Late last week, Gov. Nikki Haley of South Carolina vetoed a whole slate of budget items, including half a million dollars for domestic violence and sexual assault prevention. This week, her justifications for these cuts are finally getting some publicity:
Each of these lines attempts to serve a portion of our population for which we extend our sympathy and encouragement, but nevertheless, it is only a small portion of South Carolina’s chronically ill or abused. Overall, these special add-on lines distract from the agency’s broader mission of protecting South Carolina’s public health.
To folks who work on these issues, it seems self-evident that rape and domestic violence aren't "distractions" from public health issues so much as major public health issues in and of themselves. But stepping back from it, it's not hard to see why Gov. Haley and her supporters might not view it that way. These issues are often framed as "women's issues," and therefore somehow more personal and emotional problems than public health ones. While it would be nice if mental health were justification enough to make something a matter of public health, it's easy to see why, especially in conservative areas, the notion arises that "public health" is just a matter of every part of your body below the brain. The thing is, sexual assault and domestic violence are major public health issues even outside of the mental anguish they create.
In 2003, the CDC put together a report analyzing domestic violence as a public health issue from statistics gathered in 1995. While the data is old, there's no real reason to think the trends have changed dramatically since then. They estimated that 22 million American women have been physically assaulted by an intimate partner, and that 1.3 million had been in the past year. Of the victims assaulted, more than half a million had injuries that required medical treatment, with most involving hospitalization. To make it worse, domestic violence tends to be a repetitive situation, with many victims repeatedly visiting the hospital, which is one reason the ACA had to outlaw insurance companies treating domestic violence as a pre-existing condition and using it as an excuse to drop coverage. The CDC estimated that domestic violence absences cost the nation nearly $1 billion a year in lost productivity.
Similarly, if your only concern is the bodily health and productivity of citizens, rape is still a major public health issue. For what I hope are obvious reasons, rape is pretty likely to be unprotected sex, with all the resulting STD transmissions and unintended pregnancies that tend to follow that. In fact, about 1% of abortions annually are the result of rape, which means more than 10,000 abortions a year. Rapes are a massive strain on the hospital system, as well, because not only do hospitals have to treat the patients for injuries, potential STD transmission and potential unintended pregnancy, but they also have to help conduct a criminal investigation by administering a rape kit that collects evidence. So many of these are done a year that police departments can't keep up with them, and an estimated 400,000-500,000 are simply sitting in storage, having never been processed as evidence.
All of this means that preventing rape and domestic violence isn't just a matter of doing right by women, though that really should be enough of a reason. It also means avoiding these costs to the medical system, the justice system, and to employers who lose productivity from women whose injuries and trauma prevent them from going to work.
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