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Why isn’t domestic violence talked about as a public health crisis?
There have been myriad events labeled public health emergencies or public health crises over the last few decades—heart disease, the opioid epidemic, the impacts of climate change, the COVID-19 pandemic and the healthcare worker shortage that followed, just to name a few. Between humanitarian crises, environmental emergencies, sweeping health concerns, and viruses, public health crises are a call to action to focus on the threats most dire to our world’s well-being.
While many public health crises are declared after an outbreak of disease, the determination can also be made after civil unrest, war, widespread poverty or famine, or violence. In fact, some groups have declared racism a public health crisis. By definition, a public health crisis denotes any urgent situation in which the health of a population is negatively affected.
Who and What Declares a Public Health Crisis?
“The definition of a public health crisis is qualitative, not quantitative,” says Georges Benjamin, MD, chief executive director of the American Public Health Association, the oldest and largest public health association in America. “It represents a health threat that is substantial in size or impact such that an urgent response is needed.”
A public health crisis can be determined by the federal government or by individual states, and among the latter, the definition of what constitutes a crisis may differ. According to Tom Herman, public information officer for the Arizona Department of Health Services, a public health crisis is something that "poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability. Our department will take appropriate actions when a public health emergency is declared by the governor.”
Nationally, the Secretary of the Department of Health and Human Services can declare a public health emergency, which typically lasts 90 days. Likewise, the President of the United States can also declare a national health emergency or crisis. At all levels, these declarations make available government funding that can be allotted to address the emergency.
Experts, Health Professionals Agree Domestic Violence is a Public Health Crisis
In Benjamin’s opinion, domestic violence does fit the definition of a public health crisis.
“Domestic violence is indeed of significant prevalence and impact that it is at public health crisis levels. One of the tragedies of this phenomenon is the fact that it is amongst people who both know and are supposed to care for one another. It is a breakdown in the relationship such that conflict becomes physically or emotionally violent.”
Alicia Nichols, LSW, Deputy Director of the National Center on Gun Violence in Relationships at the Battered Women’s Justice Project agrees with Benjamin. “Most definitely,” she says, to declaring domestic violence a public health crisis.
“Domestic violence, intimate partner violence, gender-based violence—no matter what we call it … have long-lasting, far-reaching and often devastating consequences for individuals, their families and entire communities,” says Nichols. And it’s not only the physical violence inflicted by abusers that affect survivors’ health.
“Victims of intimate partner violence have higher rates of chronic stress which can lead to chronic mental health conditions, diseases, chemical dependency, substance abuse issues, complications with pregnancies, etcetera,” says Nichols.
Licensed clinical therapist and certified clinical trauma professional Kimberly Parker, BS, says it’s the amalgamation of factors that make domestic violence a true threat. “There are too many women and children being affected by domestic violence. When people think about it, they think it’s just physical. But it’s verbal, it’s psychological. Sometimes, that impacts you even more. The combination of these—it is a crisis.”
What Do the Numbers Say?
It’s estimated that one in three women worldwide will experience physical or sexual intimate partner violence in their lifetime, according to the World Health Organization, which calls violence against women specifically “a major public health problem.” Combine that with the fact that worldwide, on average, it’s estimated that a woman or girl is killed every 11 minutes by someone in her own family. And that’s just the female victims. The National Crime Victimization study found that men make up nearly a quarter of domestic violence victims with one in seven men over age 18 having experienced severe physical violence by a partner.
A Police Detective’s Take
Studies show that domestic violence-related police calls make up anywhere from 15 to 50 percent of calls to the police, depending on location, and constitute the single largest category of calls to law enforcement. These calls are not only dangerous to the victims involved, but also put police officers at risk from violence abusers, too.
According to the FBI’s Law Enforcement Officers Killed and Assaulted database, between 2011 and 2020, 503 police officers in the United States were killed on duty. Of those, 43 were responding to domestic violence calls.
Former San Diego Police Department detective Joe Bianco, now a Law Enforcement Support Coordinator with Alliance for Hope, says, when he was with the department, he responded to multiple domestic violence calls every day. He estimates the calls took up at least 25 percent of his time on duty, yet it was difficult to know if the police response was making a difference long-term to end the problem of intimate partner violence.
“Maybe on a macro level, no,” he says of changes he saw due to police intervention. “On a micro level, yes.” In cases where he could intervene, remove an abuser from the home and give the survivor time and safety in order to think about next steps, he was sure it was making some difference.
“I think there was real change in individual lives as a result of what I could do as a detective or as a team, meaning the advocates and social workers and nurses that were all working together on these cases.”
But that was just for the incidents he could respond to.
“In the grand scheme of things, some of the worst domestic violence that’s occurring, we don’t even know about. It’s what’s happening behind closed doors,” Bianco says.
A Crisis That Spans Generations
While some may think domestic violence isn’t a factor in their lives because they’re not in a relationship with an abusive partner or experiencing abuse directly, what they fail to see is how this type of violence can permeate their life regardless. If you grew up witnessing abuse, research has shown there is a high likelihood your health as an adult will be negatively affected.
“There are devastating health outcomes and complications for children who witness violence regardless of whether or not they are a direct target of the physical, sexual, or psychological violence,” says Nichols. Adverse Childhood Experiences, or ACEs, are a measure of traumatic events that occur during childhood and are able to help predict health complications in adulthood. Research has shown that anywhere from just over half to two-thirds of all children will experience at least one ACE in their lifetime which can be tied to nearly 21 million cases of depression, 1.9 million cases of heart disease and 2.5 million cases of obesity in U.S. adults, according to the CDC.
Additionally, domestic violence is a problem that replicates itself, much like the spreading of a virus. Victims of domestic violence during childhood are at an increased risk of falling victim to an abusive partner in adulthood.
Says Parker, “Women with complex PTSD who were verbally and physically abused [may] pick the same [partner] over and over again. You’re going to gravitate to what feels familiar to you unconsciously.”
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Vicarious Trauma Can Affect a Wide Population
Even if not harmed or killed, the psychological effects of domestic violence have a wide reach to everyone who cares about a victim or who believed they could trust an abuser. From family members to advocates, law enforcement to healthcare workers, the effects of vicarious or secondary trauma can look like exhaustion, hypersensitivity, hopelessness, nightmares, anxiety, depression, sleep disturbances, anger, isolation, and missed work or school days. The cost is both physical and financial.
“It is very difficult to interrupt domestic violence and usually requires many interventions over long periods of time,” says Kristine Lizdas, Esq., Director of the National Center on Legal Approaches to End Family Violence at BWJP. “This creates hardship, stress and cost for support persons. Employers, schools and community organizations experience the impact of violence in families when individuals miss work, school or meetings because of domestic violence or underperform because they are stressed and struggling to manage the violence in their lives.”
Domestic violence’s fallout not only affects the health of a population, but also its financial structure. To learn more, read “The Cost of Domestic Violence.”
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