Why violence is a public health issue

Using public health to prevent violence

Experiencing violence affects people in many ways. It not only causes physical injury or death, but being exposed to it can also cause emotional and psychological trauma. Violence doesn’t just affect the immediate victim, it affects their surrounding community, too.

Violence can affect people throughout their lives: it is associated with worse birth outcomes, childhood developmental delays, physical and mental illness, and premature deaths.

Violence is an epidemic, and with any epidemic, prevention is key. And like any health issue that leads to disability, disease and death, there is a role for public health and healthcare to play in preventing it.

A common understanding of violence can help promote public health approaches to violence prevention, and shift the focus from violence as a criminal behavior to instead viewing the experience of violence as a public health issue. Yes, violence is a behavior that some people do – but we’re focused on how people experience violence: the social and environmental contexts that predict whether they do, what happens as a result, and how we can protect them.

We can use data and research to understand what leads to violence, to advocate for and help implement strategies to reduce people’s exposure to violence - to keep them safe and prevent lifelong harm to their health.

 Are you or is somebody you know affected by violence? Help is available and you don’t have to go through it alone. Call 1-888-NYC-WELL (1-888-692-9355) for a free, confidential help line for New York City residents.

Background on violence in New York City

NYC’s homicide rate has declined…

There is a lot less violence than there used to be in NYC. Note on the COVID-19 pandemic

To look at violence, people often look at homicide rates. In recent years, NYC’s rate of homicides - the most extreme episodes of violence - has been under 5 per 100,000 people, down from a high of over 25 per 100,000 people from 1986-1990.

…but a drop in the homicide rate doesn’t tell the whole story.

In this chart, we look at three types of violent outcomes and how violence levels differ across the city: non-fatal assault emergency department visits, non-fatal assault hospitalizations, and homicides. These data show a larger burden of violence.

When broken down by geography, the data show that some neighborhoods experience violence at much higher rates than others. Neighborhoods experiencing the most violence have non-fatal assault hospitalization rates that are 10 times higher than neighborhoods experiencing the lowest rates – and 4 times higher than the citywide rate.

This pattern is consistent across the three indicators. And, neighborhoods that experience higher rates of violence have larger populations of people of color - showing that these populations shoulder a disproportionate burden of violence.

A public health approach to addressing violence

Residents of some neighborhoods are at much greater risk of experiencing violence - and its many health effects.

To prevent violence among those most affected by it, we need to explore what factors lead to it.

Violence is rooted in historical disinvestment and racism

Evidence shows that violence results from social structures that limit access to basic needs - structures that are fueled by racism, residential segregation, and neighborhood disinvestment. Where these structures persist, people are exposed to violence. For example, low-income neighborhoods of color are known to be hit the hardest.

This map shows the parts of NYC that were redlined 90 years ago as part of racist housing policy that set off decades of disinvestment and intergenerational poverty.

A map of recent shootings lines up with the heavily redlined areas of the Bronx, Harlem, and northern and eastern Brooklyn - showing clearly how today’s violence is closely related to the ways that racist policies are embedded in our society.

Decades of government and societal disinvestment from practices like redlining means limited opportunity and resources, and results in higher rates of poverty in some neighborhoods.

As a result of this disinvestment, we see a clear relationship between poverty and violence. As a neighborhood’s poverty level increases, so do assaults.

Disinvestment creates environments that threaten health

Disinvestment takes many forms. It promotes segregation, limits people’s access to basic resources, and creates environments that threaten people’s health.

In terms of public health, we say that disinvestment produces environmental factors that make certain health outcomes more likely.

Due to a history of disinvestment, New York City neighborhoods experience very different environmental factors that predict violence and other health outcomes.

By “environmental,” we mean the entire physical, social, and economic context around us: the built environment, like housing and parks, and access to schools, jobs, opportunity, healthcare, and more.

Whether or not a neighborhood experiences more violence can be explained by looking at whether its environment has protective factors, which help prevent violence before it starts, or risk factors, which make violence a more likely outcome.

What does this mean for NYC’s neighborhoods?

NYC’s neighborhoods experience these protective and risk factors very differently. Some neighborhoods have a lot less of the protective factors – and a lot more of the risk factors.

Let’s explore how by comparing two neighborhoods: Belmont/East Tremont, in the Bronx, and Tottenville/Great Kills, in Staten Island.

Poverty ranges from 6.2% to 41.5% among NYC neighborhoods. Belmont/East Tremont has one of the highest poverty rates in the city, while Tottenville/Great Kills has one of the lowest.

Neighborhood poverty is one of the environmental factors that can predict violence, with neighborhoods with higher rates of poverty more likely to also have high rates of non-fatal assault hospitalizations.

Belmont/East Tremont also has a high rate of non-fatal assault hospitalizations - one of the highest in the city (107 per 100,000 people).

Tottenville/Great Kills follows the same pattern, with one of the lowest rates of non-fatal assault hospitalizations - only 15 per 100,000 people.

Another way to compare poverty and violence rates is to rank neighborhoods from highest to lowest for each and compare their positions.

Below, we can see that Belmont/East Tremont ranks high in both poverty and assaults, while Tottenville/Great Kills ranks low for both.

When we add in other risk factors, an even more significant pattern emerges.

Below, each vertical line represents the neighborhood rankings for the risk factors of total poverty, child poverty, child homelessness, high school incompletion, disconnected youth, unemployment, evictions, foreclosures – and the violent outcome of assault hospitalizations, shootings, and homicides. Each line connects one neighborhood through its ranks – the flatter the line, the more consistent the ranks.

These risk factors describe a network of threatening environmental factors in communities that have experienced disinvestment, place residents in poverty and expose them to risks throughout their lives – culminating in higher rates of violence.

Belmont/East Tremont ranks highly for these risk factors that make violence more likely. By comparison, Tottenville/Great Kills ranks low for these factors.

A pattern emerges: neighborhoods with the highest poverty rates consistently rank high for risk factors experience more violence. Neighborhoods with the lowest poverty rates consistently rank low for risk factors experience less violence.

Why does this happen?

These risk factors make up a network of environmental threats in communities that have experienced disinvestment. Due to the inequitable distribution of resources and opportunities, some neighborhoods face a disproportionate amount of risk. These threats place residents in poverty and expose them to risks throughout their lives – culminating in higher rates of violence.

In environments where risk factors far outweigh protective factors, higher rates of neighborhood violence emerge - and threaten the health of residents of these neighborhoods.

Breaking the cycle of violence

Addressing factors that lead to violence…

The Health Department takes a public health approach to violence. This means promoting conditions that prevent violence, and addressing outcomes triggered by violence. It means working across systems and communities to reinvest in neighborhoods most affected by violence. This work includes:

• Research on the most effective policies to reduce violence, collecting and analyzing data that can be used to develop new interventions.
• Through the Crisis Management System, working with other city organizations to support community-led efforts to de-escalate violence, providing support to at-risk youth with employment, legal, therapeutic, and educational opportunities.
• Strengthening the Neighborhood Health Action Centers in the South Bronx, Harlem and Central Brooklyn, neighborhoods that all experience higher levels of violence. The Action Centers serve as community hubs for programs and resources that can decrease risk and increase protective factors.
• Working with hospitals to help them respond to the many needs – physical, social, and emotional – of people injured by violence.
• Partnering with communities to respond to neighborhood-level mental health crises and traumatic events through Rapid Assessment and Response.

With this work, the Health Department is reinvesting in communities that have experienced disinvestment so that we can build environments where protective factors outweigh risk factors.

…to reduce rates of violence.

Public health is about assuring the conditions in which people can be healthy.

A public health approach to violence prevention relies on a response from all sectors of society to address the inequities that lead to violence. It relies on creating and supporting systems so that both institutions and neighborhoods support the health of their residents.

A public health approach to violence presents an opportunity to find sustainable solutions to create healthy spaces for New Yorkers to live and thrive.

It means that we can prevent violence by eliminating poverty, providing jobs, healthy housing, and education, creating a society based on justice and equality, that offers opportunity to all.

 Are you or is somebody you know affected by violence? Help is available and you don’t have to go through it alone. Call 1-888-NYC-WELL (1-888-692-9355) for a free, confidential help line for New York City residents, or get support here.