Viral Violence and the Challenge for Public Safety

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As the screens we carry narrow our proximity to random and targeted acts of violence, many parents and families are rightfully questioning the impact viral violence has on shared perceptions of public safety and child health.

In pediatrics, we have long considered the link between media, violence and health.

We know kids who watch fake violence in movies or play violent characters in video games show signs of increased aggression. But what happens when the violence kids watch is real? Or when the cameraperson is only a teenager?

Today, youth can easily capture and consume real violence, in real-time, as a part of their daily routines – from snapping school violence, live streaming police violence, recording sexual violence, or sharing images of political violence. This is the new normal* and it’s more complex than the simple relationship between simulated exposures and aggression.

A child watching real violence from their cell phone now understands something tangible about the world; and a kid who records or shares violent imagery online can contribute to others understanding of the world. That elevation of the voices and experiences of youth can be extremely valuable. Indeed, in terms of activist’s movements like Black Lives Matter, the perspective of youth, magnified by social media, has become a national catalyst for police reform, criminal justice reform, and racial equity.

Yet, perpetual exposure to viral violence takes its toll – often manifest in feelings of victimization, grief, fear, intimidation, anger and sadness. And kids and teenagers may be most vulnerable to this kind of trauma because they are still developing the emotional and intellectual maturity to process troubling events. What is more, they rely on trusted adult figures to provide safe spaces in their life.

As we face these harrowing challenges, consider two thoughts:

1. While it’s okay to be protective, thoughtful and proactive regarding how youth experience and contribute to violent images online, we, as parents, caregivers, or providers, cannot simply turn a blind eye. While distressing, some images of violence advance our collective understanding, compassion, and empathy for the suffering that exists outside the walls of our private communities or our segregated social groups, and the privileges those spaces confer. In this way, confronting the visual of violence with a particular effort to center the interpretation of the events around the marginalized populations disproportionately affected, is the first step towards collective healing. And that healing begins with rigorous and vigilant public exploration of the ways systemic racism, sexism, Islamophobia, homophobia, xenophobia and intolerance threaten public safety.

2. As we live-stream our lives, we open windows to the neighborhoods we live in, the spaces where our kids learn and play, and the ways we perceive and are perceived in the world. When we don’t like what we see on the other side of that window, it can be easy to hide discomfort or insecurity with blame or shame or to create narratives that distort the humanity we witness. But each time one of us resists the opportunity to understand the burdens or experiences of another, we all move further from the co-existence necessary to bring peace.

*This is a piece I wrote with my friend and colleague, Dr. Wendy Sue Swanson, that was published in the July 2016 Pediatrics. It is available for free online for the first week of publication.

Black History Month and Health Inequity: The Connection between Social Realities and Clinical Norms

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Black History Month is probably one of the most underutilized opportunities to re-ignite the national conversation around social justice in America. As it is typically celebrated, like a random recollection of various contributions by “notable” African-Americans, it feels more like a stale tradition on the verge of irrelevance, than the opportunity to engage issues of racism and social inequality as historical American values that continue to define modern American life.

Last year, I shared why Black History Month remains an essential moment to nationally recognize the lives and works of African-Americans. Right? The original #BlackLivesMatters movement started in 1926.

This year, I want to flesh out examples of how historical American values around race continue to inform national issues and particularly examine how those issues impact health. I’ve talked about mass incarceration, gun violence, and gender inequality a bit in the past.

This month, I’m going to take on the industry of poverty, and child poverty in particular, and how national, state, and local public policy may engineer disadvantage in ways that have profound impacts on health. I also want to talk health systems transformation and consider new models for healthcare delivery that may uniquely serve low-income, communities of color.

And lastly, I want to speak openly and honestly about my dismay with the medical community and our lack of public acknowledgement of the deaths of Oscar Grant, Michael Brown, Tamir Rice, and the other recent victims of police brutality. Lest, we begin to believe that police are the only modern manifestation of our nation’s tragic history with race, I am going to talk about institutional racism and how physician bias directly impacts the health of communities of color, threatening their lives in quantifiable ways.

We are never farther than our willingness to look at where we’ve been allows us to be. In our plight for justice, to move forward, we have to understand where we’ve come from. In February, we are sitting in a powerful moment to look honestly at our nation’s troubled history with race and inequality and find clarity around the pressing issues of our time. Join me this month in discussing how those issues impact our health!

And if there are topics you’d like to talk about, join the conversation and leave a comment below.

On Ferguson: A Call to Medicine

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There is little to say once you’ve said this before. Although the sadness brings fresh tears, they are also old tears. The grief becomes familiar and so too the inevitable resumption of everyday life. The pain bores to the soul but settles in the subconscious, where it rests, privately born and quietly hidden, lest frustration and bitterness mire the work we do – trying to forget, but ever-reminded. So although there is nothing new to say, perhaps there is something new to do.

Here, I am looking squarely at you, my fellow physicians. We, who deal in health and disease must think critically and act effectively to address the issues raised by the death of Michael Brown and those who came before him. We are the trusted public servants charged with protecting the populations in our care, to promote health and prevent and treat disease. But are not health and disease simply the crude boundaries of life and death? Then, how will we move to protect the lives of black and brown youth that are threatened by violence? How will we confront the reality that the #1 cause of death for black males aged 10-24 is homicide? What are we doing about the death rate for young black males that is the highest among all adolescents in America? Black male teenagers are 37% more likely to die than any of their peers. And according to the CDC, because these deaths are secondary to external injury, they are by definition, preventable.

So I will ask again, what are we doing about it?

Because, despite the vaccines given to ward off the threat of disease, and the medications prescribed to prevent seizures, kill cancer, and treat infections, black males may not make it out of adolescence alive if we don’t address the violence.

In preventative medicine, we talk about risk factors to identify patients who may suffer from an illness in the future, and prevent it, before suffering and/or death could ever occur. In oncology, we talk about getting to the diagnosis and treatment early, so that in cases where it makes a difference, everything that can be done, will be done. And yet, as black youth die in the streets because of where they live, and how they dress, and the volume at which they listen to their music, we are silent. We, as a collective field, say nothing and we do nothing.

Black lives matter because all lives matter and no one gets that more than we do. So as young black bodies line our streets without reason or recourse, we must start asking what that means for all of us. We must start changing the way we teach and practice medicine. Because if we fail to protect these youth, because we don’t understand their music, or we don’t like the way they dress, or we don’t feel comfortable with the way they speak – whatever the because – then we fail ALL of our youth. We fail to do service to the highest honor of our profession, to protect the lives we care for.

Now, this issue is complicated and deeply rooted in the legacy of discrimination that defines American history and continues to inform America’s present. And you may even avoid talking about it in your personal life, let alone your clinical practice. But your, or my, discomfort does not make it any less our responsibility.

So let’s start dealing with it. I’m talking about poverty. I’m talking about racism. I’m talking about structural inequality. I’m talking about the gender wage gap, the academic achievement gap, and the housing equity gap so wide whole generations fell in and got lost. It is time to engage these topics as legitimate and enduring parts of medical education, public health messaging, and clinical prevention strategy.

No excuses.

If you don’t have the faculty to teach this material, call upon our colleagues in the social sciences to share their expertise. If you don’t know how to address community violence, reach out to non-profits who have made this struggle their life’s work. And if you shy away from the institutional failings that underlie the policies that contribute to the disparities, then call on your local, state, and federal policy makers to change the law.

There is literally no time to waste. Every faceless, nameless brown child who drops dead in the streets could have and should have been prevented. Let this issue not settle in the subconscious recess of our field while children suffer. Because in the end, it is not about Ferguson, it is not about Michael Brown, it is not about the countless others who met a similar fate, it is about what we are doing to ensure that all lives matter, regardless of the color of that life’s skin.

Remembering Newtown

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In the wake of the tragedies at Sandy Hook Elementary, it seemed America had finally lost its taste for the spoils of gunfire. Despite what gun lobbyists would have us believe, animals aren’t the only victims of loaded weapons. Guns kill kids. And while the events at Sandy Hook were horrific, only 1-2% of youth homicides occur at school.

The truth is, kids are dying in our neighborhoods.

And just when we finally seemed ready to have a responsible discussion about rights in this country, namely the right to protect ourselves from the tyranny of guns, we wait. We wait for our federal and state legislatures to grasp that the sanctity of the 2nd Amendment can never be placed above the sanctity of precious American lives.

What gives? What other lethal weapons are so protected in this country? Cars require registration and training to operate. Unsafe chemicals require warnings (and if they are particularly toxic their manufacture, distribution, and use are regulated by the government). Cigarettes cannot be sold to minors, are heavily taxed, and many states now prohibit their use in public spaces. New York even considered banning soda because it may kill someone in the future, from complications of diabetes and heart disease (which have been linked to high sugar intake).

In America, it seems, we have no problem placing limits on things we deem a threat to public safety and public health. And yet, we wait on expansive federal and state gun control. And more importantly, while we wait, polls show our collective conscience is losing sight of the urgency of the issue.

Homicide is the 2nd leading cause of death for young people aged 15-24; and if you happen to be an African-American male, it is the number ONE cause of death. In 2010, 13 kids a day were victims of homicide and more than 80% of them were killed by a firearm. And in the 3 and 1/2 months following Sandy Hook, more than 2,200 lives were lost to gun violence (a number akin to a Newtown every single day since the mass shooting).

The data is clear. People are dying and we have a system that protects gun ownership at the expense of our lives.

Tomorrow, December 14, marks the one year anniversary of the tragedies that took place in Newtown, Connecticut. Despite our nation’s horror and resolve to protect our children from further tragedies, woefully little has been done to prevent it from happening again. To see just how little, check out this New York Times chart. According to their data, it is estimated that 1500 gun laws have been introduced in various states since the massacre and of those, only 109 have become law. Of those 109 new gun laws, 70 loosen gun restrictions, making it easier for individuals to register, conceal, and use firearms in various states across the country. Some of those laws even made it easier to carry concealed firearms at churches, public parks, and schools!

This is outrageous.

It is truly shameful that as we mourned the loss of those precious 26 lives, we at once made it easier for a similar tragedy to occur.

As a pediatrician and child health advocate, I continue to stand with President Barack Obama and the American Academy of Pediatrics in demanding sensible gun reform.

If America doesn’t have a crisis of consciousness over the incredible inaction that has surrounded the death of our children, I am not sure what it will take. I pray that more children don’t fall victim to firearms before we make some changes. It is time to put our children first and prevent further injury and death by taking the responsible steps towards sensible gun reform.

* This article is adapted from a piece I wrote following the tragedy at Sandy Hook Elementary. To read the full piece, click here.

* To check out what the American Academy of Pediatrics is doing to respond to gun violence, click here.