Prothrow-Stith, Deborah 1954—

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Deborah Prothrow-Stith 1954—

Physician, educator, public health official

At a Glance…

Attended Harvard Medical School

Recognized Violence as a Medical Emergency

Bridges Academic and Community Public Health

Selected writings

Sources

In September of 1987, Deborah Prothrow-Stith became the first female and youngest ever commissioner of public health for the Commonwealth of Massachusetts. Over the next two years, she worked to expand treatment programs for patients with acquired immune difficiency syndrome (AIDS), increased funding for drug rehabilitation, and, perhaps most importantly, spearheaded the development of a special statewide office geared exclusively to the prevention of violence among the young. In 1989, her groundbreaking efforts in Massachusetts earned her the Secretary of Health and Human Service Award.

Now assistant dean for government and community programs at the Harvard School of Public Health, Prothrow-Stith has devoted her career to examining violence as a societal disease and working to find a public-health solution. She first became aware of the true dimensions of the problem while completing a six-week surgical rotation in the emergency room at Boston’s Brigham and Women’s Hospital during her third year at Harvard Medical School. Faced with an endless stream of patients suffering from knife and gunshot wounds, she could do little more than suture them up and send them back to the streets. Yet their faces—and their smoul-dering anger—continued to haunt her. Prothrow-Stith realized, as she recalled in her highly acclaimed book, Deadly Consequences, that there was “no prescribed treatment for anger that might explode into violence” and that she had “no way to protect [her] patient or the community from an outburst of rage [she] had every reason to suspect would be deadly.”

Around the same time, Prothrow-Stith learned that homicide was the leading cause of death among young black males in the United States, claiming thousands of lives each year. “The more I learned, the more perturbed I became,” she wrote. “I could not understand the blindness of my profession. How could doctors ignore a problem that killed and maimed so many young, healthy patients?... Twenty thousand homicide deaths a year convinced me that violence was a public health problem. To me it seemed self-evident: an ‘ailment’ that killed so many ought to have the full attention of physicians and others concerned with improving health.”

Spurred on by what she had observed and read, Prothrow-Stith developed her own course on violence prevention—the

At a Glance…

Born Deborah Boutin Prothrow, February 6, 1954, in Marshall, TX; daughter of Percy (an insurance executive) and Mildred Prothrow; married Charles Stith (a minister), 1975; children: Percy and Mary. Education: Spelman College, B.A., 1975; Harvard University Medical School, M.D., 1979.

Boston City Hospital, Massachusetts, senior resident in charge of medical/surgical unit, 1982, staff physician, 1982-87; Health Promotion Center for Urban Youth, City of Boston Department of Health and Hospitals, codirector, 1985-87; Harvard Street Neighborhood Health Center, clinical chief, 1986-87; Commonwealth of Massachusetts, Commissioner of Public Health, 1987-89; Community Care Systems, Inc., vice-president/medical director, 1989-90; Harvard University School of Public Health, assistant dean for government and community programs, 1990—.

Awards: Secretary of Health and Human Service Award, 1989; Secretary Louis Sullivan Exceptional Achievement in Public Service Award, 1989; Rebecca Lee Award, Massachusetts Department of Public Health, 1990; Hildrus A. Poindexter Distinguished Service Award, Black Caucus of Health Workers, 1992; World Health Day Award, American Association for World Health, 1993. Honorary degrees from North Adams State College, 1988, and Wheelock College, 1992.

Addresses: Office—Harvard University, School of Public Health, 677 Huntington Avenue, 718E, Boston, MA 02115.

very first of its kind—and taught it to students at an inner-city high school. That course was later refined and expanded, and as of 1992, it was being used in some 5,000 schools in 48 states and seven countries. Deborah Prothrow-Stith is “the leading public health person in violence prevention today,” epidemiologist Billie Weiss, director of Los Angeles’s Injury Prevention Program, told Sasha Cavander of the Los Angeles Times. “We all look to her.”

In 1991 Prothrow-Stith published Deadly Consequences, a book that outlines the public health perspective on violence and offers practical suggestions for stemming the tide of senseless homicides. In the introduction, Dr. C. Everett Koop, former Surgeon General of the United States, described the book as “a road map designed to help us lead our children and our communities out of the tragic morass in which so many are succumbing.”

Prothrow-Stith was born in Marshall, Texas, in 1954. Her father, Percy, worked for Atlanta Life, then one of two black-owned insurance companies in the South. When she was five, he received a promotion, and the family moved to Atlanta. Here she enjoyed what she described to Anita Diamant of Boston Magazine as a “real middle-class upbringing” in a new, split-level house in an all-black neighborhood. A gifted student, Prothrow-Stith decided at an early age that she wanted to be a doctor. “I liked the way people responded to that, so I just kept saying it,” she told Diamant. Following the integration of Atlanta’s schools in 1967, she attended predominantly white Therrell High, where she felt the sting of racism for the first time. She continued to excel in her studies, however, and found emotional and spiritual sustenance in the love of a close-knit family and a large group of church-going friends.

Attended Harvard Medical School

In the early 1970s, Percy Prothrow was named chief of Atlanta Life’s Texas operation, and the family moved to Houston. Prothrow-Stith finished high school there, at the top of her class. Given her sterling academic performance and the progressive social climate of the times—civil rights was high on the national agenda, and Ivy League colleges were eager to recruit talented minority students—her options were many. She followed her father’s advice, however, and selected Spelman College in Atlanta. “Spelman has a mission about producing capable black women who will contribute to society in significant ways,” she told Diamant. “At the time, if you were going to graduate school, it was going to be medical school or law school. Being good at math and the sciences, I was really pushed toward medicine.”

A health-career counselor at Spelman urged her to apply to Harvard Medical School, and she was quickly accepted. Around the same time, Prothrow-Stith met Charles Stith, who was completing his training at Atlanta’s Gammon Seminary and had just been accepted at Harvard Divinity School. The two fell in love, moved to Boston, and were married in August of 1975, three days before she began her medical training at Harvard.

Prothrow-Stith sailed through her studies, but found the university’s social environment hard to bear, especially after her positive experiences at Spelman. “I got the sense that Harvard could care less whether I graduated or not, that I was another black woman they let in and if I did fine, that was fine, and if not, well, you know, at least we were nice enough to let her in here,” she told Diamant. “I felt,” she added, “[as if] I was integrating Therrell High School all over again.” That same year, she was devastated by the death of her father, her longtime guide and inspiration. She persevered with her work, however, and during her final year of medical school, gave birth to her first child, whom she and her husband named Percy.

Prothrow-Stith’s harrowing experiences in the emergency rooms at Boston City and Peter Bent Brigham (now Brigham and Women’s) Hospitals during medical school, together with the startling reports she had read concerning homicide and young black males, quickly convinced her that in order to make a real difference as a physician, she would have to find a much broader, public-health-oriented focus for her work. Although blacks make up only 12 percent of the population, they account for 50 percent of the homicide deaths in the United States each year. For black men aged 18 to 24, homicide is the leading cause of death. According to Cavander, black males living in Harlem have “a lower life expectancy than young men in Bangladesh, the poorest country in the world.”

Recognized Violence as a Medical Emergency

In Deadly Consequences, Prothrow-Stith recalled the powerful experiences that shaped her career and led her to create her own unique medical specialty. “I wanted to understand the forces that sent so many [young males] to the emergency room—cut up, shot up, bleeding, and dead,” she wrote. “Why were so many young males striking out with knives and guns? What could be done to stop the carnage?... When I began to think about violence in a medical context, I saw the problem not as one that, say, required better surgical techniques, but one that required the creation of public health strategies such as health education in the classroom; health education via the mass media; community awareness; hospital-based screening for risk determination. I was impressed by the way these strategies were being used to combat smoking, heart disease, lead poisoning, child abuse, and other menaces to the public health. I wanted these strategies to be applied and evaluated to reduce adolescent violence as well.”

During her final year of medical school, Prothrow-Stith worked with her adviser, Dr. George Lamb, to design a prototype violence-prevention program for inner-city teenagers. The aim of the course, which she taught to adolescents at a Boston-area high school, was to warn young males of their special risks and to introduce them to constructive ways of managing anger and aggression. Tests administered to students before and after the course revealed that the program provided them with a much greater awareness of the problem and caused them to revise their attitudes about using violence as a means of conflict resolution.

After receiving her M.D. from Harvard University Medical School in 1979, Prothrow-Stith completed her internship and residency at Boston City Hospital. In 1982 she accepted a staff position there, and remained in the job for the next five years. “My experiences at the Harvard hospitals were good in terms of the medical knowledge I gained, but they didn’t motivate me in terms of giving me a reason for doing it,” she told Diamant. “With the urban black population at City, you get the sense that what you’re doing means something very significant.”

Although she found much fulfillment in her work as a hospital physician, Prothrow-Stith longed to return to her research and teaching in the area of violence prevention. She was given the opportunity to do so in 1984, when her former mentor, George Lamb, who had recently been appointed director of Boston’s Department of Health and Hospitals, asked for her help in writing a grant proposal that would bring in funding for local programs focusing on adolescent medicine. A three-year grant from the American College of Physicians enabled her to set up and direct a variety of adolescent health projects in the Boston area, including a ten-session course on violence prevention at the Jeremiah E. Burke High School in economically depressed Dorchester. One of the main components of the course was a video-recorded skit, in which students playacted fights and then analyzed the complex social and cultural reasons behind them.

Prothrow-Stith’s success in the classroom led to appearances on a number of prime-time television programs, including a Phil Donohue series entitled The Human Animal and a Walter Cronkite news special. Before assuming the job of Massachusetts Commissioner of Public Health in 1987, she was clinical chief of the Harvard Street Neighborhood Health Center in Roxbury, where she became deeply involved with the issue of teenage pregnancy. Her outspoken support of contraceptive distribution in school clinics raised eyebrows among educators and school administrators in the city, but she refused to back down from a position she saw as part of a broad-based commitment to preventive medicine.

By the early 1980s, the issue of violence in American society had earned a place on the national agenda, and the Centers for Disease Control had established a special Violence Epidemiology Branch devoted to the study and prevention of homicide. Today, violence prevention is a recognized specialty for health care professionals. “While I was in the emergency room patching up the wounded, public health officials in Atlanta… and in Washington, DC in various federal offices were looking at statistics related to ‘morbidity and mortality’ (injury and death) and coming to some startling conclusions concerning the prevalence of violence in our nation,” wrote Prothrow-Stith in Deadly Consequences. “The statistics showed clearly that injury, not illness was the most significant threat to the health of young Americans in the latter part of the century ... [and] impelled forward-looking public health officials to redefine the mission of public health and redirect their efforts.”

Although young black men are the disproportionate victims of homicide, Prothrow-Stith is quick to point out that violence knows no racial bounds. “Our children are killing each other because we teach violence, we promote it,” she told Cavander. “As a society, we think it’s justified, painless, guiltless. From the media to the movies to the presidency, the message is the same. We now have a kick-butt President preceded by a ’Make My Day’ one. Kick-butt was how Bush spoke about Géraldine Ferraro and Saddam Hussein. ’Make My Day!’ is what Reagan said to Kadafi.” American people, she added, are “infatuated with violence.”

Bridges Academic and Community Public Health

In her current job as assistant dean for government and community programs at Harvard University’s School of Public Health, Deborah Prothrow-Stith serves as a liaison between academic public health and public health practice, focusing much of her energy on the issues that preoccupied her during her tenure as Massachusetts’s health commissioner, including adolescent health, teen pregnancy, violence prevention, AIDS, and the quest for universal health insurance.

Perhaps Prothrow-Stith’s greatest contribution to date, however, has been her “Violence Prevention Curriculum for Adolescents,” now an integral part of the educational program in thousands of schools around the country and around the world. “There’s nothing like this on the market,” Alice Schaeffer, assistant educational director of Pittsburgh’s Craig House, a school for students with behavior disorders, told Cavander. The course “gives kids a totally different perception of what violence is, and gives them a way to solve problems.”

Religious faith, a supportive husband, and a close-knit circle of friends and family members make it possible for Prothrow-Stith to juggle her roles as physician, educator, wife, and mother. She and her husband, Charles, a community activist and pastor of Boston’s Union United Methodist Church, have two teenage children of their own, and act as guardians for her late sister’s son. An optimist by nature, she occasionally finds her own life, as well as the reports she reads about the deterioration of American society, too much to bear. It is then that her faith pulls her through. “When things are up to here, and I’m about to go under,” she told Diamant, “I just pray. I pull the car over or duck into this room over here and I pray: ‘I feel overwhelmed. Give me strength.’ And it helps.”

Selected writings

Health Skills for Wellness, Prentice Hall, 1994. (With Michaele Weissman) Deadly Consequences: How Violence Is Destroying Our Teenage Population and A Plan To Begin Solving The Problem, HarperCollins, 1991.

Violence Prevention Curriculum for Adolescents, 1987.

Sources

Books

Prothrow-Stith, Deborah, M.D., and Michaele Weissman, Deadly Consequences: How Violence Is Destroying Our Teenage Population and A Plan to Begin Solving The Problem, HarperCollins, 1991.