Intersection of Violence and Public Health Explored by Alumni

Skipping over ‘remember when?’ stories and the strains of “the tables down at Mory’s,” Yale School of Public Health alumni spent their June reunion in a provoking and probing discussion of violence as a public health issue.

Deborah Prothrow-Stith, M.D., the event’s keynote speaker, recalled her formative days in Boston City Hospital attending victims of violence. “We stitched them and sent them out.” Without protocols, hospital staff ignored the very real threats of retribution by victims eager to exact revenge.

“Most violence is not random, but happens in the context of people you know,” explained Prothrow-Stith, a consultant with the Spencer Stuart firm, an adjunct professor at the Harvard School of Public Health and former commissioner of health for Massachusetts.

The law only reacts–investigating crimes and punishing perpetrators. Public health practice, with its successful track record on anti-smoking, drunk driving, and seat belt initiatives, has an important role to play in preventing violence.

A culture of violence

“Violence is an ingrained part of our social history,” explained Prothrow-Stith. She cited a 15-year-old murderer who once said, “I’m the monster this society made.” In fact, the boy was the latest in a long line of violent men going back to the country’s founding, she said. They all were driven to violence by circumstance and the desire for respect.

The means to resolve conflicts, then as now, was with the gun. The annual homicide rate in Philadelphia in 1850 was about the same as it is today–18 people per 100,000. The gentlemanly protocols of dueling were codified; fights were public events and men enhanced their reputations through their prowess with a gun. It is believed that the ambulance service comes from the practice of physicians attending with their carriages to quickly get the day’s loser into care as quickly as possible.

Even Alexander Hamilton, before his death in 1804 at the hand of Vice President Aaron Burr, acknowledged the fact that dueling was illegal but chose to participate because it would otherwise cost him politically. “If Alexander Hamilton could not resist those societal pressures, how do we expect random kids in our society to?” Prothrow-Stith asked the alumni gathering at the New Haven Lawn Club. “It’s [violence] being illegal didn’t work then, and it’s not working now.” The fact that formal dueling is no longer an acceptable means to settle differences, however, provides Prothrow-Stith with optimism about society’s ability to change.

Prothrow-Stith called for greater attention to the needs in the middle of the violence spectrum–“in the thick”–where prevention has failed but where intervention workers, for example, may still have a chance at modifying behaviors before a crime is committed. This requires collaboration, interdisciplinary initiative and research. “The silos of public health organizations are a bit of a problem. We forget the intersections,” she said.

In the trenches

A panel of local experts further discussed the issue in a forum titled “Violence: Community Responses to a Public Health Epidemic.” Moderated by David Dan, M.S.W., of Resources for Human Development and Friends of the Children, the panel included Erika Tindill, Esq., executive director of the Connecticut Coalition Against Domestic Violence; Barbara Tinney, M.S.W., executive director of the New Haven Family Alliance; and Shafiq Abdussabur, a New Haven police officer and the author of A Black Man’s Guide to Law Enforcement in America.

“To not feel a sense of urgency,” Dan said in his opening remarks, “is cultural heart disease.”

Tinney, who has headed a youth-intervention initiative since 2006 when gun violence spiked in New Haven, said she has learned that the notion that violence is an accepted part of the culture of a poor neighborhood is false. “It is not accepted, but there is a sense of hopelessness. The young people involved know the difference between right and wrong. They are not morally bankrupt. But they see violence as one of the few alternatives they have. They have limited opportunities and feel alienated and disengaged,” she said.

Addressing the issue of domestic violence, Tindill said she is working to shift the focus from treating victims to preventing violence in the first place, an approach similar to what Mothers Against Drunk Driving has done.“We need criminal justice, clergy, neighbors and employers to all have a role,” she said.

At the intersection of criminal justice and intervention is Abdussabur, whose organization, the CTRIBAT Institute for Social Development, grew out of the relationships he fostered with kids as a community-based patrol officer. As he and his partner got closer to the kids, “we had to pick up the burden,” he said. They found themselves placing children into social services, mediating between groups of kids and providing safe activities.

Responding to frustration expressed by more than one attendee engaged in the issue, Curtis Patton, professor emeritus, told his story of growing up in a black neighborhood in Alabama. One day, two white police knocked at the door. One officer aimed his gun at the dog and then started asking questions. The other officer interrupted, “There are flowers in the yard. I think we have the wrong house.” Suggesting a paradigm shift in public health professionals’ approach, Patton pointed out that as much can be gained by cultivating more of what is working in a community as by looking at the problems.

H. Dean Hosgood, M.P.H. ’05, Ph.D. ’08, a fellow at the National Cancer Institute, received the year’s Eric W. Mood New Professional Award. Hosgood said, “This award truly goes to the faculty and staff who gave me the guidance to be where I am now.” Alumni Public Service Honor Roll inductees were Olga M. Brown-Vanderpool, M.P.H. ’74, and Audrey S. Weiner, M.P.H. 75.

At the awards luncheon, the Distinguished Alumni Award winner, Steven Jonas, M.D., M.P.H. ’67, implored his colleagues to also look at how guns contribute to violence. “The National Rifle Association is the 800-pound gorilla in the room,” he said. A primary difference between the United States and other countries is the widespread availability of guns. “In order to win this battle, we have to go on the offense.”

Alumni Day 2010 Slideshow