Community Empowerment and Collective Efficacy
In Suicide and Violence Prevention
(Originally published August 2022)
In past years, I occasionally attended presentations on the social determinants of health during which an academic expert asked the
highly educated audience questions such as, “Why do the Japanese live several years longer than Americans?” The initial response always
pointed to diet, and possibly rates of obesity, an understandable response in a country in which two-thirds of adults are overweight and one-third are obese. If the presenter went on to ask the audience, “If you wanted to improve your health, what would you do first?” the first response was likely to be, “eat healthy, exercise more and learn how to manage stress better,” all sensible answers for hard working professionals sitting at desks most of the workday. In these discussions, and in UW School of Social Work classes, it was rare to hear comments or questions regarding social relationships and cultural factors that affect physical health or emotional well-being. The idea that social cohesion, i.e.,the strength of relationships and sense of solidarity in a neighborhood or community, could protect health and
increase life span in another large, developed country was a new idea for much of the audience.
Experts on the social determinants of health(such as Michael Marmot) have pointed to the negative effect of extreme income inequality on the health and mortality of all social classes, not just the poor, in part because extreme inequity increases social tensions between strangers in every day social interactions. In the US, extreme income inequality has led to segregated neighborhoods and schools, and in doing so increased racial tensions and done substantial harm to Black children living in neighborhoods with concentrated poverty. On the other hand, the much-discussed Hispanic paradox in health outcomes suggests the broad protective effects of a socially cohesive culture organized around large extended family networks, several members of which live close to one another.
More than a century ago, the French sociologist, Emile Durkheim, argued that suicide rates decline during national emergencies because they increase social cohesion, which occurred among adults in the US – but not children - in 2020, the first year of the pandemic. A large increase in suicide rates for children and youth since 2010 (see Pain in the Nation: The Epidemic of Alcohol, Drug and Suicide Deaths 2022) is an indicator of diminished social cohesion, resulting from a confluence of several factors:
widespread adoption of smart phone technology that has reduced in-person social contact and increased loneliness, while leaving
vulnerable children and youth open to cyberbullying 24 hours a day.
the hardening of an educational meritocracy as a means of
sorting young people into social classes in a society which has a low regard for persons with low educational achievement the absence of community solidarity and alienation resulting from social exclusion and lack of identification of troubled youth with groups, causes, faith communities, and organizations of all types.
Social isolation, social exclusion, and a sense of alienation from the local community are likely to be associated with low self-efficacy, i.e., the confidence in one’s ability to take care of oneself and achieve personal goals. Hopeless/helpless attitudes and beliefs are a part of Major Depressive Disorder, e.g., “X ( whatever a person is depressed about) is not likely to improve and there is nothing I or anyone else can do about it.” Severely depressed people often hang on to dysfunctional beliefs even when help is available because hopelessness may be less painful than having hopes raised and then crushed once again. Pessimistic beliefs about the possibility of change act as a self-fulfilling prophecy. The unwillingness to respond to a difficult challenge ensures failure, which only confirms (once again) the validity of despair regarding the future.
In an individualistic culture, the usual idea is to address suicidal ideation and severe depression through psychotherapy or psychotropic drugs, which may often prevent suicide and reduce immediate suffering. However, focusing on the treatment of individuals cannot address the social causes of depression, suicidal ideation, and other common mental health conditions.
It also ignores the power of community interventions to change the culture that leads to social alienation and loss of hope in the future. Arguably, nothing would have a more positive effect on the well-being of American children and youth than reinvigorated and more inclusive communities which welcome the participation of young people of all ages and inspire their belief in collective endeavors to create a better world.
‘The Return of the Sun’
Michael Kral is a cultural psychologist and medical anthropologist who has engaged in community based participatory research with Inuit in Nunavut, Canada for two decades. In the first chapter of his extraordinary book The Return of The Sun: Suicide and Reclamation Among Inuit of Arctic Canada (2019), Kral comments:
“Rather than taking an approach common to suicide studies, which would be centered within the disciplines of psychology and psychiatry and focused on individual risk factors, I take a community, cultural, and historical perspective and consider the view that suicide is a symbol of social suffering.”
Kral asserts that “In this type of research, the people being studied are co-researchers. Inuit have been my collaborators, from thinking of the research questions to planning how the study will be done” and “Community action has been a primary goal.” According to Kral, a great social transformation of Inuit life occurred after WWII when “Inuit traditional life was irretrievably lost” as the Canadian government took control of Inuit land and resettled most of the population into a few large settlements. Inuit children were removed from families and sent to boarding and day schools. Sedentary life in settlements increased income inequality, reduced sharing, weakened social norms and led to a rapid increase in infectious and parasitic disease which elders believed was due to the loss of hunting as a way of life. According to
Kral, for the Inuit, “To be a man is to be a hunter.” (p. 34)
According to anthropological studies which Kral cites, the breakdown of Inuit culture over a few generations led to increased drug/alcohol abuse in the settlements and to an increase in anxiety and depression among young people. By the 1980s,tensions between parents and teenagers were intensified by parental alcohol abuse and by domestic violence that often occurred during drinking parties, and because “parents did not like the behavior of their teenagers who were staying up all night and sleeping most of the day, having multiple sexual partners and playing sports rather than doing things parents viewed as more important,” Kral states.
Kral asserts that the suicide rate for Inuit youth is 10 times the national rate. He comments: “Males make up the majority of suicides, as is the case throughout most of the world.”Kral describes large differences in suicide rates among Nunavut communities and “some communities have no suicide.”
Kral maintains that male suicidality among the Inuit occurs in disturbed romantic relationships characterized by sexual jealousy, is contagious and may be a way “of belonging with other suicidal youth.” He believes that “Suicide itself has become a norm.” He observes that “It is common for Inuit youth not to show signs of being distressed or suicidal prior to their suicide.”
The Inuit are a relatively small Indigenous population in the Arctic. Why is their story useful for understanding the large increase in child and youth suicide in the US, a wealthy society with a very different culture? Because, in both societies, per Kral, “suicide risk in the context of massive social change can best be understood through one’s sense of the future, the perceived relationship between the self and the world, and a feeling of personal value.”
Kral comments that “one of the most powerful suicide risk factors across cultures is the perception of not belonging.” Concretely, in my view an increasing number of young people do not feel that they belong to any part of American society and question whether they have a future worth living for (Silva, 2019). Kral comments: “Inuit communities need to organize themselves for action.” The same is true in this country. The suicidal ideation of many American youth and the hopelessness that accompanies it has deep cultural roots. It is not a problem that can be effectively delegated to the mental health professions.
Community empowerment in suicide prevention
Kral asserts that “Studies of suicides among native North Americans have shown a relationship between community ties to traditional values and attenuated suicide rates” and “also between fewer suicides and community/tribal control related to education, health services, police and fire services, self-government and cultural facilities.” Kral maintains that “community control and empowerment are the determining factors in successful suicide prevention and mental health outcomes in Indigenous communities.”
Christopher Lalonde, a Canadian scholar articulates this same theme in his 2007 book chapter re varying suicide rates among Aboriginal communities.
He asserts that “within Aboriginal communities that succeed in their efforts to restore systems of self-government, the relative risk of suicide is 85% lower than in communities that have not.” According to Lalonde “When communities succeed in promoting their cultural heritage and in securing control of their collective future the positive effects reverberate across many measures of youth health and well- being. Suicide rates fall, fewer children are taken into (foster) care, school completion rates rise, and rates of intentional and unintentional injury decrease.”
Kral describes how Alaska’s Statewide Suicide Prevention Council has allowed each Alaskan Native community to develop its own suicide prevention program after concluding that imported evidence-based programs were not working. Kral asserts that “The essential feature of these successful prevention projects is that they are community owned to their core.” Canada is now taking the same approach. Kral points out that Inuit activities and programs that resulted in the elimination or decreased rates of suicide were not called suicide prevention. Rather, “They were called by what they were: a youth center, community gatherings, and in other Inuit communities, going on the land with elders or starting a sports team. There was not a prescriptive program enacted across communities.” According to Kral, Inuit communities that developed successful suicide prevention programs did so without government involvement.
Kral and Lalonde point out common factors in effective suicide prevention program in Inuit and Alaskan Native communities:
community control of program development and operation strengthening of positive cultural identity and traditional values
youth participation in planning less emphasis on pathology, more emphasis on strength, resilience and empowerment
healing of disconnection between youth and parents, and youth and elders
In Great American City: Chicago and the Enduring Neighborhood Effect(2012,)Robert Sampson utilizes the concept of collective efficacy to explain large differences in rates of homicide among neighborhoods with similar socioeconomic disadvantage. Sampson asserts that “collective efficacy draws together two fundamental mechanisms, social cohesion(the “collectivity” part of the concept) and shared expectations for control(the “efficacy” part of the concept).”
Sampson reminds readers that self-efficacy is not a generalized trait, i.e., an individual has self-efficacy relative to a particular task. Likewise, a neighborhood’s efficacy “exists relative to specific tasks and is embedded in conditions of mutual trust and social cohesion.” The task Sampson is most concerned with is preventing violent crime, specifically homicide. However, he cites research that has found a relationship between the extent of collective efficacy and asthma, birth weight, self-rated health, and heat wave deaths. He comments: “Collective efficacy reaches out to capture a number of health-related dimensions that go well beyond the original application of the
theory to street crime.”
Sampson and colleagues measured collective efficacy by asking residents of neighborhoods about the likelihood that their neighbors could be counted on to act in response to specific vignettes such as children skipping school, engaging in vandalism, fighting or being disrespectful to an adult; and they asked residents to rate their level of agreement with statements such as:
“People around here are willing to help their neighbors.”
“People in this neighborhood can be trusted.”
This is a close-knit neighborhood.
These scholars then controlled for individual differences within neighborhoods related to social position (e.g., age, race, sex, social class, home ownership).
“The key question turned on the variance between neighborhoods.” Sampson writes: “We found that collective efficacy varied widely across Chicago neighborhoods and was associated with lower rates of violence measured by independent methods, while also controlling for concentrated disadvantage, residential instability, immigrant concentration and a comprehensive set of individual level characteristics,” including age, sex, income, race/ethnicity, home ownership, as well as indicators of personal ties and the density of local organizations.
One of the most important findings of Sampson’s research is that the association between poverty rates and collective efficacy weakened over 20 years, from 1970 to 1990, suggesting that experiences of “perceived disorder and violence may have a lasting and cumulative effect on collective memories” even when the residents of a neighborhood almost completely change over decades. Put another way, neighborhood ratings on measures of collective efficacy were remarkably stable over time despite changes in poverty rates, an
indication (I believe) of cultural transmission of values and attitudes which develop out of the historical experience of neighborhoods
and communities. Culture transcends individuals who come and go, or as Sampson puts it: “there is a legacy to inequality and to inequality’s relation-ship with collective efficacy.”
There is also another possibility for explaining the continuity in neighborhood ratings of collective efficacy over decades, i.e., efficacy beliefs at both the individual and community level are strengthened or weakened by the result of persistent effort to overcome serious challenges to safety and well-being. Success in one initiative builds confidence while failure undermines it.
It is of the utmost importance that community initiatives with a well-defined goal succeed, or at least have a large positive effect on a toxic social problem. Otherwise, members of a community may begin to suspect they lack the resources, determination, or resilience to confront tough challenges. As a matter of fact, there was a very large reduction in homicide in Chicago from about 1990 to 2020 which Sampson has discussed in his article, “The Birth Lottery of History.” (2021)
Sampson and his colleagues found that “the civic infrastructure of local organizations and voluntary associations helps sustain a capacity for social action in a way that transcends traditional personal ties. Organizations are equipped to foster collective efficacy, often through strategic networking.” Violence prevention, like suicide prevention, requires a total community response from public and private agencies and cannot be directed from top down by the federal government or state governments. Nevertheless, community initiatives will often need funding from local, state or the federal government. Community organizations that collaborate and genuinely invite citizen participation can stop the downward spiral of social disconnection that is having a devastating effect on American children and youth. There does not need to be a master plan, but there must be an all-in commitment to cultural change.
Kral, M., The Return of The Sun: Suicide and Reclamation Among Inuit of Arctic Canada (2019), Oxford University Press, New York City.
Lalonde, C., “Identity formation and cultural resilience in Aboriginal communities,” Chapter 4 in Promoting resilience in child welfare, (2006), ed.by Flynn, R., Dudding, P. & Barber, J. University of Ottawa Press, Ottawa, Ontario.
Marmot. M., The Status Syndrome: How Social Standing Affects Our Health and Longevity (2004), Henry Holt &Co. New York City.
Neil, R. & Sampson, R., “The Birth Lottery of History: Arrest Over the Life Course of Multiple Cohorts, 1995-2018” (2021), American Journal of Sociology, volume 126, 5.
Pain in the Nation: The Epidemic of Alcohol, Drug, and Suicide Deaths 2022, Trust for America’s Health.
Sampson, R., Great American City: Chicago and The Enduring Neighborhood Effect (2012), University of Chicago Press, Chicago, Ill.
Silva, J., We’re Still Here: Pain and Politics in the Heart of America (2019), Oxford University Press, New York City.