Violence Is Also A Health Issue


April 17, 2009|By PETER HERMANN

More than a decade ago, Baltimore police commanders gathered in a Mount Washington conference room for an extraordinary meeting to lobby 50 city and state lawmakers. They were fed up with being the only group in town charged with ending the violence consuming the city - and the only one blamed for it.

The cops wanted judicial reform, such as a community court to deal with petty crimes that clogged the felony docket. They wanted swift and competent justice for the criminals they arrested over and over. Above all else, they wanted other agencies to help solve a complex problem beyond their control.

Police officers make arrests and try to prevent crime, but mostly their involvement starts after everyone else has failed - a years-long domestic dispute that ends with a bullet; a neglected child who ends up in the morgue; a man repeatedly let out of jail whose name ends up etched on the homicide board.

I thought of this as the city's health commissioner, Dr. Joshua M. Sharfstein, left for a top post in the U.S. Food and Drug Administration, and as the mayor started looking for his replacement. Sharfstein had accelerated what his predecessor, Dr. Peter L. Beilenson, had started - the idea that violence is just as much a health issue as it is a police issue.

For both, it was more than using their medical licenses to preach clean needles, AIDS prevention and drug treatment. They immersed their agencies with the addicts and the criminals on the street - Beilenson by starting Operation Safe Kids and Sharfstein by making Operation Safe Streets a top priority.

With Safe Kids, health officers and others monitor juvenile offenders and at-risk youngsters to get them help before they get locked up. With Safe Streets, health officers tap ex-offenders to mediate disputes between gangs before gunfire erupts. Both programs mesh with a state parole and probation initiative to identify violent offenders for close scrutiny.

It's a stretch to say the police meeting in 1996 led to this type of interaction, but I know it didn't exist back then. Cops publicly feuded with judges, prosecutors, and parole and probation agents, pointing fingers after each tragedy that could've been prevented.

The system certainly isn't perfect now - bad guys on the state's offender list still end up dead or in jail, as do juveniles singled out for special attention by the state - but at least they're tracked and studied with the goal of preventing more death in the future. They're not all lovey-dovey, but I don't want them to be. There should be healthy, public debate on how to confront this problem.

Sharfstein and Beilenson not only understood that concept but also made it a priority. It's not just mindless paperwork - it's an attempt to understand the city's violent culture. Understand why people are shooting at each other, and you might understand the root causes and prevent it.

Safe Streets and other programs are largely funded with donations from foundations and private citizens, proof that people are still willing to pay to find innovative ways to curb violence and crime. The city's next health commissioner will find himself on the front lines of a battle Baltimore has been fighting and losing for decades, and he or she would be wise to continue what has been started.

In 1999, three years after the cops met with the lawmakers, they established the Criminal Justice Coordinating Council, a task force of top law enforcement officials who meet once a month to discuss the city's problems. Not everyone agrees - cops want judges to be more strict, while the judges bristle at any attempt to influence their decisions from the bench.

But that everyone is talking shows there is at least some semblance of a plan. Beilenson, now the health officer in Howard County, told me that both he and Sharfstein view violence "as a public health issue and something that can be prevented. ... It's not just vaccinations and STD prevention, but it's looking at the major causes of mortality, injury, illness and death, and, obviously, drugs and crime and violence are part of the public health domain."

Let's hope Sharfstein's successor feels the same way.

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