On June 16, 2016, the Roundtable on Population Health Improvement held a workshop at the Lutheran Church of the Good Shepherd in Brooklyn, New York, to explore the influence of trauma and violence on communities.2 George Isham, co-chair of the roundtable, welcomed participants and explained that hanging behind the podium was a peace quilt created by children of the church congregation. The quilt included several quotes, such as “Love and Open Your Hearts to Others” and “Peace Begins with Me.” Isham pointed out that this was a significant backdrop, both physically and metaphorically for the conversation of the day. As participants were painfully aware, though the workshop on community violence as a population health issue had been in the planning stages for several weeks, just a few days earlier, on June 12, 2016, Omar Mateen shot and killed 49 people and injured 53 others at Pulse, a gay nightclub located in Orlando, Florida. Isham said
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
2 The workshop was held at the Lutheran Church of the Good Shepherd because the planning committee was interested in holding this workshop in a non-academic setting. Gary Gunderson, a member of the roundtable and planning committee, introduced staff to Dan Stiger of the New York University Lutheran Medical Center who recommended the Lutheran Church of the Good Shepherd.
it was appropriate to keep this tragic national event and the loss of lives and injured people in mind, as well as to think of the families, loved ones, and others in the community affected by this violence.
In his introductory comments, Isham said that since February 2013, the roundtable has served as a venue for leaders to meet and discuss the leverage points and opportunities arising from changes in the social and political environment for advancing better population health. At previous workshops held by the roundtable, “The Role and Potential of Communities in Population Health Improvement: A Workshop” (IOM, 2015) and “Supporting a Movement for Health and Health Equity: Lessons from Social Movements: A Workshop” (IOM, 2014), several individual workshop speakers emphasized that safe and healthy communities are central to health equity and improving population health. Individual speakers also conveyed the message that community engagement and organizing are important approaches to addressing the social determinants of health, such as housing, education, and violence. Isham added that also relevant was the workshop “Framing the Dialogue on Race and Ethnicity to Advance Health Equity: A Workshop” (NASEM, 2016b), in which Gilbert C. Gee discussed how racism contributes to shorter lives for people of color and inequities in life expectancy. This workshop builds on those insights and seeks to explore ways in which communities are addressing violence and building safe, healthy, and resilient communities.
An important activity of the roundtable is to hold workshops for its members, stakeholders, and the public to discuss issues that contribute to improving the nation’s health. An independent planning committee, chaired by Thomas LaVeist, and including Theodore Corbin, Rachel Davis, Amanda Geller, Marthe Gold, Gary Gunderson, John Rich, Therese Richmond, Lourdes Rodríguez, and Daniel Webster, was charged with developing a workshop to explore community violence and trauma through a health equity lens (see Box 1-1). The workshop was designed to
- explore the impacts of trauma and violence on communities;
- explore strategies and approaches that communities and multisector partners are using to reduce violence and build resilience;
- explore the evidence base for the effectiveness of strategies and approaches for reducing the impact of violence on communities; and
- provide a platform for programs and initiatives that can serve as models for other communities, with an explicit attention to the intersections of structural racism and structural violence.
As explained by LaVeist of The George Washington University, while the tragic shooting at the Pulse nightclub in Orlando makes this seem like a particularly fitting topic to address, it is also the case that given the amount of violence that occurs every day in this country, it is appropriate any day to discuss this topic. The planning committee presented a broad range of concerns to the roundtable, such as police violence, gun violence, and trauma-informed community building, and recent work of the National Academies of Sciences, Engineering, and Medicine (e.g., IOM and NRC, 2013a,b; IOM, 2015; and NASEM, 2015).3 Members thought it was most appropriate to focus the workshop on community violence and innovative approaches to building resilient communities. Therefore, the planning committee decided this workshop should be attentive to the everyday structural violence that disproportionately affects communities of color living in poverty.
“We know that violence is a social determinant of health,” said LaVeist. Violence is a factor—along with racism; toxic stress; lack of access to healthy food; poor quality or no housing; lack of adequate education,
3 Many publications by the National Academies’ Forum on Global Violence Prevention are available at http://www.nationalacademies.org/hmd/Reports.aspx?filters=inmeta:activity=Forum+on+Global+Violence+Prevention (accessed October 31, 2016). Publications from the Committee on Law and Justice and other units are also available at http://sites.nationalacademies.org/DBASSE/CLAJ/Topics/DBASSE_080822 (accessed October 31, 2016).
jobs, and incomes; and lack of safe places to walk, play, and socialize—that shapes the health of individuals and communities and contributes to shorter lives, particularly for people of color, he added. The planning committee intended for this workshop to be a way to bring attention within the population health field to the problem of public acts of violence and its corrosive effects on health, safety, and the well-being of individuals and communities across the nation. This Proceedings of a Workshop is not intended as a comprehensive summary of the science and evidence on community violence as a population health issue. The initiatives, organizations, academic institutions, and individuals featured in this workshop are only a few of the many considered by the planning committee. Participants’ inclusion in the workshop was based on a range of factors, none of which is related to privileging or promoting particular approaches or programs over others.4
Two topics were mentioned by several workshop participants during the discussions throughout the day for their absence: (1) a focus on violence against lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) communities; and (2) a focus on domestic violence against women and children. Planning committee members did discuss community violence as public acts of violence,5 and members of the planning committee who participated at the workshop acknowledged and welcomed the comments about the lack of focus on the relationship between intimate partner violence by men against women involved in gun violence (see discussion sections in Chapters 4, 5, and 7). Also welcome were the comments about the lack of focus on violence against LGBTQ communities, particularly during the reflections at the end of the day (see Chapter 7).
This Proceedings of a Workshop synthesizes the discussions that occurred during the workshop, highlights the speakers’ perspectives on community violence as a population health issue, and discusses some of
4 The draft resource list developed by staff as background reading for the workshop includes information on many additional violence prevention initiatives, though it was also not intended to be comprehensive, but rather illustrative of national initiatives. It is available at the activity page for the workshop at the website of the Roundtable on Population Health Improvement, see http://nationalacademies.org/hmd/~/media/Files/Activity%20Files/PublicHealth/PopulationHealthImprovementRT/16-JUN-16/21%20Resource%20list.pdf (accessed October 31, 2016).
5 Examples of definitions of community violence can be found at the following sites: http://www.nctsn.org/trauma-types/community-violence (accessed September 16, 2016) and http://www.cvtcnyc.org/communityviolence (accessed September 16, 2016).
the strategies communities are using to reduce violence and the impact of violence. Chapter 2 discusses the impact of racism and violence on communities. Chapter 3 describes some social and physical interventions that can change landscapes of violence, and Chapter 4 addresses local strategies to build community resilience and safety. Chapter 5 discusses some lessons learned from select approaches and initiatives designed to reduce community violence, and Chapter 6 explores public health–informed approaches to community policing and collaboration. Chapter 7 provides a reflection on the day’s presentations and discussions.
In accordance with the policies of the National Academies of Sciences, Engineering, and Medicine, workshop participants did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the planning committee’s role was limited to planning the workshop. The Proceedings of a Workshop was prepared by workshop rapporteurs Darla Thompson and Joe Alper as a factual summary of what occurred at the workshop.