What is a public health approach

to domestic violence?

The framework of public health rests on the levels of prevention of illness, injury, and disease-- primary, secondary, and tertiary. The goal of primary prevention is to reduce the incidence of new cases by changing behavior or environmental factors, a truly proactive stance. The secondary level of prevention goes beyond identification to include appropriate early intervention (Flitcraft, 1993). Tertiary prevention is basically reactive, providing services as appropriate after the incident to lower repeated incidents of battering. The public health approach to domestic violence is committed to prevention at these various levels—a very different approach than that taken by the criminal justice perspective.

One of the major public health documents is the Healthy People Objectives For The Nation. This document, first published in 1990, lays out goals for health promotion on a wide variety of health problems to reduce the incidence of disease, disability and death and promote greater quality of life.

Despite its prevalence, domestic violence has only recently been recognized as a public health issue, with the Healthy People 2000 objectives specifically addressing the reduction of violence against women. After a decade of effort, considerable progress was made on many of the nineteen Health People objectives on Violence Prevention, with the notable exception of the goal of reducing the number of battered women turned away from shelters, in which there was movement away from the stated goal (National Center for Health Statistics, 1999).

Healthy People 2010 lists Violence Prevention as one of its major focus areas, and deems violence as 1 of the 10 leading indicators of the country’s overall health (US Department of Health & Human Services, 2000). Many of the remaining health indicators are very much related to domestic violence; among them are:

The goals of Healthy People 2010:

--by reducing domestic violence, we will be saving lives that would otherwise be cut short.

--by working to eliminate domestic violence, we will be enhancing the quality and safety of relationships, upon which life is based.

--many racial and ethnic groups experience domestic violence in disproportionate numbers. By engaging these communities to work together, developing local leadership and mobilizing their efforts, they can work toward reducing domestic violence (as well as other forms of violence) in a linguistically and culturally appropriate way that honors their norms and beliefs while promoting safety and accountability.

For more information on Healthy People 2010, click on www.healthypeople.com.

References:

Flitcraft, Physicians and Domestic Violence: Challenges for Prevention. Health Affairs, Winter 1993.

Center for Disease Control and Prevention, National Center for Health Statistics, Healthy People 2000 Review, 1998-99.