Transcript of Episode 13: Violence is Not Normal

with host David Richards [DR] and guest Mighty Fine [MF] 
Listen to the audio

[DR] This week is APHA’s National Public Health Week, a celebration of all things public health. Because today’s theme is violence prevention, we’ve invited a special guest to join the Healthy Communities podcast. This week we have Mighty Fine, Director of the Center for Public Health Practice and Professional Development at APHA.

[DR] Welcome to the Healthy Communities podcast; a public health-themed podcast that breaks down common health issues in our communities, and how Healthiest Cities & Counties Challenge projects aim to address them. I am your host, David Richards from APHA. This is Episode 13: Violence is Not Normal. 


[DR] We are recording. Thank you again for doing this. I’m here with Mighty Fine from APHA. I’ll let you introduce yourself. 

[MF] I am the Director of Public Health Practice and Professional Development here at APHA, and I work primarily on violence and injury prevention issues. I get into some other public health issues, but violence and injury prevention is where I spend the majority of my time, and I love it.

[DR] What’s your background? How did you get started in public health?

[MF] I have an undergraduate and graduate degree both in public health. My graduate degree focused on social epidemiology. My first entre into public health work was really in HIV, AIDS prevention. I started off as a counselor and tester, and doing a lot of health education and community outreach that lead into research. Then I stumbled into other aspects in public health just by happenstance honestly. 

[DR] Epidemiology is a big word in the public health world. What is social epidemiology and can you define epidemiology? 

[MF] My definition of epidemiology is the study of the distribution of determinants of disease upon a population. Social epidemiology is just another layer of that looking at the social forces that contribute to health outcomes or looking at those protective factors or things that facilitate health and well-being. 

[DR] What do you work on here? You talked a little bit about that. 

[MF] My primary focus is violence and injury prevention. I work on projects and programs that try to uncover ways that try to prevent violence and injuries in the first place, but also looking at the different levels of public health prevention like primary, secondary and tertiary, and finding the best ways for us to intervene at those different levels. Obviously, it’s really trying to focus on primary prevention and thinking about violence prevention realizing that it is preventable and not inevitable as it’s sometimes portrayed that it’s going to happen and there’s nothing we can do about it. I know from experience that there’s a lot that we can do to prevent violence and injuries. 

[DR] We talked a little bit about that before. Why should we be thinking of violence and injury as a public health issue? Also, do you want to talk about statistics and leading causes of death?

[MF] Injury and violence, I feel in my own professional bias that they don’t get the attention that they deserve because it is a huge burden on public health. If you think about injuries specifically, it’s the leading cause of death for folks from age 1-44. If you think about it, it’s a pretty big chunk of our population, particularly if we focus on the younger aspect of that in thinking about people unable to live out their lives to their fullest potential because of premature deaths from injury and violence as well. I think the other aspect of that is that the everyday person doesn’t take the full breath of what encompasses injury and violence. It can be anything from a fall, to an overdose, to a gunshot wound. It’s a lot happening to many people and I don’t know if it gets the same the same notoriety as something like an infectious disease, and I’m not here saying that we shouldn’t pay attention to that, but we have to distribute our resources accordingly to where the burden is. 

[DR] What are the social aspects of injury and violence and why is it not just an individual thing like an individual crime or injury? 

[MF] I like to think of it as collective trauma particularly when we talk about violence. When you think about someone’s exposure to violence, and what that means for their life moving forward, if you liken it to a physical wound there are treatments that are put in place to remedy that wound so maybe it’s physical therapy or whatever. There’s a lot of focus on the physical injuries but not a lot, I should say there should be more attention on mental injuries or trauma and addressing that not only on the individual level it happens at the community level particularly when we’re talking about community violence. I’m individually impacted by it but there’s a collective impact for my neighbors and others being faced with violence in your home, community and that impacts how you learn and how you grow and there are long term health impacts from that. That’s why I see it as more of a collective community issue, more so than individual. As you know, looking across risk and protective factors we know that they happen at the individual and societal. When we think about violence, we need to think about the larger issues in the community and not the individual. Once we focus on the individual it allows people to say well I’m not in a violent situation, that’s not my problem, I don’t have to deal with it. But if we think about the collective impact, that allows use to see where we interface with violence.

[DR] To take a step back to go to something that we touched on our previous conversation was the difference between violence in the United States and violence abroad, and how we as a country and as a culture has normalized violence that is unprecedented and very different across countries and cultures. Can you talk about that?

[MF] I can. We are very unique in the US. One of the issues that we have a hard time facing is the F word. And that’s for firearms. That’s what sets us apart from countries that are economically and otherwise is our access to firearms. There are estimates that say we have enough firearms for every man, woman and child in this country and that’s problematic. When we think about violence, we know that a gun has the propensity to increase the severity of the injury and even death. That’s what sets us apart is the access to firearms and the lethality of the violence here in the US.  

[DR] Back to this social issue. What happens when you normalize violence? Talk about the personal level, but also the collective level. 

[MF] Sure. The more I get involved in violence; I notice that it’s normalized in media and television. Particularly shows, movies, musical lyrics. I’m not suggesting that those things will make a person more violent; however, there are studies that have shown that if there is someone who has been exposed to violence, and they are exposed to these mediums that support violent environments and behavior, that does increase the likelihood of them to engage or be a victim of violence, so that’s what happens. The other part, is that we see it so much on television, take mass shootings for example, you often see a social media post or a news show, and people say it’s not if, but when. When we get to this point where it’s likely to happen, again not suggesting that it won’t, but we get to this state of welcoming violence, and acknowledging that it does exist, but not thinking about ways to mitigate and prevent it. Again, it’s sensationalized. Everyone can get behind a mass shooting, thoughts and prayers, but what we fail to recognize is that violence is happening every day in cities across the US whether it’s gun violence, interpersonal violence, teen dating violence, sexual violence, and it’s happening but we’ve gotten to a point where it’s “eh, it’s inevitable. What can I do?” That’s the narrative that we need to change and empower people, not just empower, but work with them to harness the power that they already have to understand that they have the ability to change it, and obviously that will include policy changes and other changes beyond the individual, but if we empower communities to show them that they have a stake in it, then that’s going to get us further along the continuum. 

[DR] My last question, in the vein of violence as a social determinant, through the public health lens, how should we look at things differently?

[MF] The great thing about public health is that it allows us to look at the collective impact. We can think about social capital, and we know that neighborhoods that lack social capital or lack social cohesion are more prone to violence. We know that neighborhoods that lack adequate resources are prone to violence. Through a public health lens, we can think about structural racism and other structural forces that exacerbate violence in certain communities. We know that it’s not by happenstance. We can think about housing policy such as redlining and redistricting, and things like that that keep people segregated and also it dictates how resources are distributed. In public health, we should look at how to mitigate and combat that every community has the resources they need to again live their lives to the fullest potential.

[DR] now, let’s paint a picture of a neighborhood, a neighborhood that has dealt with crime or injury. What is that neighborhood like and how are those people affected by it? But also, one thing that we talked about is the perception of crime and violence. So let’s talk about that neighborhood aspect.

[MF] I think that’s critical because when you think about neighborhoods where violence is happening at a higher rate than other communities, they’re segregated, they’re low income, there are poor schools there, there are limited job opportunities, there are these what we call concentrated disadvantage. If you think about social determinants of health, it’s another way to flip that coin and looking at the social determinants that lead to poor health outcomes and that’s certainly true in these neighborhoods with higher rates of crime. Sometimes there is a higher concentration of environmental hazard, and there are things like asthma and kids are missing school. What happens when you miss school? You can fall behind, then you may not graduate, so it’s a cyclical course that’s happening in these neighborhoods. We have to address each one of them individually, but also thinking about what the collective impact is in that neighborhood. I like to give the example of chronic illness. More often than not, we will be told that we need to be more physically active and you need to eat healthy. If you’re living in a neighborhood where you don’t have sidewalks, you don’t feel safe to go on a walk or a jog. How likely are you to adhere to these prescriptions of getting more physical activity? When you don’t have supermarkets where there are fresh fruits and vegetables. How do you improve yourself when your environment is conspiring against that change? That leads me to believe that we need to change the environment to which you live in order to help you and your collective community live their greatest lives. 

[DR] I love that phrase concentrated disadvantage. That perfectly describes everything in terms of injury and violence. I want to go back to those groups most affected. You talked about structural racism, you talked about redlining, who are these groups that are more disadvantaged?

[MF] They tend to be communities of color, specifically Latino and African American communities. Another part of that to your earlier point that I didn’t mention, usually when I give talks on violence in America, I ask people, “Have you ever heard of the terminology, Asian on Asian crime? Or white on white crime?” People more often than not say no. But the moment what I ask, “Have you ever heard of black on black crime?” nearly every hand in the room goes up. Why is that? There is this perception that people of color are more likely to be violent. It’s inevitable; that’s the way they are. When you have these neighborhoods where you have these harmful impacts that are mostly inhabited by people of color, it helps to fit that paradigm. We in public health have to work together to dispel those myths that people of color are more prone to violence and help people recognize that there’s been years of disadvantage that has led for these communities to be in such despair. 

[DR] I’ve never thought about it that way in terms of white on white, Asian on Asian.

[MF] I go through every racial category. The thing is, violence is very interpersonal, and as I mentioned earlier, neighborhoods tends to still be segregated in 2019, and people tend to commit violence against people who look like them, obviously not saying that other races don’t interface with other races and do not so great things. The point is, it’s not a black issue. It’s an American issue. 

[DR] That’s a really good point. To touch on that perception, how does that perception impact youth development and on the flip side, recidivism, like both sides of the coin?        

[MF] If we think about coupling that thought with the media, and if there’s this perception that you’re less than and can never be more than, there are aspects of that that are internalized. If you’re told that you can’t be, then what is there to aspire to be? That’s why it’s so important to make sure that youth have access to nurturing adults and mentoring. The sweatshirt that I have on now, it was designed by a youth in Colorado in a gang diversion program. There are mentors there who take on young men and some instances young women and they teach them entrepreneurship and they help them run a business like helping them print t-shirts and they have an income from that. It allows for some aspects for upward mobility or more so. To understand what is possible to tap into their potential to tackle sentiments of not being as good as others.           

[DR] That’s a great point. Let’s talk about those risk factors but also where we can control the narrative and to change the perception as the example you gave.

[MF] What’s important is that we often hear about resilience. Sometimes people look at that as a bad word, but I don’t think so. It’s not about empowering communities but rather to help them tap into the power that they already have and harness it. Another factor is economic opportunities. Getting a paycheck allows to afford safe and stable housing. The built environment and community design are super critical. There are studies that show that parks and other public spaces that are dilapidated are breeding grounds for drugs and other anti-social activities. But when communities come together they build upon that social capital and they overtake those public spaces. They clean it up and make it green again. Folks are walking dogs and walking there, and enjoying their neighborhood. That has shown to reduce crime in the community because it’s reclaimed by the community members. Another one would be a quality education. In some of these neighborhoods, you may have a classroom of 35 students. How much learning is actually taking place in that environment? As someone who was in an inner city school and who dealt with some of that, I would say that it was difficult. Learning became difficult to do because there were so many distractions in the classroom from there being a lot of students and the schools being ill equipped with resources. We need to make sure that we address that. Again, I mentioned that, and I can’t over state, the social networks are critically strong. I think sometimes what is missed is that when we look at these neighborhoods and juxtapose them with let’s say gentrification, which is often seen as a bad thing. But I like to say that the idea of rehabbing a neighborhood is a great idea. We want sidewalks, we want green spaces, we want people to be able to walk in their neighborhoods and to be able to go to grocery markets, but you don’t want it at the expense of kicking people out who had to face those adverse issues because then their social networks are broken. That’s a critical piece of a neighborhood and development where social cohesion is in tacked. I often like to say that, when we are helping a community blossom, we have to remember its inhabitants and not removed them from the equation. Those are some of the protective factors that we can focus on to help neighborhoods reach their full potential.

[DR] A couple of those terms that you’ve used like social capital, social networks, social cohesion, where do you start? What’s an example of a federal policy or one at a local level? 

[MF] I would say local. Others may disagree, but a lot of health is very local. There is a project out of the prevention institute which is called urban networks to increase thriving youth. It was a youth violence prevention effort called unity. The thinking behind there was to engage mayors to invest in violence prevention. If you get mayors to invest in it, they have a lot more touch points to engage with community members. Communities are a critical component and need to be involved in addressing the factors that are happening their neighborhood, but that can’t be done without policy, so that’s where the mayors and local officials come into place to help facilitate the process by allocating resources to communities that are in need and that’s where the policy level comes into place because it dictates that like school policy, housing policy. Those are the areas that we need to focus on. We know that racial segregation is one of the reasons that we got into this place. Even beyond policy, there are also practices. We have to make sure that the culture reflects the policy and vice a versa because we want them to be in sync. I’m not only told that I should do it, but that the culture dictates it.

[DR] We’ve talked about prevention rather than response. How do you deal with both? Is it possible? 

[MF] I think we have to look at the totality of the issue. Think about violence, not just as crime, this isn’t something that we can arrest our way out of. There is certainly a role for the criminal justice system, but to me, it’s not just for arrest because there isn’t really true rehabilitation that takes place in that paradigm in my opinion. We have to look at ways to address the root causes of violence again looking at the social determinants of health and also how we build on that resilience that is in these communities. We can’t rely on that alone, we have to look at both. That’s where the prevention piece falls in, really looking at those root causes that is exacerbating violence, but also in the response. There are hospital-based programs that deal with violence. Let’s say there are two people from a neighborhood and there is some conflict. One person gets shot and survives, so there is still a perpetrator and a survivor. That survivor at some point needs to be reintegrated into their community. There are these hospital-based education programs who work with the survivor and cases when they know who the perpetrator is and they work with them in some capacity to ensure that once they return to their community they won’t end up in the hospital or the perpetrator won’t end up in the hospital. Obviously, if they are caught they do jail time, but there are things such as restorative justice that are looking at that those people most impacted can work out those differences in a facilitated very involved process to ensure that the integration back into the community makes sense. There are programs like that on the response end that takes both the victim and the perpetrator into account to figure out how to reintegrate them back into the community when they return.

[DR] That’s perfect. This has been so great. Last question, how do you turn it back into your own work? What are some examples of things that you do? 

[MF] For me, I’m really focusing on youth development. Some of the work that I really enjoy doing is tapping into the youth and finding out what the biggest challenges they have are and working with them to come up with solutions or resolutions. I think often times, and as I get older, I think about this, you know the public health principles, you know the public health theories and paradigms and it all looks great on paper when you’re planning your program. You have your evaluation, you have all these things set but all of that is meaningless if it’s not going to have true impact and in order for it to have a true impact we have to engage with those persons we’re trying to help or assist because they have to be a part of the full process to be fully invested in it. In my work, I try to ensure that the communities are involved in every aspect of it so that we see the biggest return on our investment. 

[DR] This has been really great. It’s been with Mighty Fine here at APHA. Thank you so much for doing this podcast with me. 

[MF] Thanks for having me.                                                                     

[DR] That’s the show this week! Thank you to my guest Mighty Fine, and thank you all for listening. Links to more resources can be found on the Healthiest Cities & Counties Challenge website at healthiestcities.org under about the challenge, podcast. I’ll see you next time.