creating a healthy and safe city
TRANSCRIPT
-
8/3/2019 Creating a Healthy and Safe City
1/24
New Haven Public HealthDepartment
CreatingaHealthyandSafeCity:
TheImpactofViolenceinNewHaven
Complete Report
Mario Garcia, MPH
Director of Health
-
8/3/2019 Creating a Healthy and Safe City
2/24
CreatingaHealthyandSafeCity:TheImpactofViolenceinNewHaven
TableofContents
Preface.....1
ExecutiveSummary..2
1.BackgroundandScopeofReport .........................................................................................................................4
2.APublicHealthApproachtoAddressingViolence ................................................................................................5
3.NewHavenCrimeStatistics...................................................................................................................................6
4.TheHealthEffectsofViolence:PhysicalInjury ..................................................................................................9
5.TheHealthEffectsofViolence:BeyondPhysicalInjury.....................................................................................12
6.RiskandProtectiveFactorsforBeingInvolvedinViolence................................................................................15
7.ConclusionsandNextSteps................................................................................................................................20
Preface
TheNewHavenHealthDepartmentlaunchedaHealthEquityAlliance(HEA)in2009tofocusontheunderlying
causesofhealthdisparitiesinourcity.Drawinguponagrowingnumberofhealthequityeffortsinothercities
andregions,thegoalofHEAistoensurethatallcommunitymembershaveequalopportunitytoexperience
optimalhealth.
Webelievethathealthbeginsinourhomes,workplaces,neighborhoods,andschools.Healthisaproductofour
broaderenvironmentalcircumstancesasmuchasitisaresultofindividualbehaviors,actions,orhavingaccess
togooddoctorsandaffordablehealthcare.Neighborhoodconditionsplayalargepartindetermininghealth
statusandmustbeatargetofcity-wideeffortstoimproveoverallcommunityhealth.ToalignwiththeprioritiesoftheNewHavenBoardofHealthandothercommunityleaders,theHEAhasbegunbyemphasizingtheissues
ofneighborhoodsafety,obesityandtobaccouse.
Thisfirstissuebrieffocusesonthesubjectofviolencewithinourcommunities,andwasdevelopedbythe
HealthDataWorkgroupoftheHEAforpresentationtotheNewHaven HealthMatters!PlanningGroup.
Consistingofcommunityleadersfromavarietyofsectors,the HealthMatters!PlanningGroupwascreatedby
MayorDeStefanoin2010toinformandguidepolicychangesrelatedtohealthinNewHaven.Withinthis
document,wedescribetrendsincommunityviolenceaswellasthecommunityandsocietallevelfactorsthat
increasetheriskoforprotectagainstinjuryfromviolence.Wealsoidentifypossibleremedies. Thedatacomes
frommultiplesourcesincludingthe HealthEquityIndex(HEI),aninnovativetooldevelopedbytheConnecticut
AssociationofDirectorsofHealthforlocalcommunitiestousetoexaminetheconnectionbetweensocialand
economicconditionsinneighborhoodsandthehealthstatusoflocalresidents.TheHEIusesa10pointscale(1is
poorand10isexcellent)tomeasurehealthoutcomesandthesocialandenvironmentalfactorsthatinfluence
them,suchaseducationalattainment,environmentalquality,economicopportunity,andpublicsafety.
-
8/3/2019 Creating a Healthy and Safe City
3/24
ExecutiveSummary
Communityviolencecancauseinjuryanddeath.Itmayalsoresultinpsychologicalharmto,andotheradverse
healtheffectsfor,victims,witnessesandotherpeoplewholiveinareasconsideredtobeunsafe.
TheNewHavenHealthDepartmentisoneofthreelocalhealthdepartmentsinConnecticutthathasreceivedfundingfromtheConnecticutAssociationofDirectorsofHealth(CADH)tocreateaHealthEquityAlliance.This
Allianceofdiversepartnersaddressestherelationshipbetweensocialandeconomicconditionsandhealth
outcomesofNewHavenresidentsusinganoveltoolcalledtheHealthEquityIndex.Thisdocumentpresentsthe
findingsoftheAllianceoncommunityviolenceinNewHaven.
CommunityviolenceisasignificantpublichealthprobleminNewHaventhatcallsforaunitedresponse.
Althoughtheimpactofcommunityviolencecanaffectusall,theanalysispresentedhereshowsthatcertain
neighborhoods,communitiesofcolor,andyoungpeoplebearadisproportionateburdenofviolentcrimeandits
effect.
HealthMatters!isanambitiousmovementtoimprovethehealthstatusoftheCityofNewHaven,underthe
leadershipofMayorJohnDeStefano,Jr.andtheCommunityServicesAdministration.HealthMatters!aimstouselocaldatatoprioritizeandassesshealthissues,policiesandpracticesforlong-termhealthimpactonNew
Havenresidents.Itisintendedthattheinformationandrecommendationspresentedinthisdocumentsupport
theworkofHealthMatters!oncommunityviolence.
TheConcern
DatafromtheHealthEquityIndexandothersourcesofinformationprovidedbyresearchers,residentsand
governmentofficialsdetailwhycommunityviolenceisasignificantpublichealthconcerninNewHaven:
In2007-2008,deathsfromassaultwereassignificantacauseofprematuredeathascancer,heartdiseaseandaccidents.Deathfromassaultwastheleadingcauseofdeathamongmales1529.Non-fatalinjury
fromassaulthasalsocausedasubstantialhealthburdenintheCity.
TheimpactofcommunityviolenceonyoungBlackandHispanicmaleshasbeenparticularlypronounced.In2007and2008,deathfromassaultaccountedforoverathirdofthedeathsofBlackandHispanicmalesage
1529.AllthosekilledbygunfireduringthatperiodwereBlackorHispanicmales.
Over85%ofdeathsfromassaultin2007and2008werecausedbyhandguns.Thevastmajorityofthehandgundeathsoccurredoutdoorsinparkinglots,inthestreetandonsidewalks.
ViolentcrimeisnotevenlydistributedinNewHaven,butheavilyconcentratedinsomedistrictsoftheCity.Violentcriminalbehaviorisalsogeographicallyassociatedwith,thoughnotnecessarilycausedby,economic
distressandlocationswithparolees,prisonreleases,retailbusinesses,andillegaldrugmarkets.
Themajorityofcityresidentsareunlikelytobephysicallyinjuredbyviolentcrime.However,duetoavarietyofpotentiallynegativeimpactsonmentalhealth,physicalactivityandqualityoflife,theindirect
burdenofviolenceonresidentsofacitylikeNewHavenmaybeconsiderable.
-
8/3/2019 Creating a Healthy and Safe City
4/24
NextSteps
TheHealthEquityAllianceandHealthMatters!seektoidentify,developandadvancepoliciesthataddressthe
rootcausesofviolence.Communityviolencepreventioninterventionsthatarecurrentlyrecognizedasbest
practicesfocusontheknowledge,attitudes,behaviorsandrelationshipsofindividuals.Bestpracticesin
community-andsociety-levelchangeshavenotbeenwell-defined.Inthiscontextitissuggestedthatpotential
areasforpolicyinitiativesinNewHaveninclude:
Expansionofeconomicandjobopportunitiesforyouthandadults;
Physicalandenvironmentalimprovements,qualityhousing,andenhancementstocommunitystewardshipwithinneighborhoodsexperiencinghighlevelsofstreetviolence;
Improvedaccesstopositivesocialactivitiesforyouthandadults;
Furtherenhancementstoprisonerreentryprograms;
Increaseddeterrentstohandgunuseintheperpetrationofcrime.
Finally,werecommendthat:
Asystematicreviewbeundertakenofcommunity-andsociety-levelviolencepreventionstrategiesimplementedinUScities.
TheCityofNewHavenadoptaprocess,suchashealthimpactassessment,toguidedecisionsconcerningthedesignanddevelopmentofneighborhoodsthatsupportsafe,healthylives.
-
8/3/2019 Creating a Healthy and Safe City
5/24
1.BackgroundandScopeofReport
ViolenceisamajorcauseofprematuredeathintheUnitedStates.Nationally,homicideisthesecondleading
causeofdeathforpeople15-24andthethirdleadingcauseofdeathforpeople10-14and25-341.
Whiledevastating,homicidesareonlypartoftheburdenthatviolenceplacesoncommunityhealth.Violent
crimecanalsoleadtonon-fatalinjury,someofitsevereand/ordisabling.Moreover,violencemayhaveafar
reachingaffectonthehealthofsomecommunitiesasawhole.Fearofcrimemayimpactbehaviorsand
attitudes,suchasoutdoorphysicalactivity,neighborlytrust,collectiveefficacy,andsenseofsecurity,thatcan
helpimproveandmaintainphysicalandmentalhealth.
ViolentcrimeanditsimpactonhealthisaparticularconcernwithintheCityofNewHaven.Datafromthe
ConnecticutAssociationofDirectorsofHealths HealthEquityIndexdemonstratetheextentoftheproblem.
TheHealthEquityIndexusesa10pointscale(1ispoorand10isexcellent)tomeasurehealthoutcomesandthe
socialandenvironmentalfactorsthatinfluencethem,suchaseducationalattainment,environmentalquality,
economicopportunity,andpublicsafety.WithintheIndex,NewHavenscoresa1outof10forviolentcrime
whencomparedtotheothertownsandcitiesinConnecticut2.
Aspartofourcollectiveeffortstocreateacitywhereallneighborhoodsandfamiliesaresafeandprosperous,
thisdocumentwillattempttodescribecommunityviolenceanditsimpactonhealthinNewHaven.Wewillalso
considerwhysomepeopleandareasmayexperiencehigherratesofviolence.Todothis,wewillsupplement
datafromtheHEAIndexwithavarietyofstories,surveys,anddatatodemonstratewhysafetyisaneveryday
concernofmanycityresidents.WewillfocusoninformationaboutNewHavenbutwillincludefindingsfrom
othersimilarUSurbanenvironmentsasneeded.
Forthepurposesofthisdocument,wedefineviolenceas theexerciseofaphysicalforceinamannerthat
createsorisintendedtocreateinjurytoanotherperson3.Althoughintentionalself-harmandunintentional
injurycausedbyunsafeconditionsornegligentbehavior,suchasaggressivedriving,areextremelyimportant
publichealthissues,theyarebeyondthescopeofouranalysis.
Thenextsectionofthisdocumentwillprovideabriefoverviewofthepublichealthapproachtoaddressing
communityviolence.Section2willgiveanoverviewofthepublichealthapproachtocommunityviolence
prevention.Section3willpresentNewHavencrimestatisticsprimarilyfromtheFBIUniformCrimeReportand
NewHavenIndependentCrimeLog.Section4examinesphysicalinjurycausedbyviolenceinNewHaven.
Section5considersavailableinformationontheeffectsofcommunityviolenceonotheraspectofhealth.
Section6willdescribefactorsthatmayincreaseorprotectagainstthelikelihoodofinvolvementincommunity
violence.Finally,section7willpresentconclusionsincludingrecommendationsandpotentialareasforpolicy
developmenttopreventcommunityviolence.
-
8/3/2019 Creating a Healthy and Safe City
6/24
2.APublicHealthApproachtoAddressingCommunityViolence
Thepublichealthapproachtoimprovingcommunitysafetyisbasedontheassumptionthatviolentcrime,like
othertypesofinjury,ispreventable
througha4stepprocessofstudyand
action(Figure1)1.Thesestepsare:
Step1:Describetheproblemofviolence.
Step2:Identifythingsthatputpeopleat
risk(orprotectagainst)involvementwith
violence.
Step3:Develop,implementandevaluate
violencepreventionstrategies.
Step4:Disseminatesuccessfulviolence
preventionstrategiesandensuretheiradoption.
Thesocial-ecologicalmodel(Figure2)1helpstoexaminefactorsthatincreaseordecreasetheriskof
involvementinviolencebydividingthemintothefollowinglevels:
Individual:Biologicalandpersonalhistory
factors,suchasage,attitudestoviolence,
orhistoryofaggressivebehavior.
Relationship:Relationshipswithfamily,
friends,intimatepartnersandpeers,suchashavingpeersengagedinviolence,
victimizationorlackofadequate
supervision.
Community:Thecommunitycontextin
whichrelationshipsexist(schools,
workplaces,neighborhoods).Thesefactors
includepopulationdensity,availabilityof
qualityemployment,andexistenceofan
illegaldrugtrade.
Societal:Societalfactorsthathelpcreateaclimateinwhichviolenceisencouragedorinhibited,suchaslaws
andregulations,socialnorms,andcross-sectorhealth,housing,economic,educationalandsocialpolicies.
-
8/3/2019 Creating a Healthy and Safe City
7/24
3.NewHavenCrimeStatistics
Crimeratesarean
indicatorofthesafetyof
ourcommunityandits
qualityoflife.Part1ofthe
FBIUniformCrimeReport
(UCR)providesuswith
standardized,auditeddata
oncrimesreportedtoor
otherwiseknownbylaw
enforcementauthorities.
Thisreportincludes
informationonthe
numberofviolentcrimes:
murder,forciblerape,
robbery.Crimesthatare
notknowntolawenforcementarenot
includedintheUCR.
BasedonUCRdata,there
were2183violentcrimes
reportedinNewHavenin
2009,or17.7per1,000
residents(95%
confidenceinterval:
17.0-18.4).This
comparesto3.0per1,000residentsinthe
StateofConnecticut
overallinthesameyear
(95%confidenceinterval:
2.9-3.1).Amongthe
2183reportedviolent
crimesin2008,there
were12(1%)reported
murders,58(3%)
reportedrapes,906
(42%)reported
robberies,and1207
(55%)reported
aggravatedassaults4.
-
8/3/2019 Creating a Healthy and Safe City
8/24
Trends.TimetrendsinUCRPart1ViolentCrimesforNewHavenandConnecticutoverallcanbeseeninFigure
34.Between1990and2000therateofviolentcrimesdeclinedconsiderablyinNewHaven,fromapproximately
30crimesto15crimesper1,000residents.From2000to2007,theannualnumberofviolentcrimesinNew
Havenappearstohaveincreasedalthoughnottopre-2000levels4.Thisupturnstartingin2000wasnotseenin
Connecticut4orintheUnitedStatesasawhole.
5Thereissomesuggestionofadecreaseinviolentcrimessince
2007.Similarpatternscanbeseenforrobberyandaggravatedassault(Figure4)4
.
Murders.From2005-2009,thenumberofmurdersoccurringinNewHavenwere16,24,13,23and12,
respectively,withabout17reportedwithinthefirstthreequartersof2010.Theannualizedincidenceofmurder
forthe5yearperiodfrom2005-2009was14.2per100,000NewHavenresidents(95%confidenceinterval:11.4-
17.5)4.TheannualizedincidenceofmurderforthisperiodinCT3.1per100,000CTresidents(95%confidence
interval:2.9-3.4)4.
UseofFirearms.Duetothepotentialforinjury,
communitiesoftenhaveheightenedconcerns
abouttheuseoffirearmstocommitcrimes.In
2008inNewHaven,firearmsweredischargedor
displayedin87%ofthemurders,81%ofthe
aggravatedassaultsand66%oftherobberies
reportedintheUniformCrimeReport6.
UnauditedNHPDdatafromtheNewHaven
IndependentCrimeLogonfirearmcrimescanbe
seeninTable1.Between2006and2009,the
annualnumberofassaultswithafirearm(non-fatalshootings)wasbetween117and140.Inthefirst10months
of2010therewere78assaultswithafirearmreportedinNewHaven.Thisappearstobetrackingtowardsa
lowertotalthaninpreviousyears.Thenumberofstreetrobberieswithafirearmrangedfrom217to259inthe
years2006to2009,with119reportedduringthefirst10monthsof2010.Alowertotalthanforpreviousyears
mayalsobeseenforstreetrobberieswithafirearmin2010.From2006to2009,therewerebetween480and610unlawfuldischargesofafirearm(dischargeofafirearmthatdoesnotresultinashooting),with473
reportedthroughOctober20107.
NewHavenIndependentcrimeLogsuggeststhatinthefirst10monthsof2010,roughly70%ofthe119
reportedstreetrobberiescommittedwithafirearmoccurredbetween7PMand4AM.
Arrestees.Arrestsforviolentcrimesaremostcommonamongyoungadultsandmen.InNewHavenin2008,
100%ofthosearrestedformurderwereunder35years,andhalfwereunder25.Incasesofrobbery,77%were
under35,and64%wereunder25.Sixty-fivepercentofthosearrestedforaggravatedassaultswereunder35,
and41%wereunder25.Allmurderarresteesweremale,aswere91%ofthosearrestedforrobberyand65%of
thosewhocommittedaggravatedassault6.Datafromvictimizationsurveyssuggestthispatternofageandsexis
trueforallperpetrators,notjustarrestees 8.
NeighborhoodData.MappingoftheUCRPart1datawithinNewHavendemonstratesthattheriskofexposure
toviolentcrimeisnotevenlydistributedacrossareasofthecity.Figure59showsthatthehighestviolentcrime
ratesper1,000residentsbetween2000and2009occurredincensustractsinDixwelll,Newhallville,Wooster
Square/MillRiverandportionsofDowntown,FairHavenandtheHill.Therateofviolentcrimewasalso
elevatedinDwight,Edgewood,WestRiver,LongWharfandotherpartsoftheDowntown,EastRock,FairHaven
andtheHill.
-
8/3/2019 Creating a Healthy and Safe City
9/24
Overthistime
period,Westville,
ProspectHill,East
Rock,FairHaven
Heights,EastShore
andaportionof
Downtownhadthe
lowestrateof
violentcrime.
ThedatainFigure
5arecrimerates
thatarecalculated
toallow
comparisonof
neighborhoodsof
differentsizes.A
crimerateisthenumberofcrimes
committedina
neighborhood
dividedbythe
numberof
neighborhood
residents.
However,crime
ratescanbe
misleadingsince
crimesmaybecommittedagainst
non-residents.This
may,inpart,
explainthehigh
crimeratesshown
within
neighborhoods,
suchasDowntown,
thathavealarge
daytime
(commuterand
visitor)population
relativetothetotal
numberofresidents.
-
8/3/2019 Creating a Healthy and Safe City
10/24
Whenexaminingandcomparingneighborhoods,itisimportanttonotethattheviolentcrimeratemaynotbe
uniformwithinagivenneighborhoodbutrathermaybeconcentratedinspecificareasorevenonspecificcity
blocks.Also,althoughmostcensustractscorrespondtoaneighborhoodarea,therearesomevariationsin
theseboundaries(forexample,EastRockandFairHavensharepartofthesamecensustract).
4.TheHealthEffectsofViolence-PhysicalinjuryDeathfromassault.Inordertobetterunderstandtheburdenofviolenceonaparticularcommunity,weoften
beginbylookingatthespecificcircumstancesofeachcrime.Deathcertificatesthatrecordassaultasacauseof
deathofNewHavenresidentsareanimportantsourceofinformationaboutmurder.Methodsforidentifying
thesedeathcertificatescanbeseeninAppendix1.
In2007and2008,assaultwaslistedasacauseofdeathfor30NewHavenresidents:11in2007and19in2008.
Assaultwaslistedastheprimarycauseofdeathfor29ofthese,whichisequivalenttoanannualizedincidence
rateof12per
100,000NewHaven
residents.
Firearmswerethe
mechanismofassault
for87%(26/30),
equivalenttoan
annualizedincidence
rateof10per
100,000NewHaven
residents.Similarly,
firearmswerethe
mostcommon
methodofhomicide
orlegalintervention
deathsinthe16US
statesmonitoredby
theUSNational
ViolenceDeath
ReportingSystemin
2007.Theyaccounted
for66%ofmurders
(72%ofmalesand
46%offemales).
Adescriptionofthefirearmsdeathsin
NewHavencanbe
seeninTable1.Sixty-
twopercentofthose
murderedwereBlack
and38%where
Hispanic.The
-
8/3/2019 Creating a Healthy and Safe City
11/24
majorityweremalesandundertheageof29.Theoldestwereintheirforties.Abouthalfwerehighschool
graduates,while36%didnotgraduatehighschool.Occupationinformationwasnotavailablefor7people.It
isnotclearifthisisbecausetheywereunemployedorthedataweremissingforsomeotherreason.Three
weresmallbusinessproprietors/contractors,2werestudentsandonewasreportedasdisabled.Otherswere
primarilyemployedinconstruction,manufacturingandserviceindustries.Thevastmajorityofassaults
occurredoutside,inthestreet,onthesidewalkorinaparkinglot(81%).Thedeathsdidnotshowaclear
seasonalitybutwereclusteredintime.Halfofthedeathsoccurredin3one-monthperiods:6inJune2007,3
inApril2008and4inSeptember2008.
TheleadingcausesofdeathtoNewHavenresidentsfor2007and2008combinedcanbeseeninTable3.In
2007and2008,assaultwastheprimarycauseofonlyasmallproportionofallthedeathsthatoccurredtoNewHavenresidents(29/1685=1.7%).Itaccountedfor3.3%ofthedeaths(27/816)amongmales.Forsome
populationgroups,assaultwasamuchmorefrequentcauseofdeath.Itwastheleadingcauseofdeathfor
Males15to39.Inthisgroup,itaccountedfor31%ofdeaths(23/75).ForBlackandHispanicmales15to39it
accountedfor38%ofdeaths(23/60).
Giventhatmostmurdervictimswereyoungmenwhowouldotherwiselikelyhavemanyyearsoflifeaheadof
them,assaultwasanimportantcauseofprematuredeathinNewHavenin2007-2008(Table3).Although
-
8/3/2019 Creating a Healthy and Safe City
12/24
assaultisarelativelyuncommoncauseofdeathforresidentsofthecityasawhole,itaccountedfor1,063years
ofpotentiallifelosttoage65,almostasmanyasformalignantneoplasms(cancer),heartdisease,andaccidents
(unintentionalinjury).
ThedatapresentedherestronglysuggestthatassaultisanimportantcauseofprematuredeathinNewHaven
particularlyamongBlackandHispanicmenandthatmostofthedeathsresultfromgunfire.However,the
resultsshouldbeinterpretedwithsomecaution.Giventherelativelysmallnumberofdeathsfromassaultinthe
citythedatamayvaryfromyeartoyear.
EmergencyDepartmentvisitsforassault.Dataondeathsfromassaultonlyprovideapartialpictureofthe
physicalinjurycausedbyviolence.Manymorepeoplesuffernon-fatalthanfatalinjuriesfromviolence.Hospital
emergencydepartmentsareonesourceofinformationonfatalandnon-fatalassaults.Theannualizedincidence
rateofemergencydepartmentvisitsforassaultamongNewHavenresidentsfrom2000-2004was669per
100,000residents(95%CI:648-689).ThisiscomparedtotheratesinStamford,Bridgeport,Waterburyand
Hartfordof302,723,731and1134,respectively10.
DataontheageandsexofNewHavenresidentsgoingtotheEmergencyDepartmentforassaultarenot
available.However,datafortheStateaffirmthatinjuryfromassaultlikefromfatalinjuryismorecommonformen,theyoung,andpeoplewhoareBlackorHispanic.Thehighestassaultrateswereinthose20-24.The
assaultratewas86%higherformalesthanfemales,and5timeshigherfornon-Hispanicblacksand4times
higherforHispanicsthanforWhitenon-Hispanics10.
Informationonemergencyroomvisitsforassaultisintendedtorepresentmoresevereinjuryfromviolence.
However,itislikelytoalsoincludelesssevereinjuriesforpeoplewhousetheemergencyroomforprimarycare.
Thiscouldaccountforsomeofthevariationbetweencitiesanddemographicgroups.
Although87%ofmurdersinNewHavenwerecausedbygunfirein2008,asdescribedabove,mostoftheinjuries
fromassaultseenwithintheseemergencyroomvisitsdonotappeartobeasaresultofwoundsfromgunfire.
TheConnecticut-wideemergencydepartmentvisitdatashowthatthemostcommonmechanismofinjuryby
assaultwasunarmedfightorbrawl(48%ofallassaults,71%withaknownmechanismofinjury).Firearmsaccountedforonlyaverysmallproportionofthese(1%ofallassaults,2%withaknownmechanismofinjury)
10.
Circumstanceoffatalassaults.InformationislimitedonthecircumstancesofassaultsinNewHaven.Brief
descriptionsofthefatalassaultsofNewHavenresidentsin2008aspresentedintheNewHavenmediaoutlets
aresummarizedinTable411,12,13.Thesedescriptionssuggestmanyofthedeathsweretheresultsofdisputes
betweenpeoplewhokneworknewofeachother.In2008onlyoneoftheNewHavendeathswasaresultofa
straybullet11.
MostshootingsthatresultedinfatalinjuryamongNewHavenresidentsin2007and2008occurredoutdoors.
81%(21/26)happenedinthissetting:10onthesidewalk,4inaparkinglotand7inthestreet.Theremainder
offirearminjuriesoccurredinaresidence(2),abar(1),avehicle(1)andanunspecifiedsetting(1).
-
8/3/2019 Creating a Healthy and Safe City
13/24
5.TheEffectsofViolenceBeyondPhysicalInjury
Asdemonstratedabove,prematuredeathfromviolenceresultsinmanypotentialyearsoflifelostinNew
Haven.Eachprematuredeathrepresentsatragedy.Moreover,violencecanpotentiallyhaveeffectsonhealth
andwellbeingthatgofarbeyondthephysicalorpsychologicalinjuriestothosewhowereassaulted.
Psychologicalmorbidityandbereavement.Exposuretocrimecancausepsychologicalaswellasphysicalharm.
Childrenwhoarevictimsofcommunityviolenceareatincreasedriskofpost-traumaticstressdisorder14.
Availableliteraturealsosuggeststhatchildrenwhoarevictimsofviolenceareatincreasedriskofdepression
andanxiety.Witnessingviolentcrimecanalsohavepsychologicalramifications.Childrenwhowitnesscriminal
victimizationalsoappeartobemorepronetodepressionandanxiety14.Violentexposurecanbeinterpreted
byachildtomean,notonlythathis/herworldisunsafe,butalsothathe/sheisunworthyofbeingkeptsafe.
Thissituationcancontributetonegativeselfperceptionsanddepression14.
Whenaviolenteventoccursinacommunityitisoftendiscussedwidely.Margolinetalsuggestthateven
childrenwhodonotdirectlywitnesscommunityviolenceoftenhearrepeatedaccountsofaspecificincidentandmayformtheirownmentalimage
14.Insupportofthisidea,Horowitzetalfoundthatamongurbanadolescent
girlsPostTraumaticStressDisorder(PTSD)wasassociatedwithhearingaboutviolentcrime15.Youthlivingin
violentcommunitiesmayexperiencepsychologicaladaptationsincludinghopelessnessanddesensitizationto
violence16.
Dataonthementalhealthconsequencesofexposuretocommunityviolenceinadultsarescarce17.Inasample
ofwomen,Kilpatricketalfoundthatexperiencingacompletedrape,lifethreatorsustainedinjurypredicted
-
8/3/2019 Creating a Healthy and Safe City
14/24
PTSD18.ThefindingsofBordeauxetalsuggestthatwomenrarelysufferPTSDaloneasaresultofcriminal
victimization.AsaresultofthePTSDtheysufferotherpsychologicaldisordersincludingmajordepression.
Clarketalfoundwitnessingcommunityviolenceinurbanneighborhoodsincreasedthelikelihoodofclinically
significantanxietyanddepressioninagroupofWhitewomenandLatinasintheNortheasternUnitedStates17.
Finally,bereavementforfamiliesandlovedoneswhoaredirectlyimpactedbyviolencehasbeenshowntobe
particularlytraumatic.Onestudyfoundthattwiceasmanymothersandfatherswhosechildrenweremurdered
metPTSD(fulldiagnostic)criteriawhencomparedwithaccidentandsuicidebereavement19.
Safetyandphysicalactivity .Peopleconcernedabouttheirsafetymaynotfeelcomfortablegoingoutdoors
withintheirneighborhoodsandthereforemaygetlessphysicalactivity.Limitedphysicalactivityisamongthe
contributorstothenationsgrowingproblemofobesity.
Twomajorsurveyeffortsofover2,400NewHavenresidents,the2009CAREsurveyandthe2010Community
ManagementTeamsNeighborhoodQualityofLifeSurvey,includedquestionsaboutneighborhoodsafety.
Thesesurveysdemonstratedthat66%and61%ofresidents,respectively,eitherstronglyorsomewhatagreed
thattheyfeltunsafetowalkintheirneighborhoodatnight;31%and15%,respectively,feltunsafetogoon
walksduringtheday.Perceptionsthatresidentsneighborhoodswerefreeofdrugs,gangsandprostitutionrangedfrommorethan80%intheEastShoreandEastRockneighborhoods,tolessthan50%inDixwell,Dwight,
andFairHaven.
Somestudieshavefoundanassociationbetweenneighborhoodsafetyandphysicalactivitybutthefindings
havenotbeenentirelyconsistent.Gomezfoundthatamong7thgradeMexican-Americangirlslivinginbarrios
inSanAntonio,Texas,violence(perceivedandobjectivelyassessed)wereassociatedwithdecreasedoutdoor
physicalactivity.This,however,wasnotthecaseforboys20.Inanationallyrepresentativesampleof
adolescentsingrades7to12,thosewholivedinneighborhoodswithhighlevelsofcrimeweresomewhatless
likelytoparticipateinfrequentmoderatetovigorousphysicalactivity.Twootherstudiesofperceived
neighborhoodviolenceandphysicalactivitydidnotfindanassociation(amongadolescentgirlsinurban
BaltimoreandadultsinurbanSt.Louis,MOandSavannah,GA21,22).Itisnotcleartheextenttowhichthemixed
resultsseenareafunctionofthesubstantialchallengesofmeasuringbothviolenceandphysicalactivity.
However,safetyconsiderationsdoappeartoaffectparents'decisionstoallowtheirchildrentoplayandwalk
outside23.Also,withaslightlydifferentwayoflookingatthetopic,Fishetalreportedthat,inasampleofadults
inLosAngeles,perceivingyourneighborhoodasunsafewasassociatedwithahigherself-reportedbodymass
index24.
Initsrecommendationstoreduceobesity,theCDCresearcherscitedabove suggestmonitoringthenumberof
abandonedbuildingswithinneighborhoodstodevelophyper-localindicatorsofneighborhoodsafetyand
walkability.Theypointoutthatinterventionstoimprovesafetycouldincludeincreasingpolicepresence,
decreasingthenumberofabandonedbuildingsandhomes,andimprovingstreetlighting.Othercitieshave
developedpedestrianenvironmentalqualityindices(PEQI)thatcantargetspecific,block-by-block
improvementstogeneralenvironmentalconditionsandsafetyforthecitysmanyresidentswhochoosetowalk.
Insomecases,safetyfearshaveledneighborhoodstoconductsuccessfulcommunityorganizingcampaigns,for
example,forimprovedlightingorpolicepresenceonbridgesreferredtoasmuggingalleys25.Relatedtothe
issueofunsafewalkingcorridors,dozensofcommentsonSeeClickFixinwhichresidentsdetailtheirneighbors
ortheirownexperiencesbeingmuggedwithinblocksoftheirhomes,onaformerlydarkbridge,areaclear
indicationofthelevelofconcern26.
-
8/3/2019 Creating a Healthy and Safe City
15/24
ResidentcommentsonVisioningaHealthierNewHavensurvey.TheNewHavenHealthEquityAlliance
recentlyconductedacampaignaskingresidentshowtheywouldenvisionahealthiercity.Urbanenvironmental
quality(e.g.,cleansidewalks,walkability)andpublicsafetywerethetwomostcommonthemesamongthe
approximately800writtensurveyresponsesand50video-recordedinterviews.Creatingthelinkbetweenliving
inaviolentenvironmentandstress,oneNewHavenresidentwrotethatahealthyNewHavenwouldlook:
morecivil,withfewergangbangertypes.Thestressoflivinginsuchacoarseenvironment,withsomuch
"frontin'"isgoingtogivemeaheartattack(notkidding--bloodpressurehasrisensignificantlysince
movinghere).Toomanymuggings,toomuchdisrespectbetweenandwithincommunities.
AnotherpersonwhoworksinNewHavenandhasthoughtaboutlivinginthecitywrote:
It'sagreatcitybuteverytimeIthinkaboutmovingintodowntown,there'sanotherincidentofrobberyor
worse.Fearofcrimeisatremendoussourceofstress.And,stressisnotgoodforhealth.
Anothermadethelinkbetweenviolenceandreducedphysicalactivitybysaying:
Therearesomegreatresourcesinthecityforoutdoorrecreation-EastRockPark,EdgewoodPark,
streetswithgreatsidewalkslikeWhitneyandProspect.ButwhenIgooutforarunin
Dixwell/Newhallville,thesidewalksareinpoorshape;I'veranafewtimesintheDwightneighborhood,
butit'spoorlylitatdawn/duskandIdon'tfeelsafe.IthinkthatahealthierNewHavenneeds(1)abetter
infrastructureforpeoplewhowanttobephysicallyactive,and(2)bettersafetymeasures,likelighting
andthoseblueboxesyoucancallinanemergency,tomakethosepeoplewhoareoutsidefeelsafe.
AnotherwroteofavisionforahealthyNewHavenbysayingthat:
AHealthyNewHavenhascleanandsafeparkswherekidscanplayandattendnatureandsports
activitieswithoutfear.
6.RiskandProtectiveFactorsforBeingInvolvedinViolence
Publichealthseekstoimprovecommunitysafetybyimplementingstrategiestopreventinjuryandother
adversehealtheffectsofcommunityviolence.Thedevelopmentofthesestrategiesshouldberootedinan
understandingofthefactorsthatincreasetheriskoforprotectagainstinvolvementinviolence.Thissectionwill
considercommunity-andsociety-levelcharacteristicsoftheenvironmentofNewHavenandothersimilarurban
Americanenvironmentsthatmayperpetuateviolence.
AsshowninFigure2,riskandprotectivefactorsmayoccurontheindividual,relationship,communityand
societallevel.Individualriskfactorsforcommittingviolenceincludeahistoryofviolentvictimization,substance
useantisocialbeliefs/attitudes.Protectivecharacteristicsincludedoingwellinschool,havingapositivesocial
orientationandbeingreligious.Relationship-levelriskfactorsthathavebeenidentifiedincludelowlevelof
parentalinvolvementandpeersthatareinvolvedinviolence.Protectivefactorsonthislevelinclude
connectednesstofamily,commitmenttoschoolandinvolvementinconstructivesocialactivities27.
EconomicOpportunity.DatafromtheHealthEquityIndex(HEI)showthatmeasuresofeconomicwellbeingare
poorforNewHavenwhencomparedtotheStateofConnecticutasawhole2.Sinceeconomicopportunityhas
beenidentifiedasariskfactorforviolence27,thismaybecontributingtothechallengeofviolenceinNew
Haven.
-
8/3/2019 Creating a Healthy and Safe City
16/24
Table5presentstheHealthEquityIndexeconomicwellbeingscoreforNewHavencomparedtotherestofthe
State.Compositescoresforeconomicsecurity,employmentandeducationwouldallbeconsideredpoor.
Thesescoressuggestthatopportunitiesforfulltimejobs,
orotherlegitimatewaysofmakingalivingandeducation
arelimitedcomparedtootherpartsofthestate.These
dataalsosuggestthatavailablejobsmayhavelimited
potentialforeconomicadvancementandsecurity.Food
serviceworkersrepresentahigherpercentageofthe
totalworkforceinNewHaventhaninConnecticut
overall,whereasmanagementworkersrepresenta
smallerpercentageoftheworkforce.Foodservicejobs
areamongthelowestpaidpositionswhenrankedbyannualearningsandoftencomewithminimalbenefits
andlittlejobsecurity.
DatafromtheHealthEquityIndex2alsodemonstrate
thatpooreconomicwellbeingisspecifictocertain
neighborhoodswithinNewHaven.Moreover,itappears
thatareasofthecitywithhighlevelsofviolentcrime,as
presentedinFigure5,alsotendtobeareaswithlowersocioeconomicstatus.Figures6-8presentmapsofthe
percentoftheadultswithabachelorsdegree,laborforceparticipationandmedianowneroccupiedhouse
value.ThesemapscomparesocioeconomicstatusofcensusblockgroupswithinNewHaven.
Figure 6
-
8/3/2019 Creating a Healthy and Safe City
17/24
Limitedeconomicopportunityandviolence. ThefindingsofaphotovoiceprojectconductedbytheRobert
WoodJohnsonClinicalScholarsProgramandtheNewHavenFamilyAlliancemayshedsomelightonhowalack
ofeconomicopportunitymayleadtoinvolvementinviolence.Theprojectusedacommunity-based
participatoryresearchmethodtoidentifytherootcausesofgunviolenceforNewHavenyoungpeople.The
photovoicemethodusedgaveparticipants(19peopleaged14-19years)camerasandaskedthemto
photographscenesfromtheircommunityrelevanttodifferentaspectsofviolenceanditsrootcausesintheir
community.Theseimageswereusedasthestimulusfor
focusgroupdiscussions.Thecontentsofthesefocus
groupswereanalyzedtoidentifythemesconcerningthe
rootcausesofgunviolence28.
Adolescentsandyoungadultsseektofindrespectanda
placeofstatusintheworld.Animportantthemeto
emergefromthephotovoiceprojectsisthattheyoung
peopleinvolvedsawlimitedlegitimateopportunityfor
establishingthatrespectandstatus.Insomecases,youth
viewedtheeconomicsystemwithsuspiciondueto
discriminationagainsttheirparents,cheatingorwhitecollarcrime.Inthiscontext,someyoungpeopleturnto
TheGame(illegaldrugtradeandgangs)toachieve
respect.Thereforethelackofopportunityencouraged
youthtoparticipateinactivitiesassociatedwithviolence.
Sincestatusandrespectcanbeconsideredaprotection
againstviolence,thesituationisselfperpetuating.Onefocusgroupparticipantwrote:
Itslike,OK,ifImoutinsociety,youknow,workingandstuff,OK,Idratherhaverespectthanfear...
Whenyououtsideonthestreets,youdratherbefearedthanrespected.Youdratherbefearedthan
respectedinthestreets,butinsociety,ofcourse,youwouldwantrespect.
Anothersaid:
Kidsturntothestreetsfortworeasons:one,itseasytogetthemoney.Youdontneedajob
application,youjustneedalittlecashandyoucanstarthustling.Two,theyrescaredtofail.Theydont
seerolemodelswhoaresucceedingoffthestreet,andtheyarescaredthatiftheymovepasttheir
comfortzone,theywontgetanywhere.
Violenceandtheneighborhoodenvironment.InNew
Haven,thePoliceDepartmenthasexaminedneighborhood
levelfactorsthatareassociatedwithviolentcrime.
Departmentanalyseshavefoundthatacombinationof
infrastructureservices(conveniencestores,
restaurants/cafes,bars,liquorestablishments,gasstations,
banks,etc),residencesofparoleesandreleasedprisoners,
drugmarketsandlocationsofdrugviolationsincertain
localitieshavestrongspatialrelationshipstoviolentcrime.
Basedonthisanalysis,about20%oftheareaofNew
Havenisconsideredhighriskforviolentcrimes.Inthe
Figure 7
Figure 8
-
8/3/2019 Creating a Healthy and Safe City
18/24
years2003to2010atleast75%oftheviolentcrimesthatoccurredintheCityhappenedintheseareas.
WhatexplainsthefindingsoftheNewHavenPoliceDepartmentonneighborhoodfactors,thanwhentaken
together,predisposeanareatocrime?Itiswellestablishedthatillegaldruguseanddrugtraffickingfuelviolent
crimeinmanycities29.Figure8showsthedistributionofnarcoticincidentsforSeptember2010asreportedin
theHavenIndependentCrimeLog.
Thegeographicaldistributionis
similartothedistributionofviolent
crimeratesasshowninFigure5.
Anumberofecologicalstudieshave
foundanassociationbetween
violenceandthedensityof
businessesthatsellalcohol30.
Gruenewaldetal30examinedthe
relationshipbetweenneighborhood
characteristicsandtherateof
hospitaldischargeforviolentassaultin1,637zipcodesinCalifornia.
Assaultsweremorelikelyindensely
populatedpoorminorityareaswith
unstableresidentialpopulations.
Aftercontrollingfortheeffectsof
thesepowerfulfactors,assaultswere
stillmorelikelyasthedensityofoff-
premisesalcoholoutletsincreasedin
anarea.Bars,however,wereonly
associatedwithanincreaseinthe
riskofassaultinparticularlypoorunstableneighborhoods.
Branasetal31identifiedallshootings
inPhiladelphiafrom2003to2006
andthenexaminedthe
characteristicsofeachpersonand
theplaces/hewasshot.They
matchedeachpersonwhowasshot
withacontrolwhowasnotshotandalsostudiedthatpersonandhis/herlocationatthetimeoftheshooting.
Theyalsoobservedthatbeinginaplacewithahighdensityofoutletsthatsoldliquorforconsumption
elsewhere(e.g.liquorstores,conveniencestores)doubledtherisk.Peoplewhowerebothheavydrinkersand
wereinareaswithahighdensityofoff-premisesliquoroutletshadover9timestheriskofbeingshot.Barswere
notfoundtoincreasetherisk.
Ahighdensityofalcoholoutletscouldincreasethelevelofviolencebecausealcoholismoreavailableinthese
areas.Alcoholappearstodisinhibitaggressionincreasingthelikelihoodthatsomeonewillcommitanassault30.
Intoxicationcouldalsoincreasetheriskofbeingassaultedifitreducesapersonsawarenessofapotentially
violentsituationorincreaseshis/herlikelihoodtoinstigateviolenceorover-reacttoaperceivedthreat31.If
intoxicatedpeoplecongregatenearliquorstoresthismayincreasethelikelihoodofviolenceinthearea.The
-
8/3/2019 Creating a Healthy and Safe City
19/24
tendencytowardviolencemaybeaccentuatediftheoutletsareinareasofweakersocialguardianship30asa
resultoflimitedpoliceinvolvement,retailconcentrationand/orneighborhoodinstabilitycausedbyillegal
activitiessuchasthedrugtradeandeconomicdisadvantage.
Finally,ahistoryofpriorcrimesorarrestsisariskfactorforcommittingafuturefelony.Amongfelony
defendantschargedwithviolentoffensesinlargeurbancountiesin2006,71%hadapriorarrest,62%prior
multiplearrests,53%atleastonepriorconviction,41%priormultipleconvictionsand35%priorfelony
convictions.Athirdofviolentcrimedefendantswereinvolvedwiththecriminaljusticesystematthetimeof
theirarrest(8%onprobation,11%onpretrialrelease,3%onparoleand6%other)32.
In2007,over1,200peoplewerereturnedfromtheConnecticutDepartmentofCorrectionstoNewHavenon
paroleorotherformofearlyreleaseandover2,800probationerslivedinNewHaven33.InNewHaven,
recidivismamongex-offendersisalargecontributingfactortocrimeinNewHaven.In2008,aboutthree
quartersofhomicidevictimsandsuspectsinNewHavenhadatleastonepriorfelonyconviction34.
Certaincharacteristicsareassociatedwithanincreasedlikelihoodofrecidivism.Amongthosereleasedfrom
DepartmentofCorrectionsinCTin2005greatersubstanceabuseproblemsandmentalhealthneedspredicted
anincreasedlikelihoodofrecidivismwithin3yearsofrelease.AboutaquarterthosereleasedinCTin2005hadreachedtheendofsentenceanddidnotreceiveanysupervisionfromparoleorprobation
35.Thisgroupwas
morelikelytorecidivatethanthosewhodidreceivecommunitysupervision.Recidivismcanbereducedby
initiativesthatassistex-offenderswithreentryintothecommunity.Theinitiativesincludefacilitatingaccessto
jobtraining,addictiontreatmentandidentificationcards34.
7.ConclusionsandNextSteps
ViolencetakesalargetollonthehealthandqualityoflifeofNewHavenresidents.Itisacity-widepublichealth
issuethatrequirestheattentionofall.However,theexperienceandeffectsofviolencearenotequallymanifest
acrossthecity.
Fatalinjurybyassaultisanimportantcauseofprematuremortalityinthecity.AmongNewHavenresidentsin
2007and2008,almostasmanypotentialyearsoflifetoage65werelosttomurderastocancer,heartdisease
andaccidents.Murderwasaleadingcauseofdeathfrommen15to29yearsofage.Mostofthefatalinjuries
werecausedbygunfireandoccurredinoutdoorspaces(street,sideways,parkinglots).Therewasalsoa
substantialburdenofinjuryfromassaultthatdidnotprovetobefatal.
TherearesignificantdisparitiesinNewHaven,withcertainneighborhoods,communitiesofcolor,andyoung
peoplebearingahugelydisproportionateburdenofthecosts.TheimpactonyoungBlackandHispanicmalesis
particularlypronounced.In2007and2008,murderaccountedfor39%ofthedeathsofBlackandHispanic
malesage1529.AllthosekilledbygunfireduringthatperiodwereBlackorHispanicmales.Theincidenceof
non-fatalinjuryfromviolencewasalsohigherforBlacksandHispanicsandformales.
Itisincreasinglyrecognizedthatwhereweliveisanimportantdeterminantofourhealthstatus,moresothan
manyotherfactors.ThisholdstrueinNewHaven.Intheyears2003to2010atleast75%ofviolentcrime
occurredin20%oftheareaofthecity.Areasofthecitywithhighratesofviolentcrimealsohavelow
economicstatusincludingpoorjobopportunitiesasindicatedbylowlaborforceparticipation.Morelimited
economicopportunity,inparticular,isaknownriskfactorforviolence.Reversingthepreponderanceofviolence
-
8/3/2019 Creating a Healthy and Safe City
20/24
intheseneighborhoodswillthereforerequireadecidedfocusontheunderlyingsocialandeconomicconditions
thatleadtoinstabilityandconflict.
Examplesofprogramstoreduceviolence.BlueprintsforViolencePreventionisaprojectthatidentifies
evidence-basedyouthviolenceanddrugpreventionprograms.Todate,ithasassessedmorethan800programs
fromwhichelevenmodelviolenceprogramshavebeenidentified.Theseprogramsaddressviolenceprimarily
ontheindividual-andrelationship-levelthroughtechniquessuchasschool-basedcurricula,individualandfamily
therapy,youthmentoringandhomevisits.Forexample,theBigBrother/BigSisterprogrammentorsyouth
typicallyfromsingleparenthomes.TheNurseFamilyPartnershipprovideshomevisitstoat-riskpregnant
women.TheFunctionalFamilyTherapyprogramprovidescounselingtothefamiliesofyouthwithmaladaptive
andacting-outbehaviors36.
Thereisadearthofresearchontheeffectivenessofcommunity-andsociety-levelinterventionsonviolence
prevention37.Inoneexample,theRANDCorporationevaluatedtheimpactofbusinessimprovementdistricts
(BIDs)onyouthviolenceinLosAngeles37.TheBIDswereself-organizinglocalpublic-privateorganizationsthat
collectedassessmentsandinvestedinlocal-areaserviceprovisionsandactivitiessuchasplacepromotion,street
cleaningandpublicsafety.Whiletheinterventiondidappeartodecreaserobberyratesithadonlyamarginal
effectonreducingthetotalviolentcrimerate.
TheCeaseFireChicagoprogramisanexampleofaviolencepreventionprogramthatincludesindividual-,
relationship-andcommunity-levelcomponents38.Theprogramfocusesonidentifyingasmallnumberof
individualswhowereathighriskofshootingorbeingshot.Outreachworkersprovidecounselingandservice
referralstotheindividuals.Otheroutreachworkers,referredtoasviolenceinterrupters,usetheirknowledge
ofthecommunitytoidentifyconflictsandprovidemediation.Muchoftheirtimeisspentworkingtoprevent
retaliatoryviolence.Additionally,theprojecthadcommunitymobilizationandpubliceducationcomponents
thataimatchangingcommunitynormsconcerningtheacceptabilityofusingviolencetoresolveconflicts.The
interventionactivelyinvolvesthepoliceintheoutreachandcommunitymobilizationefforts.Theevaluationof
thisprogramhasconcludedthatitdoessignificantlydecreasetheincidenceofshootingsandtheintensityof
shootinghotspots.However,anevaluationoftheOneVisionOneLifeprograminPittsburgh,whichwasmodeledaftertheCeaseFireChicagoproject,didnotfindittobeeffectiveinreducingviolence.
39
WorkingtowardaHealthierNewHaven:NextSteps.TheHealthEquityAllianceandHealthMatters!seekto
identify,developandadvancepoliciesthataddresstherootcausesofviolence.However,asdescribedabove
bestpracticesincommunity-andsociety-levelchangeshavenotbeenidentified.Inthiscontext,thisissuebrief
pointstonumerousareasforpolicychangeandstructuralinterventionthatareworthyofexploration:
Policiestoexpandjobopportunitiesforyouthandadultsandcontinuededucationopportunitiestoenablepeopletoaccessbetterpayingandsaferlessstressfuljobs;
PoliciestosupportphysicalimprovementstosectionsoftheCity,includingretailareas,experiencinghighincidenceofviolencesuchasbetterstreetlighting,reducedblightandimprovementstotransportation
facilities(sidewalks,busstops).Also,policiestoincreasecommunitystewardshipintheseareassuchasthe
expansionofcommunitypolicingprograms.
Policiesthatenableaccesstopositivesocialactivitiesforyouthandadultsbyopeningupschoolsandotherlocalvenuesforcommunityuse.
-
8/3/2019 Creating a Healthy and Safe City
21/24
Increasingdeterrenttohandgunuseinthecommissionofcrime.
Furtherenhancementofprisonerreentryprograms.
Finally,werecommendthat:
Asystematicreviewbeundertakenofcommunity-andsociety-levelviolencepreventionstrategiesimplementedinUScities.
TheCityofNewHavenadoptaprocess,suchashealthimpactassessment,tohelpguidedecisionsaroundthedesignanddevelopmentofneighborhoodsthatsupportsafeneighborhoodswithphysicallyactive
residents.
ThesearejustsomeexamplesofstepsthatNewHavenmightpursuetoeliminatedisparitiesforresidentswho
areundulyexposedtoviolenceintheirneighborhoods,andtoinstitutionalizepreventivemeasuresthatleadto
changedsocialnormsaroundviolence,andimprovedsocialandenvironmentalconditionsinallneighborhoods.
Someoftheseactionsarealreadyunderway,andlistedinAppendix2.Whatweneednextistoidentifythose
areasthatarestilllacking,andtotargetadditionalpolicyinterventionstoenhancetheworkthatispresently
occurring.
Ourcommunityseffortstoeliminateviolencewillnotonlyimpactoneofthemajorcausesofprematuredeath
inourcity,theywillalsoaddressabroadrangeofpublichealthconsequencesincludingthementalhealth
implicationsofexperiencingviolenceand/orlivinginanareathatisperceivedasunsafe,andthenegative
effectsoflivinginunsafeneighborhoodsonphysicalactivitylevelsofresidents.
-
8/3/2019 Creating a Healthy and Safe City
22/24
Appendix1.Methodsforidentifyingdeathsfromassault.
ConnecticutDepartmentofHealthsuppliesNewHavenHealthDepartmentwithdatasetsofelectronicdeath
recordsfromtheConnecticutDeathMasterFilesforNewHavenresidents.The2007and2008datasetswere
usedinthisanalysis.
DeathswithanICD10codeforassaultintheunderlyingcauseofdeathfieldoranyofthe20multiplecauseof
deathfieldswereconsideredassaultdeaths.ThesecodeswereX85toY09andY87.1.Ifoneofthesecodeswas
intheunderlyingcauseofdeathfieldassaultwasconsideredtheprimarycauseofdeath.
-
8/3/2019 Creating a Healthy and Safe City
23/24
Appendix2.ExistingPrograms&StrategiesinNewHaven.
Manyprogramshavebeendevelopedtoimprovecommunitysafety.School-basedandfamily-basedprevention
programsareabletoreduceyouthviolence.Programsinwhichformeroffendersmentoryouthathighriskfor
violencehaveshownsuccessinmanyurbanareas.Cognitivebehaviortherapymayreducethepsychological
harmthatchildrenendureduetoexposuretoviolence.Progressiveurbantrafficengineering,educationand
enforcementprogramshavereducedinjuriescausedbytrafficcollisions,whilegreatlyimprovingsafeaccessto
walking,masstransitandbicycling.Environmentaldesign(lighting,physicalcodeenforcement,improved
visibility,etc.)hasbeenshowntosignificantlyreduceopportunitiesforcriminalactivityandimprove
neighborhoodsenseofsecurity.
NewHavenPoliceDepartmentprograms
BlockWatchesandCommunityManagementTeams(CMTs)
LivableCityInitiative
Youth@Work
StreetOutreachWorkersProgram(CityofNewHaven/NewHavenFamilyAlliance)
NHPSSocialDevelopmentPrograms
NewHavenSafeStreetsCoalition
CityofNewHavenCompleteStreetsLegislation
NewHavenEarlyChildhoodCouncilFamilyEngagement
DomesticViolenceTaskForce
CitywideYouthCoalitionmemberprograms
CommunityMediation/PeerMediationinSchools
Mentoringprograms
NewHavenCollaborativeforYouth(behavioralhealth)
CommunityFoundationforGreaterNewHavenNeighborhoodsofChoice(e.g.,trafficcalminginChatham
Square)
YaleChildStudyCenterCommunityPolicingPartnershipandNationalCenterforChildrenExposedtoViolence
(NCCEV)
CliffordBeersGuidanceClinic
UnitedIlluminatingLighttheNight
-
8/3/2019 Creating a Healthy and Safe City
24/24
Appendix3.HealthEquityAlliance/NewHavenHealthDataWorkgroup
AmandaDurante,Epidemiologist,CityofNewHaven(Chairperson)
MarkAbraham,ExecutiveDirector,RegionalDataCooperativeofGreaterNewHaven(DataHaven)
ThomasButcher,ProjectDirector,RyanWhite,NewHavenHealthDepartment
BethComerford,DeputyDirector,Yale-GriffinPreventionResearchCenter
ShantaL.Evans,Director,NewHavenHealthEquityAlliance
LewisMadley,LaboratoryDirector,NewHavenHealthDepartment
ElaineOKeefe,ExecutiveDirector,OfficeofCommunityHealth,YaleSchoolofPublicHealth
JesseReynolds,DataAnalyst,Yale-GriffinPreventionResearchCenter
DavidSavage,Network for Community Engagement Coordinator,CommunityMediation,Inc.
ContactInformation
Aspartofthiswork,theHealthEquityAllianceactivelyseekscommunityfeedbackandquestionsaboutthe
informationwithinthisreport.Wealsowelcomeparticipationinourefforts.PleasecontactShantaEvans,the
HealthEquityAllianceDirector,[email protected](860)869-8779.