Monday, December 17, 2012

Violence is a public health problem


Greetings,

On April 16, 2007, I was in Florida on vacation from my job at Boynton Health Service. I was rocking my 8 day old grandson when my daughter hollered from another room, “Dad, something bad is happening at Virginia Tech.” When I walked into her study and saw the headlines on her computer screen, my mind immediately traveled to Blacksburg, Virginia where I pictured my college health and counseling friends and colleagues at Virginia Tech in the midst of a nightmare that had become a frightening and deadly reality. I knew they would be among the people responding to the carnage that had occurred, but given the stressed and distressed students who seek assistance every day at college health and counseling services, my first thought was for their personal safety. I silently hoped that my friends had been spared physical injuries so that they would be available to help others with recovery and not have to first deal with their own.

Unconsciously, my mind quickly jumped to my own campus, a large urban university with a complex and diverse student body 850 miles from Virginia Tech. While the University of Minnesota has many unique characteristics and is located in a markedly different part of the country, it has more similarities to Virginia Tech and other post-secondary institutions than differences. What was happening in Blacksburg could have been happening on any college campus anywhere in the country.  

Five years later I was in the middle of the State Community Health Services Advisory Committee (SCHSAC) meeting when I heard the news from Newtown, Connecticut that multiple students and staff at the Sandy Hook Elementary School had been shot. With a sense of déjà vu, my mind traveled to the Connecticut school where I pictured the well-rehearsed response of school, law enforcement, and medical personnel doing what they were trained to do in the face of great danger and tragedy. But my mind also jumped to the elementary schools in Blaine, MN and Jacksonville, FL where my grandchildren are matriculating. 

My mind travels and my sense of fear, anger, and disbelief reminded me that all of us are affected by violence wherever it occurs. No one and no area is immune to these kinds of events. We are all vulnerable.  Having had shooting events at Red Lake and Rocori High School reinforces that vulnerability. 

In 2007 I felt an intensely personal connection to the tragedy that had occurred. I’m feeling the same way about last week’s tragedy in Connecticut. This personal connection makes me want to do something as an individual to keep similar events from happening again; but what can an individual do? Looking back on 2007 when I was monitoring a terrible situation with an 8 month old in my arms, I realized that what I had done in raising my children, getting involved in their schools and in our neighborhood, coaching soccer, volunteering with special needs individuals, and being a present and supportive father and grandfather were probably the best things that I could have personally done to help prevent similar events in the future. The importance of staying involved in the lives of one’s children, grandchildren, and community is probably no different today. 

However, as someone working in public health, there is also a profound professional obligation to work to prevent these kinds of events from happening again. Violence is a major public health problem. It affects a large number of individuals directly and it affects everyone in our society indirectly. It affects both our physical and our emotional health and it detracts from our ability to optimally enjoy our environment and our society. It is also a problem that is preventable. The precursors of violence are evident throughout our society – adverse childhood experiences (ACEs), unaddressed (or ineffectively addressed) mental health problems, bullying, easy access to firearms, racial and economic disparities, sexual exploitation, family disruption, substance abuse, lack of economic opportunity, media messages, and many more. While all of these have been seemingly intractable problems, we should not assume that they are impossible to change. I believe they are amenable to changes in appropriate policies, in the environment that fosters violent behaviors, and in the social, education, and mental health systems that fail to effectively deal with troubled individuals.

The precursors to violence can be changed with a systematic and comprehensive approach. We need to review whatever epidemiological information we have on violence and determine what other information is needed. We need to learn more about “best practices” and/or “evidence-based” approaches to violence reduction. And we need to solicit partners in the effort to prevent violence, if it is to be successful. We also need to recognize that implementing these measures will take a long-term commitment to some bold actions and changing some of the ingrained patterns of functioning in our society.

As I watched my daughter care for her infant son in 2007, I realized that all of the work that people do to reduce poverty, improve child development, support families, foster social justice, increase educational achievement, enhance communication, and strengthen parent-child bonds serves to prevent myriad future physical and mental health problems. These, in-turn, help to prevent violence. There is no vaccine that will prevent violence, but I’m hoping that what we do today to address all forms of violence in our communities through policy, systems, and environmental change will help reduce the problem and alleviate the worry and the fears from my grandchildren and all children so that they can reach their full potential and help lead us all into a more peaceful future.

Ed