C. Social Health
Crime represents a serious threat to neighborhood stability that can affect the residents’ health directly through violent acts, substance abuse, and financial loss. Crime directly impacts neighborhoods when residents decrease outdoor activity to avoid exposure to unsafe conditions (Ross, 1993). Fear of crime is also associated with prolonged stimulation of the fight-or-flight response, which in turn is linked to reduced resistance to infection and cancer as well as the exacerbation of chronic health conditions (Fremont & Bird, 2000). Crime influences health indirectly because the presence of recognizable cues sends a message that social cohesion is weak. Even low-level property crimes such as littering, vandalism, and graffiti are signs of a disorganized community, the implication being that social cohesion has been replaced by individualism and alienation. An organizing framework that distinguishes social health in a neighborhood includes the following: (a) physical features of the environment shared by all residents in a locality; (b) availability of health environments at home, work, and play; (c) services provided, publicly or privately, to support people in their daily lives; (d) sociocultural features of a neighborhood; and (e) the reputation of an area (MacIntyre, Ellaway, & Cummins, 2002). This research paper now presents these components with reference to an existing public health and criminal justice collaboration: the Chicago Smart Start project.
The Chicago Smart Start project is budgeted for $3,350,000 over a 5-year period and is co-funded by the city of Chicago and the U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention (Chicago Safe Start, 2008). The mission of Chicago Safe Start is to prevent and reduce the impact of exposure to violence on children ages 5 and younger. The project is a true reflection of the adoption of a public health perspective by the criminal justice system. With an emphasis on quantifiable outcomes, Chicago Safe Start categorizes social health into risk factors, protective factors, and treatment (Chicago Safe Start, 2008).
Risk factors are characteristics, variables, and/or conditions present in individuals or groups that increase the likelihood of that individual or group developing a disorder or adverse outcome (National Center for Children Exposed to Violence, 2008). Chicago Safe Start subdivides risk factors into four categories: (1) biological (e.g., prenatal exposure to drugs and/or alcohol), (2) individual (e.g., low academic achievement, including poor reading skills or a weak commitment to education), (3) family (e.g., exposure to and reinforcement of violence in the home), and (4) community (e.g., presence of gangs and drug dealing, which provide violent role models and rewards for violent behavior).
Protective factors are characteristics, variables, and/or conditions present in individuals or groups that enhance resiliency, increase resistance to risk, and fortify against the development of a disorder or adverse outcome (National Center for Children Exposed to Violence, 2008). Chicago Safe Start subdivides protective factors into three categories: (1) individual (e.g., capacity for empathy and respect for all people and their values), (2) family (e.g., positive, sustained attachments with at least one adult family member, teacher, or other adult), and (3) community (e.g., schools, families, and peer groups that teach children healthy beliefs and set clear standards).
The accumulation of protective factors can theoretically offset the accumulation of risk factors, leading to a promotion of social health; however, when communities disproportionately experience the burden of risk factors, then efficacious treatments must be developed. Public health officials define treatment as a form of intervention that is typically long term and characterized by an ongoing relationship with a particular type of service provider. The goal of treatment is to provide long-term support and remediation of symptoms (National Center for Children Exposed to Violence, 2007). The Chicago Safe Start project addresses physical health by linking Medicaid to clinical services. Services include, but are not limited to, screening, diagnosis and assessment, testing, psychotherapy, prescriptions and medication monitoring, emergency care, and health education. Mental health treatments are provided by linking separate funding sources, such as the Committee on Women’s Treatment and the Domestic Violence and Substance Abuse Initiative. Community health targets high-risk teen parents, by providing home visits, screening and assessment, and parent group services.