‘We Needed to Do More Than Stitch People Up and Send Them on Their Way’.
With a career as an internal medicine physician, healthcare advisor, public health professor, associate dean, and former state commissioner of public health, Deborah Prothrow-Stith has amassed a comprehensive, hands-on understanding of the most pressing public health issues in Massachusetts. During her professional career in the Bay State, Prothrow-Stith succeeded in defining youth violence as a significant public health problem that should be viewed through a lens of prevention, rather than imprisonment.
“I started my work in violence prevention because of an experience I had with a young man when I was working in the emergency room,” says Prothrow-Stith, who received her medical degree from Harvard Medical School. “After I gave him stitches, he told me not to go to bed because he was going to go out and cut the person who had harmed him.
“I felt like we needed to do more than stitch people up and send them on their way.”
After that encounter, Prothrow-Stith began to study and dissect the root causes, complex challenges, and preventative measures associated with multiple forms of violence, including youth violence, gun violence, intimate partner violence, sexual assault, child and elder abuse, and suicide. She worked as a primary care physician with an emphasis on adolescent health at Boston City Hospital, and at an adolescent clinic in Dorchester. She then advised hospitals and other healthcare institutions on leadership as a principal at Spencer Stuart. She has also taught at the School of Medicine, as well as at Harvard T.H. Chan School of Public Health, where she served as an associate dean. By the time Governor Michael Dukakis appointed her to become the state’s health commissioner in 1987, Prothrow-Stith was acutely aware of the epidemiological evidence and public health need for a substantive, state-wide effort to address violence, especially in inner cities. To her, it was clear that violence prevention efforts should mirror the public health strategies implemented for smoking and HIV prevention—through education.
As health commissioner, Prothrow-Stith established the first Office of Violence Prevention in a state department of public health. The office focused largely on youth violence, conducting continuous research and developing educational programming to treat the multiple factors and root causes of adolescent aggression.
On October 23, Prothrow-Stith, who currently serves as dean of the College of Medicine at Charles R. Drew University of Medicine and Science in Los Angeles, will deliver a talk titled “Violence Prevention: Guns, Public Health, and Health Care,” part of the Dean’s Seminar series. Ahead of the talk, Prothrow-Stith spoke about current youth violence in the US, police–civilian relationships, the March for Our Lives student movement, and for-profit enterprises—and how each of those subjects have impacted the national quest to reduce violence of all forms.
You’ve studied and prioritized youth violence prevention for 40 years. Is the current state of youth violence different than it was in previous decades?
I think we’ve learned a lot over the years about risk factors of violence. There is also good literature on school violence and the things that can prevent episodes of school violence. I think it’s really to our advantage to continue the public health research-oriented aspects of this work, especially in the area of gun violence. We’ve got more to accomplish, but the contributions over time have been substantial.
Public health messaging on youth violence is also important, and it has to change as cultural aspects of the generation change. The message has to keep up with the culture of the times. One effective message we constructed at Boston City Hospital was “friends for life don’t let friends fight.” Even the meaning of words will change over time, so we have to be careful in that regard.
You also developed violence prevention courses for youth, which are still used in some middle and high schools. Can you describe the components of these curriculums?
The Violence Prevention Curriculum for Adolescents was a high school-based curriculum published by the Education Development Center in Newton, and it was a part of their portfolio for one or two decades. It was one of the first efforts to take the message of violence prevention to the classroom and treat it as a health education subject. The curriculum builds on basic public health principals and the tenets of health promotion, applied to violence. It offers basic lessons about violence and the epidemiology of violence, such as the causes of fights, and how homicides occur in the context of people who know each other. It sets the stage for students to talk about getting along, handling anger, and discussing strategies for conflict resolution.
Another curriculum I helped develop is called The Peace Zone, which was developed in partnership with the Louis D. Brown Peace Institute and The Lesson One Foundation. The curriculum was, and still is, for elementary schools, and it teaches students how to deal with and heal from the emotional issues that arise with pain, anger, and death.
The issue of violence creates a unique cycle of problems. One of the things I learned is that when anyone is murdered, family members—often children or siblings—experience many types of sequelae, from depression to suicide. It is a very complicated problem with a lot of consequences that aren’t always understood or recognized, especially by healthcare providers.
How do police–civilian tensions and mistrust in communities, especially minority communities, perpetuate incidents of violence?
Bad policing is part of the problem, and it is only beginning to receive attention, so we have fewer models of what can make it better. But I think the introduction of smart phones with cameras has made it very clear that the death that show up as justifiable homicide in the yearly uniform crime reports is not always justifiable. Communities are dealing with stress, anger, grief, and outright fear. Who do you call if someone is creating a problem for you? Do you call the police to protect you if you’re a young black man? I don’t even have to say more. Everybody understands that question, which is really a statement about how horrible it is that the people who are paid by your tax dollars to protect you don’t protect you. That’s where we are as a society.
What role does money and for-profit institutions, such as private prisons and youth detention centers, play in exacerbating the conditions in which violence is borne?
That’s a very complicated question. You’ve got people in prison who serve as cheap labor to the corporate world. Then there is money made in the gun industry, and the movie industry, and so on. It is very difficult in the United States of America to stop doing something that is making money.
With respect to gun violence, do you believe the March for Our Lives student movement will succeed in influencing politicians to develop stricter gun safety policies?
I was inspired by the students. Their efforts came at a time when I needed an energy boost. They intentionally cut across class and race to ensure that the agenda was not just about white, middle-class students, which was part of the problem. That was very inspiring and helpful.
What other necessary efforts can the clinical and/or public health industries undertake to address the issue of violence?
There’s a lot that we need to continue to do, and some of it we don’t even know yet—we haven’t quite connected all the dots. We needed to have a prevention agenda in the emergency room. and now, 40 years later, I do feel that we’ve made a lot of progress in that area. But the prevention agenda is still not the standard of care in emergency rooms across the country. So many places are still stitching people up and sending them out. But many primary care doctors, especially pediatricians, are now doing anticipatory guidance and talking with parents about ways to prevent violence among their children, ways to discipline children, and about guns in the homes. But not everyone is doing that. We have a long way to go, but I feel very good about the progress that we’ve made.