Helping people live longer has been a central goal of medicine for decades. The quest to extend life raises an interesting question: Should we keep investing in research aimed at adding even more years to the already impressive gains in the average life expectancy that occurred during the 20th century?
Changing the Structures That Enable Sexual Harassment and Assault: A Public Health Imperative » SPH | Boston University
It has been nearly one year since The New Yorker and The New York Timespublished their investigations into Harvey Weinstein. In that time, stories of sexual harassment and violence have emerged from seemingly every corner of our society. We have seen high-profile allegations against prominent figures in politics, entertainment, and journalism, among other fields—and, just this week, a reckoning, when Bill Cosby was sentenced to 3 to 10 years in prison for sexual assault. These have done much to catalyze our present overdue reckoning with endemic sexual abuse in our society. Yet, as Thursday’s Senate Judiciary Committee hearing demonstrated, we are far from a national consensus regarding the voracity and import of these claims.
Moreover, as the many personal stories of abuse have shown—often shared using the viral #MeToo hashtag—the vast majority of sexual harassment does not make headlines. A chart from the Center for American Progress shows how common sexual harassment is in almost every industry (Figure 1). I note that even these figures almost certainly under-record the prevalence of sexual harassment in the US population, and do not include particularly high-risk populations like sex workers.
Figure 1. Total sexual harassment charges filed, by industry, fiscal years 2005 through 2015
Frye J. Not Just the Rich and Famous. Center for American Progress Web site. https://www.americanprogress.org/issues/women/news/2017/11/20/443139/not-just-rich-famous/Published November 20, 2017. Accessed November 21, 2017.
That systemic sexual abuse is now being more fully addressed suggests we may have finally begun to reckon with the gender inequities and entrenched power imbalances that allow such harm to flourish. The existence of these conditions shows that this crisis is not just a matter of powerful people using their position to hurt others, but a failure of society to stand up for the values of justice and inclusion that should be a bulwark against exploitation of any kind. It also opens the door to how public health can help mitigate the problem of sexual harassment and violence, by working to build a society where this is no longer acceptable.
This epidemic has long been a cruel fact of life for the 321,500 Americans over the age of 12 who are sexually assaulted or raped each year; the very ubiquity of sexual violence places it at the heart of public health. One in five women, and one in 71 men, will experience rape at some point in their lives, yet 63 percent of sexual assaults are not reported to the police. A small silver lining appears to be that sexual assault and violence seem to be decreasing in the US. According to the Rape, Abuse & Incest National Network (RAINN), the rate of sexual assault and rape has fallen by 63 percent since 1993. Additionally, harassment in the workplace appears to be decreasing, with the best data on this (General Social Survey data) showing a decrease from 6.1 percent in 2002 to 3.6 percent in 2014. As with other challenges to population health, sexual violence affects some populations more than others, with marginalized groups suffering most. Women, especially women of color, experience disproportionately high rates of sexual violence—90 percent of adult rape victims and 82 percent of juvenile rape victims are female. Rates of sexual violence are comparable or higher among LGBT populations compared to heterosexual populations. Transgender populations are at a particularly high risk of experiencing sexual assault—for example, 12 percent of students expressing a transgender or gender non-conforming identity in grades K-12 reported experiencing sexual violence. Although it is difficult to compare populations due to underlying demographic differences, age-adjusted estimates suggest that sexual assault of people with disabilities is about twice as high as for those without disabilities.
In addition to the trauma associated with harassment and abuse itself, there is abundant evidence that sexual harassment and violence is associated with subsequent poor health. A recent study found workplace sexual harassment exposure is linked with a higher level of depressive symptoms. Other studies have reported similar findings, including an analysisthat linked harassment to feelings of anger, self-blame, and self-doubt. The effects of sexual violence include self-harm, substance abuse, depression, post-traumatic stress disorder (PTSD), sleep disorders, and suicide attempts. In the US army, women with administratively recorded sexual assault victimization had higher odds of later mental health treatment, attempting suicide, demotion, or attrition. Early lifecourse sexual assault has been linked with an elevated risk of HIV infection and teenage pregnancy. As I have reflected in previous notes, exposure to traumatic experiences affects health across the lifecourse.
The goals of public health are inseparable from the goals of social justice—to create a world where the conditions around us allow everyone to thrive, where there is equity between groups, where inclusion creates the networks and bonds that nurture well-being. A society characterized by systemic sexual harassment and violence is one where these goals have not been reached. Addressing this problem means addressing the core concerns of public health—the improvement of conditions in which people live and work, and the closing of health gaps—to create a culture that no longer accepts sexual violence and the broader injustices that enable it. It means reckoning with perpetrators and identifying humane and evidence-informed ways to ensure that they do no further harm, and creating a world where collective action ensures that sexual violence is unacceptable, protecting all. The military provides an example, in microcosm, of how improving community conditions can mitigate the likelihood of sexual harassment and assault. In a recent study, our team foundunit support—including factors such as comaraderie and acceptance of women as part of the team—was linked with lower risk of sexual misconduct. This suggests the key role of equity, respect, and inclusion in mitigating assault and harassment.
How can we help foster these conditions? First, we can continue working towards a community that prizes fairness, equity, and, above all, social justice, where all are treated with dignity and respect. To do this, SPH, and the broader BU community, remain committed to providing resources for students, faculty, and staff to report any harassment or assault they may have experienced. As outlined in a recent message from Provost Jean Morrison, BU’s Sexual Misconduct/Title IX Policy and Student Sexual Misconduct Procedures will remain the same, despite the issuing of new guidance from the US Department of Education. The Sexual Assault Response & Prevention Center (SARP) is also on hand to provide confidential support and promote prevention through educational programs. The Office of the Ombuds is an additional safe space where members of the BU community can discuss concerns about sexual misconduct in a confidential setting. Finally, Boston University is implementing mandatory, University-wide sexual misconduct training for all students, faculty, and staff. Last week, the Provost sent an email to the BU community outlining this training; details can also be found on the University’s website. This training is an important opportunity for us to become ever-better at ensuring our community remains a safe, respectful space for all.
Second, we can lend our voice to the ongoing discussion around the issue of harassment and sexual violence. Public health is inextricably linked to the broader conversation—it is this conversation that shifts attitudes towards making the acceptable unacceptable, in order to improve the social, economic, and environmental conditions that shape health. This fits with our role as an academic community—to contribute to the ongoing discussion about health, and, through this engagement, to nudge public opinion in a healthier direction. This is, in part, what I am trying to do with this note, and what we can all do in our respective spheres. Systemic inequities, and the poor health they create, thrive on society’s lack of engagement with core challenges. It is only by having honest, sometimes difficult conversations that we can lay the groundwork for a healthier world.
Finally, in an effort to facilitate such conversations, we will be hosting a discussion about the Kavanaugh Supreme Court nomination hearings and sexual violence on Tuesday, October 2, from 2:30 to 5 p.m. in Hiebert Lounge. This event provides an opportunity for members of our community to be together and discuss the topics emerging around the Kavanaugh Supreme Court nomination hearings—specifically, the topics of sexual violence, support for survivors, and adolescent perpetration of sexual violence. The event will be informal, and any thoughts, questions, and perspectives are welcome. All students, staff, and faculty are invited. Professor Emily Rothman and SPH alumna and instructor Nicole Daley will help begin the conversation. We will be joined in the conversation by Provost Jean Morrison, Dr Lisa Fortuna, and Professor Megan Bair-Merritt.
If there is anything positive to take from the disturbing news emerging from recent events, it is that we may use this as a time to engage in thoughtful conversation, and to redouble our efforts to create the conditions that improve the health of all.
Until next week.
Warm Regards,
Sandro
Acknowledgement: I am grateful to Professor Emily Rothman, University Ombuds Francine Montemurro, Meaghan Agnew, Kara Peterson, Catherine Ettman, and Eric DelGizzo for their contributions to this Dean’s Note.
The Public's Health: Mental Health on Campus | Public Health Post
College students experience highs and lows. But with more than 10% of today’s students reporting suicidal thoughts, the highest rate since the first widespread surveying on campuses, the lows appear to have deepened. College counselors point to growing stress and distress among students, with more than a third reporting that they have been diagnosed with a mental health condition, most often anxiety or depression, but also increasingly with eating disorders and forms of self-harm. There is considerable variation across schools, not explained by school size or competitiveness, but there remains a consistently higher prevalence of all mental health problems among students from lower socioeconomic backgrounds (financial stress is the most common risk factor) and among students with minority gender and sexual orientations.
Health Is an Extension of Politics | Dean's Note
If there is one lesson that recent years have taught us, it is that elections matter. The outcome of the 2016 election had consequences for our country, our world, and our health. Some of these consequences have been excruciatingly immediate. They include the physical and psychological harm done to children who have been separated from their families at the US border, the danger faced by women all over the world who lack basic reproductive care due to the Trump administration’s reinstatement of the Mexico City Policy, and the devastation in Puerto Rico that was worsened by the administration’s indifferent response to Hurricane Maria. Other, less-immediate consequences will be felt most strongly in years to come, especially if the US does not change course from the administration’s policies. They include the environmental damage caused by industrial deregulation, the danger of disinvesting in public goods, and the widening economic inequality that the administration has done little to halt and much to advance. In recent weeks, we have seen these imminent and long-term dangers converge in the potential appointment of Brett Kavanaugh to the US Supreme Court. Should Kavanaugh be confirmed, he will likely be the deciding vote on a range of issues core to health, including reproductive rights, the legal equality of the LGBT population, and voting rights.
Health is Politics on a Grand Scale | Fortune
When I suggest that health is linked to politics, many readers will likely think about the political back-and-forth around Obamacare that gripped the country for a decade. And Obamacare—designed as it was to provide as many Americans as possible with access to health care—matters indeed. But, I would argue, it is one very small piece of a larger picture. And that picture is that health is inextricably linked to politics, on a large scale.
The Public's Health: Broken Justice and the Public's Health | Public Health Post
The incarceration rate in the United States (698 per 100,000 people) is higher than any other large country in the world, and nearly five times higher than the median worldwide. There are about 2 million incarcerated adults, or nearly 1 in 100 Americans. Meanwhile another nearly 5 million people are on probation or parole, for a total of 7 million adults—about 1 in 35 US residents—under correctional supervision.
Building Cities That Bounce Back | Dean's Note
Last week, I co-wrote an article with Joan Saba, a partner at the architecture firm NBBJ, on how we can build more resilient communities by combining the ideas of architecture and public health. With hurricane season underway, the need for such resilience has rarely been more apparent. As I write this note, Hurricane Florence approaches the Carolinas and news reports warn of the storm’s potential destructiveness. These reports come almost exactly one year after Hurricane Maria showed us how devastating such storms can be. Whether Florence will approach Maria’s devastation is a question to be answered by time, hopefully in the negative. However, whether or not the Carolinas—or any region—have the resilience to absorb and recover from a disaster like a hurricane is a question we can indeed answer now.
The Public's Health: The Promise of Palliative Care | Public Health Post
As the population ages, patients seeking care for multiple chronic conditions has become the norm. Sixty percent of Americans die following a prolonged illness; the “compression of morbidity”—the burden of disease and disability limited to a brief time before death—has not yet become a reality in the United States. The care of persons with serious chronic illnesses like cancer and heart disease then often falls to families whose members absorb the burden of a loved one’s needs, with negative effects on their work, finances, relationships, and community engagement.