The Movement towards Violence as a Health Issue promotes the application of an equity lens to all prevention work and advocacy to ensure efforts to reduce violence contain an explicit focus on also reducing inequities. Similar to other health inequities, violence disproportionately affects groups that have been marginalized due to their socioeconomic status, race/ethnicity, sexual orientation, gender identity, disability status, geographic location, or some combination of these factors. The costs of violence are experienced by individuals and communities across the United States both in the direct loss of life and injury and through long-term negative social, economic, educational, emotional, behavioral and health impacts of exposure. Violence is the largest inequity and is a social determinant that negatively impacts all other social determinants, meaning that disproportionate victimization and exposure to violence perpetuates inequities across all outcomes and living conditions by limiting access to the conditions necessary for individuals and communities to thrive.
+ The Heckler Report shows the persistant and expanding racial inequity of homicide victimization
While inequities persist amongst all identities, some of the most drastic inequities exist between racial groups. In 1985, the Secretary of HHS, Margaret Heckler, produced a report on Black and Minority Health that highlighted the greatest health inequities between the black population and the white population, at the time. Thirty-years later, another assessment was conducted that highlights how the same inequities still exist today, particularly as it relates to homicides.
+ Leading causes of death by race show direct impact of violence (homicide and suicide)
Data from the Center for Disease Control and Prevention shows that homicide and suicide remain within the top three leading causes of death for communities of color and outpace the rates for white communities:
+ Exposure to violence perpetuates inequities across all sectors
Beyond direct victimization, exposure to all forms of violence, including community violence, intimate partner violence, child abuse, and suicide, has long-term negative impacts and undermines all other social determinants of health. Exposure rates are persistently higher for people of color, perpetuating a wide range of racial inequities. According to the Prevention Institute: "African American children are twice as likely to witness domestic violence, and 20 times more likely to witness a murder compared to white children." Additionally, "American Indian and Alaska Native communities suffer from a violent crime rate that is two to three times greater than the national average."
+ Multiple forms of trauma play a significant role in determining outcomes:
Historical trauma theory, an expanding framework in the field of public health, is based on the premise that “populations historically subjected to long-term, mass trauma – colonialism, slavery, war, genocide – exhibit a higher prevalence of disease even several generations after the original trauma occurred.” This results in persistent community-wide inequities, including physical, psychological, social, and economic, all contributing to higher risk factors for the perpetuation of violence. This intergenerational component coupled with present-day chronic exposure to violence and trauma experienced by these communities emphasizes the need to examine the system-level causes of trauma, whilst meeting the needs of individuals. By integrating the historical understanding into health approaches to violence prevention, programs can more effectively address the risk factors that increase susceptibility to violence victimization and perpetration.
Interpersonal and structural violence are intergenerational factors that have been inflicted on marginalized communities over hundreds of years without adequate or appropriate interventions. Despite significant progress to promote and protect the rights of all people in the United States, discriminatory policies and practices remain and the effects of current and past policies continue to marginalize communities. This intergenerational experience has produced pervasive historical trauma, which has a similar negative impact on physical and behavioral health and the perpetuation of violence as other more commonly recognized forms of trauma.
The history of systemic oppression and violence against people of color, the LGBTQ community, immigrants, women, and other groups that have been marginalized through systems of power is extensive. It is imperative to acknowledge that current inequities across all sectors and the perpetuation of violence are tied in a history of racism, discrimination, exploitation, and violence that reaches back to colonialism and slavery.
+ Applying an equity lens creates safer and healthier communities:
Numerous efforts, programs, and organizations have assisted with ameliorating inequities by creating solutions outside of the traditional reliance on the criminal justice system. Health-based solutions have been applied with communities that have long faced high rates of violence, but this has happened in pockets and often without sustainable funding to ensure their full integration as a legitimate method for violence reduction and systemic change. If these proven public health methods and programs were fully recognized and supported by the federal government, their application could be expanded and, as a country, we could move closer to a state of equity.
+ Why the health approach is effective for addressing inequities:
Additionally, these conditions and our current responses to violence, which rely heavily on the criminal justice system, are not working and have contributed to the systematic criminalization and mass incarceration of people of color. Geographical clustering of intense levels of interpersonal and community violence is directly linked to the limited options made available in regards to the conditions necessary for healthy outcomes.
+ Impact of violence on other social determinants of health:
The World Health Organization defines social determinants of health as "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems."
The social determinants of health have become a central component of health equity disucssions because they provide the broader population-level context of specific health outcomes. Violence is typically viewed as an outcome of the social determinants of health, but it has become clear that the presence of violence can undermine other social determinants, as demonstrated in this diagram:
+ Additional resources for understanding equity, violence, and health outcomes:
APHA - Health Equity
Prevention Institute - Links Between Violence and Health Equity