Cincinnati Children's Blog

We can end carnage we see in our ERs

The carnage we see in our emergency rooms has to stop, and I am convinced we have the ability to do it.

The author has seen the results of violence in the Cincinnati Children's pediatric trauma center

We have been able to transform Haiti’s seemingly intractable epidemic of drug-resistant tuberculosis and AIDS and to get the indigenous population to take life-saving drugs, even though dominant ideology said it could not be done.

We have found a way for a paralyzed man or woman to use brain waves to operate a computer or move a motorized wheel chair.

Why, then, can’t we address the social ills plaguing our inner cities?

Our nation has the capacity to do so. The challenges are daunting.  There are issues of cost, complexity of administration and management of expectations.  But they are not insurmountable.

Top-down interventions to reduce urban violence and an exclusive focus on individual moral behaviors have never worked and will not going forward. Success over the long term will require concurrent transformational changes in the environments in which affected children, adolescents, and young adults live.

We know that violence, though highly publicized, is just one of a clustering of health disparities and social ills that are inextricably linked and associated with the truly disadvantaged. Other disparities include low infant birth weight, high infant mortality, obesity and accompanying diseases and complications – diabetes chief among them but also sleep disorders, heart disease and high blood pressure – asthma, unintentional injuries, and premature death from preventable illnesses. We know that these consequences of durable and increasing poverty are endemic to specific geographic communities.

If Cincinnati follows national trends, nearly 30 percent of our young black males between 19-29 years of age, living in areas of concentrated disadvantage, are involved with the criminal justice system – either on parole, on probation, or under community supervision. These same areas account for the highest infant mortality rate of any city in Ohio and high rates of low birth weight.

Accompanying these health-oriented consequences, in these very same communities, are shared social conditions such as pervasive moral cynicism, hopelessness and despair. Furthermore, urban sociologists have concluded that the systemic social dynamics contributing to social disorder, out-migration, withdrawal of civic involvement and deepening poverty are largely results of structural dynamics and less individual characteristics.

It is a tangled, Gordian Knot of factors that appear to be impossible to untangle. Without knowing it, we can easily revert to a fatalistic view that such communities will always be with us and that the best hope is to contain their problems so that they do not affect the “real world” around them.

We argue, however, that the solution to unraveling the Gordian Knot starts with mobilizing the assets of the community, individual, informal social entities, businesses, faith-based organizations, and institutions located there.

This community-based approach addresses both the individual and social underpinnings of the behaviors and related decision-making that prevail in troubled communities. It recognizes this social context of behaviors – those that are both helpful and damaging – must assume a more central place in our thinking of effective levers for social transformation.

Most importantly, it provides a critical piece of the answer to solving the puzzling knot that would deceive us into thinking that urban poverty is intractable.

Victor F. Garcia, MD, developed Cincinnati Children’s first regional Level 1 Pediatric Trauma Center and served as the director from 1991 to 2009. After seeing an increase in children admitted to Cincinnati Children’s with gunshot wounds, Dr. Garcia led the development of the Cincinnati Initiative to Reduce Violence and served as the Co-Chair until 2008. He is an integral part of ongoing efforts to reduce violence in Cincinnati’s inner-city core.


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