Dr. Georges C. Benjamin, Executive Director of the American Public Health Association, joins us for an urgent discussion about the far-reaching effects of domestic and sexual abuse that threatens not only individuals but also the fabric of society itself. Our conversation traverses the vast landscape of public health, from the quality of the air we breathe to the unseen threats like domestic violence that lurk in the shadows. Dr. Benjamin's passion for making healthy choices accessible to all is a clarion call for change in the way we approach community safety and individual well-being.
In this episode we dissect the critical role public health plays in our daily lives, especially amidst crises like the COVID-19 pandemic. With Dr. Benjamin's guidance, we navigate the day-to-day victories achieved through public health initiatives, from clean drinking water to safer roads and effective immunization campaigns. Likewise this episode peels back the layers of our health systems, revealing the intricate network that strives to maintain our collective well-being and the importance of collaboration across various sectors to tackle public health emergencies head on.
Finally, we cast an unflinching eye on the unique challenges that underserved populations face when confronting domestic violence. Dr. Benjamin spotlights the American Public Health Association's dedication to inclusive health initiatives and their tireless efforts to prevent violence before it begins. Together, we explore the necessity of building trust and resilience within marginalized communities and the imperative to create a healthier, safer nation for every individual. This is a powerful call to action, urging us to recognize and respond to the public health crisis of domestic violence with the urgency and compassion it demands.
Dr. Georges C. Benjamin, Executive Director of the American Public Health Association, joins us for an urgent discussion about the far-reaching effects of domestic and sexual abuse that threatens not only individuals but also the fabric of society itself. Our conversation traverses the vast landscape of public health, from the quality of the air we breathe to the unseen threats like domestic violence that lurk in the shadows. Dr. Benjamin's passion for making healthy choices accessible to all is a clarion call for change in the way we approach community safety and individual well-being.
In this episode we dissect the critical role public health plays in our daily lives, especially amidst crises like the COVID-19 pandemic. With Dr. Benjamin's guidance, we navigate the day-to-day victories achieved through public health initiatives, from clean drinking water to safer roads and effective immunization campaigns. Likewise this episode peels back the layers of our health systems, revealing the intricate network that strives to maintain our collective well-being and the importance of collaboration across various sectors to tackle public health emergencies head on.
Finally, we cast an unflinching eye on the unique challenges that underserved populations face when confronting domestic violence. Dr. Benjamin spotlights the American Public Health Association's dedication to inclusive health initiatives and their tireless efforts to prevent violence before it begins. Together, we explore the necessity of building trust and resilience within marginalized communities and the imperative to create a healthier, safer nation for every individual. This is a powerful call to action, urging us to recognize and respond to the public health crisis of domestic violence with the urgency and compassion it demands.
The subject matter of this podcast will address difficult topics multiple forms of violence, and identity-based discrimination and harassment. We acknowledge that this content may be difficult and have listed specific content warnings in each episode description to help create a positive, safe experience for all listeners.
Speaker 2:In this country, 31 million crimes 31 million crimes are reported every year. That is one every second. Out of that, every 24 minutes there is a murder. Every five minutes there is a rape. Every two to five minutes there is a sexual assault. Every nine seconds in this country, a woman is assaulted by someone who told her that he loved her, by someone who told her it was her fault, by someone who tries to tell the rest of us it's none of our business and I am proud to stand here today with each of you to call that perpetrator a liar.
Speaker 1:Welcome to the podcast on crimes against women. I'm Maria McMullin. Public health crises are often summarized as recurring issues that deal with the body internally, such as disease, addiction or chronic conditions that are typically explained by biological compromises, environmental challenges or socioeconomic responses. Because of these restricted viewpoints, phenomena such as domestic or sexual abuse are not readily considered to be a public health crisis, despite the physical, psychological, emotional and financial damage that they cause to the victim. Public health crisis, despite the physical, psychological, emotional and financial damage that they cause to the victim's health, as well as to the public's sense of safety and security. This episode will explore the consequences of not recognizing and acknowledging how gender-based violence can be a threat to all. Our guest is Dr Georgia C Benjamin, one of the nation's most influential physicians, who knows what happens when preventative care is not available and when the healthy choice is not the easy choice. As executive director of the American Public Health Association since 2002, dr Benjamin is leading the association's push to make America the healthiest nation. He came to APHA from his position as secretary of the Maryland Department of Health and Mental Hygiene.
Speaker 1:Dr Benjamin is a graduate of the Illinois Institute of Technology and the University of Illinois College of Medicine.
Speaker 1:He started his medical career as a military physician in 1978, when he trained in internal medicine at the Brook Army Medical Center.
Speaker 1:In 1981, he was assigned to the Madigan Army Medical Center in Tacoma, washington, where he managed a 72,000 patient ambulatory care service as chief of the acute illness clinic and was faculty and attending physician within the Department of Emergency Medicine. A few years later, dr Benjamin was reassigned to the Walter Reed Army Medical Center in Washington DC where he served as Chief of Emergency Medicine. After leaving the Army, dr Benjamin chaired the Department of Community Health and Ambulatory Care at the District of Columbia General Hospital. He was promoted to Acting Commissioner for Public Health for the District of Columbia and later directed one of the busiest ambulance services in the nation as interim director of the Emergency Ambulance Bureau of the District of Columbia Fire Department. Dr Benjamin's academic career has consisted of a full range of endeavors, from teaching and policy research to academic program development and management. He has combined his practice and academic experience as an emergency physician with public health to become one of the nation's foremost experts in public health emergency preparedness. Dr Benjamin, welcome to the podcast.
Speaker 3:Thank you for having me.
Speaker 1:It's great to be with you. You are the executive director of the American Public Health Association. Tell us about your work and describe some of the overarching topics and issues that you address.
Speaker 3:Well, you know, APHA as an organization has been around since 1872, and we're a professional society of people interested in public health and the broad ranges of public health, from making sure that you as an individual can be healthy, as well as the systems that enable you to be healthy or can get in your way to be healthy. We try to address those as well. So we've looked at things such as gun violence, climate change, access to healthcare, immunizations. During the COVID pandemic, we were very much involved in both looking at the science and advising policymakers on how to move the nation forward to try to reduce the impact of that terrible, terrible disease process. So it ranges across just about anything that could impact your health.
Speaker 1:Yeah, those are some really big issues and they're very widespread, right. I mean they impact all of us at any given time.
Speaker 3:Well, they do, and you know, people often think in a very narrow way about health and healthcare, and we try to think about it in a much broader sense Again, going way upstream, to the things that we think are involved in making it very difficult for you to be healthy. We often talk about trying to make the healthy choice the easy choice you to be healthy.
Speaker 1:We often talk about trying to make the healthy choice the easy choice, yeah, so let's focus in on that a little bit, because the concept of public health and public health crisis may mean different things to all of us. How do you conceptualize that and how does maybe the general public think of what public health means?
Speaker 3:You know, I like to think of public health the way, by the way, the rest of the world thinks of public health as the umbrella entity. And then you have kind of individual health, health of a particular individual, and population health, which is the health of a group of people. And I like to think of it that way because I think that is a more practical way to think about it. Here in the United States we have kind of a healthcare delivery system and then we have a public health delivery system and of course they overlap substantially. So again, thinking about it kind of as an umbrella, that everything is public health, then you can talk about how do we make people healthy from an individual perspective and how can we make groups of people healthy, as a way to try to think about the framing there.
Speaker 1:So what is a public health crisis? Because when I think of public health crisis, the most recent one that comes to mind would be COVID.
Speaker 3:Well, I think we should think about a crisis as anything that is growing substantially or has the potential or has reached our inability to contain it using the normal processes that we use, so that we have to bring in extra supports, extra resources, extra people, maybe more money, and to think about how we manage it differently than we would normally do on any given day.
Speaker 1:So, as you've shared, public health is a much broader concept than just being healthy or avoiding actions that could cause someone to be unhealthy or are threats to public health, such as refraining from smoking or wearing a mask when you are sick. Could you provide us with examples of what public health involves, and in what ways does public health, awareness initiatives and education impact our daily lives?
Speaker 3:So let's just walk you through today, anyone's particular day. You know you get up in the morning and you drink water because you're thirsty. That water is safe to drink because of public health actions. There's a group of people that have made sure that there are no contaminants, infectious agents or toxins in that water which allow you to drink it. So, having safe water to drink, you eat your breakfast and hopefully you're eating a nutritious breakfast. The public health community has worked to try to define what a nutritious breakfast is and, of course, all your other meals for the rest of the day, and try to do the things to educate you on the proper way to eat those meals.
Speaker 3:Secondly, if you're someone who gets exercise in the morning before you go to work or before you go to school, the idea of becoming more physically active so you can maintain ideal body weight, and also there are a lot of other health benefits from being more physically active than inactive, and so the public health community looks at both the science behind how best to be active as well as it's been a health benefit, and so we promote that activity when you get either on your bike to ride where you're going and you put on a helmet. Public health community has looked at the science around wearing a bicycle helmet so that if you were to fall, you would not have brain injury. If you get into an automobile, we have promoted seatbelts and in fact you know so that if there's an automobile collision, you'll be more likely to survive. And in fact, the public health community worked with a broad range of people across other sectors engineers, public safety individuals, people who build roadways to try to make both the car safer, people safer in their cars and the roads that we're driving on safer, as a way of dramatically reducing automobile collisions and making people safer if there, tragically, is a collision. We've also worked to make it safer for pedestrians to walk the streets. So now you know, we looked at the science around crosswalks and things like that and lights and some of there's a lot of science around that in order to not just make it safer for people to walk across streets, but also for the drivers so that they don't run into people we have, when you get to work, the buildings are designed for safety purposes. The actual the breadth of the steps when you climb up steps have actually been looked at to make sure that people won't trip and fall. There's actually a group of scientists that do public health, that look at that kind of way to design buildings so they're much more healthy, in a way to try to reduce that.
Speaker 3:So then you know, when you go home in the evening and oh, let me just add, and of course, working in a smoke-free environment so that both, hopefully, you're not using tobacco, but also that others aren't using tobacco, so that you don't get sick from their secondhand smoke, and to make sure that the materials that are used in your work environment are safe, so you're not exposed to toxins. And then when you get back home, we've done things such as remove the lead from gasoline so that children aren't exposed to lead, because the lead is a toxin moving lead from the paint in your walls. So, again, mostly because kids get exposed to lead. And when you go to bed at night, we've worked with people who make clothing and pajamas so that your clothing won't ignite and if it was to catch on fire, that it wouldn't combust so quickly, so that you can get out of them.
Speaker 3:So public health does a lot of things and has influenced a lot of things. And then we also like to point out that many, many other jobs that you might not think of have a health component, but they do. The people that pick up our trash every day. They're providing a public health service because they're reducing the opportunity for rodents and other pests to get into those things, and of course, they carry disease. In fact, some of the greatest plagues on our planet were from the Black Death, of course, from flies and rodents. So public health really is involved in some way in almost everything that happens to you every single day, and we're not only the ones that do public health, but other people have pieces of what they do that improves the public's health as well.
Speaker 1:Basically, everything that you've worked on in the interest of public health affects all of us. It's every aspect of our lives.
Speaker 3:Well it does. And then when you get sick, obviously you know we have a whole range of preventive tools to try to keep you from getting sick in the first place, like vaccines, for example, or if you should get sick. There's a whole range of researchers who create therapeutics, working with scientists in the pharmaceutical industry to try to improve your health. They tend to be historically on the medical care side of the house, but they're extraordinarily good scientists and, again, their interest is in making sure that you can stay healthy if you can, but if you do get sick for any reason, how we can store you back to normal as quickly as possible.
Speaker 1:Okay, so we've identified the public health crisis, we've defined that, we've identified public health and what that means, and so then there are some other things that can contribute to public health and safety or to a public health crisis that are not very often considered a health issue but probably should be. And the one I wanted to focus on today is domestic violence and how that can contribute to public health or actually to the detriment of our communities, because domestic violence is not simply a private fight between two people that resolves on its own. It leads to debilitating physical and mental abuse, fear and sometimes to death. How does domestic violence relate to and impact public health?
Speaker 3:relate to and impact public health. Well, it's very important to remember that if it hurts people or kills people, both physically or mentally, then it is something that we should be concerned about from a broad public health perspective. And so domestic violence does both. It both has both a physical element to it and it has a mental element to it, and not just a mental element between those two people. But it often involves and engages a whole range of other people. You know they get part of that process. Family members get involved in these domestic events, the law enforcement community gets involved in this law enforcement, you know, in these domestic events. And, of course, again, it's violence, and violence in and itself is a societal issue which has to be addressed, and it is increasingly becoming a real crisis. It ebbs and flows, for sure, but violence is occurring more and more frequently in our community, and domestic violence is often one of these things that is not well recognized until it becomes an extremely serious problem.
Speaker 1:Do you identify domestic violence as a public health crisis at this moment in time?
Speaker 3:I believe that domestic violence absolutely is a public health crisis at this time, both because it is growing in its incidence as well as because of its corrosive effect on both the relationship between those people involved as in, indeed, its relationship to society.
Speaker 1:Yeah, I completely agree with that. We see a lot of that in the work that we do at Genesis Women's Shelter and Support. So to those points then what are some approaches, models or strategies that can be employed for both the victim and the offender in order to reverse the effects of this public health crisis?
Speaker 3:Well, I think the first thing of course is early counseling and everyone not just putting their heads in the sand when you have a dysfunctional relationship, to try to get those relationships to try to engage early in a process that diffuses whatever the conflict is, getting both parties to understand it. But in many situations you cannot resolve it and in that situation those folks are just not meant for one another. But we also want to make sure it's not just viewed as just a relationship issue where two people don't disagree, because sometimes the abuser in that relationship is aggressive, is engaged and is not simply a disagreement between two people. And we also want to make sure that people understand that it doesn't have a gender bias. Women can be abused, men can be abused. It does not matter what your sexual orientation is. Those relationships can result in domestic violence. So any place where you have at least two people together can result in a domestic violence situation and the sooner you catch it and try to address it, the better.
Speaker 1:And that's pretty true of most public health crises. Right, they don't discriminate. Anyone could get. If there's a threat to public health, like the COVID pandemic, anyone was susceptible to getting it, some more than others, but in domestic violence most often, while both women and men can be abused, most often it's women. So there are vulnerabilities that make you more likely to be affected by a public health crisis where others may not be as affected.
Speaker 3:Well, it's just realizing that it's a power relationship. It's about power at the end of the day, and the power relationships in many ways will make this corrosive. There's also the dependency relationship, the fact that the individual that is being abused often feels dependent on their abuser, and there's conflict in relationship. I mean, there is certainly a relationship there between these people. They may really love one another, but that relationship has gotten off track and it doesn't have to be physical. It can be physical. It can be physical and mental. It can be only mental but tragically, all too often it results in both physical injury in addition to the emotional scarring that occurs, and sometimes, particularly if there's a gun in the home, it can result in death using that firearm.
Speaker 1:Yeah, I'm glad you came back to the idea of how gun violence impacts public health, because I wanted to ask you what your take is on gun violence prevention and what policies are available that individuals, family members and service providers who want to keep communities safe can explore.
Speaker 3:Far too often when you try to get into a legal argument about the Second Amendment and the right to bear arms, et cetera, when there actually is a way to reduce injury and death from firearms. You know there are many, many things in your home that are dangerous Razor blades, chemicals. You know, as a parent we spend hours and hours thinking about how we can childproof our home for our kids. You know we put our medications away so the kids can get them. We put them in childproof bottles. We put little things in the socket so the kids won't stick things in the socket. We put latches on our cabinets so they can't get a hold of toxins and theoretically, hopefully, we put them up so the kids who are crawling around can't get to them.
Speaker 3:Well, firearms are the same way. You have a firearm in the home. We don't tend to we should, but we don't tend to lock them up. We don't separate the firearm from the bullets. We often don't go to firearm training so we know how to properly use the firearm. We know that there are some things that we can proactively do, like red flag laws, where we know there is a person who, for one reason or another, should not have a firearm because of their mental health status, because of their criminal justice status, because they've been an abuser again, because the incidence of a higher instance of people being killed or injured with a firearm in a domestic violence situation. There's something called red flag laws where you can appropriately go to a judge and get that firearm taken out of the home. So at least you diffuse the risk of being injured or killed with that firearm. Criminal background checks are very effective and putting those in place, you know, remember I mentioned earlier about the things we use for cars and make cars safer.
Speaker 3:We can make firearms as a tool safer. You know right now if the gun is loaded, there's no way to know it's loaded. Far too often you hear these stories about someone thinking the firearm was unloaded, handing it to somebody else in the firearm, then you pull the trigger and it goes off. Or a child playing with the firearm and killing themselves, or a playmate. So having load indicators, a way to know that that firearm is actually loaded, making sure that we can license firearms, you know, in communities so that we make people safer with them. So you've actually had some firearm training making sure that's a requirement. You know we require people to go to driving school and get a license to drive a car, and yet we don't require that for a firearm, which is certainly a very dangerous tool.
Speaker 3:So we can make the firearms safer, we can make people safer with their firearms and we can make sure the environment is safer in a variety of ways by making sure that firearms aren't allowed in certain places. They don't have a place in a bar. They don't have a place in schools. They probably don't have a place in church. There are places where we just don't need to have firearms on a routine basis. Should a firearm be in a gun range? Of course that's where you fire your weapons, but there are many other places where firearms should not be and we ought to have rules and regulations to define where it is safer to have a firearm than other places in order to reduce the risk.
Speaker 1:Yeah, so I appreciate all of those ideas that you just mentioned. Are you working on any of those with legislators or others to make it safer to own a gun and keep a gun?
Speaker 3:We are absolutely working with people both on the side of people who believe very strongly in firearms and people and owning a gun and people who are opposed to broader use and access to firearms. We're working with both sides of the aisle on that. We work with legislators. We're doing a job to educate people on what those risks are and evidence-based solutions like red flag laws, criminal background checks, licensing, laws around firearms and recognizing that simply having a firearm in your home puts you at a higher risk of being injured or killed by your own firearm. The evidence is pretty clear on that and you know I know people get freaked out when you say that. But look, anything that is dangerous in your home puts you at a higher risk and, again, doing things to try to reduce that risk in your home is very important.
Speaker 1:And the risk in a domestic violence situation is increased when there is a firearm. So when you combine those two types of crises right the domestic violence, public health crisis and gun violence as a public health crisis you have a recipe for the perfect storm crisis, you have a recipe for the perfect storm.
Speaker 3:You have a perfect storm and about a million women are killed annually by someone who cared about them in a domestic violence situation, with a firearm.
Speaker 1:Yeah, so I mean, it seems to me that talking about both of those things in the same vein would make sense and hopefully explain to legislators and decision makers why it would be really smart to improve gun regulations, especially if for no other reason to get guns out of the hands of offenders.
Speaker 3:Oh, absolutely Absolutely, you know, and responsible gun owners are all for this. This is not rocket science, and there are many very responsible gun owners who agree with that perspective, as do I.
Speaker 1:So, in that vein, some of the other first responders to domestic violence calls are people who are health care workers, and you've spent a lot of time in the emergency department as a physician and you've probably seen your share of victims of one type of violence or another. What would you consider the primary challenges to doctors and nurses when confronted with the issue of domestic violence?
Speaker 3:Well, you know, also, the person who's been victimized is often afraid, sometimes in denial. I mean, they know they've been injured, they know that. That's why they came to the emergency department. They're afraid to go back, quite commonly because they're afraid that person will hurt them more or may kill them. And that's one issue. Second issue sometimes just a dependency when am I going to go? And of course we have wonderful places for shelters, for places for people to go, but sometimes you know they're afraid to go there. And then, of course, if there are children or other people involved in the relationship, they're often afraid for the kids. So you also have to remove not just the significant other, the spouse or partner, but you also have to deal with the kids. And sometimes they're afraid of what's going to happen to my kids and they're afraid of that.
Speaker 3:Sometimes those children have also been abused and so it can be a very complex decision on the part of someone who feels trapped and, you know, tragically, is both afraid, feeling trapped and maybe concerned about the others that they're in the emergency department. But these kids are still at home and the abuser is at home. Sometimes the abuser is there, sometimes the abuser will bring them to the emergency department, you know, for a checkup or to fix whatever was injured. And they're there, right there next to them in the bedroom, I mean in the emergency department, and they are, you know, kind of overly attentive in the emergency department. And the woman has a black eye. You know they've been abused and you know, trying to separate the two of them so you can get the story is sometimes very difficult.
Speaker 1:Oh yeah, I mean. All I could think of when you were explaining that scenario is he's there in order to silence her from talking about the abuse.
Speaker 3:Absolutely, absolutely. You know, and then you know when. This is one of the and then so many situations where that that abuse is exacerbated when that person has been drinking or on drugs or other substances, and they are quote unquote the sweetest person in the world when they haven't been drinking. But when they've been drinking they get angry and they get more abusive, and so these cycles of abuse and over-attentiveness creates enormous conflict in the victim and the counseling that has to occur is to allow them to really see that they're at risk and that this relationship is not going to get better in this corrosive you raise a really good point, because drugs and alcohol addictions are another type of public health crisis, right?
Speaker 3:There's no question about that. We have far too many people who are both addicted to drugs, addicted to alcohol, and those numbers are growing as well.
Speaker 1:Yeah, and so then the intersectionality of, you know, domestic violence, gun ownership, and then you know substance use becomes a different type of perfect storm.
Speaker 3:And you have to ask those questions. You know, when you're doing your clinical exam, you have to ask, you know, is there a firearm in the home? You know, is there a use of alcohol? What happens when your significant other is drinking? By the way, sometimes both of them are drinking or using drugs in this process. So you know, and if it's an, if it's a illegal substance, trying to get that information out requires you to convince them appropriately that, look, you're not there to judge them, you're not there to lock them up. You're not a police officer. You're really there to help them. You're not there to lock them up, you're not a police officer. You're really there to help them. So hopefully they will share those intimate details with you, but a lot of times they won't.
Speaker 1:Yeah, I mean to your point. When you go to the doctor for any reason, if you're not honest as the patient about what medications you're using or what your lifestyle choices might be, then the physician can really only help you to the point that you are honest with them.
Speaker 3:That's correct.
Speaker 1:And I understand that in many cases, especially when it's a person who's a victim of domestic violence, there's a lot of fear to admitting different types of things, but there are limitations to what can be done to help victims if we can't create an atmosphere of trust.
Speaker 3:Well, there's fear. There can be shame Not always, but there can be shame. There can be. You know, I should be able to handle this. Sometimes it's not that bad. This time it was just the worst. And they're not recognizing that this can accelerate. In other words, three weeks ago they were yelling at them, two weeks ago they threw something. Today they hit them and they don't realize that that's an accelerating pattern of violence and threat.
Speaker 1:Yeah, absolutely, and education about the escalation of abuse and how the cycle actually works is really important, and healthcare workers can sometimes help to facilitate that education. There are other specific populations that work with and experience, you know, domestic violence, and I want to talk about a couple of them, and one of them is the military, because you have spent a considerable amount of time in the military, where domestic and sexual violence can be hidden or not talked about. How does the hierarchy and power dynamics within the armed forces impact military victims and survivors, which possibly contribute to gender-based violence and that public health crisis?
Speaker 3:Yeah, it's a real challenge because the military society is structured as a higher-purpose society so that the relationship between a more senior enlisted or officer and a person who is more junior to them, first of all that relationship is not supposed to occur. But it may occur because people are people and they have these relationships. Secondly, you, as the significant other in that relationship, even if you're not in the military, realize that your engagement in this domestic violence activity, and if you report them, you know that it impacts their ability to work, it may impact their career Again. So you're feeling you're kind of dependent on them and typically, you know you've both been assigned and you're at some place. You're not around any family members, it's just you and the family.
Speaker 3:You know you've both been assigned and you're at some place. You're not around any family members, it's just you and the family. You've been, you know, assigned to some post and so your support system, which you would normally have if you're around family members in the community in which you grew up, is all gone. So you're now truly, truly dependent on that individual and so that relationship may you know the living conditions and where you are may exacerbate it, and so it requires the command structure to be extremely supportive. They have to be on guard all the time to looking for those relationships and they have to be able to be willing, as a command structure, to engage in that. And, of course, the higher the rank that goes, the more power that individual has and the more control they have over their environment. And then you, as the family member even may have even less control because you're now with a very, very powerful person and so, yeah, it becomes more complex.
Speaker 1:Definitely, and speaking of people in authority or people with power, there's also law enforcement, which and you mentioned law enforcement a couple of times you know a few earlier in this conversation. But there is statistically sound evidence revealing that lethality risk to law enforcement who respond to domestic disturbance calls is disproportionately higher than other dangerous calls that they take, meaning that domestic violence calls can almost always be violent or turn violent for law enforcement when they respond to them. How can this fact be interwoven into the public health paradigm to the degree that actionable change can occur?
Speaker 3:I think the change we have to. Of course we know the statistics that these domestic violence calls are often some of the more conflicted calls that law enforcement is going to respond to. And you're right, they're dangerous calls and sometimes you don't really know who the abuser is. You have to figure that out. You're going into someone's home, so you're going into their personal domain. So that's one risky issue. You don't know whether or not there's a firearm there or not, so you may or may not be going into an environment where there's a weapon of some kind. It may not be a gun, maybe a knife.
Speaker 3:Sometimes the conflict between these two people you go in the person is clearly an abuser, and then you go to confront the abuser and the person that's abused, being abused, may turn on. Again they're having conflict, particularly if the law enforcement has to use increased force to subdue that individual, again the person being abused. They certainly don't want. They want the abuse to stop, but they don't at least maybe not initially want that abuser to be injured either, and so the police are coming in and using a fair amount of force to contain that abuser.
Speaker 3:Now you have two people you have to deal with and, like any of us who've ever been in the middle of a fight and you come across two people fighting.
Speaker 3:You're not quite sure how it got started, you're not quite sure how long it's been going on and you're trying to break it up. It happens far too often that you now find yourself fighting two people. Even if it's just trying to contain two people can be a lot more difficult, and so that's probably why these that's one of the reasons these things are so conflicted is that you're walking into a fairly confusing situation where the emotions are not necessarily as clear as you would think they should be, and so and law enforcement first of all needs to be trained to manage these. So good training is important Sometimes if you notice a domestic violence call, and I would encourage more resources so that you have someone from the social services department to join the police officer, but also having someone also who can spend the time as part of the engagement with these two people to try to deal with the psychological aspects of that along with the police, you know. So having these kinds of crisis response teams so they can be addressed in a collaborative way, can be very, very important.
Speaker 1:Yeah, this is the crisis within the crisis right way can be very, very important to do. Yeah, this is the crisis within the crisis right. This is the crisis for law enforcement. Responding to domestic violence calls is inside of the public health crisis of domestic violence.
Speaker 3:That's correct. That's correct Because it's you know, it's viewed, obviously by the police officers as a public safety crisis that they're going into, and then, fundamentally, it's a dangerous response and it's on their list, very high on their list, of dangerous responses, and of course, they want to go home to their families at the end of the day as well.
Speaker 1:Yeah, I mean, as you taught us just a few minutes ago, safety affects health.
Speaker 3:That's right.
Speaker 1:So safety for a law enforcement professional, safety for a child whenever that's in danger. It can infect personal health and if it's enough times and enough people impacted, it affects public health.
Speaker 3:That's correct, it does.
Speaker 1:So you've convinced me we have a crisis.
Speaker 3:There's no question, this is a crisis proportions. It does require more resources, more training, more coordination. There's so many things that we should do more differently to try to address these things.
Speaker 1:It seems, though, that there are community leaders and government legislators that are hesitant to declare domestic violence as a public health crisis. What do you think you know some of their reservations might be?
Speaker 3:You know they're all different. You know, sometimes it's just the fact that it requires additional resources and they're making resource. You know decisions, some things are. More importantly, we commonly have people who believe that it is these are individual choices that these people can. Oh, why doesn't she just leave him? Why doesn't he just leave him or her in the case of a male being abused?
Speaker 3:And again, as I said earlier, it's just, it's not that simple and you know, having a place to go is a big deal, having resources is a big deal and your kids is a big deal. So these are complicated societal questions. But also, I do think we do have people who are in high office that have their hands in this thing and they're just denied for one reason or another and hopefully we can do a better job of educating them so that they understand what this impact is. These are not just individual personal decisions, but they have a societal impact as well because clearly, you know a police officer responding to a domestic violence situation at someone's home, the neighbors it's not secret, the neighbors see it, the neighbors know about it, they sometimes know these people and sometimes the neighbors get involved. So it can be a complex issue.
Speaker 1:Combined with the fact that there are also vulnerable populations who are disproportionately impacted by gender-based violence or domestic violence. These are typically communities of color, communities that are perhaps maybe English is not their first language. If we're just focusing on the United States people in the LGBTQI plus community, they are all disproportionately impacted by gender-based violence, and then they also have lack of access often to services that could meet their personal health needs. So there are a lot of challenges within those populations to get responses to domestic violence and gender-based violence, and then that in itself is a public health crisis on a different level for people in underserved communities. So let's talk about that. How does a public health crisis like domestic violence disproportionately impact people who are in underserved populations?
Speaker 3:more so or don't have the resources. Where there's more stress in the household, where there is when a conflict happens, they're unable to get away because the community has not built the shelters or doesn't provide the training to the police officers who are responding, and don't have the kind of evidence-based, comprehensive response, groups are not going to have as good an outcome when they do have to respond.
Speaker 1:Obviously, if you wish or there's also people who just won't call the police. They don't trust the police.
Speaker 3:They don't trust the police. I mean, the other thing is people who will suffer in silence because they're afraid. You know, call the police and INS shows up because of the fact that you are of a Hispanic heritage or you are in a Somali community or some other community where the police have identified that there are undocumented individuals living there.
Speaker 3:So you so they're afraid to call, even though they may be legally here, et cetera. Their experience with the police has been one of that's resulted in fear. When the police have not treated them the same way they would treat someone if they're going to a $5 million mansion with a domestic violence case. Again, these people don't have the power relationships. They don't know the mayor, they don't know the city council people. They're not. You know. They feel threat each and every day and when they've even gone to the medical care facility for care, they have not been treated well. They've been discriminated against, they've been treated and they've been talked down to. So their trust of the system, whether it is the criminal justice system, the law enforcement system, the medical care system, even, in some cases, the social service system, because the only time the social service folks come to see them is when they want to take their kids away when they want to accuse them of doing something that they hadn't done.
Speaker 1:Those kinds of things, those people are afraid to come forward become more educated about what is available in their own neighborhood for response to domestic violence or access to health care related to gender-based violence. What options can we give people?
Speaker 3:Well, I think the first thing we need to do is spend a lot more time educating broadly the public, policymakers, the media.
Speaker 3:We have to deal with stigma.
Speaker 3:We have to destigmatize all these activities so that people don't feel undervalued you know the fact that they feel valued enough that they deserve to get the care that they need.
Speaker 3:And then we need to appropriately spend our taxpayer dollars to build those infrastructure and support systems so that they have the support systems that they need. And then we need to work hard to endanger trust. So trust is easy to lose and hard to gain, and what you have to do is you have to have these groups of society, these responsible individuals police doing community policing, the social services folks engaging these communities in a constructive way, the medical community going in, using community health workers and other trusted individuals that go into the communities to build that trust so that you have trusted pathways, so that people are much more comfortable. These are not people that they don't know that they've met them ahead of time. They trust them. They're there for other needs that they have and so, therefore, once they're comfortable getting their needs met for their day-to-day activities of life and living, then when these crises occur, they're much more likely to be trusting in those environments.
Speaker 1:Yeah, I would love to see all of those things happen and I know that you are leading the American Public Health Association's push to make America the healthiest nation. Is the response to domestic violence, gender, race violence, gun violence and many of the other things we talked about. Are those within that push? Are they all part of that initiative to make America as healthy as it can be?
Speaker 3:They absolutely are. We have several violence-related programs. We're working with others to particularly look at the intersection of violence, mental health for particularly targeted populations that are underserved sexual minorities, communities of color, sexual minorities, communities of color women, lower income individuals in particular and we try to build equity into everything that we do the idea of making sure that we identify those populations that are most at risk and those people with the least resources to be able to help themselves, and then trying to build institutions to try to help those people address these challenges whenever they hit them.
Speaker 1:That's great work. I appreciate all of the information you shared with us. I thank you for your service, for the work you're doing and for talking with me today.
Speaker 3:Listen. Thank you very much. I've enjoyed our conversation.
Speaker 1:Thanks so much for listening. Until next time, stay safe. Thanks so much for listening. Until next time, stay safe to learn more and register today, and follow us on social media at NationalCCAW for updates about the conference, featured events, presenters and more.