"I think all violence that interrupts and disturbs the stability of families, communities, and people should be looked at. Gun violence is under the umbrella of overall violence."
It’s National Public Health Week, so last week, Dear Evanston's Linda Gerber spoke to Evonda Thomas-Smith, Evanston’s Director of Health and Human Services. In a wide-ranging interview, Linda and Evonda discussed youth gun violence, Evonda’s work, and ... her grandmother.
We thought this week would be the perfect time to post the interview.
PART I: EVONDA ON GUN VIOLENCE AND PUBLIC HEALTH
DE: Should gun violence be treated as a public health crisis?
ETS: Well, I make it more global than that. I think all violence that interrupts and disturbs the stability of families, communities, and people should be looked at. Gun violence is under the umbrella of overall violence.
We’re at crisis level with all forms of violence. Sexual assault, physical violence, emotional violence. It’s tearing the fabric of our communities and so it is a public health crisis and a true social public health problem.
DE: We’re used to hearing about violence from the point of view of the police. How is violence viewed from a public health perspective?
ETS: Public health practitioners look at violence like an epidemic, like an infectious disease, or an infectious process. And when we address any epidemic, or any infectious process, we have to do an assessment. We survey the landscape. So we do surveillance tracking.
What that means is that we look at the number of incidents or the number of cases. In a gun violence situation, we may look at the number of shots fired in a particular area. We may look at the number of homicides that are related to gun violence. We do this assessment to see what we’re dealing with. And understanding the numbers, the number of cases, the number of incidents, the number of times that it occurs, gives us a really good picture of what do about it.
Then we assure that the information we find is compiled and shared and that a treatment, or intervention, or program, or activity is created to address the issue. And then we establish policy that really holds us all accountable as to how we go forward.
So in an infectious disease for instance, let’s just take H1N1. H1N1 was a novel strain of flu that occurred in 2009 that really impacted large populations of people. And so because it was an epidemic, we as public health practitioners had to assess the damage and create a plan to address it, which was a vaccination.
So with violence, we create an intervention, then we then evaluate it: did this intervention eradicate it, stop it, decrease it, maintain it? We decide how to measure our success. Is success reducing the number of deaths related to gun violence? Is success making sure we have no more than last year or the last six months? Or is success educating and informing people differently about how to manage conflict?
And then we evaluate how we accomplish our goal. So we’re constantly assessing, reassessing, assuring, intervening, evaluating, reassessing, assuring. It’s a cyclical process that never ends unless you’ve eradicated the problem.
DE: In Evanston, what would success look like?
ETS: The measure of success has been shared with us by the community that’s most impacted. They want to reduce the number of guns in the community; reduce the availability of the hardware; reduce the number of shots fired; reduce the number of homicides; and also reduce the level of conflict that exists in the community.
So we’re trying to raise awareness and decrease the tolerance for gun violence. Because, unfortunately, when things happen for a period of time, we become tolerant to it. And so the community standard must be intolerance for gun violence.
DE: How do you get that message across? Or how do you reawaken that intolerance?
ETS: You have to find ways to educate without creating anxiety. We don’t want people to feel that they’re in a war zone. But we don’t want people to have a false sense of safety. So it’s giving real information, clear information. It’s being honest about what really is going on and not inflaming it. We want people to live in a just community.
We try to be clear and consistent with the information, and we share it with a variety of different gatekeepers in the community, using different ways of messaging. And sometimes we’re not even the message carrier. Sometimes we give the information to others in the community so they can pass it along to their subgroup of community members.
I think you really have to meet people where they are and assess what message will speak to them most. Because what’s meaningful for one group might not be meaningful for someone else. So we have to check in to see what’s important and valuable to that constituent.
DE: Gun violence in Chicago is said to have spread like an infectious disease. How vulnerable are we to catching that virus from our next-door neighbors?
ETS: Well there’s no border at Howard Street. We can’t have this false sense of ‘We’re in Evanston, it could not happen.’ I mean our hope is that it doesn’t. I’m from Chicago, and it’s very daunting to see what’s happening to the community where I was born in and raised.
But the reality is that conflict and gun availability is pervasive. So I don’t want to say that we’re like Chicago, because we’re not. But I don’t want to say that we’re protected because we’re not Chicago.
DE: Did you do a survey about people’s concerns in Evanston where violence showed up as a major issue for the community?
ETS: We’re a certified local health department. And what that means is we have to do a community-wide health assessment. Actually we do four very comprehensive assessments: we assess our skill level; our work force; our partners in our systems; and then we assess our residents’ perspective of how they view a healthy community. Unfortunately, we only ask maybe a total of six questions that were related to violence. And only two of the six were specifically related to gun violence. And out of a 90-question survey, I didn’t think that that was a good sampling of the perspective of violence. But with that being said, there was a demand from the community to look at violence.
DE: Can you give us a health report on our city with regards to youth gun violence?
ETS: We just started gathering and tracking data on violence, so we don’t have enough information to give you an assessment of what that looks like.
The bigger picture for me as a public health practitioner is the trauma that children are left with that may be untreated, because we’re really unaware of the impact of the trauma.
DE: Tell us about the trauma on families, the trauma on victims, as well as the perpetrators.
ETS: When you look at trauma, you really have to individualize it because each of us reacts differently. You know, some of us don’t react. Some of us hide the reaction, and the manifestation might happen later in life. The challenge we have is that there are so many micro-traumas. You know, it’s, ‘I heard the gun.’ Or ‘My brother was shot.’ Or ‘My brother shot the gun.’ All of those are traumas, and I don’t think we as a community are doing a good enough job having those discussions, because in public health, we want to prevent it from happening. But the reality is that it’s already happened. So we have to do trauma-informed care. We’re trying to shore up more practitioners in the field of trauma to address this.
And let me tell you what we’re seeing in children. More children are being removed from the classroom. More children are having anti-social behaviors like biting and kicking and fighting and scratching at a younger age. We usually would see anti-social behavior at the age of 10. Now we’re seeing it amongst three- and four-year-olds. And so by the time a child is 10, they’ve already formulated how they’re going to respond to the world. And to undo that is more challenging than to prevent it from happening.
I remember growing up in Chicago we would say the ‘bad kids’ were teenagers. And now, unfortunately, we’re saying the “bad kids” are kindergarteners. That’s a concern for me.
DE: The trauma we’re talking about is a result of many things. You can’t necessarily attach that to violence. It could be a withholding of love.
ETS: It could be many things. And it’s so complex to peel back those layers. But we know that violence, gun violence, whether it’s the perpetrator or the victim, is traumatic. And so that tears the fabric of community. You know whether it’s in a household, or on the block, or in the ward. And then it creates anxiety for the school district because that is a large convened audience that is in the middle of a hot spot.
DE: Is the high school addressing it?
ETS: I want to believe that yes, they are. I think many of us are having the conversations. The challenge is that things move so fast. Then you have other competing issues.
So we’re very reactive. If something happens, we launch into action mode. But then, as you know, it kind of wanes until something happens again. In public health, we remain vigilant about being proactive because the reality with an infectious disease is you never know when it’s going to be dormant or when the incidents level will rise again.
DE: That’s an interesting illustration. Are there conditions in our city that make it vulnerable to victimization and perpetration?
ETS: I think historical conditions, yes. I think structural and institutional policies are not fair or equitable, yes. I think stress and the urgency of how we live, yes. There are many components. There’s racism, there’s classism, conditions that unfortunately are embedded in some of the foundations of our practices, in the way we live, inherent in our world.
DE: On the flip side, what are our strengths and resiliencies? We believe that Evanston’s progressive, that we have the will to grow and evolve. What would you point to as a reasonable expectation that we could rise to the challenge?
ETS: I think Evanston is incredibly engaged. I think there’s a high level of volunteerism here. And there’s a high level of sharing of resources. When there’s an issue or problem, Evanston shows up and comes to the table. We are intentional about creating strategies. I’ve never seen a community that, you know, something happens, a committee is established. A task force is formed. And people show up. And people commit. That’s why I serve in this capacity. I know there’s a constituency out there that cares. Sometimes it can be overwhelming because you’ve got 10 groups coming to you saying we want you to help us solve this issue. And so there’s competing priorities.
DE: Why do you think African American adolescents and young adults are disproportionately affected by community violence?
ETS: Because of segregation, because of history, because of stress, because of layers of conditions they have to navigate. The income, educational, socio-economic disparities that exist amongst African American children and those who are not African American.
DE: That’s pretty complex. Is there anything from a public health perspective that could serve as a medicine or a vaccination?
ETS: I wish there were. Because if there were we would figure it out and inject everybody. I wish I could say all you need is love, but there’s so many other things people need to thrive. There’s no magic pill. Because so much has been done, intentionally, unintentionally, there’s so much that has happened that we just can’t erase and unring the bell. In my perfect world, it exists. But in the reality of the world I work in, it does not.
So that’s the lens that I work from. That’s why we’re always assessing and we’re always asking because we haven’t figured it out yet. Families and communities are resilient. We don’t come with our cape to save the day. We roll up our sleeves and say how can I get you to the next level? I don’t look at communities in deficit. I always tap into the resiliency because I can build from there.
But I always ask the question, ‘Where do you want to be?’ ‘What is a just and safe community for you?’ Because maybe it’s just a safe street the person can walk down. Maybe it’s better lighting. Because we’re talking about gun violence now, I’ll talk about gun violence, but there are so many other needs and concerns families grapple with. Does that make sense?
DE: It does. So what is the plan? When you’re asked for help, what does the overall approach look like?
ETS: We have health priorities. The three top health priorities from the assessments we receive were: first, looking at violence, overall violence, from a public-health approach. And second, addressing the mental health gaps that exist in our community. Third is addressing chronic health conditions. For adults that’s obesity, and for children it’s obesity and asthma. Those are our top health priorities. But then there are other things that we do because they’re mandated services.
Like for environmental health we have to do restaurant inspections, food inspections. So there are things we have to do that are required by law in order for our department to exist and function. Those are to establish clean air, safe food and clean water. Those are mandated services. Then we have a community-health improvement hierarchy, and then we issues that we’re reacting to because they happen in our community.
For example, there was a short window of time when we looked at suicide prevention, because of the number of suicide attempts and successes we had here. Now we’re grappling with the opioid epidemic. It hasn’t really come here as the way it has in other municipalities, but we have to stay on the pulse of what’s happening out there.
We have to stay connected to what the community needs are, because sometimes when we’re looking at the entire landscape, we have a different bird’s eye view of what’s happening than you would in your home, in your neighborhood, or in your ward, right? But your issues are very important to you. So we take the council goals and priorities, we take our health goals and priorities, and then we look at what the data tells us as we look across the entire landscape.
DE: I’m in awe of the capacity that you must have to hold all that.
ETS: I have a really good team. A phenomenal staff where we all contribute, and share our expertise, and we roll up our sleeves. And we have fantastic partners. You know, our school districts, Northwestern University, our hospitals, our community members, our boards and commissions, all of our volunteers. So we don’t do it in isolation and we certainly don’t do it alone.
PART II: IN HER GRANDMOTHER'S FOOTSTEPS
DE: Is this personal for you?
ETS: Yes. Very much so.
ETS: Early in my youth I was exposed to public health and how you can create a deeper impact if you really work to heal community. Now as a nurse, I’m real clear that, when people get sick, they need care and hospitals. And I enjoy working in labor and delivery and watching life come, and unfortunately seeing life leave. But I wanted to have more impact, and so my experience in my summers as a young girl, being under the tutelage of my grandmother who was a public health nurse, watching how she navigated systems to heal communities, was very impactful for me.
Watching her do it, I knew early on I wanted to be just like her. And so I shaped my career path around watching my grandmother. I knew I’d either be a public health nurse like my grandmother, or a teacher like my mom. For me, it’s about touching people. Whether you’re teaching them, instructing them like my dad, or healing them. I just, for lack of a better phrase, smashed all that together.
And I get restored and I get healed by serving. I think I’m serving and healing, but I get it back. So it is personal. Yeah, very much.
DE: Tell us more about your grandmother.
ETS: So my grandmother, Gladys, was an activist. In her community, health care was too far away for people to get to easily. And during that time people got sick, really sick.
So my grandmother’s entire back yard was a garden, and she not only grew and harvested vegetables and fruits, she also created tinctures and ointments from what she grew. She fed them to people. Whether she made you homemade soup or a tincture that she put on a wound. She would use everything. She would take a newspaper and wrap collard greens in it and soak it overnight. And then from from the broth, she would create soups and create medicines and preserves.
And we’d fish. Everything we ate either came out of the river, or came out of the back yard. My grandparents had one car and it was never parked in the garage because that’s where she preserved all her jams and jellies. She would take a jar and she might take some turnip greens and mustard greens and put them in a Ziploc bag and she would pack her medicine bag.
She’d put the food in there, the jelly and jam, and then this tincture, or that ointment, or powder, in mason jars. She’d take her stethoscope and drag me along, and she knew where the sick were. And people would tell her where the sick were. People would knock on the door, ring the doorbell, and say, Ms. Gladys, Ms. Gladys so-and-so is sick. Ms. Gladys, so-and-so fell down the stairs.
She would grab her bag and me and we would go to the house. I don’t know how she kept all this in her brain, but she had what she called her ‘tickler file.’ It was a little steel container with index cards where she wrote down people’s names, addresses, their temperatures.
She would come back home and record everything she did. So she knew who needed stitches out. She knew who needed to have their bone reset because they had a injury on the playground. She knew who was diabetic. She knew who had high blood pressure. She knew who was mentally ill. She would even go and sit and talk with people. She would just provide companionship. That was part of her healing.
She would knock on doors and check on people. And she was so compassionate. She was stern though. She knew when you didn’t take your medicine. She knew when your blood pressure was off. I just wanted to be as knowledgeable as she was. I wanted to serve in the way she did. I just wanted to sit at her feet. And she did this until she was 77 years old. So if I live that long, and serve that well, and have still compassion for humanity, you know yeah. It’s very personal.
DE: Do you see yourself going out to the community with your medicine bag?
ETS: That’s how I started. My second job was at Chicago Department of Public Health doing home visits to high-risk babies. So I would go with my bag and uniform and I would go and visit babies who were discharged from the NICU to their home in the Cabrini Green projects. And I will tell you, I never felt unsafe, because there was this level of respect for a nurse. The gang bangers who were shooting each other would stop and they would escort me up to the apartment.
I would have diapers and formula so they knew that I was not coming to take away, but I was coming to give. And then there were days they would say, ‘it’s not safe.’ And I would get back in my car and come back the next day. They would tell me, like neighbors would tell my grandmother, if somebody else was sick. ‘Well you know nobody comes to visit her.’ Or ‘She had a baby and nobody checks on her.’ And I would check on her.
DE: Just like Gladys. Where did your grandmother live?
ETS: Nashville, Tennessee. And today my aunt, who is 98, lives in my grandmother’s house. The same little white shanty house at the bottom of the hill. So I do feel it’s a full-circle moment. I miss doing home visits because when you meet families in the hospital situation, it’s very different than when you’re in their home. Families are really vulnerable when you’re in their space, when they’re very sick, and you have to respect that. I’m real clear about meeting people where they are. And not telling them where they need to be. Because sometimes systems can disempower people and disempower families. And so I never want to take that for granted.
DE: Is what’s happening with the budget stalemate in Springfield affecting community access to healthcare here in Evanston?
ETS: Yes. Some services have been cut or reduced. Staff laid off, programs closed. And so when there’s a need and you can’t meet the need, yes, it’s a domino effect for families. For instance, our mental health services. For low-income families to get psychiatric care is next to impossible in Evanston. And that’s because psychiatric care is expensive. And the Affordable Care Act has a component of behavior health services in it, but providers haven’t figured out what that looks like. The provision of that care is absent in Evanston. And so for families who need it, they’re really struggling. The stress is high, the service is low. We’re starting to see an increase in unacceptable preventable health conditions because of the lack of the state budget.
DE: What about the correlation between the lack of mental health care and violence. Is that manifesting here in Evanston?
ETS: There are a lot of mental health conditions that are not diagnosed because people are not getting care. The evidence tells us there is a correlation. And so would I say that it exists in Evanston, sure. But I don’t know that. I anecdotally I would think so.
DE: Thank you, Evonda.
For more on National Public Health Week activities: cityofevanston.org/Home/Components/News/News/1354/249