Headlines ring with the assertion that violent crime is epidemic – and researchers at the School of Public Health and Tropical Medicine are responding as they apply classic public health approaches to stop the transmission of violence. All this in a city that has wrung its hands over the crime rate in recent years, but also where Mayor Mitch Landrieu has taken a more forceful and targeted approach to reducing murders.
High rates of poverty, low rates of educational success, and high rates of health risk factors in childhood, such as abuse, injuries, and even poor nutrition may contribute to the cycle of crime and victimization in New Orleans, where the overwhelming majority of violent crimes are committed by young African American males against fellow African American males. At times, the profound social problems that underlie the epidemic of violence may seem intractable.
“There is a lot you can do without waiting for profound social transformation to take place to stop the chain of transmission of violence,” emphasizes Mark VanLandingham, Thomas C. Keller Professor of Diversity in the Department of Global Health Systems and Development. “This is what makes the public health approach so powerful and successful for such a wide range of problems. John Snow knew next to nothing about the science of cholera, and yet he was able to short-circuit the sequence of events leading to an outbreak by having the pump in the center of the action disconnected. A public health approach can similarly disrupt the sequence of events leading to a homicide. We don’t have to wait until we’ve solved – or even fully understood – all of the underlying problems before we can have a huge impact.”
Tulane professors and students are working on a wide range of issues to address violence, including:
- Working to prevent the use of corporal punishment to discipline children.
- Reducing dating violence among New Orleans youth.
- Reentry of offenders into society.
- Analyzing the factors around murders as they happen, in order to form policy recommendations for prevention.
- Developing courses such as “Violence in the Community” and “Violence as a Public Health Problem.”
- Building sustainable violence prevention efforts by acting as a resource for community leaders.
“The public health approach is appropriate,” argues Catherine Taylor, associate professor of global community health and behavioral sciences, “because of the enormity of the problem as well as the numerous population-based avenues for preventing and reducing violence.”
TACKLING MURDER IN NEW ORLEANS
In an effort to address the complexity of murder and near-fatality in New Orleans, Mayor Landrieu has created the Mayor’s Strategic Command to Reduce Murders, an initiative within the broader NOLA for Life strategic plan.Researcher David Seal, professor in the Department of Global Community Health and Behavioral Sciences, serves as director of research on the Strategic Command initiative, which began in 2012.
“My team’s job is to analyze murder cases in real time, within 24 to 72 hours, and really starting to pull comprehensive information beyond what goes into the police reports,” he explains. That data will be used to get violence prevention information to people who may be victims or offenders, and to their community. Previously, Seal worked with the Milwaukee Homicide Review Commission. In addition to parsing out the murder data, Seal facilitates multiple action teams comprised of key community and law enforcement stakeholders who meet regularly to review the data summaries and make policy and procedural recommendations to reduce murders and non-fatal shootings. Components of this effort include working on reentry programs for people being released from prison and trauma response teams for the communities in which violent crime occurs. The recommendations then go to an executive action team, headed by the mayor, for review and implementation.
“This approach had a really positive effect in Milwaukee. It led to policy change and led to legislative change around weapons,” says Seal. And although the program is new to New Orleans, Seal notes, “already there are some things that, because of discussion, people are starting to do differently in their departments. I know that in Milwaukee, a lot of the early changes had to do more with internal changes, like how agencies communicate and share information, which leads to better data and more nuanced analysis.”
This is just one component of the mayor’s effort and the effort of community leaders throughout the city, emphasizes Seal.
“For me the real indicator is going to be whether this collective body of work has been successful. Each piece is attacking a different part of the problem,” he says. Seal noted that murders are down 28% through the first seven months of 2013 compared to 2012, suggesting the NOLA for Life strategic plan is having an impact.
Public health students and researchers are actively involved in every aspect, he says. Seal employs two master’s-level graduate research assistants on the Strategic Command. They conduct data analyses and attend community meetings, a unique opportunity to get real-world experience in applied public health.
Before violence results in a death, it is often pervasive in relationships. Violence between young people is a focus of researcher Aubrey S. Madkour, assistant professor in the Department of Global Community Health and Behavioral Sciences. Her research has shown that while violent behavior has not increased as a result of the upheaval of Hurricane Katrina, dating violence remains higher than the norm. Dating violence is considered to be hitting, slapping, kicking, or any physical violence in the past year.
Prior to Hurricane Katrina, dating violence in New Orleans increased from about 13 percent to 25 percent among teens responding to a school-based survey. “It’s very high here,” says Madkour, “and it seems to be maintained post-Katrina.”
She will begin a new study this fall around the dating violence problem in New Orleans. Madkour will be recruiting youth ages 13-18 for in-depth interviews and focus groups to get their perspective on the dating violence problem.
“The goal is to better understand, from teens’ perspectives, what dating violence is, what are the personal, situational, and contextual factors that feed into dating violence problems, when and why violence emerges in dating relationships, and what might be some approaches to addressing dating violence that youth would find appealing and helpful,” she explains.
Madkour says that when she teaches about violence as part of her adolescent health course, she knows that “students have their eyes opened about the magnitude of violence.” But her strategy is not to dwell on the statistics. She also brings in community members and experts, such as adjunct professor and criminologist Peter Scharf, who can talk about the violence prevention strategies they are implementing every day.
Catherine Taylor looks even earlier in childhood for the roots of violence. She is working on developing messages to change community and individual norms that support hitting children. Although parents who hit their children as part of discipline do so with the best of intentions, Taylor points out that those children are at risk for higher aggression and related social problems as they grow up.
“Different kinds of violence and aggression are so pervasive, and so much is acceptable and expected, that one of the biggest challenges is working to go against the norms that support violence,” she says. She has coauthored a paper in Clinical Pediatrics highlighting research results showing parents are most likely to seek child discipline advice from pediatricians, followed closely by advice from religious leaders.
GETTING THE NUMBERS RIGHT
According to VanLandingham, even if you don’t need to address or even understand all of the underlying causes of violence before you can have an impact, one thing you do have to have is sufficient political will. Accurate population estimates and accurate murder statistics are necessary for obtaining and directing the resources necessary to reduce murder. And this, agrees Scharf, is a tremendous challenge for public health researchers working on the problem.
“A lot of time we are given political numbers to work with and you have to really drill down to get the real numbers,” says Scharf. This, in part, is what Seal is working on, with a real-time analysis of murders as they happen so that essential data can be gleaned from each situation and form the basis for recommendations that might help reduce violence.
Immersed in violence research, Tulane’s public health experts find themselves challenged to be creative, intuitive, and accurate in the face of very real challenges. In international settings, securing accurate information about incidences of violence while maintaining safety both for the victims and researchers can be very challenging, but also necessary to address the needs that exist. The World Health Organization provides recommendations for keeping victims of violence safe during research, which protects researchers as well.
Stateside, researchers face their own issues of safety and of trust. “Criminals lie,” points out Scharf, who works inside prisons to better understand the roots of crime and violence and the challenges of returning to the free world. But often, so do politicians, who may only want to report politically favorable numbers, and parents, who don’t want to acknowledge harming their children.
Nonetheless, Tulane researchers and students wade into the fray, armed with the slim but powerful tools of public health and the belief that good information and the strength of communities can ultimately reduce violence.
The students who come to the school to work on issues of crime and violence are unique, say these professors. They are passionate, idealistic, and many of them are already committed health professionals who will go back into their communities with evidence-based solutions.
“What attracts public health students to a place like New Orleans is that there is a lot of work to be done here. It reflects the problems our students will see overseas, increasing interest in repopulation, violent crime, and rebuilding health infrastructure. For students who want to have an impact on the world this is an excellent place to study and work, because we have this core of expertise where students will come away with exposure to the problems and state-of-the-art ways to address them,” says VanLandingham.
— Madeline Vann