What can public health do about riots?
One of the answers that you’ll hear a lot in public health is “it depends.” This is because we in public health don’t like to deal in absolutes. Things are not black and white in the world, and we in public health don’t pretend that they are. That’s what makes us different from politicians and other people who seem to think that the lines between categories in real life are clearly delineated when far too often they are not.
As I listened to the radio while trying to get out of Baltimore yesterday (April 27, 2015), I couldn’t help but think of what I could do. Thinking more broadly, I thought of what public health could do in response to the type of situations in a community that lead to social conflicts and, sadly, riots. I had an exceptionally long commute out of Baltimore because of the developments around the city, so I got a chance to think about this.
There is no doubt that the so-called “War on Drugs” has been an abject failure. At some point, the US Congress got together and decided that people who used cocaine should face one set of consequences while those who use crack cocaine should face another. That sweeping legislation was bottom-up, affecting the addict as much as the dealer, throwing addicts not into mandatory treatment but into jail, killing any chance of a future for them. To make things worse, Blacks and Hispanics, who were more likely to use crack cocaine, were targeted for enforcement while Whites were, on average, treated with more mercy by the courts.
So you end up with a disproportionate amount of minorities in jail or with a criminal history that prevents them from getting the treatment they need to get off of drugs and further prevents them from getting meaningful jobs. What’s worst, the same legislative process prohibits financial aid for education for anyone with any kind of history of encounters with law enforcement over drug use. Even minor offenses could disqualify you from being able to get an education to help lift you out of poverty and into a life of productivity.
Public health comes into play because we need to guide our policymakers into making the right, evidence- and science-based decisions when addressing a health problem like drug addiction. The best idea back then, and now, would have been to establish “drug courts” that would sentence addicts who commit non-violent offenses to community service and mandatory drug rehab. When those who do commit violence are incarcerated, they get treatment while in prison so they come out not as addicts but as people who don’t have a drug addiction to contend with on top of the stigma of having been imprisoned. Then again, prisons should have never lost their goal of rehabilitation and social re-adaptation. When they lost that and became reservoirs of crime, and cogs in the prison industrial complex, we as a society lost in more ways than one.
Public health also comes into play in the subject of food deserts and food swamps. Many of the places that became flash points for violence in Baltimore last night were located in areas where good and healthy food is scarce. Once food stores are lost and liquor stores take their place, it’s not long before other urban problems move in. Good public health policy can help in making the right decisions to make sure that communities have a good source of food, a place that they can value and care for. Because I can assure you that few people (outside of the owners) will mourn the loss of a liquor store, especially when many more can be found up and down the same block.
Then there are the issues of mental health. Mental health should never be seen as being apart from physical health. It’s just as imporant. Likewise, it’s just as important for us in public health to address the population’s needs with regards to mental health. Are there enough mental health professionals per unit of population? What’s the rate of depression? How many suicides are you seeing? Do schools have the capacity to offer counseling services to their students when something bad happens?
While children can be very resilient to a violent and sub-obtimal environment, a lifetime of living in a high crime area can take its toll. Sure, some come out perfectly “normal,” but, on the average and in the long run, crime (especially violent crime) chips away at the mental health of an entire population. Just look at the levels of post traumatic stress of a war zone. Then compare the rates of violence in said war zone to some of the inner cities here in the United States.
So it is up to us in public health to understand the incidence and prevalence of mental health disorders along with the infrastructure (or lack thereof) for dealing with these at a population level. Helping people deal properly — i.e. in a health way — with trauma reduces their tendencies to deal with trauma in so many ways that can be detrimental to themselves and their communities. Giving them the tools to do so should be up to us in public health, those of us who are trying to understand things happening at the population level.
During the week, the leadership at the school of public health has been encouraging the students to do their part to help Baltimore heal. Almost predictably, the responses from the students have been varied. Some want to protest. Others want to help those affected by the rioting and looting. Still others want to address the root causes of what has caused all this. So it was very encouraging to see so many public health students take up the call to help the city recover and heal.
It’s going to take more than just a few discussions here and there about race relations. One program to address community policing is not going to cut it. If Baltimore is to heal on all levels, then there must be a Manhattan Project-style effort to heal it. Everyone needs to pitch in, including people outside of Baltimore, the people who go in for a few hours a day to work and/or study. To do anything less is to force the next generation to go through the same situation, and nothing could be more unjust than that.
