Applying a Public Health Approach to our Nation’s Violence Epidemic
We live in a violent culture. Not a day goes by that we don’t read about another act of senseless violence. From the proliferation of mass shootings like what we saw in Las Vegas a few weeks ago to the youth stabbing here in a Bronx High school last month. Predictably, there have been renewed calls for action, be it gun control or improving school safety standards. Though both are important, they are singular solutions. We need to apply a public health approach to bring a comprehensive solution to our complex and multi-faceted epidemic of violence.
Violence is a leading public health threat in our nation today impacting the health and safety of our communities. It is a leading cause of injury, disability, and premature death that disproportionally impacts youth and people of color. The United States is far more violent than other advanced nations. According to a 2016 study published in The American Journal of Medicine, Americans are 10 times more likely to die from firearms than citizens of other developed nations. And a chart developed by Kieran Healy, a professor of sociology at Duke University shows that the United States is about three times as violent as 23 other wealthy nations.
We started talking about violence as a public health issue over 35 years ago. In 1979, the United States Surgeon General’s Report, Healthy People, identified stress and violence as one of the top priority areas for the nation. The report stated that violence can be prevented and clearly recognized violence as a public health issue that can be addressed using a public health approach. In 1980 a landmark report by the Department of Health and Human Services, Promoting Health/Preventing Disease: Objectives for the Nation, established the first ever national goals for violence prevention.
Still, in 2015, 17,793 people were victims of homicide and 44,193 took their own lives. Homicide is the third leading cause of death for young people ages 10 to 24 years old. In 2014, 4,300 young people were victims of homicide—an average of 12 per day. For the same year, another 501,581 were treated in emergency departments for injuries sustained from physical assaults.
So what do we mean by a public health approach to violence? We mean prevention. The public health approach includes collecting data and doing analysis to define the problem, identifying the people and communities at greatest risk while identifying both risk and protective factors and then developing and testing prevention strategies. Once strategies are proven effective, they must be adopted at scale.
Violence is preventable, not inevitable. The public health approach is built on the premise that violence is a learned behavior that can be unlearned or not learned at all. It is based on evidence that violence is rooted in complex, underlying issues and is often a predictable behavior in unsafe environments in which people live and raise their families.
Cure Violence, a neighborhood-based, public health oriented approach to violence reduction and prevention, is one that has shown promising results. The program employs community-based “outreach workers” as well as “violence interrupters” in neighborhoods with high rates of gun violence. These workers use their relationships, networks and influence in a community to dissuade specific individuals and residents perceived to be at risk for committing a violent act not to engage in violence. The evidence indicates that when Cure Violence strategies are implemented as intended there is the potential to “denormalize” violence in whole communities.
Cure Violence was launched in New York City in 2010. Today there are 18 programs around the City. A recent evaluation conducted by the John Jay College of Criminal Justice, City University of New York documented gun violence trends before and after the opening of two programs in the South Bronx and East New York, Brooklyn. In the South Bronx, gun injuries were down 37 percent after implementation and in Brooklyn, gun injuries were down 50 percent after implementation. Additionally and probably most important, young men in neighborhoods with the Cure Violence program reported declining support for violence as a means of settling disputes. The study provides promising evidence that a public health approach to violence reduction and prevention works.
Violence affects people in all stages of life and there are different forms of violence—child abuse, youth violence, intimate partner violence, sexual violence, elder abuse and suicide. All are strongly interconnected. There are many examples of successful initiatives that are being implemented around the country. We have learned that by using a public health approach, we have an opportunity to create and sustain evidence-based solutions to prevent violence.
So what are we waiting for?