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Why Communities Must Nurture Every Child

Dr. Deborah Prothrow-Stith, the Massachusetts Commissioner of Public Health and an assistant dean at Harvard School of Public Health, recently delivered the keynote address (excerpted here) at the 1996 Annual Meeting of the American Academy of Pediatrics in Boston.

Let me begin by reading to you a brief essay. It was written by a young woman, Tanya Parker:

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"Within each and every one of us there is a fear, maybe a fear of flying, a fear of an animal, or even the fear of death. My worst fear is dying in the street. Every morning I wake up and I kiss my daughter and I thank God we have made it through the night.

"I live in Spanish Harlem and I am surrounded by crack heads and drug dealers. This is not the type of environment I want to raise my child up in, but I'm stuck here, until I get to a higher level. Every night I can hear loud explosions. The children run through the streets screaming and cursing, as though fighting were going on. And you know a lot of times they're just doing that for fun because they want to be heard. They enjoy disturbing people at 4 o'clock in the morning by throwing bottles at cars, just to hear the alarms go off.

"Sometimes I sit in the dark and I think about when it is all going to end, or is this the end? I just keep feeling pain in my heart when I look at all the children in the streets suffering. It just keeps getting worse and worse. Tears run down my face when I embrace my daughter and I pray she doesn't become another victim of life. Everyone is born an innocent baby that is full of joy. All they want is to be loved and comforted, and they want to have play time and food. I began to wonder what goes through the minds of these teenagers that still receive love and comfort and play time from their parents. Why do they resort to violence, as a baby resorts to crying when hungry?...."

I read Tanya's essay often because it reminds me of some pretty important things. Actually, as a parent, it reminds me that my children will get my time and my attention and my money and my resources - one way or the other. But I decide whether it's going to be early on in a preventive and loving way, or whether it's going to be at 4 o'clock in the morning in the middle of a crisis....That's not just true for me as the parent of my children, that's true for me as an adult in the community. The children in the community will get my time and my attention and my money and my resources - one way or the other. As adults we decide through public policy whether it will be early on, in a loving and preventive way, or whether it will be 4 o'clock in the morning when they are throwing bottles at cars, just to hear the alarms go off.

I like Tanya's essay because it reminds me of the public-policy challenge that faces us. I wish that all you need do is be the best clinician or researcher or administrator that you can be. But that's not enough. We have to collectively attend to this public-policy issue, which is why I'm excited about the Academy's initiatives in this area of violence prevention. Because right now our country's public policy is out of step with ... what we need to prevent violence.

Tanya's essay also reminds me of that African proverb, it takes a village to raise a child. You know, at the end of the essay, she asks an interesting question. She says, now, when a child gets love and play time and food from his or her parents, why then would he resort to violence? What else does he want? ...

We've asked that question, maybe like this: "You know, that kid is from a pretty good family. I don't know how he got mixed up in this."... It's clear to us that having a healthy child in a healthy family is not enough, that if the community is unhealthy, by the time that child becomes an adolescent you can start getting some pretty bad outcomes. And our community is unhealthy...

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What else do they want?... I think they want healthy communities. They want other adults who care about them. They want small businesses that care about them. They want writers and producers of children's television who care about them. They want school teachers and school administrators who are doing more than collecting a check. They want elected officials who care more about them than getting reelected.... If we're going to deal with this problem of violence in America, it will be because we use our public policy to build healthy communities around all of the children, not just some ...

I'm reminded of a man whose son was killed. The reporter interviewing him said, "You know, you did everything right. Your son went to the best school. He was an athlete. He was a scholar. He had a scholarship for college. He was well-liked... You did everything right and yet he was killed." The man looked up and said, "I forgot to do one thing. I forgot to raise the other children."

As I started studying this problem I learned a few things that I want to share with you.... The first ... was that violence is preventable.... [The] homicide rate [22 per 100,000] that we had for young men in the United States in 1987 ... was 4.5 times higher than the next highest industrialized country ... [and] 70 times higher than the country at the bottom of the list.When I saw this, I said, "It's bad news." ... But the good news is this: Violence is not inevitable.... If it were, you would expect the homicide rates from country to country to be very similar. This kind of wide discrepancy said to me ... we're doing something wrong ...

There's another little bit of good news, which is that the '94 and '95 rates show a decline in some cities ... Boston is one of those cities. In fact, we have not had a homicide of a juvenile in this year 1996 to date, compared with 12 last year. That good news further reinforces, to me, that this ... is a problem we don't have to have.... It's also an American problem, not just an inner-city problem... Not just a problem of young black men or young Hispanic men, but Americans....

[The] homicide rate for white men in the United States [is about 17 per 100,000]. It is 3 1/2 times the next highest country, 45 times higher than the country at the bottom of the list - an American problem.... [The] homicide rate for young black men in the United States ... literally goes off the chart.... That homicide rate is about 160 per 100,000.

[These] data ... don't tell us as much detail by ethnic group as we'd like. A Latino young man could be labeled black, could be labeled white, could be labeled "other." The other thing that they don't tell us that is critical here is that there are socioeconomic variables that seem to be more important than race.

Though we measure this and label this as black, the studies that look at both issues of poverty and race show pretty clearly that this is a proxy for chronic urban poverty ... One study in Atlanta, repeated in New Orleans, used overcrowding, where overcrowded whites had the same high homicide rate as did overcrowded blacks. Less crowded blacks had the same lower rates.... [T]he homicide rate among young black men in the military is lower than the homicide rate for white men ... [and] these are young men with access to guns. [It] strongly suggests that social, political, economic, and cultural issues are the important issues, not race.

Why spend time here? Because some look at this and want to look at the genetic predisposition for violence. I want us all to read off the same page, as they might say in a Southern church, ... because while it's labeled race, it really is a marker for social, cultural, and political influences.

Guns and their availability are important to discuss. Alcohol and its role is important to discuss.... But ... we don't want to leave out this cultural factor ...

[W]e are a country that teaches our children to admire violence.... It's not just movies and television.... Our culture has become mean.... It's sports. You know, it's one thing to tell a kid to go tackle him. It's another thing to say, "I want you to put him out of the game for the season."

This meanness is ... in our public policy. It's in three strikes and you're out. It's in trying juveniles as adults. It's in stiffer sentences. It's in some of the most popular political rhetoric of the day.... We're caught up in this cycle that requires us to change - not the children, because they can't break the cycle.... It's up to us....

There are groups like Parents of Murdered Children, Mothers Against Violence in America. They have a huge role to play. In fact, I feel like they are the leaders of this national movement that is emerging ...

But the professional commitment is the one that I need to put on the table here today. Our public-policy challenge is about doing things differently, not stitching them up and sending them out, because we know that's mean. Not spending more money and more time on them, after they're pregnant, because we know that's mean. Not continuing to say, no more after-school, sorry you don't have a soccer team, maybe next time. That's mean. The meaner we get, the meaner they get. The meaner they get, the more trouble we're in.

We're in pretty big trouble right now.

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