HJBR May/Jun 2023

violence prevention, there are so many touch points where we can make a differ- ence. In my talk today, I’m going to give several examples, and one is there are evidence-based programs, like “Caught in the Crossfires” and “SafeER Teens,” where you can intervene in the healthcare sys- tem — whether it’s referral to community resources, motivational interviewing — to help reduce future violence and some of the health outcomes. There are also things that can be done in the communities. We pub- lished this in our “Vital Signs” [report] ear- lier this year, looking at firearm violence — things like community greening where you take a vacant lot and you green it, brings communities together, decreases violent crime because the area is no longer blighted and brings connectedness. Those are a lot of the ways that we can start to really build communities and prevent violence. Editor Do you think it’s possible to elimi- nate violence in our lifetime? And if so, how? Houry Yes, I think violence is a broad term because when you look at it like child mal- treatment, suicide, partner violence, youth violence... my hope is we reduce it. I would certainly love to eliminate it, but I think if we could reduce it in our lifetime, that would have significant consequences. One of the ways we do that is focusing on childhood trauma or adverse childhood experiences because if you were exposed to childhood trauma, including abuse yourself or wit- nessing it in the home, you’re more likely to go on to have five of the 10 leading causes of health conditions and death. So, if we can prevent childhood trauma, that will prevent future violence and health conditions. Editor I read that article that you published on violence and health conditions; it was an interesting connection between the two. I’m not quite sure we’re looking at violence as a community that way. Houry I think that’s why focusing on early childhood is so important, whether it’s education, nurse-home partnerships, and family visitation, parenting programs, all of that can really put together the building blocks that are needed. Editor You must hear a lot of scary scenar- ios at CDC. Which ones keep you awake at night? Houry I gave a lecture to med students yes- terday, and I called it my sleep at night rule. I always say, tackle everything you can so that you can sleep at night. I think for me at CDC, it’s just making sure we are always able to stay on top of some of these new emerg- ing pathogens and infectious diseases. We do that through a lot of our surveillance systems. Right now, there’s an outbreak in two countries with Marburg, and that cer- tainly worries me because there aren’t a lot of therapeutics or interventions for that. But then on the flip side, I look at what hap- pened pre-pandemic with things like mater- nal mortality, violence (as we talked about), drug overdoses, and those were going up before the pandemic and then worsened. So, I say if anything keeps me up at night, it’s that we need tomake more progress on a lot of the leading causes of death in our coun- try. There’s a lot more that we can still do. Editor You have the ears of the leadership in Louisiana right now. What do you want them to know that they may not know already? Houry I’d say a few things, and one is we can prevent so many health conditions and issues through public health. By investing in public health now, we prevent diseases and long-term issues later. It’s a cost savings. It does cost money to invest in public health and prevention, but it saves long-term. There are ways we can do that, whether it’s through making sure that we have more community health workers that are able to go out to communities to provide vaccina- tions; that we have these early childhood interventions to prevent childhood trauma — I think that is really important to prevent some of these long-term consequences; then I think making sure people are aware of things like high blood pressure, diabetes, cancer screening, really staying up to date on all the prevention screening that’s needed to prevent having those consequences of cardiac disease, end-stage cancer, all of that when we can, earlier on, intervene. Editor A lot of those we believe are tied into our food system, the food that we actually eat, and the poorer you are, the less healthy options are available to you. Is the CDC looking at that, and is there any kind of policy change that might be able to help? Houry We’re doing a lot of work around health equity and social determinants of health. We are funding some communi- ties to do pilot programs where there’s a food desert. How do you then bring in local farmer’s markets to ensure that these com- munities do have access to fresh fruits and vegetables, and how do we ensure that these communities also have physical activity and safe walking paths? We are looking at a lot of ways to decrease the disparities we’re seeing in a lot of these health equity conditions. Editor So, if a community wants to sign up to make that happen in a particular area, they just reach out to...? Houry On our website, we have information on health equity, and we also have informa- tion on our social determinants of health grant program. It’s a small program at this time, but one that we’re always happy to provide technical assistance to communi- ties on as well as best practices. Editor Well, thank you. Is there a question you wished I would’ve asked you? Houry Yeah, I would just say at CDC, we have data to where they can look at COVID, they can look at flu. Certainly, we even have emergency department surveillance of other conditions as well. We have local and state data for communities to really see what the pressing health issues are, so they can monitor and respond too in timely fashion. HEALTHCARE JOURNAL OF BATON ROUGE I  MAY / JUN 2023 23