The U.S. Army and Violence Prevention: Thoughts on a Summer Interning at SCY
This week's blog was written by Nell Birch, medical student and recent intern at SCY, reflecting on her experiences this summer with SCY and Army training.
This summer, I chose to intern at SCY because I believe in the importance of a public health approach to violence, and because I wanted to learn more about the work being done to prevent violence in Chicago. The interconnectedness of our environment and our health has fascinated me since I began my study of public health in college. The role of toxic stress, violence, and other adverse childhood experiences in poor health outcomes has been well-documented, and as a medical student as well as a public health student, I know that addressing these determinants of health is vital.
Those beliefs, and my work with SCY this summer, is partly why I found my experience training with the United States Army so interesting. A year ago, I joined the Army as part of the health professions scholarship program (HPSP). This summer I attended a kind of condensed basic training and learned the essentials of how to be an American soldier. I shot a gun for the first time, aiming my M16 at the center of mass of a human silhouette. I learned about the rules of war, and the conditions under which the United States Army considers violence acceptable.
Even before this summer, I was feeling the dichotomy between my chosen profession and my role as a soldier. Although I’ll be working as a doctor, the Army emphasizes that everyone, commissioned or enlisted, is a soldier, and they are subject to the same standards of readiness regardless of their specific branch of service. It feels strange to swear “do no harm” at the same time I recite the soldier’s creed, which includes the line “I stand ready to deploy, engage, and destroy, the enemies of the United States of America in close combat.”
Despite this, and though the goals of SCY and the US Army at times seem wildly divergent, many of the reasons I’m interested in violence prevention are also the reasons I decided to join the Army—namely, the pursuit of health equity.
Violence Prevention and Health Equity
There is often a fundamental unfairness about the way that people who are most affected by violence get involved in the first place. Much of violence is socially, economically, or environmentally driven, and a number of victims are simply in the wrong place at the wrong time. Cycles of violence are difficult to escape, and exposure to violence can have an enormous impact on development and future achievement. The current model of violence prevention works to address this unfairness and to change situations that make violence seem inevitable.
Military Medicine and Health Equity
The Army, on the other hand, deals with another kind of inequity brought on by violence. The Army is currently facing a physician shortage that affects the quality of and access to care that soldiers receive. Soldiers’ interactions with violence are less random than those that plague Chicago, so the unfairness they face is more that when they are victims of violence, they may suffer harsher consequences because they cannot get the care that they need. Interestingly, this burden is distributed in a way that is similar to Chicago, since young African American men make up a percentage of enlisted military members that is disproportionate to the population of the U.S. Soldiers also face unique health challenges related to their service. Stress, exposure to violence, and living in adverse environments are influential factors affecting the health of soldiers, a fact well supported by the high rates of mental illness, substance use disorder, and even cardiovascular disease in current military members and veterans. And yet, they still don’t always get the amount or quality of care they deserve, despite being put in a position where they are more at risk to develop those conditions.
If equity is our goal in healthcare, and I believe that it should be, we need both practical violence prevention methods and equitable access to care for all populations. No one should have to suffer because they happen to live in a neighborhood affected by violence, just as no one should die or become permanently disabled by an injury for which they should have received treatment.
As a future health professional, I have the opportunity to address inequity, and feel lucky to work with both SCY and the US military to achieve that goal.