US Secretary of Health and Human Services: We support free screening/counseling for interpersonal & domestic violence

Free screening/counseling for all women and adolescent girls for interpersonal and domestic violence

Dear Secretary Sibelius:

I am writing to you, our US Secretary of Health and Human Services, to express enthusiastic appreciation for the support that you have voiced for the recommendations contained in what you have characterized as the “historic” Institute of Medicine report, "Clinical Preventive Services for Women: Closing the Gaps."

I strongly endorse all of the recommendations contained in the report. With my fellow professionals, volunteers, and concerned community members who are committed to preventing and ending domestic violence, we celebrate in particular the Report’s recommendation that the minimum package of free clinical preventive services for women to be provided by all insurers include “screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner.”

The Report notes, with documentation, that “prevalence rates of domestic abuse measured in health care settings range from four to 44 percent within the year of being asked about the abuse, and from 21 to 55 percent over a lifetime (page 102).” The Report goes on to document the following:

“The immediate health consequences of interpersonal and domestic violence include injuries and death . . . as well as sexually transmitted infections including HIV infection, pelvic inflammatory disease, pregnancy, and adverse psychological responses. Several chronic mental health conditions are related to interpersonal and domestic violence, including posttraumatic stress disorder, depression, anxiety disorders, substance abuse, and suicide. Long-term physical conditions include chronic pain; neurological disorders resulting from injuries, gastrointestinal disorders, such as irritable bowel syndrome; and migraine headaches; and various other disabilities (page 103).” Traumatic brain injury, evidence of which has been reported in 30 percent of domestic violence victims seen in emergency rooms for health issues associated with domestic violence, contributes to the impairment of cognition, emotions, behavior, and physical functioning, and the profound effects of this impairment on the daily lives of victims and survivors.

Children witnessing domestic violence or living in households characterized by ongoing patterns of domestic violence are more likely than other children to suffer disruptions of their social, psychological, and academic functioning, and impairments of their physical health and well-being. In addition, surviving victims and children experience the devastating effects of domestic violence long past the first decades after their escape from the abuse. Health care clinicians, educators, and policy-makers know that children exposed to domestic violence – and such co-occurring adverse childhood experiences as emotional/physical abuse/neglect – are at greatly increased risk of severe adult obesity and ischemic heart disease (even among nonsmokers). Indeed, the delayed social and medical burden borne by survivors and their communities may be even greater than the burden borne during their years of experiencing ongoing domestic violence. In the words of science writer Paul Tough, “if we trust the data, and we want to prevent heart attacks, it makes as much sense to try to reduce adverse childhood experiences, or counter their effects, as it does to try to lower cholesterol.”

I share the conclusions that you, our US Secretary of Health and Human Services, voiced when you accepted the Report on July 19, 2011: “This report is historic. Before today, guidelines regarding women’s health and preventive care did not exist. These recommendations are based on science and existing literature.” Now we call on you, as do editorial writers from coast to coast, to implement these recommendations.

This is a health initiative that promotes a healthier country. Let’s keep working together to make our country, and our world, a better, safer, and healthier place, one interaction at a time.

Sincerely,

[Your name]