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Reflections on the Day
The traditional conclusion to this roundtable’s workshops is for the roundtable members, as well as other workshop participants, to offer their reflections and reactions to the day. “It is very difficult to do work in this area and do it well, but it is really important to do it.” said Thomas LaVeist of The George Washington University. “I was struck by how diligent the researchers are in trying to bring rigor to what is an extremely difficult topic to study well.” He also noted that violence can be a violence prevention strategy in that reacting quickly to an ambiguous threat can be lifesaving because the one time that response is wrong, an encounter could be fatal. In some ways, he said, violence is often seen as being pathological or indicative of a mental health condition, but in fact it could illustrate a healthy brain’s response to an unhealthy context.
LaVeist commented that moving people out of their neighborhoods to move them into opportunity does not sound like a successful policy because inevitably there will be individuals who are not moved and as a result have even less opportunity. He also said it is unfortunate to think of the problem of violence in terms of hot spots and hot people because in his view they are two sides of the same coin. “We need to have strategies that focus on place and we need to have strategies that focus on people,” said LaVeist.
LaVeist’s final comments were in response to an earlier comment about the workshop not addressing domestic violence. He said the workshop planning committee decided to contextualize this workshop in a particular way by focusing on everyday structural violence that has dis-
proportionate impacts on communities of color living in poverty. He also remarked that male-on-male violence was a narrative thread that came through in the workshop, but there are other gendered perspectives that this workshop did not address that could be a topic for a future workshop.
Mary Pittman of the Public Health Institute remarked that John Rich’s theoretical framework on racism and violence was a good introduction to the workshop. She then noted that the interventions described at the workshop are long-term solutions that need sustainable funding. That funding needs to support better pay for those individuals who are taking on these dangerous roles as violence interrupters. She also commented that there were so many sectors and interventions discussed that a mapping exercise might help prioritize where to apply specific interventions. Other points she raised were the importance of having trusted players in the community and the link between trauma and violence. She also said she was somewhat surprised that the faith community was not mentioned much in the discussions and that she found the final panel framing of the relationship between the justice system and violence as a welcome approach.
Marthe Gold of The New York Academy of Medicine commented that the presentations emphasized the link between the environment and violence, a connection that fits into the broader discussion about determinants of health, but the idea of hot people described by DeVone Boggan was a new concept to her. That idea got her to thinking about how hot people live everywhere, come in every color, and come from every culture and how many there might still be even if the nation could magically erase the deprivation these communities face. “What do we do with them? How do we reconcile the fact that there are people that you do not change, who are intractable, who for whatever reasons, will always be sour on the world?” she asked. She also wondered what those attending the workshop could do to help create pressure to diminish the role of guns in American society and to engage the media to become more attuned to the losses that everyone suffers—not just privileged communities—when violence occurs.
Lourdes Rodríguez of the New York State Health Foundation commented on the parallels between hot people and high users in the health care system and how thinking about hot people in that way might lead to new solutions. She also drew another parallel between the services available for veterans returning home from combat to help them deal with the effects of trauma and individuals returning to the community who have been incarcerated. She wondered if society could suspend its biases regarding the latter if the nation could then think about ways of helping those individuals heal the effects of the traumas they have experienced in life. Rodríguez’s final comment regarded the idea of characterizing the
young people arriving at emergency departments as not having had caring adults in their lives. It may be that the adults in their lives are working 80 hours a week at two jobs to try to support their families.
Phyllis Meadows of The Kresge Foundation and the University of Michigan said she felt a sense of failure and hope after the day’s presentations. She also thought about the young people who were the focus of the day’s conversations and how society has created an image of them that gives others permission to walk away from them. “What I heard today was clear justification for why we cannot walk away from this topic,” said Meadows. Her sense of failure comes from not knowing how to move other people to pay attention to these young people and not knowing how to move from talking to action. An important realization for her was that these young people have their own stories and that the individuals most responsible for violence are victims as well. “There are so many narratives in this, from the person who commits the violent act to the person who experiences it, to the family,” said Meadows. It is important for their voices to be heard and their stories to be told. Her final comment, speaking as someone who works for a foundation that provides support for programs, was to consider what changes need to be made to make violence reduction programs no longer necessary. She commented that foundations are thinking about how to take a systems approach to these problems, and hopes that in the future more attention focuses on policies and systems: medical, justice, and others that contribute to the violence in communities.
Samara Ford, an undergraduate student at Harvard College, remarked that as someone interested in public health, she was inspired to hear experts talking about the topic of community violence at a workshop. One of her takeaway messages was the need to look at the intersection of self-worth and violence given the likelihood that if a young person feels his or her life has potential, that person will not put his or her life at risk. Her final comment was to remember that the discussion about community violence as a population health issue should also include the LGBTQ community, which is often the object of violence and suffering the health consequences of experiencing that violence.
George Isham of HealthPartners commented on the peace quilt hanging behind the podium that was created by children of Lutheran Church of the Good Shepherd, where the workshop was held. One of the squares said “Peace Begins with Me,” and he commented on the optimism contained in that statement. The statement also made him wonder if peace is the opposite of violence. He then noted that in the aftermath of the June 12 Orlando nightclub shooting, some of the resulting television and political commentary distorted that incident into a single issue or self-aggrandizing rationales. “The country could use the reminder that this
is a complex issue,” said Isham. “One of the opportunities we have is to draw attention to that fact and draw on the expertise that we have heard during the course of the day.”
Steve Smith from the University of Florida and a National Academy of Medicine Anniversary Fellow commented on how easy it is to be pessimistic about violence in society and how scary the topic of violence is for young people in the United States. However, he was impressed with the optimism espoused at this workshop that comes from these successful programs. “I think it reinforces the idea that we have to encourage and help facilitate these home-grown, community-driven interventions,” said Smith. He suggested there might be an opportunity to have a workshop at which programs demonstrating successful population health interventions were published as a guide to others wanting to start programs.
Bobby Milstein of ReThink Health commented on the idea that the consequences of discrimination and racism unfairly disadvantages some communities and advantages others, but they also sap the strength of the entire nation. In his opinion, there has not been enough research done to identify how the strength of the nation is diminished by racism and discrimination, and he would like to hear more about that. He noted that there is a great deal of money invested in the prison-industrial complex because of the way the nation criminalizes violence while at the same time there are these many programs desperate for funding that create real value. “People who otherwise would have died are now here, families are better connected, there is just enormous value surrounding the things that we heard today, but not necessarily connected to the larger value equation, as it were,” said Milstein. His sense is that these promising initiatives are being conducted on a shoestring despite the massive size of the problem. “I think it would be marvelous to learn a little bit more about the scope of the problem and its economics relative to the resources that are going to make a difference,” he said.
Milstein also remarked that nonviolence is a discipline that has to be taught and learned and that nonviolence has saved many lives in addressing injustice. He wondered, then, when the nation lost its connection to non-violence. In his opinion, nonviolence can reconnect thriving economies that are more inclusive. In that vein, he commended the Boston Globe, which in the wake of the Orlando shooting published a list of tools for stopping gun violence (Boston Globe, 2016). “This is a major newspaper taking a stand in a way that is not just reporting the problem, but saying it has got to stop and here is how. It is just a remarkable landmark that, to me, is a move away from just observing this dynamic and saying if it is going to stop it is going to have to be people taking a stand and saying this as they have never done before in a spirit of nonviolence,” said Milstein. He also applauded Connecticut Senator Chris Murphy’s (D-CT)
filibuster in the Senate on June 15, 2016, to demand action on gun control. LaVeist thanked Milstein for mentioning the filibuster and thought it important to acknowledge what was happening in Congress.
Speaking as a member of the clergy, Gary Gunderson of the Wake Forest School of Medicine commented that there are some quarter of a million congregations in the United States, and probably 99 percent of them do not engage these issues even though they would be well organized to do so. Rather than assuming that unless there is government intervention, change will not happen, Gunderson said, “There is very powerful testimony here that if you can be relevant and tenacious and follow the way that every single faith tradition has ever spoken to, you can shift the pattern of these most profound and intractable problems.”
To close the workshop, Sanne Magnan commented that during the workshop, “We have felt emotions of sadness and anger, and yet out of all of that has also come hope.”
