6 minute read
A Public Health Approach to Public Safety
Since the murder of George Floyd, there has been an amplified public discussion about how we improve our collective public safety. The term a “public health approach” to violence and safety has gained more widespread use. As with many terms used in our public conversations about public safety, there may not be a common understanding of that term. As Commissioner of Health in Minneapolis, I had 15 years to explore what a public health approach to violence entails and how to put that notion into action. How we talk about and describe an issue has a powerful impact on the types of actions and solutions that seem possible. If we conceive of public safety as solely a matter for police and the criminal justice system, then our ideas for action will be limited to that focused policy area. On the other hand, if we think of public safety more broadly, including a public health approach, then the range of strategies can encompass more of the underlying factors that contribute to the risk of violence. Research has shown that community risk factors like living in areas of high concentrations of poor residents and diminished economic opportunities increase the likelihood of community violence. In 2006, Minneapolis was experiencing a spike in community violence and the term “Murderapolis” was being applied to the City. It was clear to leaders in Minneapolis that while the police were an important element of a public safety strategy, they were insufficient to address all the underlying issues that contribute to violence. The Minneapolis Health
By Gretchen Musicant, RN, MPH
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Department convened a small group representing the major cultural groups in the city to identify strengths and gaps in the city’s approach to preventing violence. The group concluded that an important first step was to ask the City Council to declare that youth violence was a public health issue, which they did. As part of that action, they put in motion a yearlong indepth community driven process to flesh out the concept and recommend action. That work led to the development of the initial Blueprint for Action that has since been revised as knowledge, experience, and community needs have evolved. The Blueprint identified three levels of prevention that need to be addressed: primary, secondary, and tertiary.
Primary prevention includes those efforts directed at lowering the risks across an entire population. For a physical health issue like diabetes, that might mean improving access to healthy food and exercise opportunities for most people. Applied to violence, it includes strategies like making sure that all youth have access to caring adults beyond their immediate families — through sports, afterschool programs and organizations like Big Brothers/Big Sisters.
Secondary prevention includes the efforts directed towards preventing a health problem among a population with heightened risk. Again, for diabetes, this might include working with people diagnosed with pre-diabetes to develop a personalized diet and exercise plan. When the health challenge is youth violence, the at-risk population might include youth who have violated curfew or who are missing school often. Strategies include intensive youth outreach and case management for young people brought to the City’s Juvenile Supervision Center and engaging more people in diversion activities that bring together the community, perpetrators of low-level infractions and those who have been harmed by those infractions to reconcile the parties and oversee a plan for restitution.
Tertiary prevention includes approaches to limit further harm to those who are already affected by a health problem. For the care of those with diabetes this might include efforts to control A1C levels. When applied to violence, there are a number of tested programs that have shown their positive impact. Perpetrators of violence and victims of violence are often very similar in their risks and needs and are both regarded as people included in tertiary prevention programs. One example is a hospital-based program called Next Step, now operating in several Minneapolis hospitals. A staff person who is well steeped in the community and knowledgeable about resources connects with the person injured through violence before they are discharged and stays connected after discharge. The program has reduced
hospital readmissions and positively impacted retaliatory violence. Another program is an employment program for gang affiliated young people. The program’s impact is measured not only in the amount of job training and employment but also in whether the participants are involved in a violent incident while participating in the program. Many of the strategies to prevent violence are relationship based and include helping young people access help with the most fundamental of needs: housing, education, and employment. The fact that most young people impacted by violence need help in this way is a painful example of the inequity in our community. Creating more equity across our community will certainly impact the amount of violence that we see. A public health approach to violence looks at the individual and collective risk and protective factors, and works to enhance resilient factors and address risk factors. Community violence perpetrators and victims are statistically likely to be adolescents and young adults, therefore a focus on assuring positive youth development is closely connected to violence prevention. This includes working to assure that youth have: positive relationships with adults outside the family; mastery of skills and accomplishments that are valued; and a sense of self-worth and purpose. Unfortunately, there has been a significant, steady, measurable decrease in the investment of public and private funds that help young people achieve these youth development milestones at the local, state, and national levels since 2003. An important violence risk factor is exposure to and experiencing trauma. Research is showing that trauma has a clear impact on the nervous systems, affecting how future events are responded to and the risk to one’s health overall. Addressing immediate and long-term trauma should be integrated into health care. As community safety is reimagined, an important component of improving our current situation requires us to work proactively to prevent violence and not simply respond to it after the fact. There is a role for each of us in this: as professionals in our work; through community involvement; and as citizens influencing public policy. Healthcare providers can screen their patients for trauma and discuss the issue with their patients. They can make sure that they are aware of community resources and are able to refer their patients to them. Healthcare providers can also use their trusted voice to advocate for investments in youth development and violence prevention efforts.
Link to Current Blueprint
http://www2.minneapolismn.gov/government/departments/health/office-violence prevention/blueprint/
Gretchen Musicant, RN, MPH, is the recently retired Minneapolis Commissioner of Health. She received both her nursing and public health degrees from the University of Minnesota and was a Mondale Fellow at the U of M Humphrey School. She is a recipient of the Gaylord Anderson Leadership Award from the University of Minnesota. She can be reached by email at gretchenmusicant@ gmail.com.
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