San Antonio plans to tackle violence with a public health approach. Here’s what that looks like.

A skyline view of downtown San Antonio. (Istock/Getty Images, Istock/Getty Images)

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San Antonio will become the latest Texas city to leverage a public health framework in a bid to prevent violence. The approach uses evidence and research to better understand the causes and circumstances of violence — and develop ideas to better avert it.

Officials in the state’s second largest city are focusing on four areas: Crimes committed by youth, incidents involving guns, sexual assaults and domestic violence. Residents identified those four areas as priorities.

“A public health approach to any community issue starts with understanding the nature of the problem: Using data, talking to residents and using that to advise us on what to do,” said Erica Haller-Stevenson, the city’s public health administrator. “Ultimately when you look at violence as a public health issue, you’re looking at it beyond public safety. You’re looking at the way violence impacts people deeply and over their lifetime.”

With the so-called beyond-policing approach, San Antonio joins Houston and Austin, whose similar programs are already underway and growing, as well as municipalities across the country.

“In the last 10 to 15 years, the public health community has really come to see violence prevention as something that is directly their own, and taken a more active leadership role in conversations about addressing violence,” said Jeff Coots, a professor at John Jay College of Criminal Justice in New York.

In San Antonio, officials who’ve worked on the plan expect to brief City Council members about it this month before formally launching. The first year may consist of a lot of researching and connecting dots and humans, according to a November draft shared by a city health spokesperson.

[A public health response helped reduce fatal car wrecks in Texas. Can it do the same for gun deaths?]

The draft plan outlines 50 prospective milestones for each of the four pillars. For instance, by December 2025, the initiative calls for increasing the number of firearms voluntarily surrendered under programs to help tackle gun violence and creating a map of services that support victims of sexual violence.

By December 2028, the plan aims to reduce the number of repeat sexual assaults and child abuse by people previously investigated or convicted of such crimes and decrease truancy in schools to help reduce violence among youth.

“We want to set foundations for the work,” Haller-Stevenson said. “Our community does a lot of work in some of these topics but people often are doing different things and we lose the opportunity to combine our efforts. If we combine our efforts and combine our resources, we could have a really big impact rather than scratching at the surface.”

Making sure violence prevention organizations are not operating in a silo is a key factor to the success of such programs that use a public health framework, according to criminologists.

There have been several shifts in recent years in how public officials — and everyday Americans — view law enforcement’s handling of crimes and the causes behind those crimes.

Police have received heightened scrutiny in the wake of several high-profile killings — including the 2020 death of Houston native George Floyd, who was murdered by a Minneapolis police officer.

At the same time, America’s murder rate increased in 2020 as the onset of the coronavirus pandemic upended society. And while overall crime has recently declined, the vast majority of Americans perceive it as increasing.

As the U.S. experienced decreases in crime last year from the previous year, Texas has seen a steady increase of gun violence affecting young people over the last decade, soaring suicides by gun in the last two decades and an overall number of gun deaths that last year reached a level not seen in almost three decades.

[“It’s hell”: Surge of Texas kids dying from gun violence carves canyons of grief through families]

Meanwhile, there’s also been more federal money available for the research of gun violence in particular. In 2018, Congress explicitly said that the federal government can study gun violence as long as the research doesn’t promote firearm control.

Criminologists say community buy-in will be vital to programs like San Antonio’s and can be achieved by working with leaders in neighborhoods that bear the brunt of violence. Adequate funding that ensures people remain connected to crucial services — like food benefits or therapy — will also be important, criminologists say. .

San Antonio officials do not have specific funding earmarked yet for the plan but have increased funding to a violence division of the city’s health force that has 104 physicians, deputy city manager Maria Villagomez said. That increase came from the city’s general fund and through federal government grants, she said.

“These programs need to be well-staffed and they need to have adequate resources so sometimes those can come with a price tag that is eye-popping,” said Dr. Alexander Testa, an assistant professor at UTHealth Houston School of Public Health in San Antonio.

Testa is the principal investigator of a program being established at Memorial Hermann in Houston to intervene in potential acts of retaliatory violence by talking to gunshot victims at their hospital bedside.

“The purpose of this is to use the hospital setting as a way to identify people who are at risk for violence and offer them an opportunity of resources to pull them out of that violent lifestyle,” Testa said.

There are other programs in Harris County.

An alternative 911 response sends teams of two — consisting of a certified EMT and a crisis intervention specialist — to nonviolent calls for service.

After launching in March 2022, the program aimed to respond to 751 calls in one particular sheriff’s office district, said Lupe Washington, director of the county’s community health and violence prevention services. The initial teams responded to more than 2,000 calls. The program has now been expanded into a second sheriff’s office district.

The county also runs a violence intervention program in four zip codes that have the highest rates of gun violence in the county. People from those communities, often called “credible messengers,” establish relationships with residents and try to intervene in potential acts of violence. They do that by helping those in need find resources like rent assistance, navigate bureaucratic systems and sometimes apply for jobs.

Additionally, the county has hospital intervention programs at two hospitals, including Ben Taub, which like Memorial Hermann is a level one-designated trauma center. That means they are equipped to offer the highest level of care for trauma patients, such as those with gunshot and stab wounds.

“We are out there really trying to be proactive,” Washington said.

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