HJBR Mar/Apr 2023

VIOLENCE Q&A economic and social supports they need to thrive, the skill sets to deal with conflict while also changing opportunities for vio- lence (e.g., access to guns) and to heal from the trauma, which has significant physio- logical and behavioral effects. Is there something we as the healthcare industry should be doing differently to help the situation? The healthcare sector has come a long way in trying to understand and address social determinants, and I would include structural and systemic violence as a key determinant. So, one key action would be to recognize the role that it may play in patient’s lives, as well as historically in terms of what patients have been through and the amount of healing that may be needed (and addressed to reach optimal health). That will take increased screen- ing for violence. Then, there is a need for resources, which the healthcare industry can also assist with. Providing necessary resources is essential, but it is difficult for the healthcare industry to do that alone for some resources (e.g., housing and economic support), which is why cross-sector part- nerships are essential. However, providing referrals and patient navigation to support patients is critical. Finally, providing greater access to affordable mental health services is also essential and certainly could be done within the healthcare sector, but it will also take structural (e.g., the way mental health services are reimbursed in this country) and social (e.g., stigma that still surrounds men- tal healthcare) changes. Can this be fixed or even eradicated in our lifetime, or is that just a pipe dream? Yes, it can. Systems and structures were created, and they can be dismantled and changed. We need the commitment, political will, and norms changing to make that hap- pen, but it is possible. There have been huge shifts in howwe understand and treat other health outcomes and behaviors (e.g., smok- ing and seat belt wearing); so, it’s possible, but we must work at a larger scale than just the individual — we need collective, societal shifts to eradicate violence. n “If we can treat the trauma, we can treat violence; if we can change systems and structures that foster violence and create trauma, we can change the course.”