I have been invited here today to share news of practical steps we took in my home town in Florida, work which started with the improbable partnership between me, a physician, and our sheriff, our highest ranking law enforcement officer. We and other community partners who joined the effort began to address (without even knowing it) the UN Sustainable Development Agenda : inequalities in health care access and outcomes, inequalities in educational access and outcomes, violence against women, and poverty. Specifically, our efforts addressed the root cause of community violence, which is violence at home.
I will share the results first so that you may be motivated to hear the rest of the story.
After using data and maps to identify neighborhoods suffering the greatest health inequities, we brought neighborhood based services to them which within four years resulted in a reduction in unintended pregnancies, a reduction in premature births, and a stunning 45% reduction in cases of child abuse and neglect.
You might ask, what kind of community was this where such changes could be made so fast?
Alachua County, Florida, my home for the last 34 years, has many advantages. There are just over 3000 counties in the US. We rank r top 3% on clean air and on fresh water availability. However, our child focused rankings demonstrate the inequities in our community. We ranked in the bottom 4% of counties on infant mortality, which is the death rate of infants in the first year of life. The most common cause of infant mortality is premature birth, widely known to occur more commonly in women who are stressed.
By stressed, we mean women who have bad, sad, or scary things happening in their lives.
And now, I think you may begin to see that what we learned about reducing stress for these women may well apply to women of reproductive age who are experiencing civil war, who are refugees, or who are struggling to deal with manmade or even natural disasters. All of such women have bad, sad or scary things happening in their lives.
In Alachua County, I would like to highlight three types of stress reduction interventions: health care, provision of concrete family supports such as food, clothing, and shelter; services for victims of domestic violence.
Let’s start with health care since this is the service I had a part in.
When we made GIS hot spot maps to highlight the neighborhoods suffering the most inequities, a colleague suggested that we enlarge the maps and mount them on poster board to carry them around to show to community groups who may be interested in partnering. At first I thought this was a crazy idea, but I now believe this was perhaps the ideal first step in our effort. There is something about maps that got our partners energized to help like no other data form I can think of.
Showing the data encouraged others to share their data with us, and soon we had overlapping hot spots for health disparities, domestic violence, child abuse and neglect, as well as poor school performance and food deserts. These neighborhoods were failing to meet the basic needs of its residents, and in turn, children and young families were failing to meet community expectations for success. People who saw the maps wanted to help!
For example, two colleagues donated a clinic on wheels and suggested that we take health care to the hot spot neighborhoods. Volunteer health professionals staffed a free clinic which visited identified neighborhoods on a regular schedule. No appointments needed.
When we asked patients what service they would like from the clinic, an astonishing number of women requested pregnancy testing. If their tests were negative, our nurse asked each woman whether she was happy or sad with that result.
We learned that these vulnerable women did not always have the luxury of choosing the day for sex, the time for sex, or even the partner for sex, therefore, the majority were relieved to hear they were not pregnant. We offered them long acting reversible contraception free of charge. The birth control shot lasted three months, and we told them to return then if they would like another injection. They came back and sometimes brought their daughters or mothers or aunts or girlfriends or neighbors who wanted the shot also. Without our planning to do so, our free clinic on wheels became a trusted source of family planning.
When the sheriff looked at our map for health inequities, she said that her hot spot for calls to her for service overlapped with our hot spot for health. Review of her call data showed that the most common reason to call was domestic violence. Most of the victims were women. The Sheriff responded.
When entering the home, Sheriff’s deputies were trained to ask each victim 11 questions about their partner such as, “Has your partner ever threatened to kill you? Do you think your partner is capable of killing you? Does your partner have a gun? Has your partner ever threatened to commit suicide? Does your partner use too much alcohol? Has your partner ever choked you? Has your partner ever harmed or threatened to harm your pet, your loved ones, your most cherished possessions?”
Victims who answered yes to three or more of the questions were told by the deputy that in his or her experience, they were at very increased risk of being murdered by their partner. Victims were then given the opportunity to use the deputy’s cell phone to speak to the domestic violence service provider in our area. By using the deputy’s phone, the perpetrator would not be able to see the phone call by looking at the victim’s cell phone. Furthermore, a team of law enforcement, victim’s advocates and child advocates reviewed the cases of those victims at highest risk, providing wellbeing checks, free counseling, and advocates looking out for them should they wind up in court.
The third intervention was the establishment of a neighborhood resource center which provided, among other services, concrete family supports. Sometimes the bad, sad, or scary things that bring stress to these lives meant not having enough food, having the electricity turned off, being evicted by a landlord, or needing clothing for a job interview or cold weather.
So, we did three interventions to address inequities in our community: health care (specifically reproductive care), increased safety in the home for women and children by addressing domestic violence, and assured the availability of concrete family supports in times of need.
You may wonder what we are working on now. A diverse partnership between law, medicine, psychology, and restorative justice created Peace4Gainesville, closely allied with the River Phoenix Center for Peacebuilding. We are working to educate our community about the consequences of unresolved trauma or stress. We are collecting resilience building tools for all ages, starting at birth. The goal is to reduce trauma (the bad, sad, scary events) at the same time as we increase resilience.
In order to make peacebuilders we need to start at home within our most important relationships with our life partner and our children. New brain research tells us that resilience to stress can be developed at any time in the life course, and efforts to build the resilience of individuals in the community can pay big dividends, especially when the benefactors of such efforts are children and their young parents. Tara Brach, psychologist, says ”Resilience grows when we become intentional about bringing our best to difficult life seasons.”
Resilience building requires no expensive equipment. It includes learning breathing techniques, meditation, and other ways to control our internal emotional state, the emotional state that when uncontrolled, leads to violent behavior.
Should you need partners in your home countries or communities, as you address inequities and natural and man-made disasters, may I suggest you look to some of the 1.2 million members of Rotary International whose president Risely addressed the membership saying that “Building Peace is a Primary Goal of Rotary Service. “ Rotary’s areas of focus are in concert with the Culture of Peace promoted by the United Nations: water and sanitation, disease prevention, maternal child health, literacy, and economic development.
To conclude, we all have a part to play in sowing seeds of peace. Perhaps we start by plucking the weeds of intergenerational violence. As the Ambassador from Hungary quoted Betty Williams as saying, “Peace is action not words.”