Tuesday, April 13, 2010

An End to Violence?

This semester I've been auditing a course in Public Health Law and it has caused me to research the differences between the law enforcement model for dealing with crime and violence with the model that health care professionals use.

A publication by the National Institute of Justice compared the two models and their approach to violence. The most clear striking difference is the law enforcement focus on punishing offenders and making victims serve as witnesses. Public health professionals see both offender and victim as in need of services, medical and psychological.

Clearly, the modern policing and public health responses to violence have much in common. They both emphasize preventing the occurrence of violence over responding after violence occurs. They emphasize community involvement in identifying violence problems, setting priorities among them, and devising solutions. Both approaches suggest the possibility that carving up the general violence problem into component parts may reveal solutions that would otherwise remain concealed; just as skin cancer and lung cancer call for different preventive strategies, so might drive-by shootings, convenience store robberies, and spouse assaults.

Both approaches recognize that violence or its consequences may be preventable not only by changing individuals' behavior but by changing their physical or social environments--for example, by isolating illegal firearms, alcohol, drug markets, or lone employees who handle cash from places where unemployed young men congregate. Finally, both approaches begin with the notion that a community's violence level may be reducible in either of two ways: through a relatively sweeping intervention, such as reducing media violence, or by accumulating small reductions in violence, each achieved by finding and solving some specific problem that underlies a cluster of violent events occurring at one location, involving one set of perpetrators and victims, or arising from one kind of situation. In short, both approaches seek significant reductions in overall violence by solving one underlying problem at a time.

Agreement on these shared principles by no means ensures that practitioners of public health and law enforcement will approach a concrete urban violence problem in the same way. Comparative analyses have suggested that some subtle differences in priorities may have important operational implications. For example, the criminal justice models, both traditional and new, retain a commitment to punishing perpetrators of violence -- as both a matter of justice and a means of demonstrating to children and youths that society condemns violence. In contrast, the writings of public health practitioners rarely discuss the moral implications of intentionally injuring another person. Public health practitioners tend to view victims of violence primarily as persons in potential need of psychological and other services, whereas law enforcement practitioners often think first of victims' roles as witnesses. Both approaches view communities as important players in violence prevention. However, community policing practitioners tend to view officers as problem solvers on behalf of a community, whereas public health professionals stress empowering communities to solve their own problems, with or without police help. |Reducing Violent Crimes and Intentional Injuries - NIJ Research in Action|(emphasis added, citations omitted)

These views are also reflected in the fact that public health relies on research a more scientific approach, while law enforcement uses a political and moral approach.

As I'm deeply mired in the legal and law enforcement view, I find the public health perspective interesting.

Update: One reader wrote in to suggest that there is a regrettable lack of understanding and trust between the health and law enforcement communities.

Perhaps that is why it can be so challenging to work on a multi-disciplinary team.

Saturday, April 10, 2010


Skye Mountain Rescue team in action, originally uploaded by B℮n.

First Aid: Head to Toe Assessments

The Community Emergency Response Team (CERT)website has a new video up about checking a victim from head to toe for injury. Now, the check in this video would take place AFTER you've checked for breathing and a clear airway.

Here's the video link: CERT head to toe first aid assessment video.

Here's the video homepage generally.

This video was very helpful to me because checking the head and neck for injuries without aggravating any existing injuries is a concern of mine. I hope you found it helpful too.

For a first aid checklist, I use the following mnemonic.

ABCD: Airway - Breathing - Circulation - Damage

Tuesday, April 06, 2010

Collateral Murder & the Tragedy of War

Wikileaks production at Collateral Murder of the massacre of a dozen civilians in Iraq is tragic.

Watching the footage, I can understand how the aircrew could think the camera was an RPG in the stress of the moment and their reaction was swift. Listening to the audio commentary of the gunner and pilot is chilling.

But the callousness of these actors as revealed on the audio track shouldn't distract us from the larger issues raised by this episode. James Fallows makes an excellent observation when he writes:

[A]s with Abu Ghraib, there will be a strong temptation just to blame (or exonerate) the lower-level people who pulled the triggers, but that deflects us from real questions of responsibility.

There will be lot of those "real questions" to consider, from rules of engagement to the apparent cover up of the footage. But the threshold point I meant to start with is this: The very high likelihood of such "tragedies" occurring is a very strong reason not to get into wars of this sort.

By "of this sort" I mean: twilight-zone urban warfare, not to mention "discretionary" or "preventive" wars, and situations in which a heavily armed-and-amored occupying force of foreigners tries uneasily to mix with a population overwhelmingly of a different race and religion and language. For their own survival, the occupiers need to be hyper-suspicious and ever alert -- even though today's prevalent Counter Insurgency doctrine ("COIN") warns of the self-defeating consequences of behaving this way. (Indeed, a mounting debate about the COIN approach in Afghanistan is whether the effort not to seem distant from the local population is exposing US soldiers to too much risk.) It is a situation with enormous potential for miscalculation, misunderstanding, and tragedy. And therefore one to avoid if you have any choice at all....

We could not know that [the episode depicted in the Wikileaks video] would occur. But we could be sure that something like it would. It's not even a matter of "To will the end is to will the means." Rather the point is: You enter these circumstances, sooner or later you get these results.

A failure of tragic imagination is what I most criticized in war supporters in the months leading up to the invasion of Iraq, and it was much of the reason I opposed the war.

|Atlantic Online (emphasis in original)|

Mr. Fallows is far too diplomatic to say that George W. Bush and most of his ill-fated administration were warmongering fools, so please let me.

Wars are always tragic and often contain crimes against humanity such as systemic rape, genocide as well as chemical and biological warfare.

I'm not idealistic enough to think that we can easily abolish war... the end of war shall require significant human evolution. Not unimaginable, but not on the horizon either.

But this shouldn't cause us to sugarcoat the nature of war either. Major General William Tecumseh Sherman once wrote:

You cannot qualify war in harsher terms than I will. War is cruelty, and you cannot refine it; and those who brought war into our country deserve all the curses and maledictions a people can pour out.... You might as well appeal against the thunder-storm as against these terrible hardships of war. They are inevitable...|Letter to the Mayor and Councilmen of Atlanta|

I recall marching in LA against the invasion of Iraq, part of the largest anti-war protests the world have ever seen. But the dye was cast, Bush sent in the Marines... and what happened on the Wikileaks video in July, 2007 is certainly the type of crimes that happen when the Marines (and the Army and the insurgents) come to town.

The fact that Wikileaks broke this video is news in itself. Phil Bronstein observes how the Internet makes all of part of the discussion of this video and participants in the outcome.

I've seen a fair number of people killed in countries at war, including combatants, journalists and civilians. Even at ground level, though, in the midst of bone and blood spray, sorting things out is near impossible.

I am sure of one thing: tragedy aside, this is all good for us in the bigger sense, starting with the video release. Transparency is the victor here. More information and even more yelling back and forth gives everyone more data and opportunity to make up their own minds. And it keeps life-and-death topics like war fully in the bull's-eye heat of aggressive social interaction.

That's what's really changed since my war correspondent days. No one today has to be a passive non-combatant in the important moments of our culture. |The Wikileaks Incident: How Social Media has Changed Warfare Coverage - SF Gate|

I hope Congress holds hearings on this matter and all of the civilians killed in the invasion and occupation of Iraq, which some estimates believe could be as high as 100,000 souls.