A Public Health Approach to Violence Prevention

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Law enforcement agencies should adopt a public health approach to addressing issues related to violence, say researchers at Utah State University.

In a paper sponsored by the university’s HEART Initiative, researchers Kira Swensen, Gabriela Murza, Sandy Sulzer, and Maren Voss, explain that it’s been more than three decades since then-Surgeon General C. Everett Koop called for incorporating a public health perspective into law enforcement.

As the justice system struggles to cope with strained budgets in communities plagued by violence, the researchers argue it’s long past  time to follow through on his recommendation and develop partnerships between public health agencies and law enforcement.

“Public health and law enforcement have a lot in common,” the paper said. “Both sectors want to improve the health and safety of their communities and to stamp out violence.

“Coordinating the efforts of the two sectors can bring a balance of prevention and reaction approaches, which are customizable behavioral changes to the specific community.”

It could also save taxpayers money, the researchers added, noting that “in an economy where funding is scarce, and many agencies are having to do more with less, combining efforts offers a win-win opportunity.”

The researchers cite estimates showing  that every $10 spent per person on public health programming can have a return of over $16 billion within five years, the researchers cite.

The HEART Initiative paper also notes that 46 states spend an average of $150,000 annually on incarcerating one juvenile.

“One method of reducing these costs through public health efforts is engaging youth in violence-prevention programs that reduce risk factors and increase protective factors,” the report said.

“Regular home visits to low-income, first-time mothers by trained nurses resulted in half the arrest rate by age 15 compared to youth not involved in the program, and $4 saved for every $1 invested.”

The two approaches—public health and law enforcement—too often are seen as opposed to each other in purpose and practice, the researchers said.

“Public health uses a prevention approach to address issues related to violence, whereas the criminal justice field traditionally relies on a more reactive approach to address violence,” said the paper.

Translated into real life, a criminal justice approach to public safety focuses on prosecutions and incarcerations, whereas a public health approach emphasizes, social support, and case management as a way to assess problems and protect the public, the researchers explain.

But both approaches could usefully complement each other, according to the paper.

Public Health Benefits for Law Enforcement

One successful program, the Nurse-Family Partnership in California , sponsored by the Prevention Institute, found that low-income first time mothers who saw trained nurses regularly in their home resulted in healthier households overall, and reduced child abuse rates.

Notably, participants had one-third as many arrests, and their children were half as likely to be delinquent 15 years later, the HEART Initiative paper details.

A report describing the program quotes Rob Reiner, Chair of the California Children and Families Commission, as saying, “Violence prevention begins in the high chair, not the electric chair.”

Moreover, the researchers write, there are community and “human” benefits that result in adding public health perspectives into law enforcement.

“Partnered public health and law enforcement can increase coordination and community cohesion,” the researchers detail, noting that through funding community safety programs and promoting community resilience through depression, anxiety, and suicide resources, families and neighborhoods will be safer.

The researchers cite a health intervention program from Utah called Housing First, which provides housing for sober and employed people experiencing homelessness. In the first decade of its implementation, there was a local 91 percent drop in chronic homelessness, and a decrease in local crime.

Another example comes from the Fitness Improvement Training (FIT) Zone program in East Palo Alto, CA., where community outdoor spaces were built in areas that saw high rates of gun violence and gang activity. This recognizes the biopsychosocial model of combating crime, as the residents in the community saw the outdoor spaces as helping them deter criminals and reclaim their shared space.

The FIT Zone program’s evaluation found that shootings decreased by 27 to 58 percent in the areas where outdoor spaces were created, and the offenders didn’t move to another area, as crime didn’t increase in nearby communities, the HEART researchers detail.

Recommendations

Overall, the Heart Initiative researchers note that bold change and improvement can be made by:

      • Coordinating between public health and law enforcement agencies;
      • Adopting, investing in,  and expanding promising, evidence-based public health approaches; and
      • Sharing methodologies, information, and data analysis to enhance the ability to address societal, socioeconomic, and environmental causes of violence across the public health and law enforcement communities.

Utah State University’s HEART Initiative — an acronym for Health Extension for Advocacy, Research, and Teaching — is a new pilot initiative four-year program that works to integrate a biological-psychological-social model to community health.

The full paper can be accessed here. 

Andrea Cipriano is a TCR staff writer

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