Treating youth violence as a menace to public health

Can the medical model help eradicate this plague?

By Dwight Hobbes

Contributing Writer

Dr. Deborah Prothrow-Stith, noted author of Deadly Consequences: How Violence Is Destroying Our Teenage Population and a Plan to Begin Solving the Problem, was in the Twin Cities recently to deliver the keynote address, “Violence and Public Health,” at the Women’s Advocates’ 40th Anniversary Community Conversation.

The subject alone should be enough to grab your attention as a malady that continues to chronically plague communities of color, specifically African American neighborhoods. For instance, in 2011, teen violence contributed to the high rate of Black youth from as young as 10 to the age of 24 being victims of homicide.

Without knowing the exact number, we know anecdotally that rate isn’t merely high, it’s tragically catastrophic. Minneapolis Police Departments, though, note that over the past 14 years roughly one-third of the city’s violent crime and half of the city’s shootings have taken place in North Minneapolis, where so-called at-risk (i.e., Black) adolescents increasingly subsist unsupervised by responsible adults and many deem it imperative to lead a life of thuggery.

These teens, it has to be said, are by no means the only ones indulging violent lifestyles: Drug-dealing gangs of young adults are a disastrous fixture in North Minneapolis, South Minneapolis and St. Paul. So, indeed, the subject is of great significance.

Moreover, this event is one of profound importance because Dr. Prothrow-Stith inarguably is one of the best-qualified individuals to informatively speak on the issue. Among highlights culled from her bio, President Bill Clinton appointed Prothrow-Stith to the National Commission on Crime Control and Prevention. She is one of the United States’ foremost figures in addressing violence as a matter of public health.

With Deadly Consequences, in 1991 she became the first author to present violence from a public health perspective to a national audience. Through numerous television and radio programs as well as in print, she explained how families, schools and communities can constructively counteract youth violence without simply throwing jail-time at youngsters, starting them out in life on a dead-end existence of recycled incarceration.

Here is a quote from Deadly Consequences: “I wanted to understand the forces that sent so many [young males] to the emergency room — cut up, shot up, bleeding, and dead. Why were so many young males striking out with knives

and guns? What could be done to stop the carnage?

“…When I began to think about violence in a medical context, I saw the problem not as one that, say, required better surgical techniques, but one that required the creation of public health strategies such as health education in the classroom; health education via the mass media; community awareness; hospital-based screening for risk determination. I was impressed by the way these strategies were being used to combat smoking, heart disease, lead poisoning, child abuse, and other menaces to the public health. I wanted these strategies to be applied and evaluated to reduce adolescent violence as well.”

Importantly, she was selected as part of a Boston coalition that called on leaders in government, education, law enforcement and other fields. Their collective work is renowned as the “Boston Model.” By the mid to late 1990s, Boston had gone almost three years without a juvenile homicide.

“The more I learned, the more perturbed I became,” said Prothrow-Stith. “I could not understand the blindness of my profession. How could doctors ignore a problem that killed and maimed so many young, healthy patients? Twenty thousand homicide deaths a year convinced me that violence was a public health problem. To me it seemed self-evident that an “ailment” that killed so many ought to have the full attention of physicians and others concerned with improving health.”

She created the Violence Prevention Curriculum for Adolescents, which has been utilized in 500 schools in all 50 states and in eight other countries. She has received 10 honorary doctorates and the Award for Exceptional Achievement in Public Service from Dr. Louis W. Sullivan, former secretary of the Department of Health and Human Services, for her pioneering work on homicide as a preventable public health problem.

Asked by email what she finds significant about coming to the Twin Cities to address issues of youth and family violence, Dr. Prothow-Smith answered, “There’s a groundswell in the Twin Cities for improving communities and safety. Minneapolis provides a fantastic example of a successfully implemented, coordinated, multi-sector approach to violence prevention.

“The City’s strategic plan, Minneapolis Blueprint for Action to Prevent Youth Violence, had five goals: foster violence-free social environments, promote positive opportunities and connections to trusted adults for all youth; intervene with youth and families at the first sign of risk; restore youth who have gone down the wrong path; protect children and youth from violence in the community. This approach engaged community members and leaders from the across the area and has seen substantial results.”

How hopeful is she that the condition here will change? “We are all affected by violence. It affects where we live, where we work, where we go to school and whether our children go to school or we go to work. Further, these impacts are disproportionately felt by disenfranchised and under-resourced communities who nearly always suffer the most and bear the greatest burden in health and safety outcomes and have the fewest resources to respond to these mounting challenges.

“But we know how to prevent violence in our communities and in our homes. Building off the Blueprint for Action, which focused on community violence that affects youth, I have full faith that we can implement comprehensive strategies to change the norms and structures that lead to and support violence. We can identify risk and resilience factors and turn unhealthy environments into suitable places for children and families to thrive.”

What steps can we take as a community to move forward? “Violence is preventable if it is approached with commitment and sustained attention. Violence is not the problem of one neighborhood or group, and the response and solution are not the responsibility of one agency or one sector.

“Any one group, organization or field cannot prevent violence in isolation. It requires coordinated and comprehensive efforts and resources, and the active cooperation of sectors and fields that might not typically work together. It is past time to seize the opportunity to work together collaboratively, building on what we know works to prevent violence.

“Violence is a complex health, social, and environmental issue. Reducing and preventing violence requires a new way of thinking that examines and addresses the underlying causes in communities and policies that lead to violence in the first place. The most effective and sustainable strategies for preventing violence are community- or population-based, build resilience in individuals, families, and communities, and address the multiple risk factors associated with violence. We must begin to expand our focus from individuals to environments and from criminal acts to healthy norms in order to build national momentum for a childhood free of violence.”

Also participating in the Women’s Advocates’ 40th Anniversary Community Conversation  was Ramsey County Commissioner Toni Carter, who Dr. Prothow-Smith states, “has recently led several Ramsey County system change initiatives including a three-year evidence-based juvenile detention alternatives initiative that has resulted in a reduction in the number of youth detained at the Ramsey County Juvenile Detention Center and the development of system and community alternatives to detention for lower risk youth.”

Representing law enforcement was St. Paul Police Commander Mary Nash, who commands the department’s Family and Sexual Violence Unit. The event took place July 24 at Penumbra Theatre, 270 North Kent St., St. Paul.

Dwight Hobbes welcomes reader responses to P.O. Box 50357, Mpls., 55403.