy level to make communities safer, healthier places to live and prevent violence?

Kristin Schubert: I think it goes back to how you think about what a healthy community is. How do we bring business and industry back to areas that are lacking job opportunities? How do we get people stabilized financially? How do we get them housed? Housing as a fundamental component of people’s health is so essential. So housing policy, job policy, school policy—we all need our kids to be able to go into a safe school environment. A more specific approach is using schools as a lever for policy change. Start Strong has created a model school policy that focuses in on prevention. Does a school have a curriculum on healthy relationships? Do they have a protocol in place should something occur on their campus that is balanced and restorative rather than punitive? I think it will go a long way in creating a culture change, norms change, and attitude change around this issue. Importantly, we will begin to make intimate partner violence a public, not a private, issue—one that everyone has a stake in preventing. And hopefully the ripple effects coming out from this will be vast.

Tags: Community violence, Education, Housing, Interpersonal violence, Prevention, School Health, Violence