Tag Archives: public health

The Interrupters: Public Health and Violence

The conventional response to violence has relied on criminalization, policing and longer prison sentences, yet violence persists. In 2011, Steve James released a documentary, The Interrupters, to capture the violent landscape of our cities through the eyes of “violence interrupters,” activists working in the tradition of non-violence to interrupt confrontations before they become violent. This documentary tells the story of three activists working to protect their Chicago community from the violence they once created.

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The Interrupters, Trailer. 

The film’s main subjects work for an innovative organization, CeaseFire, founded by Gary Slutkin. Slutkin, an epidemiologist and physician who battled infections diseases in Africa, says that violence mimics infections like tuberculosis and AIDS. He believes that treatment for violence should follow the same plan as those for diseases: “go after the most infected, and stop the infection at its source.” Rather than thinking of violence from a moral issue (good people vs. bad people), Slutkin approaches violence from a public health one (healthful vs. unhealthful behavior).

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Gary Slutkin, TedMed Talk. 

CeaseFire and the Violence Interrupters are part of an effort to apply the principles of public health to the violence of the streets. CeaseFire tries to deal with these quarrels on the front end through former gang members, or interrupters, who mediate criminal activity on city streets. They “operate in a netherworld between upholding the law and upholding the logic of the streets.

You can watch the full length documentary online here.

You may also read the interview with filmmaker, Steve James, here.

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This post is part of the Social Justice Topic Series on From Punishment To Public Health (P2PH). If you have any questions, research that you would like to share related to P2PH or are interested in being interviewed for the series, please contact Morgane Richardson at justpublics365@gmail.com with the subject line, “P2PH Series.”

 

Guns and Suicide: A Public Health Crisis

Guns, the most lethal means of committing suicide, represent a public health crisis.

Most imagery conjured up by the idea of gun violence in the national debate involves on one end, a bad person with a gun, and on the other end, another person scared senseless by the bad person with the gun, waiting for the cavalry.

But the numbers paint a different picture – one that continues to prove difficult to digest for folks on both side of the debate .  In fact, suicide is the leading type of firearm death, and teenagers, young adults, and males aged 75 and older are currently at the highest risk for this type of death. According to the CDC, suicide is now the third-leading cause of death for teenagers.

Of the 100 people who take their own lives every day in America  – that’s almost – 40,000 deaths a year -  most use a firearm.  More people choose a firearm over all other intentional means combined, including hanging, poisoning or overdose, jumping, or cutting. But Americans are not more suicidal than the citizens of other comparable countries (populous, wealthy). They just have more access to the most lethal means of committing suicide. A gunshot is an irreversible response to what is often a passing crisis – possibly worsened by the temporary depressive fog of alcohol. Suicidal individuals who take pills or inhale car exhaust or use razors have time to reconsider their actions or summon help, but gunshots are merciless game-changers.

prviate guns public health

According to the Harvard Injury Control Research Center, the states with the three highest suicide rates (Wyoming, Montana and Alaska) are also the top gun-owning states, and researchers agree that bringing a gun into the home not only increases the risk of gun-related accidents, but also the risk of suicide. Specifically, that research finds:

“Gun owners and their families are much more likely to kill themselves than are non-gun-owners. A 2008 study by Miller and David Hemenway, HICRC director and author of the book Private Guns, Public Health, found that rates of firearm suicides in states with the highest rates of gun ownership are 3.7 times higher for men and 7.9 times higher for women, compared with states with the lowest gun ownership—though the rates of non-firearm suicides are about the same. A gun in the home raises the suicide risk for everyone: gun owner, spouse and children alike.”

It is perhaps time, then, to abandon the myopic view that those who would take their own life are not influenced by the availability of suicide methods, and accept that whether or not they survive is dictated primarily by how they choose to go about it. About 85 percent of suicide attempts with a firearm end in death (drug overdose, the most widely used method in suicide attempts, is fatal in less than 3 percent of cases.)

Research on suicide by the Harvard Youth Violence Prevention Center has also shown that one of the biggest myths is that suicides are typically the result of careful advance planning. While this may be the case — individuals who attempt suicide often succumb to a complex series of problems — empirical evidence suggests that they act impulsively in a moment of heightened vulnerability.

While the recent enactment of the Mental Health Parity Rule (which will guarantee that most insurance coverage offers access to mental health services on par with physical health coverage) brings hope to many whose lives would be vastly improved by access to mental health services, the collection and study of gun-related data has been severely undermined in the past two decades, and with it a crucial means of pushing forward sensible gun policies.

Despite President Obama’s reversal earlier this year of the NRA-sponsored amendment that barred the CDC from studying the causes and prevention of gun violence, researchers are still unable to answer many key questions such as the number and distribution of weapons across the country – slowing down prospects for life-saving policy reform. So much grief could be softened, if not avoided, by addressing the public health crisis of guns and suicide.

~ This guest blog post was written by Alice Cini is a social justice advocate and Social Work Fellow at the John Jay College of Criminal Justice’s From Punishment to Public Health Initiative. You can follow her on Twitter @CinikAl.

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This post is part of the Monthly Social Justice Topic Series on From Punishment To Public Health (P2PH). If you have any questions, research that you would like to share related to P2PH or are interested in being interviewed for the series, please contact Morgane Richardson at justpublics365@gmail.com with the subject line, “P2PH Series.”

Reframing Gun Violence as a Public Health Issue

Our series on “Punishment to Public Health” continues. This week, we turn our attention to gun violence as a public health issue.  In many ways, this is a key example of the way that our usual policies of criminalization around guns have failed us as a society.

No Gun Sign - Mall of America(Image source)

The harm from guns to peoples’ health is hard to deny.  The U.S. leads the world in gun deaths, according to a World Health Organization (WHO) study. Guns claim more than 30,000 lives each year in the U.S., more than five times the number of deaths from illegal drugs each year. While a great deal of media attention focused on the tragic shooting of elementary school children at Newtown, CT.,  the Children’s Defense Fund estimates that 2,391 children have been shot by guns since the beginning of 2013 alone.

Currently, our response to guns and gun policy is one that oscillates between a punitive criminalization of some gun owners and a staunch, Second Amendment defense of other gun owners.  How might society be changed if our approach to guns and gun violence were reframed as a public health issue, like seat belts or smoking?

no smoking sign(Image source)

We’ll explore some of the research on guns and look at some of the ways that activists and documentary filmmakers are contributing to a resistive reframing of gun violence as a public health issue.

Challenging Punishment: From Mass Incarceration to Public Health , Human Rights, and Restorative Justice

This post is written by Ernie Drucker.

In my book A Plague of Prisons , The Epidemiology of Mass Incarceration in America  (New Press, 2013) I proposed a public health model of mass incarceration, arguing that the war on drugs and its harsh sentencing policies ignited our epidemic of imprisonment. But the fact of  the imprisonment of 10 million  Americans in the last 40 years  demands more than re-imagining the problem – it demands solutions.

Plauge of Prisons book cover

The war on drugs fueled a “race to incarcerate”, deepening America’s racial and economic disparities , and drawing resources away from other vital social and health programs. The resulting criminalization and mass incarceration of three generations of young minority males has left a trail of mass trauma and imposed systematic disadvantages on this population – direct consequences of “toxic punishment” (Golash  D. The Case Against Punishment: Retribution, Crime Prevention, and the Law. NYU. 2005). The vast  “criminal industrial complex” that has been built upon mass punishment, is now rapidly commoditizing criminal justice through privatization , e.g.  in halfway houses for re-entering prisoners and special schools for juveniles – with little accountability for outcomes or collateral consequences.

The politically powerful and highly institutionalized system of mass punishment has taken on a life of its own and will not easily give up the lifetime grip it maintains on the population of former prisoners, all the while continuing to confer severe disadvantages on successive generations in urban communities where they are concentrated – i.e. increased homicide and suicide rates , greater risks of their own children’s future imprisonment , higher infant mortality rates , and shortened life expectancies , lower rates of employment and wages , less education ,  more failed marriages , and lower voting participation , associated with near universal felony disenfranchisement.

With growing privatization  of prisons , we can expect even less transparency and public accountability, as we  extend criminalization and mass punishment to other areas of social conflict – immigration, race relations,  sexuality – each of which now provides multiple  opportunities for our “culture of punishment” to assert itself in new areas  e.g. in 2012 over 500,000 “illegal” immigrants were held in detention centers and 400,000 deported; 500,000 sex offenders arrested , imprisoned,  and placed on computerized registries .

 Eric Holder, Attorney General(Image Source)

A Watershed Moment

Fortunately we are now at a turning point in this struggle – one we must take advantage of . US Atty. General Eric Holder recently said that  “too many Americans go to too many prisons for far too long, and for no truly good law enforcement reason.” This was an important first step toward a national recognition that our decades long war on drugs has been ineffective, expensive, and cruel.  As bipartisan support grows in  Congress for overhauling U.S. drug laws, Holder has ordered Federal prosecutors to remove any reference to quantities of illicit drugs that trigger mandatory minimums .

But it is only through re-thinking and challenging  our fundamental ideas about punishment that we will  find a way out of the shadow of this great crime against humanity that mass incarceration represents.  The recent case of Trayvon Martin demonstrates the limitations of our criminal justice system -  based as it is on narrow model of blame and punishment . But what are the alternatives to this ancient and almost universal trope that has now become the  foundation of our system of justice in America? One vital step in that direction is challenging punishment itself , turning our attention to the social injustices that underlie both crime and punishment.

When viewed through a public health lens which views  mass incarceration as a collective problem that require social solutions

I’m working on a new book challenging America’s “culture of punishment” within a pubic health model based on human rights and restorative justice principals and practices. Instead of relying, as it does now, despite lip service to ideas about  rehabilitation  based on  “correctional” systems that are, in practice vast engines of cruel retribution – even torture . My new book will map the road to restorative justice through such challenges and how these new models can allow us to put an end to mass incarceration and heal the mass trauma it has left behind .

Three Key Steps to Move from Punishment to Public Health

To launch this process in America here are three steps we must take:

  1. Recognize the  Toxicity of Punishment Punishment can be a form of state violence and mass trauma, where pain and suffering are intentionally applied to human beings in the name of justice. Research shows that “toxic punishment” is “excessive or prolonged activation of stress response systems ( and has) damaging effects on learning, behavior, and health across the lifespan” (Harvard, Center on the Developing Child).  [2] Mass incarceration is mass exposure to toxic stress. The public-health model and epidemiology of punishment , as a form of violence, allows us to examine the impacts of  mass punishment and its health consequences (Velasquez-Manoff, “Status and Stress,” New York Times, Jul 27, 2013).
  2. Challenge Our Most Toxic Systems of Punishment:  we need to recognize and end the most toxic forms of  punishment that characterize our system of  mass incarceration. This first means reducing the size of the problem, for it is the huge scale of incarceration that drives the significance of its impact on public health and casts a shadow over American life.  We can do this by setting a goal of limiting the use of prisons as the default response to so many actions by so many people – with a goal of getting back to levels before the epidemic of mass  incarceration began – a figure of 100/100,000 populations in line with that of other modern democracies .  Challenging mass incarceration we can build on other successful campaigns against punishment in America :  e.g. opposition to the death penalty and rolling back the Rockefeller drug Laws. A great place to start is with reining in the massive use of solitary confinement – the most prominent and most torturous of all methods use in modern incarceration – the US , with 5% of world population and 25% of its prisoners, America accounts for over 50%  of those held in punitive isolation. We must take on and learn from  these cases , examine their  sustaining sources, organizations, and  leadership. Publicize the ways in which we can reduce incarceration without compromising public safety and work to build public support for alternatives to punishment .
  3. Build New Systems Based on Public Health , Human Rights , and Restorative Justice: Restorative principals and models of conflict resolution based on human rights do not impose toxic punishment – they work to break the cycle of retributive violence by challenging the use of collective punishment as tools of state power, replacing them with public health methods and outcomes, and  show that these better serve legitimate public concerns about public safety.

Positive changes in drug polices are gaining new momentum in the US , with more state undertaking marijuana’s legalization. But reducing the length and frequency of drug-related incarceration going forward, however welcome, wont do anything about the large population of drug users already stuck in our prisons and the post prison correctional control over the lives of millions more. Over 300,000 drug offenders are still serving out long terms under the now discredited mandatory sentencing policies. Most of these are young minority men with children, drawn from our poorest urban communities. We must consider ways to remove most prisoners from the strangle hold of the criminal justice system  – an amnesty that would allow those who  can do so to re-establish a useful place in our society and in those communities most affected by mass incarceration – restoring them to full citizenship – the most essential ingredient to human rights.

~ Ernie Drucker, PhD, is a Research Associate at John Jay College-CUNY and on the faculty of the Mailman School of Public Health.

From Punishment to Public Health: Our Next Social Justice Topic Series

Today begins our new month-long social justice series called From Punishment to Public Health.  In this series we will explore how public health might offer a more humane and just approach to social ills than the current approach that is based on criminalization.

Overcrowded Prison Source: http://en.wikipedia.org/wiki/Prison, Creative Commons Attribution

Is this the best response to social ills?
Source: http://en.wikipedia.org/wiki/Prison, Creative Commons Attribution

Since at least the 1970s, the response to drug use has been one that emphasized punishment and criminalization. The punishment framework has shaped the collective response to drug use for the past thirty years, in the US and globally. Catch phrases like “lock ‘em up and throw away the key,” three strikes you’re out, and “let them rot in jail,” have characterized this time period and this attitude toward drug use.

More recently, the reliance on criminalization has been giving way to an approach that is more rooted in a public health. For example, in 2013, US Attorney General proposed moving away from mandatory minimum sentences for drugs. And, as the Patient Protection and Affordable Care Act (ACA) – colloquially known as “Obamacare” – goes into effect, an estimated 32 million Americans will have new access to drug treatment programs. Outside the US, other countries are moving to legalize drugs (such as Portugal, Uruguay) and closing prisons due to lack of inmates (such as the Netherlands).

How are these policy changes transforming the lives of everyday people? Are public health approaches to the criminalization of drugs really better or do they simply expand control over citizens? Through a variety of knowledge streams (e.g., podcasts, data visualizations, and blog posts) we will host a month-long conversation between academics, activists and journalists about the shift from punishment to public health and if that moves us closer to a more just society. As we did with the stop-and-frisk series, at the close of this series we’ll pull all these resources together in an all-in-one guide that you can download for your own use.

In the coming weeks, we’ll also curate a mix of academics, activists, and journalists talking about how to address this complicated social justice issue.  To open this series, we will feature the following:

The aim of JustPublics@365 is to foster just the innovative work that can foster connections between academics, activists and journalists who are working to address some of the pressing social problems of our time.  From where we sit in the heart of New York City, criminalization is at the top of the list of pressing social problems because of the deleterious effects it has on the democratic life of the city and the nation.

So, we offer this series on Punishment to Public Health as another case study of how we might reimagine scholarly communication for the public good.

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Click here for more information about our Monthly Social Justice Topic Series.

If you have any questions, research that you would like to share related to P2PH or are interested in being interviewed for the series, please contact Morgane Richardson at justpublics365@gmail.com with the subject line, “Stop-and-Frisk Series.”

 

Using Big Data to Improve Public Health

Big data holds the promise for helping solve big problems and improve health. In their book Big Data, authors Kenneth Cukier and Viktor Mayer-Schonberger describe how tracking flu symptoms via Google searches is much faster than the traditional methods used by the Centers for Disease Control (CDC).

The problem with traditional data collection on health such as those at the CDC is that they can be time-consuming and cumbersome.  A key reporting mechanism that the CDC uses is from doctors, who are, in turn, reporting on the patients they’ve seen in their office consultations.  Relying on these reports builds in a delay of a week, sometimes longer, into the data the CDC is collecting.

Big data, the data that’s collected already in a variety of ways, can be mined, analyzed, and curated in ways that can help improve health of whole populations, not just individuals.  As with the example of the Google flutrends, there is some hope for addressing asthma through the use of big data.

Making progress in the treatment of asthma requires data outside of the self-reported information from asthma sufferers that doctors generally rely on. The new Asthmapolis may offer part of the solution. Asthmapolis seeks to eliminate the “inability to collect information about where and when people develop symptoms.” Asthmapolis uses inhaler sensors, mobile applications, advanced analytics – in other words, big data -  to help physicians identify those patients who need help controlling the disease before exacerbation.

How does this research impact the public?  In Louisville, Kentucky, for example, a city with particularly difficult air quality conditions for those with breathing disorders, Asthmapolis teamed up with health officials to collect data by sensor in the inhalers of project participants. This helps Asthmapolis and city leaders understand when and where people with asthma develop symptoms, in turn identifying community-wide asthma triggers that can be eliminated. This means that using big data has the potential to improve health by monitoring individual asthma attacks  as well as creating population-level changes in environmental policies that may trigger asthma.

Some policy makers and physicians have raised the concern that the nation’s most pressing health epidemics are in fact appallingly low-tech, and that it’s local reforms and relationships, not high-tech solutions that are needed. The brains behind Asthmapolis are trying to fuse the two approaches together; the on-the-ground experiences of asthma sufferers, the technology that allows for location-specific data, lightweight sensors, and continual monitoring, with a continued conversation about enacting real change on the municipal level.

As promising as Google flutrends and Asthmapolis are, big data raises big questions about that information gets used.  Do we have faith in our institutions to create change that will improve health for everyone from the enormous amounts of data that such a project will gather?  Or, will political action still be necessary to compel leaders to do the right thing?  Only time will tell.