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Violence: A Public Health Approach to Prevention

 

Violence prevention is an issue that is considered relatively new, especially when thought of in the context of public health and general prevention efforts.  Violence was first recognized as a potential health problem just 50 years ago, and only within the last 30 years have active research and preventive efforts in violence been given wide consideration and legitimacy. This page is dedicated to understanding violence prevention within the realm of public health. It provides general information, historical context and tools for moving violence prevention further.

 

CHI has been engaged in community-based violence prevention efforts for over a decade. Within our foundational commitment to building healthier communities, CHI has been long recognized the connection between public health and violence prevention. Through partnerships with entities such as the Prevention Institute and the Institute of Medicine, CHI has adapted a public health approach as a framework for all community-based violence prevention initiatives. Information on this page is meant to further system-wide understanding of the public health approach to violence prevention and to engage colleagues in community and organizational violence prevention efforts.

 

What is a Public Health Approach?

 

A public health approach to any health issue – often chronic disease (e.g., Diabetes, heart disease, cancer) – focuses on the following tenets:

 

     o The approach is population-based. It assesses the health status and needs of a given population, then implements interventions, evaluates effectiveness, and provides culturally-sensitive and competent care (American Medical Association, 2002).

     o The approach will increase protective factors and reduce risk factors.

     o The approach must be prevention-centered.

Case Study: Urban Networks to Increase Thriving Youth (UNITY) is a systematic approach to violence prevention that involves several of our nation’s largest cities in efforts to prevent youth violence before it occurs. It focuses on an expansive population of youth and provides an evidence-informed structure for increasing resilience and decreasing risk in communities. Assessment of programs demonstrates a great reduction in violence through this preventive approach. See related statistics.

 

 

 

 

 

Why does it apply to violence?

 

o Violence is one of the leading causes of death and disability in the U.S. (Centers for Disease Control and Prevention (CDC), 2013). Simply - violence IS population-based.

o Violence disproportionally affects youth and people of color. For persons between the ages of 15 and 34, homicide and suicide are among the top three causes of death (CDC, 2013). “Among 10 to 24 year-olds, homicide is the leading cause of death for African Americans; the second leading cause of death for Hispanics; and the third leading cause of death American Indians and Alaska Natives (CDC, 2010).”

o Violence is directly linked to poor health outcomes. Asthma, heart disease, cancer, stroke, chronic obstructive lung disease, diabetes and hepatitis all have much higher incidences in victims of violence than in non-victims (Unity, 2012).

o Most of all – VIOLENCE IS PREVENTABLE! We know we can make a difference, and we should make a difference. (See the Model Programs box at right for examples.)

 

What can be done?

 

Health providers are in a unique position to support the framing of violence as a public health issue. With issues of violence being a significant part of the care we provide in our emergency departments and other settings, we are compelled to address the issue of violence. We shouldunderstand the historical evolution of violence and public health, tell our stories, and draw the connections with our facility, community, state and federal leaders. It will take a continued shift in social policy and scientific thinking about violence to effectively position it as a public health crisis.

The History of Violence Prevention as a Public Health Issue

 

• Understanding the intersection between violence and public health brings new meaning to the nature of prevention. Below is a timeline of violence and the public health approach adapted from the CDC (2012).

 

o 1960’s: The U.S. becomes better at preventing chronic disease; violence rises to become one of the top causes of death in the U.S.

o 1960’s – 2000: The public health community increasingly accepts that behavioral factors are associated with disease prevention.

o 1960’s-1970’s: Child maltreatment and intimate partner violence were widely recognized as impactful, detrimental problems to society that could not be solved through justice system-means alone.

o 1979: The U.S. Surgeon General’s Report on Healthy People identified “control of stress and violent behavior” as one of the top 15 priority areas for the nation.

o 1980’s: This decade witnessed an “epidemic of violence,” among adolescents aged 15-24 and specifically affecting male, non-white populations aged 15-19.

o 1983: CDC creates the Violence Epidemiology Branch. It studies cluster incidents around murders and suicides.

o 1985: The U.S. Surgeon General conducts a workshop – on Violence and Public Health. It encourages health providers to become involved.

o 1986: The World Health Assembly declares violence a leading worldwide health epidemic.

o 1990’s: Widespread expansion of CDC efforts, including a publication on youth violence prevention, extensive research and trials around violence and public health, and the development of a youth behavioral surveillance system to track and research violence, among numerous others.

o 1999: The U.S. Surgeon General releases a report on youth violence that discussed patterns, risk/protective factors, and cost-effectiveness of prevention. (Youth violence set the stage for understanding prevention with regard to all forms of violence.)

o 2000: The World Health Organization (WHO) creates a Department of Injuries and Violence Prevention.

o 2002: WHO publishes a World Report on Violence and Health.

 

The Current State of Violence Prevention and Public Health

 

• Now, current practices recognize violence as a public health issue and approaches to violence prevention are developed similarly to those of chronic disease. Emerging trends indicate a broad spectrum of change that will be essential to national reduction.

 

o Evidence-based practices and evidence-informed practices are being applied to violence prevention and demonstrating that prevention is possible!

o The health system is transitioning from a system of sick-care to well-care, with a major focus on prevention - a mandatory part of essential health benefits for all Americans under the Affordable Care Act.

o States and the federal government, in addition to private sources of funding, are recognizing the need to fund violence prevention. They are beginning to understand and support efforts that will create healthier communities and save money in the health and justice systems.

o The general public is aware of and ready to support violence prevention. Horrifying violence acts, and a mass media that focuses on violent content are pushing the population to support and call for prevention.

The Future of Violence Prevention and Public Health

 

The future depends on you, on your families, and your communities. The case for violence prevention is a strong one, but it must continue to be made. Health advocates, community activists, legislators, community leaders and YOU – everyone must work together to support funding and policy that will continue to elevate violence as an issue of public health that must be addressed. The case must be made to facility leaders, community leaders, and state and federal leaders. Here are a few suggestions for making your case that apply whether you are a violence prevention program leader, a concerned health care provider or a concerned citizen:

 

o Know your facts! Know the history of the issue and know what the experts say.  (See the “Expert” box at the right for helpful resources.)

o Understand that violence is PREVENTABLE. Learn about model violence prevention programs and how they have affected neighborhoods, communities and even social and public policy. (See the “Model Programs” box at right for helpful resources.)

o Understand that “savings” related to violence prevention are counted in both human and financial costs.  (See the “Making the Case” box at right for helpful resources.)

o MAKE THE CASE & ADVOCATE! Whether by letter, in-person visit, report, presentation, or any other medium that will reach leaders, take the information you learned and your understanding of the issue and present it.  Collaborate with other organizations – schools, nonprofits, churches, etc. – and increase the size of your presence and your presentation.  (See the “Advocate” box at right for helpful resources.)

Remember – this issue is fairly recent when compared with other issues affecting public health. Violence has always existed and has always impacted health, but it has only been recently recognized as such. We live in an opportune time to make our case, and we simply must be patient and perseverant!

 

©2011 Catholic Health Initiatives, All rights reserved.

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