Violence Prevention: A Public Health Perspective

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Traditionally, violence in the United States has been the concern of law enforcement and criminal justice agencies. Only recently has this exclusive relationship changed. Public Health officials have now recognized violence as an epidemic - one responsible for the loss of so many lives, mostly young lives, and immeasurable suffering in all communities, especially communities of color. Public Health prevention strategies have historically proven effective in reducing destructive behavior. The particular methodology of Public Health lends itself well as the comprehensive approach needed to address an all-pervasive problem such as violence. University of South Florida Professor and Associate Dean, Dr. Adewale Troutman MD, MPH, CPH explains the Public Health perspective:

The Public Health approach is scientific, organized and based upon solid theory and principle. You can measure a condition and recognize when it is in epidemic proportion by the number of cases that has increased above what ought to be expected. Risk factors are then identified using the specific Public Health methodology. Primary, secondary and tertiary prevention are used to eliminate those risk factors and decrease the incidence of that particular condition. Constant monitoring and evaluation of the programmatic interventions is also a necessary component of this approach. So, measure the condition, identify risk factors, implement prevention strategies, and evaluate those strategies - those are the four key elements of the Public Health approach.

Problem Solving Methodology in Community Health is a free-flowing methodology that, when looking at causation, allows you to put in anything and everything that has an impact on the problem you are trying to solve. It doesn't limit you to a blind focus of what is traditionally considered health care. So if you recognize poverty, or unempowerment or cultural attitudes toward women as contributing to the problem of domestic violence, it is acceptable within this methodology  to include those things as part of the solution. You would pull in all of the partners you need who have expertise in those particular areas to work together to give you an overall solution to the problem.

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The focus of Public Health is on collaboration, partnership, and awareness that problems are multi-disciplinary and therefore have to be addressed by a multi-disciplinary team. I worked in a clinic in Newark where I had a particular patient who was diabetic, had hypertension and arthritis, but she wouldn't come to the clinic. She lived two blocks away and it didn't make sense that she wouldn't come to the clinic. We discovered that she lived in the projects on the sixth floor and that there were thugs in the neighborhood that would charge her to leave the building. It was not about access to the clinic.

If the thinking was strictly access, "...where is the clinic?" "...is the clinic close enough?", then we entirely overlook the real issues. It is necessary to recognize the multi-factorial nature of the problem and what would have to be a multi-disciplinary approach to solving that problem. In this instance, we would have to work with the criminal justice system, the Housing Authority and the Police Department in order to create a situation where this lady could come to the clinic. Public Health is about looking at multi-factorial causation and problem solving and working with a team approach. Nothing is outside the realm of solution.