Preventing Sexual Harassment and Assault: A Public Health Imperative
Before beginning today’s note, an acknowledgement of World AIDS Day this past Friday. The recent history of AIDS is, in many ways, illustrative of the need for public health’s mission of closing health gaps as we work toward the goal of healthy populations. While tremendous advances in treatment and prevention have greatly mitigated the AIDS epidemic, deep inequities remain, both in the US and internationally, with much of the disease now concentrated within socioeconomically marginalized communities. This argues for our pursuit of a more equitable, just future, where no one is forced to suffer the disproportionate burden of preventable disease.
Today’s note is another example of how inequities and injustice create the conditions for poor health. In recent weeks, since The New Yorker and The New York Times published their investigations into Harvey Weinstein, stories of sexual harassment and violence have emerged from seemingly every corner of our society. High-profile allegations against prominent figures in politics, entertainment, and journalism, among other fields, have done much to catalyze our present overdue reckoning with endemic sexual abuse in our society. As troubling as each new account of misconduct is, it is reassuring to see our national consciousness begin to change, as we move towards a world where victims of sexual violence are heard and supported, and perpetrators are less shielded by privilege. Yet as the many personal stories of abuse have shown—often shared using the viral #MeToo hashtag—the vast majority of sexual harassment does not make headlines. A recent chart from the Center for American Progress shows how common sexual harassment is in almost every industry (Figure 1). I note that even these figures almost certainly under-record the prevalence of sexual harassment in the US population, and do not include particularly high-risk populations like sex workers. I refer all to our upcoming symposium, “Understanding Commercial Sex Policy: A Global and US Perspective,” that, in part, addresses this latter issue.
That systemic sexual abuse is now being more fully addressed suggests we may have finally begun to reckon with the gender inequities and entrenched power imbalances that allow such harm to flourish. The existence of these conditions shows that this crisis is not just a matter of powerful people using their position to hurt others, but a failure of society to stand up for the values of justice and inclusion that should be a bulwark against exploitation of any kind. It also opens the door to how public health can help mitigate the problem of sexual harassment and violence, by working to build a society where this is no longer acceptable.
This epidemic has long been a cruel fact of life for the 321,500 Americans over the age of 12 who are sexually assaulted or raped each year; the very ubiquity of sexual violence places it at the heart of public health. One in five women, and one in 71 men, will experience rape at some point in their lives, yet 63 percent of sexual assaults are not reported to the police. A small silver lining appears to be that sexual assault and violence seem to be decreasing in the US. According to the Rape, Abuse & Incest National Network (RAINN), the rate of sexual assault and rape has fallen by 63 percent since 1993. Additionally, harassment in the workplace appears to be decreasing, with the best data on this (General Social Survey data) showing a decrease from 6.1 percent in 2002 to 3.6 percent in 2014. As with other challenges to population health, sexual violence affects some populations more than others, with marginalized groups suffering most. Women, especially women of color, experience disproportionately high rates of sexual violence—90 percent of adult rape victims and 82 percent of juvenile rape victims are female. Rates of sexual violence are comparable or higher among LGBT populations compared to heterosexual populations. Transgender populations are at a particularly high risk of experiencing sexual assault—for example, 12 percent of students expressing a transgender or gender non-conforming identity in grades K-12 reported experiencing sexual violence. Although it is difficult to compare populations due to underlying demographic differences, age-adjusted estimates suggest that sexual assault of people with disabilities is about twice as high as for those without disabilities.
In addition to the trauma associated with harassment and abuse itself, there is abundant evidence that sexual harassment and violence is associated with subsequent poor health. A recent study found workplace sexual harassment exposure is linked with a higher level of depressive symptoms. Other studies have reported similar findings, including an analysis that linked harassment to feelings of anger, self-blame, and self-doubt. The effects of sexual violence include self-harm, substance abuse, depression, post-traumatic stress disorder (PTSD), sleep disorders, and suicide attempts. In the US army, women with administratively recorded sexual assault victimization had higher odds of later mental health treatment, attempting suicide, demotion, or attrition. Early lifecourse sexual assault has been linked with an elevated risk of HIV infection and teenage pregnancy. As I have reflected in previous notes, exposure to traumatic experiences affects health across the lifecourse.
The goals of public health are inseparable from the goals of social justice—to create a world where the conditions around us allow everyone to thrive, where there is equity between groups, where inclusion creates the networks and bonds that nurture well-being. A society characterized by systemic sexual harassment and violence is one where these goals have not been reached. Addressing this problem means addressing the core concerns of public health—the improvement of conditions in which people live and work, and the closing of health gaps—to create a culture that no longer accepts sexual violence and the broader injustices that enable it. It means reckoning with perpetrators and identifying humane and evidence-informed ways to ensure that they do no further harm, and creating a world where collective action ensures that sexual violence is unacceptable, protecting all. The military provides an example, in microcosm, of how improving community conditions can mitigate the likelihood of sexual harassment and assault. In a recent study, our team found unit support—including factors such as comaraderie and acceptance of women as part of the team—was linked with lower risk of sexual misconduct. This suggests the key role of equity, respect, and inclusion in mitigating assault and harassment.
How can we help foster these conditions? First, we can continue working towards a community that prizes fairness, equity, and, above all, social justice, where all are treated with dignity and respect. To do this, SPH, and the broader BU community, remain committed to providing resources for students, faculty, and staff to report any harassment or assault they may have experienced. As outlined in a recent message from Provost Jean Morrison, BU’s Sexual Misconduct/Title IX Policy and Student Sexual Misconduct Procedures will remain the same, despite the issuing of new guidance from the US Department of Education. The Sexual Assault Response & Prevention Center (SARP) is also on hand to provide confidential support and promote prevention through educational programs. The Office of the Ombuds is an additional safe space where members of the BU community can discuss concerns about sexual misconduct in a confidential setting.
Second, we can lend our voice to the ongoing discussion around the issue of harassment and sexual violence. Public health is inextricably linked to the broader conversation—it is this conversation that shifts attitudes towards making the acceptable unacceptable, in order to improve the social, economic, and environmental conditions that shape health. This fits with our role as an academic community—to contribute to the ongoing discussion about health, and, through this engagement, to nudge public opinion in a healthier direction. This is, in part, what I am trying to do with this note, and what we should all do in our respective spheres. Systemic inequities, and the poor health they create, thrive on society’s lack of engagement with core challenges. It is only by having honest, sometimes difficult conversations that we can lay the groundwork for a healthier world.
Finally, aiming to facilitate those conversations, we will be hosting an event, “Sexual Harassment and Sexual Assault: A Conversation,” on December 6, from 4:30 p.m. to 6 p.m., in the 670 Albany Street Auditorium. The event is intended to provide a forum for discussion about the public health consequences of sexual violence and harassment, and their implications for building healthy communities. More information about the event will be forthcoming.
If there is anything positive to take from the disturbing news emerging from the past month’s events, it is that we may use this as a time to engage in thoughtful conversation, and to redouble our efforts to create the conditions that improve the health of all.
Until next week.
Sandro Galea, MD, DrPH
Dean and Robert A. Knox Professor
Boston University School of Public Health
Acknowledgement: I am grateful to Professor Emily Rothman, University Ombuds Francine Montemurro, Meaghan Agnew, Kara Peterson, Catherine Ettman, and Eric DelGizzo for their contributions to this Dean’s Note.
Previous Dean’s Notes are archived at: http://www.bu.edu/sph/tag/deans-note/