Domestic Violence: More than a Political Issue

The issues of domestic violence (DV) and sexual assault are increasingly in the public eye and became central issues in the 2016 presidential election. This increased attention presents an opportunity to frame DV as more than just a social or political issue but rather as critical to public health. Current trends in the healthcare landscape also make now an opportune moment to act and increase attention and resources focused on DV.

DV is widespread and its link to poor health outcomes is well-documented:

1. Over 1 in 3 women experience physical violence, rape, and/or stalking by an intimate partner in their lifetime.
2. DV affects over 12 million Americans each year, disproportionately young, low-income women of color.
3. DV has immediate, short-term, and long-term health effects that go beyond bruises and fractures: DV can lead to chronic pain, immune, endocrine, and gastrointestinal disorders and can double the risk of asthma and diabetes. Survivors of DV are three times more likely to have a mental health condition.
4. DV’s impact also goes beyond the primary survivor: research on the impacts of Adverse Childhood Experiences (ACEs) has demonstrated wide-ranging negative health impacts of early childhood trauma, including witnessing DV among parents.

As the healthcare landscape has shifted to increasingly recognize the social determinants of health, such as housing and food security, DV must be recognized as a critical factor leading to poor health outcomes. While it’s not always thought of in dollar terms, DV places a cost burden on health systems and on society at large: health care utilization and cost for survivors of DV are up to 20% higher, and stay higher for up to five years after victimization. Though hard to quantify, our recent literature review found that the medical cost burden from DV in the first year after victimization ranges from $2 to $7 billion nationally.

Strengthening the Case for DV Response and Prevention

DV is both treatable and preventable. Effective partnerships between healthcare organizations and domestic violence agencies are needed to expand screening and referral activities (which are reimbursable under the Affordable Care Act) into a more complete response to the needs of DV survivors. Healthcare and DV leaders can take three key steps to build the case for collaborative efforts to address DV:

1. Demonstrate the effectiveness of current programs through smoother communication and referrals,
2. Develop approaches to measure the impact of their work over time through collection of data on health outcomes, utilization, and cost, and
3. Work together on policy changes that support DV prevention.

JSI, with the support of Blue Shield of California Foundation, is helping to build that case through capturing lessons learned from an innovative project promoting such partnerships in California, and researching evaluation and policy strategies.

The recent election sparked a national conversation about violence against women that had been ignored for too long. In the wake of the outcome, efforts to protect women’s health and prevent violence are critical. In the health field, we can capitalize on the increased public attention and opportunity in the healthcare landscape to address DV as a critical public health issue.

Written by Eliana Greenburg and Jeremy Cantor