EP 45: Crime as a Public Health Issue
When the Centers for Disease Control and Prevention (CDC) looks into the ailments of a particular community, it's safe to assume the concern is infection or some similar local threat to human bodily health. So when the CDC started investigating the youth violence plaguing Wilmington, Del. -- a first-of-its-kind study -- it was different. But not inconsistent. Increasingly, communities and their governments are reframing their approaches to crime, by considering it a treatable public health issue before one of criminal justice. On this episode we delve in with several voices from the conversation. A portion of it comes from a session of the National League of Cities' annual conference held late last year in Charlotte. CDC report on Wilmington, Del., firearm violence and prevention - http://www.dhss.delaware.gov/dhss/cdcfinalreport.pdf Southern City magazine, "Crime as a public health issue" - https://www.nclm.org/resourcelibrary/Shared%20Documents/Southern%20City/JanFeb2018.pdf CitiesSpeak, "Leaving mass incarceration behind: How cities are turning to a public health approach to violence" - https://citiesspeak.org/2016/09/26/leaving-mass-incarceration-behind-how-cities-are-turning-to-a-public-health-approach-to-violence/ Daniel Latorre - http://www.thewisecity.org/
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Transcript
On this episode of Municipal Equation. I'll never forget a juvenile murderer saying to me, commissioner, I'd rather be wanted for murder than not wanted at all.
If you're gonna be wise about making sure you don't damage or you take care of the skin or the body of of a city, that's very different than taking care of the fabric of the city. You know it's not so much a matter of what they do. It's a matter of what happened to them. Them. And how do we how do we address that as a as a society? Looking at what we traditionally call crime as a public health issue, treating the source of the problem, and how even the CDC has gotten in on this with cities. My My name is Ben Brown, and this is Municipal Equation, a podcast about cities and towns in the face of change from the North Carolina League of Municipalities, episode 45.
Cities are so are are one of the most magical, complex things that humans do. And you need everybody, you know, sort of as Jane Jacobs talked about it, you need everybody involved in the making of it in order to make it, you you know, suitable for everybody. It sounds really simple, but as a principle, if you think about that, that can help steer away from a lot of problems.
You might recognize that voice. Daniel Latore from a few episodes back about wise cities versus smart cities. This is more from that interview. I hear about that being talked about in sort of like a youth crime way and addressing it as a, not a criminal justice approach, but a public health issue. And if there are indicators out there, if if a child is is not doing well in a certain arena, there may be problems elsewhere that where lights could kick on. And if we if we kinda treat the city like the body and we we kinda bring everybody in together to address the the the ailing area, cross data, analyze, try to figure out where things are going, where where could we kinda step in and create an intervention that would stop a problem down the road. And I'm kinda getting off track a little bit here. No. No. That's your area. It feels like that to where if you have different kind of agencies, so to speak, attacking the same problem without defining it as criminal justice or what without defining it as, you know, whatever banner you wanna put it under, then you might be able to find things or discover things about the process that you wouldn't have otherwise. Totally. So so no, like, you mentioned,
thinking about the city as a body, you know. So just like there's one here's another great example. So, just on a on a metaphor level, it's really interesting, you know, I I'm half Colombian, you know, half American. And some of when I listen to a lot of the urban and social urbanism, work and and ideas going on in Latin America, the one thing that I noticed, is that the metaphor is often about the you talk about the urban skin. Right? This is the sort of in Spanish, the. But in in English, we often talk a lot of the common metaphor is the urban fabric. So right there, that's a very different level of intimacy Right. Or sent you know, if you're gonna be wise about making sure you don't damage or you take care of the skin or the body, you know, of of a city, that's very different than taking care of the the fabric of the city. Right. So there so there's there's a lot of these metaphors that we live by that really kind of, affect the care and concern that we bring to a discussion.
In October 2017, President Trump declared the widespread opioid abuse issue a national public health emergency. Because obviously it's gotten to a point where it's not just a drug and crime problem.
Why effective today, my administration is officially declaring the opioid crisis a national public health emergency under federal law, and why I am directing executive agencies to use every appropriate emergency authority to fight the opioid crisis. The opioid crisis is an emergency, and I'm saying officially right now, it is an emergency. You know, when I was growing up, they had the LSD, and they had certain generations of drugs.
There's never been anything like what's happened to this country over the last four hours. If we've shifted that from a crime lens to a health lens, of course, the opioid thing is a beast of its own, but if we're looking through a public health lens at something that might have previously been viewed through the crime lens, what are the possibilities for the public health lens on crime more broadly? This is not an original question that I'm posing. It's an observation that more and more authorities, from federal to local, are talking this way. Some of them always have, but it's certainly a thing right now, referring to, for example, gun violence as an epidemic and reacting to it the way doctors would to an infectious disease. Gotta say real quick, this is not an episode about gun rights or mass shootings and what they may relate to with mental health funding or congress or anything like that. I'm bringing this to you as coverage of a panel that I listened to in late November twenty seventeen at the National League of Cities annual conference. I gotta warn you, the audio in the room was pretty rough. And so the clips I'm gonna play, just know that I'm acknowledging that the audio that I captured from this session was pretty rough, but the conversation hits a lot of important thoughts. When the Centers for Disease Control and Prevention, or the CDC, looks into the ailments of a particular community, it's safe to assume the concern is, you know, infection or something like that. So when the CDC started investigating the youth violence plaguing Wilmington, Delaware, it was different, but not inconsistent. Looking at the data on crimes committed, fatalities, incarcerations, recidivism, and other pain points, city officials were going to the word epidemic. I mean, yeah, we hear the word epidemic used all over the place. You know, epidemic proportions. You can say that about just about any widespread bad thing. But Wilmington, Delaware's largest city with about 70,000 residents, was seeing notably bad vital signs. In 2013 alone, the staggering figure of one hundred and fifty four documented shooting victims.
I came across a, newspaper article that stated that the set up for disease control had gone into Southern Delaware, and did an investigation of the epidemic proportionate amount of suicides that I know people were experiencing. This is Wilmington, Delaware city council president, Hanifa Shabazz. So I've been they can do it for suicide, why not homicide?
Shabazz gathered up all kinds of data to support the theory that there was something more at play in Wilmington than just crime and violence. Just too much happening for it to be normal. And I say that I felt that our children, knowing the nature of our children,
knowing knowing of local African American being one myself, and knowing the various, environment and conditions that we have experienced in the city of Wilmington, I knew that that our children were, acting other than themselves. That that was not their nature. That it had to be something other than, a natural phenomenon that would cause them to do the heinous crime of picking up a gun and getting it to blow someone's head off. I knew that was not the nature of our children.
She rounded up the data and got the support of the governor and the state secretary of public health who submitted a request to the CDC to come investigate. I gotta interrupt.
Sir? What convinced
the state? This is Jack Calhoun from a community crime prevention organization
called Hope Matters. What what how did you frame it for the state and the governor to support you? What convinced them?
Well, I believe the data that we got from my kids count, education scores, the amount of young people that were incarcerated, the high recidivism, all of those factors that leads that that are and data, as you said, data that supported the fact that we were an epidemic state. And and the many other reports I've said were already on the shelf, that we've already test what they've already done, all supported that there was an epidemic of some sort, that we were very much a dysfunctional operator, that we had not created an environment that nurtured our children. But because if the some children and and Southern understand Southern is low income, poor Caucasian population. In Southern Delaware, the children were committing suicide. And here in the Northern low income African American children are committing homicides. There's something we adults are not doing. Kids were growing up unhealthy. Unhealthy. Correct.
Unhealthy. In 2015, the CDC came out with its first ever report about gun violence in a community. 14 pages that recognize things like disconnection between public agencies that could be sharing data. Data that if overlapped or analyzed together could create a new picture or give a new clue. The report, for example, said most people involved with gun violence in Wilmington were young men with other violence in their pasts, and that integrating data systems could better connect at risk youths with positive forces or preventive forces from mentorship to straight up medical care when they need it most. Indicator sources, according to the report, could include school absences, child welfare visits, or even parental unemployment benefits data, the report said. And I can anticipate people saying things like, you know, flinging this kind of data around is publicly risky or maybe even intrusive or unfair, like having unemployment benefits being seen as an implication of something else that's bad. Just for the part of this podcast, I'm noting those concerns. The report seems to go with the idea that an assortment of things, you know, that getting out of silos, as they say, is an important step toward a new kind of observation and treatment.
From the report This could potentially help prevent the subsequent violent crime that affects individuals, families, and neighborhoods throughout Wilmington. Such an approach can be an important component of community wide efforts to prevent multiple forms of violence.
This has been a multi year initiative, and I'll say that in the follow-up research I did about this, the media has been pretty tough on it in terms of effects and whether it's working. That's at least in part because funding hasn't been adequate, reportedly, to carry out the kind of work that the report recommends. But the point is, it's a different way of tackling a problem in a city, using the epidemic metaphor to reframe the approach to violence and other crime. I'm I'm just really heartened to to kind of see nationally this attention to looking at crime as a public health crisis. This is Kristin Zakis, a former Charlottesville, Virginia city councilor. She noted the past approaches to crime and justice and how people were perceived in their character. You know, good guys or bad guys. Like, it's just how we were made, and that determines the treatment that we get. For a long time, it was evil. You know, you were evil.
And so, you know, draconian punishment was was appropriate for you. You know, we could, you know, beat you or, you know, hang you or, you know, do something horrible. And then the lens shifted to a matter of moral failing, she said. That there was something, you know, you had you were weak and you had made poor choices, and so we had the, you know, the idea of the penitentiary that you would, you know, kind of see the error of your ways to harsh consequences and then come out and and, you know, beat the right person. And if you didn't, then you did it again and and again and again. And then there's the idea that if we just view criminals as criminals through and through, then all's fair for us. You know, we can we can assign them hard labor and such because that's the only way to extract value out of them. But that's clearly and when we meet people as children, and they're all full of life and and hope and and enthusiasm and then to see what happens, you know it's not so much a matter of what they do, it's a matter of what happened to them. And how do we how do we address that as a as a society?
Well, thanks to science, we know these days that the brain isn't so simple. We've documented actual chemical changes in the brain of children affected by trauma or neglect, Zekas pointed out. There was a study published last year in the journal proceedings of the National Academy of Sciences that connected criminal behavior and previous brain injuries. That stuff doesn't necessarily make someone a criminal, but Zekas pointed out that it does impact their ability to plan their lives and manage their impulses. And that can lead to bad things. You know, the crime of of opioid
use is considered a health crisis. Even the president is considering it health crisis, a a public health crisis, which is refreshing. It's not that it isn't, because it it totally is. But twenty years ago, similar drugs, were considered criminal justice crisis. And so the the answer was to put people in jail and to separate them from society.
Jack Calhoun, the panelist you heard earlier, he was actually the moderator. He said it needs to be more of a standard to connect police and human services, cut the gap between them and just join them together. There are some examples that he says are really positive. He said in Chicago, in cases of either extreme violence or suicide threats, police have access to on call mental health workers. In Baltimore, you'll find chaplains riding with police. In Boston, police precincts have in house social workers, allowing for remedies within the family when an officer might otherwise arrest a youth and frustrate his or her life with a placement in the criminal justice system. Calhoun used to be a commissioner with the Massachusetts Department of Youth Services. Drawing from that time, he said at risk youths might embrace the positive interest from a community and its government. Non condescending outreach to improve their health and prospects and abstain from treating them as future criminals. I'll never forget a juvenile murderer saying to me,
commissioner, I'd rather be wanted for murder than not wanted at all.
So you've got changes meant to be preventive, or course changing, when it comes to what builds up to crime and, say, youth violence, a trend away from reactionary measures that can maybe backfire. That's according to, well, a lot of people. But here's Daniel Latore.
And here's the problem with surveillance is that it's there's claims of it being deterrent, but it inherently sets up a posture of looking at the aftermath of something going wrong. So almost in inherently in that concept doesn't actually address the source of the problem. Right? Because ultimately, what would you like to you would like to not have crime happen Mhmm. And then just have better forensics. Yeah. You know? So the other thing too is just on the same technology level is, you know, so if you if you think that safety is primarily a police matter and security matter, you're gonna get all these proposals for technology solutions around surveillance and, and, the sort of militarization, you know, of cities. Right. Yeah. If you think if you bring more people to the table like you mentioned and you bring urban planners and sociologists and public health people, you would then start to realize that a lot of the different, sources of, public safety have to do with the way the urban environment is designed. So there's a whole movement of, crime prevention, through urban design that basically allows things like having greater visibility in public space. You know, because a lot of crimes happen where people feel that they're hidden away and can't be seen. Bryant Park in New York City was surrounded by a tall hedge and had very narrow entrances. And so, basically, people stopped going in it because because especially women, didn't feel safe. Yeah. So, the policing tried to, you know, go through sweeps and kick out all the drug dealers and the the sort of sources of, the misdemeanors and and smaller crimes, and then they would just come back. So it was a vicious cycle, you know, and it was clearly not working. And you could say, well, that's human nature. You just gotta be tough on crime. But thankfully, there were enough people in governance at the time that said, well, let's look for a different way. KBS did research. They studied the behavior and they said, okay, we'll remove the hedges around the park so you can see into the park so anyone on all the sidewalks around it can see what's happening in the park and you can see other people and you can then also escape so that you didn't have to just if you needed to get in and out of the park you can enter anywhere not just through these very very narrow entrances. So what happened? The crime went away entirely. And people started then using the park which meant that any criminal intent tended person was even less likely to go there because it was basically, taken up by people who were actively using it, you know? So it pushed out the crime. Now the crime went elsewhere into other less safe spaces, but that's just a matter of kind of spreading out those design changes to other parks and public spaces that were, similarly not as safe because of the lack of visibility.
And then, of course, there's the old fashioned positives of health, just straight up health. Here's Zakis talking about a community cooking program in Charlottesville.
At this dinner, I was serving. I had the the stuffing and the kale salad. And some of the grown ups were not quite sure about that kale salad and were looking at it funny. All the kids wanted the kale salad. They'd skipped the turkey, the stuffing, the mackerels. They took macaroni and cheese. But they were eating green beans and kale salad because they grew kale in in school and they learned to cook it. And they knew they had made a kale salad that they liked. Kids were coming back a third on kale salad. And and That was more stuffing for me then. Well, but actually, yeah. Exactly. The parents were gonna go ahead and take it. But it it really shows that that population level, you know, that that vitamin for everybody
is lifting all of the kids and then making Alright. So for the next six hours of this episode just kidding. But there's enough here to where we could really go all night. The point is to put a fridge magnet on this conversation as more and more cities have it. Or as local governments look for alternatives to the old fashioned crime and justice start to finish mass incarceration approach on bad guys and good guys by treating it as a public health issue and looking at the sources to prevent spreading. May not work in all cases, but the conversation is happening more and more. I'll close with a line from an opinion piece on City Speak. That's the blog in the National League of Cities About cities getting away from the days of mass incarceration. Violence and crime are local challenges. Because they understand our neighborhoods and our people best, local governments must be at the forefront of developing policy solutions. I'll have links in the show notes to a spread of information discussed in this episode, including the Wilmington, Delaware report from the CDC. If you'd like a written version of this episode in article form for anyone who prefers it that way, you can find it in the January, February edition of Southern City Magazine at nclm.org/southerncity. Thanks to the National League of Cities for arranging this panel. Again, the audio you heard was from City Summit. That's NLC's national annual conference that was held in November 2017 in Charlotte, North Carolina. I'd love for this episode to serve as kind of a hub of ideas in this space. So tell me what your city is doing on this topic. I'd love to talk about it on a future episode. What's worked in your community? If your local government has tried something different that ended up working, email me at bbrown@nclm.org or tweet at me. The handle is at muni equation. That's at m u n I equation. Past episodes at nclm.org/municipalequation. NCLM stands for North Carolina League of Municipalities. That's who makes this podcast possible. And another episode ahead. Thanks for listening. We'll talk to you soon. This has Ben Brown.
