Is public health helpful to end rape and domestic violence?
Why do some professionals believe there is only one solution to a problem? Complicated issues, like health care, global warming and sexual violence / domestic violence, require comprehensive solutions. So I was surprised when I saw the title of the letter from Andy Klein appearing in February 2010 issue of the National Bulletin on Domestic Violence Prevention is “DV is not a public health problem.” Klein claims that
Declaring DV to be a public health emergency takes our eyes off the ball. DV is a criminal justice emergency, a continuing failure of the criminal justice system to stop criminals from committing crimes repeatedly. Well intended counseling by health professional will not stop their patients’ victimizers.
I will not reduce addressing domestic violence to criminal justice solutions. However, in this article, Klein reduces public health response to health care providers screening while suggesting the value of medical personnel is to “assist law enforcement” by recording victim reports of abuse.
I see a public health approach as much more than screening. Klein identifies Swine flu as a public health emergency (though public health people call it H1N1). The incidence of domestic violence and sexual assault exceed that of Swine flu; and its impact is significant to people’s health and well-being. In a PreventConnect eLearning unit on social justice and public health, I examine how the lessons learned from public health response to disease can influence our efforts to prevent sexual violence.
Public health is more than epidemiology, health care and infectious disease control. I studied Community Health Education where I learned how public health provided some valuable ways to address issues such as domestic violence and sexual assault:
- Public health changes the conditions of a community and society to solve a problem,
- Public health addresses the root causes,
- Public health goes beyond responding to the problem,
- Public health seeks to prevent it from happening in the first place.
Public health informed efforts such as DELTA, Rape Prevention & Education, and StartStrong are engaging communities to take action to prevent domestic violence, sexual abuse and teen dating violence. PreventConnect is a online community of people using public health concepts to advance prevention.
I agree with Andy Klein there are limits to the public health approach to preventing domestic violence and sexual violence. A public health framework alone is not enough to understand the problem and develop the solutions; we have to also look to other approaches, such as human rights and justice. While there are some elements common to public health success stories like tobacco prevention and using car seats, the work to end domestic violence and sexual assault is more similar to the work of the civil rights movement: we must shift norms of how we define men and women, relationships and family, and power itself.
How have you found public health concepts helpful to developing domestic violence and sexual violence prevention initiatives?
I agree that the public health concepts are helpful and have framed the way that we go about building preveniton programs but also agree that there are multiple frameworks that assist in the process of utilizing the public health concepts. I am so happy to hear that more and more people are talking about and using human rights concepts in their work. Although I am a feminist and don’t see that word as a bad word, I understand the implication it can have when working with others who don’t understand it the way that the movement does. I really find that the human rights framework is assistive to my work both in my belief system and when working with others outside of our field. I am finding that it wraps our communities as a whole instead of separating domestic and sexual violence a woman vs. man issue as some do. Domestic and sexual violence are complex problems therefore requiring complex solutions.
Great comments David, I am using some of your comments tomorrow in a presentation.
Thanks SO much!!
Why can’t it be not only a criminal justice emergency but also a public health problem as well? Why can’t the two co-exist? Some people are more likely to disclose being the victim of abuse to thier doctor rather than to a police officer. Health care providers often cross report to law enforcement, and if something isn’t working then we should fix the systematic faliures. I agree that there are many. More PRIMARY prevention is needed, improve swift accountability, safety and economic justice, etc….but by discounting that this is a public health problem and the role of health care providers -we are doing a disservice to not only the victim/survivor…but also to the community.
This post is perfect, David. I must admit I have a general “WTF” reaction to Klein’s article, and you articulated that in a professional manner.
I have to say, I have often chaffed at the idea of DV as public health, and while there is most certainly health implications in domestic violence – victims and perpetrators are not diseased. DV isn’t something that one can catch or cure. Instead we are living in a society that promotes, allows, excuses, and even encourages domestic violence. I worry that public health modeling allows some to decide this is not their problem, that it’s something that other people get, I am concerned that public health puts responsibility on victims to take “preventative” measures or “cure” themselves. Its problematic to think about a social issue in a medical model. While the CDC has done and continues to do amazing work especially in prevention, I worry that we’re setting ourselves up in a less than perfect model because that is where the money is coming from.
I agree with Kate that a medical model is too limited for addressing domestic violence and sexual violence. Though I see public health can be different than a medical model; public health looks at issues from a “population” lens – thus it has to examine the social and community aspects of the issue
Kate, you are right that domestic violence is not a disease with a “cure” – but it is a complex problem that require addressing the norms that create the environment that causes the violence in the first place.
The public health model (for population x, define a problem, test solutions, and deploy) is a wonderful frame for violence prevention. It’s well augmented by theories and models of behavior change.
I don’t know of anyone who advocates only using a public heath approach, however. As David said above and I’ve heard him say before: domestic & sexual violence are different than requiring car seats in automobiles. It is different than speed limit signs and swine flu.
I think this sentiment is intuitively understood, if rarely stated so precisely, by people trying to reconcile a public health approach with the traditional feminist frame of the work.
Public health’s focus on root causes (and prevention perpetration) is consistent with survivor-informed work that isn’t victim blaming, while focusing on multiple contexts– not just individual-level stuff.