Homicide, Gun Violence, and Epidemiology in Detroit

More about the above map HERE

The Detroit Police Department (DPD) has been making strides to improve their operations, including: cracking down on internal corruption, adopting data-driven crime tracking, and utilizing innovative approaches for crime prevention. When Chief James Craig was hired he brought back a data-driven model of policing that tracks where crimes happen, by whom, as well as where police patrols are deployed. This is an important step forward for the DPD to manage the large land area of Detroit while utilizing statistics to plan police asset allocations. Being aware of crime trends and locations is critical to understanding how best to improve safety in Detroit. Last year DPD and Crime Stoppers held a gun buy back event in Detroit and early this year it was reported that a Federal investigation by the ATF (Bureau of Alcohol, Tobacco, Firearms and Explosives) collected a number of illegal guns after setting up a fake barbershop in Detroit. The ATF’s primary goal was to identify key “trigger pullers” in the community who are committing violent crimes.

“What we need to understand gun violence is a #publichealth approach.” – David Satcher #APHA13

— Prevention Institute (@preventioninst) November 4, 2013

These data-driven and community focused approaches are critical to making Detroit safer as well as utilizing police and community resources more effectively. Innovative and effective approaches to crime prevention are desperately needed in Detroit. A crime prevention approach rooted in public health is gaining traction in reducing homicides in other major US cities. The Cure Violence program uses a public health/ epidemiology approach to identify “trigger pullers” who contribute to the spread of homicide and crime in communities by sending violence “interrupters” who are former gang members into the streets to intervene. The Man Up! program in Brooklyn uses this same approach and saw 363 days without a shooting or killing this past year.

My own research shows that homicides in Detroit follow a disease diffusion pattern across the city. Emanating from two key hotspots while continuing and spreading from those areas throughout the year with over 80% of Detroit homicides committed by gun.

It was announced today that $1.6 million will be granted to fund, “36 AmeriCorps volunteers to analyze crime statistics and help neighborhood block clubs and other groups learn how to report crime, keep an eye on the neighborhoods and how to avoid becoming victims.” The Free Press article notes that the program has been in effect in Midtown and East Jefferson over the last three years and they have seen a 44% reduction in crime. Funding ($722,000) for the program comes from the Kresge Foundation, Skillman Foundation, Henry Ford Health System, Jefferson East Inc., and Detroit Medical Center. Does this signal Detroit taking on a public health approach to crime and violence? I sincerely hope DPD and funders push for more public health strategies for crime and homicide prevention.

If anything this is welcome news over involvement from the Manhattan Institute (proponent of increasing incarceration rates to reduce crime) and the expansion Stop-and-Frisk in Detroit. There can be only positives in getting residents and police officers to meet on common ground instead of police officers wantonly stopping and frisking innocent Detroit residents. Hopefully the involvement of Foundations, Health Systems, and community advocacy groups can continue to improve the DPD approach to crime prevention.

Critical Questions on Mental Health in America

The topic of America’s mental health system and the need to improve it has become a hot topics following the most recent gun violence at an elementary school in Connecticut. Most of what I have heard from the media and politicians is a broad “need to improve mental health.” It is always a very generalized statement without many specifics on how or where or to what end. It is likely that these pundits and politicians have no idea, but I think this leaves a critical gap in the mental health discussion.

“As soon as I’m finished speaking here, I will sit at that desk and I will sign a directive giving law enforcement, schools, mental health professionals and the public health community some of the tools they need to help reduce gun violence.

We will make it easier to keep guns out of the hands of criminals by strengthening the background check system.  We will help schools hire more resource officers if they want them and develop emergency preparedness plans.  We will make sure mental health professionals know their options for reporting threats of violence — even as we acknowledge that someone with a mental illness is far more likely to be a victim of violent crime than the perpetrator.” – President Obama 01/16/13

An article that I read noted that it was easier to buy a gun than to access mental health services in America. Why is that true?

Mental Health Services Stigma

I seems as though the mental health climate in America is very similar to the stigma associated with PTSD within military circles. With the conflicts in Afghanistan and Iraq I remember reading that soldiers wouldn’t seek out counseling  for their PTSD because it was interpreted as if the soldier was unfit for service and had serious issues. This applies in both the military and civilian settings. When a soldier leaves duty they may still face stigma related to their PTSD.

Likewise, this often plays out in the civilian world. Seeking counseling is never seen as a positive endeavor. Meeting with a psychologist is a negative event in your life that you never hope to repeat and you most definitely don’t tell anyone publicly. But why?

Why Seek Mental Health Services?

What causes people to seek out mental health services? Are individuals only referred by their family doctor or sometimes do they attend because they are required?

Many people seek out mental health services as a result of substance abuse. Dealing with addictions is probably the most well recognized aspect of mental health in the US. However, there is often a high degree of stigma even for those with mental illness and addictions. Overcoming the stigma and discrimination against those in need of mental health is a huge hurdle if President Obama and others hope that mental health will be more easily accessible among the general public.

Other well known reasons for mental health services are: depression, bipolar, anxiety, and PTSD. Nearly 80% of individuals who suffer from depression say that they experienced some form of discrimination (Mental Health America). Other studies have found that racial discrimination and an individual’s level of poverty also contribute strongly to mental health. However, a recent poll has found that stigma against depression and seeking treatment for depression is decreasing.

Where are Mental Health Services Accessed?

I know for many students being on a campus makes it fairly easy to meet with a Counselor at various locations. How would individuals without easy access find and utilize mental health services. I know that individuals can go to a hospital or an emergency room if they are in immediate need of mental health services, but that can’t be the ideal method of accessing mental health.

Most people probably have no idea that they have access to preventative mental health care with their insurance, however this goes back to the stigma associated with seeking such treatment. The other major barrier to accessing mental health services is the high cost with a minimum around $100 and extensive treatment reaching over $10,000. As a result of the cost barrier, only around 7% of all adult Americans accessed mental health services (NSDUH report).

Since the majority of mental health tends to affect poor individuals this cost barrier makes it even harder to identify and treat mental health. Mental health services is included in the “essential health benefits” piece of the Affordable Care Act, but it is left up to States as to what is included. Without some serious thinking about why, how, and where individuals access mental health services – improving access will just be more political rhetoric. If we are serious about improving the mental health system then we need to be asking serious questions.

real life public health isn’t sexy

The field of public health does not lend itself to being glamorous or satisfying after a full day’s work.

I currently work as a Community Health Worker (CHW) in Detroit supporting a NIH funded grant using behavior change techniques to tackle childhood obesity among African-American adolescents.

Snapshot: Thursday, December 1st, 2011

After a meeting with my supervisor, I had three family appointments scheduled for the day. My first appointment was with a family that needed to be caught up after missing 2 weeks. We provide transportation for families that come into the office, so I had called them a cab. However, the cab company had not sent the cab after 45min. and the appointment had to be rescheduled for another day. My next appointment was with a Teen who obviously preferred not to be meeting with his Mom and me. We worked through topics on Hunger and Cravings, but had to finish early because I had another family appointment coming up. After waiting 10min., I called my last family to confirm and they had forgotten they were supposed to come in today.

I spent my 8 hours that day driving a lot and meeting with only my supervisor and one family. It was a long, trying day to only be able to check a few items on my weekly to-do list. The over-used quote that I have to keep reminding myself is:

“An ounce of public health is worth a pound of health care”

Hopefully somewhere down the line the families and Teens that I work with will someday use the skills and information that I share. All I can do is offer my knowledge and support for their efforts while reinforcing their positive changes.

Public health has become a buzzword along with the growth of the global health field. It’s great that health has become such a prominent topic of interest, but not everyone is going to save a life or change entire communities. Buzzwords don’t make the best career choices. It may be that you spend all day tracking people down and hoping some knowledge sticks, maybe you make posters for wellness events, or even get covered in dirt planting vegetables with kids who prefer to play video games. Public health isn’t sexy; work can be dirty, sometimes lonely, unappreciated and often unnoticed.

Public health is not a new field. It has been around for a long time, but in the media it has most often been portrayed by medical doctor drama series that always have to include twisted webs of personal relationships and hookups in broom closets from Boston to Kandahar.

Public health is intense and has its own great stories and dramas – can’t these stories tell themselves without the backdrop of casual sex and relationships gone wrong? When will the public be ready to watch a show that is about real public health?

The truth is that although public health may not be as glamorous as a television drama, but it is full of exciting adventures, dramatic endings, and stories of hope.

better health + growing population ≠ societal collapse #7billion

With each additional billion people on Earth, the collective news pundits, academics, development experts, and politicians freak out. Many pundits have been talking about the world’s population hitting 7 billion and how that relates to all the issues that we are seeing today. To many authors, talk show hosts, and even economic and development experts, population is the cause of everything. This is just fear-mongering and bandwagon journalism. The facts give a clearer picture.

If you’ve ever read Jared Diamond’s book, Collapse, the themes are all related to overpopulation and the Earth’s carrying capacity. We are constantly improving our health systems and keeping people alive longer than ever before in human history. As we grow in population there will be a breakdown in our social fabric and we will enter into international civil war over precious natural resources, like vegetation, water, etc. It happened on Easter Island, why can’t it happen on a global scale? In short, and to simplify: we are all screwed. I’m going to leave Malthus out of this conversation, but he is a good guy to read about if you are interested in population.

Environmentalism, Population Health, & Politics

Most of the pundits have talked about the impacts of overpopulation on the environment, but what about the impacts on health? This is an important area where the late Dr. Paul Epstein was world-renowned for his work connecting the growing environmental threats and their serious impacts on human population health.

By connecting climate change, exacerbated weather and environmental conditions, and the deep crises these create for the health of human populations, Dr. Epstein made the critical link between the health of our planet and the health of the people living on it.

Recent years have seen increased famines, droughts, and floods, loss of arable lands and increasing desertification, not to mention the inability of governments to respond to these crises. Some of Epstein’s work highlighted the increase of cholera after severe flooding and the increased range of malarial mosquitos as mountain tops warm up. Climate change and environmental issues are related to consumption, which is disproportionately carried out by wealthy countries consuming the majority of the world’s resources even with smaller percentages of total world population. Likewise, famines aren’t caused by too many people, but rather from bad government, violence, and global inequality.

The issues that many would like to attribute to the growing population are really fueled by politics. Population growth and climate change are above all else a political issues.

Fertility vs. Population Growth: (think incidence vs. prevalence in epidemiology)

Everyone needs to take a step back and look at the numbers. Population numbers are increasing with population growth increasing in a number of key countries, however we need to also look more closely at fertility rates rather than simply population growth numbers.

Many areas that have high birth rates also have high infant mortality rates, so it is not completely implausible that families would have a higher number of children to account for the poor health conditions their children might face and not survive. Likewise, areas with high fertility rates often see high infertility rates due to the increased risk to women of infection from multiple attempts to have children.This is where the debate about family planning and contraceptives enters the discussion.

Helen Epstein writes that if men and women have “frank conversations” that may be the best contraceptive. However, John Seager, President of Population Connection, offers a rebuttal that conversations cannot replace contraceptives. He notes that the need for access to knowledge and adequate health care is just as important. He writes,

“When women can control the timing and spacing of their childbearing, they can get an education and a job, and take better care of their own health and the health of their existing children. What could be more empowering than that?”

Population Control as Development

Following Word War II, population control became an important issue for the US to pursue around the globe. The  world food crisis in 1967 made Congress recognize the importance of population growth and it allocatd $35 million to USAID for population control activities. Today, USAID is single largest funder of population control activities in “developing” countries.

During the World Population Conference of 1974:

“Opposition came not only from traditional Roman Catholic quarters, but also from many Third World countries, which saw the focus on population growth as a way to avoid addressing deeper causes of underdevelopment, such as inequalities in international relations. […] India argued that ‘development is the best contraceptive,’ and criticized the high consumption of resources in the West.”

Many began calling for changes to the status quo, however no one asked why the needs of the poor weren’t being met in the first place. Glaring inequalities in distribution of income, land, and power were avoided. Politics came out on top as Western powers pushed “developing” countries, with the backing of international donors, to deliver family planning to the poor, “without fundamentally altering the social order in which they live.”

Developing countries and activists called for “integrated development” focused on addressing both poverty and population.

Solutions

Nothing is so cut-and-dry or simple when it comes to development, especially in regards to population health which pulls on issues ranging from: climate change, women’s rights, income equality, access to health care, infant mortality, family planning, and the list could go on. The population question touches on so many different issues that it only makes sense that health is at its core.

Seager makes good points about the need for women to be able to care for their own health and that of their existing children. Others have lauded similar ideas, specifically feminist groups who called for “voluntary motherhood” and the idea that unwanted children would become defective.

Recently, Bill Gates has touched on the issue of a growing population. He noted that a greater focus on infant/ child health could have a significant impact on slowing population rates and improving the health of populations around the world. As discussed in “fertility vs. population growth” – more surviving children will decrease population rates, in turn this would ideally improve the quality of health care available with smaller, healthier populations.

Gates pushes the idea that mobile technology can help to register new births and ensure that all children are vaccinated. However, the flip side of his optimism is the need to increase the capacity of health care systems to make this goal a global reality. Women play a critical role in this discussion and too often they are marginalized without the knowledge or resources to make changes. Women and health care systems need to be empowered to provide for newborns and children who will be the future of our world.