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Can Health Reform Help Reduce Violence?

The Affordable Care Act could present opportunities for cities and counties to implement policies aimed at reducing violence, according to community leaders and violence prevention experts at a forum last week in Sacramento.

“In the context of health reform, I think there are opportunities we’ve never seen before that really emphasize the value of violence prevention,” said Leslie Mikkelsen, managing director for the Prevention Institute, a not-for-profit based in Oakland that runs health and violence prevention programs. “We have much better alignment now between health and violence prevention.”

The forum, “Preventing Violence, Promoting Health,” was presented by the Center for Health Improvement and co-sponsored by the California HealthCare Foundation, which publishes California Healthline.

It’s difficult to address the broad spectrum of violence at the policy level, forum participants said, because it’s so varied — from spousal abuse to street violence to child abuse. But they also said cities and counties across the state are using new funding streams to promote policy initiatives that view violence as a public health threat.   

“The cost of violence on society is huge,” said Howard Spivak, director of the Division of Violence Prevention for the Centers for Disease Control and Prevention. “But one of the biggest challenges is aligning services in communities.”

Spivak argued that, in order to be effective, there needs to be increased collaboration at the local, state and federal level, as well as among law enforcement agencies, schools, public health departments and faith-based groups. Those organizations must be able to share information to evaluate what’s working and what’s not.

“Everyone does have a role in this,” Spivak said. “Across the board [at] city agencies — [from] parks and recreation, to sanitation, to public health, to police.”

Paula Hawthorn works in Oakland for the not-for-profit group Soldiers Against Violence Everywhere, spending most of her time in some of the city’s most violent neighborhoods.

“I’m here because I’m looking for answers,” Hawthorn said, noting that the city is embattled with high homicide rates and pervasive street crime.

Spivak said work that Hawthorn is already doing, walking the streets doing outreach, and working with law enforcement and religious groups to get to the root of violence, is the right approach to combating the problem.

“We are already spending a lot of money on this stuff, and if we aligned it and directed it more effectively, we wouldn’t have to necessarily be talking about a whole lot more new resources to do violence prevention,” Spivak said. “Alignment means getting everyone at the table together.”

Benita Tsao, program director for the Prevention Institute, said California is ahead of the curve in looking at violence as a public health issue. She pointed to resources available under the ACA as a driver for prevention.

For example, she said, all health plans in 2014 will be required to cover violence screenings and counseling as a form of mental and behavioral health, as an essential health benefit. And there’s also new money available, such as community transformation grants, about $103 million in federal money for communities to create programs aimed at reducing smoking, poor diet and lack of physical activity.

“Today, more and more police chiefs and mayors are saying we can’t arrest ourselves out of this problem,” Tsao said. “Local health departments are embracing violence prevention as part of their responsibility, and the money is already there to get this going.”

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