Domestic Violence: A Lifelong Intervention — 2019 National Summit

On average, nearly 20 people per minute are physically abused by an intimate partner, meaning more than 10 million Americans are victims of physical assault in just one year. Over 4 million children a year are exposed to some form of physical violence in their homes, and African Americans and Latinos are more likely to experience both male to female or female to male intimate partner violence than any other demographic. Domestic violence can be emotional and economic abuse. Perpetrators may use control or isolation, along with verbal abuse such as coercion and threats to intimidate victims. To get to the root cause of why violence occurs, we must view trauma at different stages across the lifespan and develop effective solutions at these stages to ensure violence is not replicated. This was the topic for “Breaking the Cycle: A Life Course Framework for Preventing Domestic Violence,” a Breakout Session at The Root Cause Coalition’s 4th Annual National Summit on the Social Determinants of Health. Arnold Chandler, President of Forward Change Consulting, joined other health equity leaders to examine the importance of a multigenerational approach to address social determinants of health as it relates to domestic violence.

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Forward Change partnered with Blue Shield of California Foundation to approach a framework of life course analysis as a pathway to prevention. Interviews with domestic violence field leaders, research and longitudinal studies were used to show the significance of early detection. “If we’re thinking about prevention, we have to think about it intergenerationally,” Chandler said. Chandler reminded his audience that we are most vulnerable as children, during the time when we observe and learn behaviors that we adopt in adulthood. “Domestic violence is more concentrated among young people,” he said. “A large share of the children exposed to domestic violence are under age 5.”

Brain imaging in infants exposed to domestic violence affects how the brain functions, even in utero, and research has shown the effects can be as harmful as PTSD. Babies born to mothers who were subjected to violence are more likely to experience inflammation, which contributes to poor health and a higher propensity for depression. Witnessing abuse as a child puts you at higher risk for health problems like anxiety, depression, heart disease, diabetes and other health issues. Because women between the ages of 18-34 experience the highest rates of intimate partner violence, Chandler says stressors in early relationships including young parenthood may contribute to turmoil in the home, and is only exacerbated when others are living in poverty. Unemployment, substance abuse, alcohol, education level and other life course development factors can determine the likelihood that someone will commit or be exposed to violence.

Prevention of intimate partner violence across the lifespan means an investment in holistic care that prioritizes the social determinants of health from the minute an individual is born. The CDC provides a framework for combating domestic violence, which includes strengthening economic support for families and modifying, “the physical and social environments of neighborhoods.” Hospital systems and the community must work in coalition to ensure that individuals receive the social support they need at home, which will support their mental and physical health. Social services can provide counseling, employment and vocational training, but we must invest in them and destigmatize asking for help so that the public knows where to receive support, particularly in vulnerable populations. According to the Rural Health Information Hub, a “lack of providers plays a role in the overall care of victims and survivors of abuse, with limited funding and higher per capita costs for social services leaving limited resources for specialized staff to help with violence and abuse support.” Cross-sector collaboration among healthcare providers, social service community groups, schools and faith-based organizations can also help prevent violence through proper training to identify warning signs, and also act as avenues of support. Increased screening, telehealth access and informational brochures may help increase knowledge on risk factors and help destigmatize coming forward for victims.

Through a life course examination of a home environment, generational habits and access, health equity leaders may more effectively identify and target specific prevention pathways for addressing root causes of poor health, including domestic violence. There is an increasing need to address the social influencers that can impact a lifetime of health and perpetuate unhealthy behavior. Root Cause Coalition Partners provide resources for victims of domestic violence on how to identify unhealthy behavior, mitigate it, and leave an unhealthy situation. Conferences like the Root Cause Coalition’s National Summit continue to explore related avenues that impact health through research, development and methodology across sectors. For our efforts to be sustainable, it’s important that we remember how social determinants impact the community, because the community is who we rely on to help create a replicable framework that ensures all individuals achieve health equity in our time.