Public health expert Dr. Anthony Iton says that if you give him your address, he can tell you how long you’re likely to live. His prediction isn’t based simply on homicide rates or disease prevalence. It’s based on the stress of living in neighborhoods that aren’t safe, where, for instance, children avoid playgrounds for fear of stray bullets and adults stay home at night for fear of being assaulted.
Iton, the California Endowment’s senior vice president for Healthy Communities, was addressing an audience of police chiefs, who learned from his presentation that the community conditions that alarm public health officials are sometimes the same conditions that boost crime rates.
It was just one example of common ground among public health and police officials underscored by an executive session convened by Director Bernard Melekian, former Pasadena (CA) Police Chief, who now leads the Office of Community Oriented Policing Services in the U.S. Department of Justice. Melekian has made it a priority to hold these types of discussions as a way to identify new ideas and approaches for more effective community policing strategies.
At the session, which was co-sponsored by The California Endowment and the Center for Court Innovation, police chiefs from across the country, along with social policy experts and public health officials, explored ways to partner to reduce crime, not just as a matter of justice and public safety, but as a public health priority.
The discussion highlighted the common ground between the approaches used by public health officials and police. For example, both respect data and track success by the numbers, whether it’s the rate of assaults or the spread of a flu epidemic. As Ruben Gonzales, Jr., of the Center for the Study of Social Policy said, “Sometimes it’s just semantics that separates the approaches.”
Both also use mapping to chart the “outbreaks” they seek to control. In fact, the location of health and crime outbreaks often overlap as Iton illustrated by comparing maps of violent crime hot spots to geographic concentrations of stress-related killers like heart disease, high blood pressure and cancer.
For even though overall crime rates may decline, they stay higher in areas where a cycle of poverty and lack of community resources leave few positive choices. And even in areas where crime has dipped, said Ron Davis, Police Chief in East Palo Alto, “the fear is still high. Fear may have more of an impact on stress than actual crime rates,” he added.
A public health approach to policing may promise better results in neighborhoods where youth violence is the highest and life expectancy is the shortest. An essential first step in a public health approach is sharing information.
In Milwaukee, a Homicide Review Commission brings together not only law officers investigating a case, but a range of representatives, including community service providers, health officials, community organizers and members of the faith community. “You get a different perspective from each level of these reviews,” she says. By sharing information, participants not only crack individual cases “much as a team of physicians can diagnose and treat patients more effectively by sharing knowledge” but they also identify system-wide weaknesses and recommend changes. “They know our goal is to develop prevention, suppression and intervention strategies,” said Dr. Mallory OBrien, who has led the commission since supervising its launch in 2004.
The commission makes recommendations about ways to break the cycle of violent crimes in particular neighborhoods. As a recent example, a study of gun violence showed only a short time between a gun purchase and its use in a crime, and that a high percentage of those guns were bought by young black females. In response, a prevention campaign was launched last year in neighborhood beauty parlors, aimed at discouraging young women from buying guns for their men.
Another proactive program that employs a public health model is the California Safe Communities Partnership (also known as CeaseFire) which seeks to intercept crime “carriers,” the small minority of troubled youth that can create a majority of gang violence. Working with the support of the faith-based community and employment and social service agencies, authorities and community leaders meet with gang-involved youth to encourage them “through both moral appeals and threats of serious law enforcement consequences” to stop violence. In this way, CeaseFire works to identify and defuse potentially violent situations before they occur. In Stockton, Calif., the program is credited with reducing gang-related homicides by more than 75 percent, while Salinas has, in a year, seen half the number of shootings and an 80 percent drop in homicides. Similar success has been seen in Boston, Chicago, Cincinnati and Indianapolis.
If were going to work together, when we work with public health, it forces us to be proactive, said Madison (Wis.) Police Chief Noble Wray. But, he added, while reactive crime-fightingpolice cracking down on perpetratorsis something policymakers will pay for, getting the funding for proactive policing can be a tough sell.
That was the issue in Milwaukee when the Homicide Review Commission launched in 2004. “We knew the dollars were drying up,” said OBrien, “so we wanted to focus our investments on identifiable risks.” The result: The districts where the commission operated saw a 52 percent decrease in homicides while others saw only a 9 percent decline. But with the high cost to the public of criminal trials and incarceration, even a small reduction in crime can offset the costs of the public health approach.
The emphasis that police, politicians and the public put on crime rates is one key difference between law enforcement and public health: While public health officials are rarely held accountable for an epidemic of disease, police are routinely blamed for an outbreak of crime.
The preventive approach is “a much more effective form of policing,” said Joseph Brann, the former Hayward (Calif.) police chief and founding director of the COPS Office. “Organizations that are sincerely committed to it are able to reduce staff and crime rates where people have the guts to do it.”
Another challenge lies in getting communities in crisis to trust the police and vice versa. But here, too, the public health approach may offer an advantage. Said Thomas R. Simon of the CDCs Division of Violence Prevention: “When you think of violence as a public health problem and focus on stopping violence before it starts, you can get more people to the table.”
Long Beach (CA) Police Chief Jim McDonnell agreed: “If you have a tendency to look at crime from a public health standpoint, it takes away some of the demonization away from the people who commit that behavior.” That, he said, is the “first step in making headway with the community. The public health model changes the conversation.”
