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August 24, 2023
Public Health Health Equity
Harold A. Pollack
Selwyn Rogers, Jr.
Jun 7, 2023
May 24, 2023
Aug 23, 2022
Back to The Milbank Quarterly Opinion
Not long ago, some of us were asked to attend a meeting at our institution on the topic of development and employment opportunities for young people in the communities that surround our campus. Similar meetings surely occur at myriad peer institutions across urban America. We offered several ideas:
These ideas were graciously received. Then the conversation awkwardly moved on. We realized that these proposals did not address this particular meeting’s main, albeit unstated, goal: to reduce the high crime and violence rate involving youth in these same communities.
Youth violence causes much harm and imposes practical and reputational costs to our own university, nestled within the South Side of Chicago. Our university has a legitimate need to ensure that our faculty, students, patients, staff, and surrounding community members are safe from robbery and assault, property crime, and firearm-related injuries. We ourselves are all too familiar with these harms. Dr. Rogers is a trauma surgeon and founding director of the University of Chicago Trauma Center. He has spent decades treating fatal and nonfatal injuries resulting from gun violence. Over the past five years alone, the University of Chicago Medicine Trauma Center has cared for more than 8,000 victims of firearm-related injuries. Dr. Glasser is a primary care physician who has treated innumerable young people who bear physical and mental scars of interpersonal violence, scars which often remain throughout the life course. Dr. Pollack co-founded the University of Chicago Crime Lab and now co-directs the University of Chicago Urban Health Lab. He has been robbed or beaten several times in his adult life; his gentle, disabled cousin was beaten to death by two 16-year-old boys in a botched home burglary.
Given our professional and personal experiences, we wholeheartedly support a portfolio of effective and evidence-based interventions to reduce such harms, including more-effective regulations concerning access to lethal weaponry by young adults and by others who pose predictable public safety threats; measured deployment of surveillance technologies, such as street cameras; evidence-based linkage interventions for people who experience mental health and addiction challenges; school-based mental health services; youth summer employment opportunities; generous disability benefits; enhanced and coordinated community violence intervention strategies; and a strong, effective, and collaborative police presence, fielded in partnership with communities most affected by such violence.
These health and social service interventions are all well-justified, independent of their relationship with violence prevention. Yet our strong focus on crime reduction easily leads us astray in justifying them—particularly those of us who work in institutions nestled in areas of endemic violence. In a society focused on the disproportionate rates of violent offending and victimization among young black men—that otherwise shows tenuous commitment to the well-being of these young people, their families, and their communities—we face understandable incentives to justify worthy policies and interventions in terms of violence prevention. It’s essential to remember the genuine costs and harms to conceptualizing and framing youth development and employment interventions exclusively, or even primarily, through such a calculus of crime reduction.
The most dehumanizing aspect is to view young people, especially those of color (and other stigmatized groups such as fellow citizens who experience serious mental illness) through the dominant lens of their potential criminality. Beyond the moral injury of this view are practical concerns highlighted by Hetey and Eberhardt. Well-meaning efforts to address disparities can bring unintended consequences, especially when they inculcate “stereotypic associations linking Blacks with crime” through a narrow focus on violence and criminality. In turn, this can lead to increased support of punitive policies and over-policing, reinforcing a vicious cycle of over-policing, crime, and erosion of community.
This framing also privileges crime reduction as the implicit benchmark for policies and philanthropic interventions, sometimes at the expense of other, equally important goals. There may be tactical political benefits in framing Head Start, the Supplemental Nutrition Assistance Program, math tutoring, social-emotional counseling, disability income supports, or other worthy efforts as crime prevention. But if these programs do not reduce crime, they may be viewed as failures, even when they accomplish their respective primary goals of educational enrichment, improved nutrition and educational performance, improved mental health, and economic self-sufficiency. Policies that uplift human potential ultimately may have a crime reduction element, but this potential should be viewed as an intersectional benefit and not a primary goal.
The aforementioned university meeting underscores another challenge. The violence prevention lens can lead us to overlook the needs and capacities of community members whose situation merits considerable attention, but who are not visibly involved in the matrix of problem behaviors or community violence. There’s a notable lack of excitement among policymakers, funders, and the public regarding school-based mental health interventions that reduce mental health symptoms among girls who are not, in appreciable numbers, involved in community violence. Profound intersectional inequalities involving older adults and people with physical or cognitive disabilities in low-income communities similarly receive less attention than do public safety challenges.
Viewing youth of color through the dominant or exclusive lens of violence prevention distracts us from centering their own interests and perspectives in our community development and public health efforts. It leads us to miss opportunities to engage young people as critical assets –rather than as objects of behavior change interventions—in efforts to nurture and protect our wider communities. Embracing the voices of youth from high promise populations as potential sources of solutions alters the relationship from a deficit framework to an asset-based one. For example, consider the potential impact of collaborative discussions with affected youth about their perspectives on possible interventions that the medical, public health, and university communities could collaborate in and support.
Finally, we reduce ourselves in our capacities as community members when we engage unidirectionally or act with implicit self-interest in our dealings with our neighbors. Rather than acting with generosity and humility, we easily act out of arrogance and self-protective isolation, missing opportunities for meaningful learning that accompany open engagement and exchange.
We understand and share the sense of urgency regarding violence reduction and prevention. Still, we as a public health community must proceed with caution and self-awareness when we adopt crime reduction as a primary mode through which we justify our work and engage our communities.
Harold A. Pollack, PhD, is the Helen Ross Professor of Social Service Administration at the University of Chicago. He is faculty codirector of the University of Chicago Health Lab. He researches services for severely disadvantaged populations for individuals at the interface between Medicaid and the criminal justice system.
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