The Relationship between Public Health and Violence 
Prevention
May 2014 
Voiceover: Beat Intro
00:00	
This is the Beat—a podcast series that keeps you in the know about the latest community policing 
topics facing our nation.
Kimberly Brummett
00:08	
Hello and welcome. My name is Kimberly Brummett and, on behalf of the COPS Office, I’d like to 
introduce you to Howard Spivak, Director of the Division of Violence Prevention in the National Center 
for Injury Prevention and Control at the Centers for Disease Control Prevention, or CDC. Dr. Spivak is 
here to discuss with us the relationship between public health and violence prevention. You and many 
experts speak about a public health approach that can be used to prevent violence. Can you explain 
the benefits of this approach and how it can help law enforcement promote more meaningful and 
effective prevention?
Dr. Howard Spivak
00:42	
Yes. You’re actually asking me two questions. So I’m going to start with what the benefit of the 
approach is and then tie it into how it can help law enforcement promote more meaningful and 
effective prevention.
First of all, public health is engaged in this issue of violence because of the huge burden that it takes on 
the health of individuals and populations in this country. Not only does it result in injury and death, but 
there’s growing evidence that there are long term consequences to exposure to an involvement with 
violence that actually, for younger children, can affect the development of their brains and for people 
at any age, can increase their risk for chronic disease and chronic mental health problems. So the cost 
of this is enormous and goes well beyond the obvious costs of the acute effects of violence. 
The second thing is that there is a growing body of evidence that shows that violence is preventable. 
Violence doesn’t need to happen and can be prevented before it even starts. So, as important as it is 
for us to respond to violence, it’s equally important that we move as upstream on this as possible and 
do the kinds of things that actually reduce the presence of violence in people’s lives and in 
communities because we know these exposures have such serious long-term consequences. The way 
public health approaches issues like violence, is to, in fact, look for strategies that focus on prevention 
and early prevention as much as possible to avoid any consequences, short or long term, from these 
issues. We go about it with several very conscious steps. One, is that we collect a lot of information on 
issues like violence, that not only help us to understand the magnitude of the problem but also help us 
to better understand what the factors are that either increase risk, or, in fact, provide protective 
elements, that help people avoid violence or involvement with violence. The second thing is that we 
then develop programs and strategies that look at how we can modify those risks and, in fact, enhance 
the protective factors. Then we take that information and that understanding of the strategies that 
work and then work with health departments and other partners, including the criminal justice 
system, to put these strategies in place at large a scale as possible so that we can actually bring these 
efforts to a level that really make a difference not, again, just for individuals, but for whole 
populations. And that’s extremely important. 
Now, what public health can bring to and support the work of the criminal justice system and police, is 
that we can bring this perspective, moving far upstream and dealing with these issues in as a 
proactively a way as possible so that we don’t focus resources just on the important response 
services. We can actually begin to direct resources to the prevention end of the spectrum, which then 
ultimately saves both human cost as well as financial costs further down the road. And we have many 
examples with how this works with violence. We have a whole spectrum of programs that can be put 
in place in communities that help individuals and families to have healthier lifestyles and, in fact, 
reduce or eliminate violence in their lives. These range from very early intervention programs like 
nurse home visiting programs around the birth of a new child; to parenting support programs for 
parents of all types—but, in particular, parents who may be having difficulty with parenting; to 
programs that we can put into schools that help kids develop the skills to deal with conflict and anger in 
a more successful and pro-social way; to community level strategies from street outreach to policy 
changes at a community level. All of which supplement, augment, and compliment the work that the 
police are doing in dealing directly with violence and violent crime and working with the kids who are 
already engaged in this violent behavior and need more than just the early intervention and 
prevention services that I’ve talked about. 
Kimberly
05:43	
A 1979 Surgeon General Report made one of the first explicit links between public health and law 
enforcement. It identified violent behavior and stress as significant risks to health across America’s 
communities. Four years later, the Centers for Disease Control and Prevention established the 
Violence Epidemiology Branch, which later became the Division of Violence Prevention, to focus 
primarily on the public health approach to violence—preventing violence before it starts. Can you 
describe some of the key efforts and partnerships, besides what you’ve already mentioned, with law 
enforcement agencies, this division has helped facilitate?
Howard
06:19
Yes. I think this question does emphasize the point I’ve already made, which is always important to 
restate. That is, violence has consequences beyond its immediate, obvious effects. And that’s why 
preventing it from happening in the first place is so important. Even if we intervene and eliminate the 
violence later on in the process, some of the long-term events may happen anyway. So preventing it 
in the first place becomes all the more important. I’d like to give you a couple of examples of 
partnerships we’ve done with the criminal justice system and with the police, which I think have been 
extremely helpful and important. 
One is our work with the Department of Justice around the National Forum for Youth Violence 
Prevention, where many different disciplines and agencies have come together under this umbrella of 
the forum, where the Department of Justice is coordinating it and organizing it and many of the 
resources were being directed toward responding to violence—re-entry programs, programs that 
worked with kids who were already in the juvenile justice system—all extremely important work. But, 
the cities that were part of the forum were paying very little attention to early prevention. Our 
involvement in the forum has been to bring more attention to the early prevention of violence before 
it happens, to compliment all the other work. I think our being there and working with the Justice 
Department and working with the criminal justice system as well as the other partners at the forum 
have really created a broader balance of the efforts of the forum and I think will make the forum far 
more successful. Prevention is now becoming as an important and balanced component of this works 
as the response and re-entry, and service elements have been. 
Now, on a more specific programmatic level, there are a number of cities where health departments 
have received funding through the CDC to develop youth violence prevention activities. The core of 
their work involves building partnerships with other key players and communities, the police being 
one of those partners, but also other sectors—parks and recreation, community development of 
various sorts. Some of the work we’ve done has shown that there are strategies involving green space 
development. There are strategies involving changes in the built environment and the physical 
environment around people that can greatly influence levels of violence in a community, which then 
makes the work of the police and the criminal justice system easier because there are fewer young 
people entering the flow into violent behavior.
Another specific example is the way the data that we collect in public health can help supplement and 
augment the work of the police. One example is the use of emergency department data, which is a 
very sensitive source of information that gives real time information on where hot spots are 
happening. Many more violent injuries present to the health care system than present to police. And 
so use of emergency department data along with the data that comes in through the more traditional 
police sources, gives a richer picture of what’s going on at a community level, can better identify 
hotspots, can better direct services and concentrate services in important ways. There have been 
some important lessons learned as a result of this. For example, some of the data that has come from 
emergency departments has shown us that there are certain places in communities where violence is 
more likely to happen. One of those places is around stores that distribute single-serve alcoholic 
beverages. Often they’re convenience stores selling very small bottles of alcohol or beer or wine in 
small bottles. And, in fact, based on this information, we’ve also found that communities that have 
limited the sale of those kind of alcoholic beverages in the single dose containers, have actually 
drastically reduced the level of violent injuries that have occurred in those communities. The police 
data alone may not have picked all of that up because many of these injuries were being brought to 
emergency departments and were not necessarily being brought to police departments. So, the 
linkage of this data becomes very important. What it really teaches us is that we all have pieces of this 
puzzle. The more we are capable of putting these pieces together, the better all of us can do our work. 
The last thing I want to say with respect to this, is we have a system called The National Violent Death 
Reporting System, which is a system that takes information from multiple sources, from death records, 
from coroner’s offices, from police departments, links it together and allows us to look at violent 
injuries in a more comprehensive way so that we can put pieces together—better understand the 
circumstances of that violence, and where there may have been points of entry where the violence 
could have been prevented. It’s taught us a great deal about the dynamics of domestic violence and 
intimate partner violence. It’s taught us some of the elements related to youth violence. It’s taught us 
a great deal about the dynamics and circumstances around suicide. This information has allowed the 
development of programs and strategies at the state level and the local level that have more 
effectively addressed these problems and reduced rates of violence—both self-inflicted violence as 
well as externally-inflicted violence. Again, augmenting and supplementing and complimenting the 
work that the police are doing. 
Kimberly
13:02
What role does the private sector play in the public health approach to violence prevention?
Howard
13:08
The private sector plays a very important role. One of the things we’ve learned in public health is that 
there are very few sectors that don’t have a role in this. There are many departments in government, 
especially local government, that by the nature of the work they do, are actually contributing to 
violence prevention without even realizing it. For example, the cleaning up of empty lots is very 
important because we know that the physical environment people live in and function in affects their 
behavior. If a neighborhood looks better, the behavior of people in those communities changes along 
with the improvements in those communities. 
With respect to the private sector, we know that there are a number of contributions that the private 
sector can make to this. One of the key elements is the development of business improvement 
districts. We now have several studies that show us that when there are dollars invested in 
communities, even relatively poor communities, if there are dollars invested for business 
development and business improvement, that it has significant effects on rates of violent crime and 
violence in general, and not just street violence. It may, in fact, have effects even on violence in the 
context of people’s homes, the more hidden violence that we often don’t see as much of as is really 
there. Yet these are circumstances that then become risk factors for young people becoming involved 
with violence later in their lives. So investment in business development and economic development 
is one element of this. 
A second element of the private sector is the understanding that the physical and social environment 
that people live in is very important. And that investment in creating opportunities for building social 
networks in the community is very important. So, the development of youth centers, the 
development of places where people can gather and develop social connections become very 
important. People who are socially connected tend to be less violent than people who are more 
isolated and less involved in a community. These are just a few examples of how the private sector can 
be an important and key player in this work. 
Kimberly
15:44	
Much like law enforcement, public health policies and practices are often implemented at the local 
level. They take on a distinctive characteristic as they adapt to local circumstances, problems, and 
challenges. One size does not always fit all. Can you identify some of the more unique and successful 
local public health violence prevention strategies that are currently in operation?
Howard
16:05
Yes. It’s very important that strategies be appropriate for the communities that they’re being put in. 
There’s really two elements in this. One is determining the readiness of a community for any given 
approach, either programmatic or policy level. If communities aren’t ready for something, trying to fit 
them into those communities can often be frustrating and not terribly helpful. 
And then the second element of this is that communities need to have a sense of ownership of what’s 
going on in their communities. Programs not only need to look at being designed appropriately for 
community  but they often need to be modified with community input itself so there’s not only 
ownership of it but there’s a sense of participation in that. 
There are a number of strategies that have been used. For example, in Denver, where we fund a 
youth violence prevention center at the University of Colorado, they’ve been implementing and 
evaluating a strategy called The Communities of Care Model, which is in many ways essentially a 
community organizing model where the community is engaged in the process—where information is 
shared at a community level so that there is an increased understanding of the problem. The 
community then becomes an active participant in the actual design and development and decision 
making over what the best strategies are that fit the community. There is increasing evidence that 
engaging communities in this way can play an important role in the success of programs. I would also 
add that this becomes a great opportunity for police and other members of the criminal justice system 
to become part of a process. I know that there are many police departments that have become 
involved and are much more actively in engaging communities in the work they’re doing. I think what 
public health brings is yet another way of entering a community and working with a community and 
bringing in all of the key stakeholders, the police being one of those key stakeholders but community 
leadership and community representatives as well. So Communities of Care is a great model. 
Another extremely good model has been one that grows out of something I mentioned earlier, which 
is the understanding of the role that alcohol plays in this. And there’s a very good example in 
Richmond, Virginia, where we also fund a youth violence prevention center, where the information 
about where violent injuries were occurring and their relationship to vendors who are distributing 
these single-serve alcoholic beverages—that there was that association. The community then took 
that information and they initiated community action to change rules around the sale of alcoholic 
beverages. So the information that was provided to the community allowed the community—
empowered the community—to take a successful action in creating change that then made their 
community safer. 
There are many examples of this, around street outreach, around concentrating of services, around 
engaging and integrating public service and community service into these initiatives that have all been 
either successful in advancing the work of violence prevention or are showing extreme promise in this 
work. 
Kimberly
20:08
Fabulous!  Well thank you, Dr. Spivak, for all this important information and for your time and 
expertise today. 
Voiceover: Beat Exit
20:15	
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20:31	
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