Violence Reverberates Across Communities and Generations

October marked National Domestic Violence Awareness Month, and as part of our efforts, the Foundation was proud to support the October issue of Health Affairs — Violence and Health — which examines the consequences of violence for survivors, perpetrators, and communities. The idea for this important issue arose from a seed planted during a panel discussion at Grantmakers in Health three years ago and marks a real contribution to our collective work on, and understanding of, this pressing health issue.

Now that it has come to fruition, we’re reminded that this topic is as urgent and essential as it was then. The impact of domestic violence on our nation and the state of California runs deep. A 2017 Foundation-commissioned survey showed that 58 percent of Californians have been touched by domestic violence — either as a victim, as an abuser, or through a close friend or family member. That means more than half of our state’s population is affected by domestic violence. And that’s 20 million people too many. These sobering statistics show us that violence has been — and remains — an epidemic that threatens the strength of our communities, the health of our families, and the promise of too many futures.

Violence threatens the strength of our communities, the health of our families, and the promise of too many futures.

This important issue of the journal also connects the two aims of our Foundation’s mission — to make California the healthiest state and end domestic violence.

I was fortunate enough to attend discussions surrounding research in this publication in both Washington, D.C. and Los Angeles, and I wanted to share some of the ideas that resonated with me at both of those events.

One of my biggest overall takeaways was the need for a coordinated, prioritized research agenda around domestic violence. Researchers from many fields are pursuing areas of interest that touch on domestic violence. We need collectively to identify what the biggest and most important gaps in knowledge are, then push this agenda with public and philanthropic funders. We have a long way to go to build a body of knowledge, a formidable cadre of researchers, and a field of practice in this area of violence. No other major cause of injury and death has so meager an investment from government and philanthropy. We hope this selection of studies is just a starting point for research examining the intersection of violence and health.

No other major cause of injury and death has so meager an investment from government and philanthropy.

In DC, we had a rich discussion and made numerous connections among this varied but related group of papers, which fell into broader categories of community violence, mental health and suicide, and firearms. Some ideas that stood out to me: 

• Gender and race deeply influence the forms that violence can take, including who the perpetrators and victims are. Only one of the articles in this issue focused on domestic violence, and several others on race or place. But issues of gender, race, and inequity run through almost every article in the volume.
• Gun violence and mass shootings dominate our national dialogue about violence, along with a confusing and stigmatizing discussion of mental illness. But the impact goes beyond guns. While access to a gun makes it five times more likely that a woman will be killed by her abusive partner, there is also lethality over the long term in all forms of violence. The health effects of violence can show up a generation later in the form of life-threatening illness.
• We also cannot forget that violence is not just inflicted on others. Suicide and self-injury are as important to this discussion as murder and assault.
• Violence is shaped by social norms and conditions, which means it must be approached at a community and policy level. Interventions that work in one place may not work in another.

In LA, the presentations and conversation, which focused on violence and health as well as policy responses to violence, left me with these impressions:

• Criminalization of domestic violence is not the solution. Simply putting offenders in jail does not prevent recurrence of violence nor provide support that is needed for healing and change. Anticipated and actual police encounters for people of color, especially youth, create a lasting trauma.
• Preventing retaliation is an important aspect of breaking the cycle of violence. Retaliation only creates more violence.
• Health workers can have a powerful influence by using the “golden moment” after an incident of violence to counsel and to advise on preventive measures to take if there is a gun in the home.
• Business, organized labor, and youth are relatively untapped sources to drive change in norms and attitudes about violence.
• An opportunity exists to engage gun owners in changing norms around safety. 

A final conclusion from all of this research is a belief that remains at the core of our work: preventing domestic violence is possible.

Blue Shield of California Foundation has been among the nation’s strongest advocates for ending domestic violence, contributing more than $100 million to address and prevent domestic violence in California since 2002. We know that violence creates cumulative harm that spreads through generations and significantly impacts health and wellbeing — both directly and indirectly. Until we fully understand the connections and consequences of violence, we cannot stop its self-perpetuating cycle. However, we strongly believe that ending domestic violence is possible, and that together we can break the cycle of abuse so that we can create a new generation of Californians who are safer and stronger than ever before.

A final conclusion from all of this research is a belief that remains at the core of our work: preventing domestic violence is possible.