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Vol. LXII, No. 5
March 5, 2010

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Intersection of Violence and Medicine
Where Interventions in the Lives of Young Black Men Can Make a Difference

On the front page...

On its face, it may not seem natural to treat urban violence as a medical concern. But Dr. John Rich, a professor and chair of the department of health management and policy at Drexel University’s School of Public Health, made a compelling case for doing so during his recent Wednesday Afternoon Lecture Series appearance at Masur Auditorium.

Rich, a physician, is also director of both the Center for Nonviolence and Social Justice and the Center for Academic Public Health Practice at Drexel. He’s won a MacArthur Foundation grant, or “genius award,” for his innovative work in the area of understanding and preventing traumatic violence in inner-city youth and has been awarded funding from NIMH as well as the CDC. He has also recently published a book, Wrong Place, Wrong Time: Trauma and Violence in the Lives of Young Black Men.


  Dr. John Rich gives WALS talk in Masur.  
  Dr. John Rich gives WALS talk in Masur.  

Trained in internal medicine, he first began seeing the effect of violence on the youth of Boston, the city in which he completed his residency and the place where he first began meeting with young victims of gunshots and stabbings to learn why the cycle of violence seemed to perpetuate itself.

“Almost inevitably, after I had sat with them for an hour or so hearing their story, the young men would turn to me and say, ‘Well, Doc, I guess I was in the wrong place at the wrong time,’” Rich said.

These kinds of statements made him and his colleagues wonder if the victims were covering for their own bad behavior.

“We somehow assumed in many ways that young black men in particular didn’t just get shot, they got themselves shot,” he said. But this sentiment began to change when he reviewed the stories and realized there were common trends that trapped these men in a pattern of cyclical violence and repeat traumatic injury, and it wasn’t just coincidence.

By listening to the stories, Rich hopes, the medical community can begin to “think about what the wrong place and the wrong time really are and how we can create a right and safe space for these young people.”

Early in his career, he remembers seeing few young black men in primary care but plenty rotating in and out of the emergency ward. Wanting to change that dynamic, he founded the Young Men’s Health Clinic at Boston Medical Center. While this brought some men into a medical setting—some for the first time since they were children—Rich began to learn more about what normal meant for these people and what forces shaped their everyday lives.

Rich met with audience members after his talk for a further exchange of views.
Rich met with audience members after his talk for a further exchange of views.

He found that not only were four-fifths of them uninsured, but nearly half had experienced violent injury in the past, more than half had witnessed a shooting or a stabbing, nearly half felt harassed by the police and a quarter said they did not feel safe. As a result, they largely mistrusted the police, lived by the code of the street and had few outlets allowing them to break the cycle.

“It made me realize that the issue of trauma and adversity was very much primary in the lives of these young men.”

Digging deeper, Rich found that homicides involving black men under the age of 40 accounted for the vast majority of total violent deaths in Philadelphia (where he later moved to work at Drexel) and that other violent actions disproportionately included young black men. Nationally, homicide is the leading cause of death for black men between ages 15 and 24.

“In these communities where we are seeing these young men, they are constantly surrounded by violence,” he said.

The trend is compounded by exceptionally high rates of HIV infection, incarceration and unemployment, as well as a continuing thread of discrimination by police and hiring managers, which further complicates the lives of young men of color.

Beyond the weight of the human tragedy of those statistics, Rich found that the cost of treating violently injured men, as well as the loss of productivity, totaled in excess of $37 billion a year, making violent injury a major strain on the nation’s economy.

Rich then knew he had to record the narratives of these young men and analyze them to see what recurring violence and social trauma were doing to them and how he might be able to help. He played clips of the stories, including one from a man who had been shot in the head twice and lived to tell the tale.

Through interviews with men who had experienced at least one violent injury, he found that 65 percent met the full criteria for post-traumatic stress disorder. This information was a turning point for Rich and gave him insight into how—if the men were sent back home with no intervention strategies—it was likely that the men might be seen again in the emergency room.

This insight gave an emergency department-based intervention program—similar to the clinic Rich started at Boston Medical Center—a unique opportunity to step in. In the Healing Hurt People program at Hahnemann/Drexel Hospital in Philadelphia, a survivor of street violence serves as its primary liaison to patients who show up in the ER. The program, directed by Dr. Theodore Corbin, an emergency medicine physician, is able to intervene with these troubled men, letting them tell their stories and release their trauma and then focusing their energies on more positive coping strategies. Many of those same men now express a desire to shun violence and instead actively challenge themselves to get a job, go to school and stay away from illicit activities.

For Rich and Corbin, this is music to their ears, but it’s also just the beginning.

“There’s hope, and the hope depends on having a trauma-informed approach that recognizes the experiences of our patients and the experiences of violence,” Rich said. “And [it depends on] engaging them in the opportunities that allow them to envision the future.” NIHRecord Icon

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