Health Education: The Missing Link in Violence Prevention
Homicide rates in our nation's 10 largest cities this year were up 36 percent compared with the first quarter of 2015. This spike has brought renewed national attention to the problem of violence in America, which is by far the leading cause of death for black males between the ages of 15 and 24—responsible for more deaths than the next nine leading causes combined. America's high rates of lethal violence also help explain why our life expectancy compares so poorly with the figures for other wealthy nations.
As the country grapples with how to address this major public-health problem, one potential policy lever has been largely ignored: health education. The United States spends more than $600 billion on K-12 public education annually, which includes a portion dedicated to formal health education in our public schools. While the focus varies by state, most of that health education concentrates on such concerns as substance abuse, sexually transmitted diseases, internet safety, CPR training, and nutrition.
Why not expand the focus of our school systems' health education to help address the most important health problem young people face in our nation's cities—violence?
What would such an approach look like? First, it might need to look very different from traditional health education. Students already know what violence is, and in far too many distressed urban areas, they unfortunately understand its consequences all too well. What they need is help understanding how to avoid it.
To help youths avoid violence, we need first to understand what violence in America actually looks like. TV shows like "The Wire" conjure up images of premeditated violence committed to further some instrumental end of a drug-selling gang. In contrast, in our hometown of Chicago, as in most big cities, a majority of all homicides stem from altercations that turn into tragedies because someone overreacts to a provocation. Often the provocation can seem quite minor, while the response seems very impulsive—almost automatic.
Youth Guidance is a Chicago-based student advocacy organization that helps young teens of color navigate difficult life experiences through their Becoming a Man (BAM) and Working on Womanhood (WOW) programs. The organization was originally founded in 1924 as the Church Mission of Help to provide programs of assistance for youths in need.
Watch a video of students from the BAM and WOW programs share their experiences of life as a teen in Chicago: Growing Up In Violence.
According to a growing body of research in behavioral economics, we all engage in these sorts of automatic responses all the time. They are usually adaptive to the situations we commonly face. For teenagers growing up in distressed urban neighborhoods where institutions of formal social control are often overwhelmed, it is often adaptive to react aggressively to any provocation to deter future victimization. While this automatic response may be adaptive in many circumstances, it can lead to tragedy when a gun is at hand.
Our research team at the University of Chicago Crime Lab has been working for the past several years with a Chicago nonprofit, Youth Guidance, studying its Becoming a Man program, more widely known as BAM. The program has been highly effective in addressing these sorts of impulsive, automatic responses that can lead to violence. BAM offers young men weekly, one-hour group sessions during the school day and a counselor they can seek out throughout the week. The program teaches youths to slow down in high-stakes situations and carefully consider the situation and their possible responses.
The Crime Lab's first study of BAM, implemented in the Chicago public schools in the 2009-10 school year, found that the program decreased violent-crime arrests by 45 percent, in just one school year. Youths who participated in BAM were also 19 percent more likely than their nonparticipating peers to graduate from high school on time.
While these results may seem too good to be true, they come from a randomized controlled trial of the sort regularly used to provide gold-standard evidence of effectiveness in medicine. Moreover, our team replicated the findings in a second study of BAM, which found a 50 percent reduction in violent-crime arrests.
The basic idea behind this intervention seems to work with even the highest-risk young people. Our team also studied a program that shares some common elements with the Becoming a Man program, but was delivered by members of the detention staff within the Cook County Juvenile Temporary Detention Center. Participation in that program reduced the rate of readmission to the facility by 21 percent over 18 months.
A number of important details about how to deliver this kind of approach at large scale would need to be worked out. Should public school staff members deliver this type of program, or should schools partner with local nonprofits? How can we identify and hire enough effective counselors to staff the programs? And, of course, there would be the question of how to pay for it.
But, given the enormous social and financial costs of youth violence and the promise of repurposing existing health education resources to make real progress on preventing violence, perhaps the better question is how can we afford not to invest in proven strategies to tackle this public-health crisis?
By meeting youths where they spend a great deal of their time—in school—with a program that works to reduce violence, we may be able to take a transformative step in national health education and finally give youths—many of them among society's most vulnerable—the opportunity for a future that every young person in America deserves.
Vol. 35, Issue 37, Pages 20-21Published in Print: August 3, 2016, as Health Education Holds Key to Violence Prevention