HJBR Mar/Apr 2023

HEALTHCARE JOURNAL OF BATON ROUGE I  MAR / APR 2023 27 Solutions. In New Orleans, homicides are occurring at a level not seen since 2004. New Orleans has the highest murder rate per capita in the U.S. Other cities like Baton Rouge and Shreveport are also well above the national average in rates of violence. Furthermore, the pandemic drastically increased the already wide gap between exposure to violence for Black and other minoritized populations, and this is partic- ularly the case within subgroups. For exam- ple, the firearmhomicide rate increased 35% nationally and 87% in NewOrleans between 2019 and 2020, with the highest rates and largest increases among black men and boys. And among pregnant women in both Louisiana and nationally, homicide is a lead- ing cause of maternal death during the peri- partum period. Is violence a disease, and, if so, is it an infectious disease? Violence is a major public health threat, and it has all of the historical, population, and individual characteristics of an infec- tious disease, e.g., routes of transmission, incubation periods, and different clinical outcomes. Research has also demonstrated the contagious nature of violence, among many types of violence. When an individual is exposed to violence as a victim or a wit- ness — in their community, at home, or else- where — they become more at risk of devel- oping violent behavior. However, there are other factors in addition to exposure and victimization that ultimately predicts likeli- hood of engaging in violent behaviors, like poverty. Louisiana has a long history. Is violencemore prevalent in Louisiana than it has been historically? It depends on the type of violence. Struc- tural violence was more overt back in the day, but it doesn’t mean that it is still not occurring today. Compared to the late 80s and early 90s, gun violence is not more prevalent but certainly has more media attention today than in previous years. That is also the case with other forms of violence too, given that most now recognize the pub- lic health threat of violence and there are more forms of surveillance and data sys- tems that can better capture violent events. Other forms like cyberbullying are more prevalent today than in previous years, given society’s technology advancements. According to the FBI, Louisiana has the highest violent crime rates in the United States. What makes our citizens more violent? First, to equate violent crime rates with individual propensity for violence is reduc- tive and inaccurate. Louisiana residents are not any more or less violent than residents of any other state. Rather, violent crime rates in Louisiana are connected to structural factors. Louisiana is consistently ranked as one of the worst states for overall child well-being, economic well-being, education, health, and in family and community and has one of the highest child poverty rates in the country. All of these factors are related to poor quality education and economic opportunities that perpetuate enduring poverty across the state. “When an individual is exposed to violence as a victim or a witness — in their community, at home, or elsewhere — they become more at risk of developing violent behavior.” Can violence be learned or unlearned? The wording of this question is problem- atic. Focusing on the individual serves to shift us away from the necessary focus on structural determinants (poverty, racism, and state violence) of violence inmany mar- ginalized and poor communities, but in all communities. We will not end the epidemic of violence by focusing only on individuals. The question we should be asking instead is what are the structural or macrosystemic factors that create the conditions for inter- personal violence in communities. The interpersonal violence in Black, Latine, and poor communities, in particu- lar, often stems from trauma — both individ- ual and collective trauma — resulting from concentrated and intergenerational poverty, economic and labor disinvestment in these communities, and unequal access to health- care services. If we can treat the trauma, we can treat violence; if we can change systems and structures that foster violence and cre- ate trauma, we can change the course. So yes, violence can be “unlearned” but most importantly, it’s about giving people the