Policy Expert

by NORA DUNNE | photography by BRUCE POWELL

Lori Post takes a high-level approach to protect
worldwide victims of abuse, neglect and exploitation.

Her accomplishments reach far and wide:

In the last 25 years, Lori Post, PhD, has developed methods to identify victims of violence and ways to hold their perpetrators accountable for their crimes. She has also influenced policy passed into law increasing penalties for female genital mutilation; established a screening and prognostic tool to recognize victims of elder abuse visiting the emergency department; developed background check systems for healthcare providers that is now in the Affordable Care Act; and worked with organizations around the world to eradicate violence against women.

“There’s a link between all of my work, and it’s addressing risk factors of vulnerable populations,” says Post, the inaugural director of Feinberg’s new Buehler Center for Health Policy and Economics. “All of my career, I’ve been driven by the conviction that we cannot remain complicit while women, children and the elderly continue to be abused, neglected and exploited. Academics can play a strong role in informing policy.”

From Small-Scale Interventions to Policy

Post was taking an undergraduate forensic science class at the University of London when she was first exposed to the physiological aftermath of domestic violence. She recalls an autopsy of an elderly woman who had died of a heart attack according to the initial examination. Further testing, however, revealed signs of decades of physical abuse, including broken bones in various stages of remodeling, detached retinas and subdural hematomas. A few years later, Post remembered that woman when she was pursuing a master’s degree in demography.

“I was working with a team of professors who wanted to estimate the prevalence of women older than 65 years who are abused by their husbands,” she explains. “I thought, why not look at women who have died?”

Post cross-referenced police, prosecutor and domestic violence shelter records of older deceased women who had died from injuries and was able to complete the task. The work eventually inspired her PhD dissertation. After completing a postdoctoral fellowship in epidemiology in 1999, she received her first major grant: From the Centers for Disease Control and Prevention, it assessed community efforts to protect women and children from domestic violence in Michigan’s Upper Peninsula.

All of my career, I’ve been driven by the conviction that we cannot remain complicit while women, children and the elderly continue to be abused, neglected and exploited. Academics can play a strong role in informing policy.

“I learned that more than half the cases of domestic violence there involved Native American women, even though the reservation only accounted for 3 percent of the population,” Post says. She published the results of the project in the Journal of Interpersonal Violence. “I noticed a pattern of vulnerability due to ethnicity and poverty.”

In 2008, Post joined Yale University, where she continued assessing individual and community interventions but also started to drift toward policy.

“For every one person you help, 20 get in line,” she says. “I began looking at the underpinnings of these problems and how policy can be used to solve them from a higher level.”

For example, she says extreme poverty and food insecurity are often the underlying causes of violent practices such as female genital mutilation, child marriages, widow cleansing and witch hunting.

“Female genital mutilation helps secure a marriage in resource-poor environments,” explains Post, who is looking at outcomes for Feed the Future, an Obama Administration initiative to reduce poverty in the world’s poorest countries, most of them in Africa.

Post is quick to point out that violence typically associated with developing countries spreads to developed countries, too, as populations migrate. The Centers for Disease Control and Prevention estimates that more than half a million women and girls in the United States were at risk of female genital mutilation or its consequences in 2012.

“Change happens when we hold people accountable — the doctors who perform these procedures and the families who subject their daughters to them,” she says. Last year, she delivered expert testimony to the Michigan Senate Judiciary Committee before members passed a set of bills making female genital mutilation a felony punishable by up to 15 years in prison (the federal penalty is up to five years).

“There’s also an education component, helping people understand the harm that happens. These women and girls have high rates of infertility and very bad outcomes during birth,” Post adds. “This is not a ‘cultural practice’ like food, language or art. These are ‘harmful traditional practices’ based on income inequality.”

A Leader at Northwestern

Since arriving at Northwestern early last year, Post has been building the new Buehler Center into an anchor for investigators who want to explore how their own work can inform policy decisions. Her group will ultimately provide resources on everything from designing studies to engaging stakeholders who make policy decisions to calculating return on investment for interventions.

“We can help faculty interested in the policy and economic ramifications of many medical and public health issues,” she says, citing opioids and successful aging as two areas where this kind of work will have a major role. “We’re a great place to catalyze research and build interdisciplinary teams.”

“Lori has been working tirelessly to strengthen the Buehler Center’s presence and to engage diverse members of Northwestern’s faculty and staff to contribute to this vibrant new hub for health policy and economic studies and scholarship,” adds Ronald Ackermann, MD, MPH, director of Feinberg’s Institute for Public Health and Medicine, which houses the center.

Post is also the Buehler Professor of Geriatric Medicine in the Departments of Emergency Medicine and Medical Social Sciences at Feinberg.

We can help faculty interested in the policy and economic ramifications of many medical and public health issues. … We’re a great place to catalyze research and build interdisciplinary teams.

Positive Change

Though she believes in the power of policy, Post is also a realist: “Just because you have a law doesn’t mean people follow it. It’s illegal to beat your wife, but if you live in a culture where people don’t believe victims, victims will stop reporting what is happening to them.”

With this in mind, Post has developed an approach to align public will with political will to secure positive social change. Her work in the area has gained the attention of the World Health Organization, World Bank, Rockefeller Foundation, United Nations and USAID.

She also believes that better policy is key to ensuring perpetrators don’t have opportunities to commit their crimes again.

“Our laws on domestic abuse and sexual violence are so outdated and ineffective,” she says. “The best laws, like one just passed in Scotland, look at patterns of behavior. Here, each event is treated as a singular event, and we ignore emotional and psychological coercion, which is more devastating than a beating. So how do we stop long-term, repeat predators?”

Above: In March, Post helped organize a workshop for health policy investigators, civil rights lawyers and policymakers focused on combating female genital mutilation, held at the University of Oxford. Below right: James Adams, MD, chair of Emergency Medicine bestows Post with a medal marking her investiture as the Buehler Professor of Geriatric Medicine during a ceremony last summer.

Post has an answer to this question in the area of elder abuse. In Michigan, she developed a comprehensive background check system for workers in long-term care and hospice facilities, to make sure people who have done things like steal Social Security checks or physically abuse or neglect patients don’t slip through the cracks.

“I found that people who are applying for jobs in long-term care have three times the criminal history rate as the general population,” she says, citing a review she published in the Journal of Advanced Review. “Previously, many types of crimes were not discoverable by doing background searches, so perpetrators would just move to a different type of facility or a different state and begin offending again at a new job.”

Post’s background check system has become the gold standard: It’s spread to other states and was funded by the Affordable Care Act as the national model. And Post has become an expert on public health violence surveillance, delivering presentations to the Centers for Medicare & Medicaid Services and trainings to the FBI. She’s currently working to apply her work to gun control policy, as well.

“While background check systems developed to screen long-term care providers inform firearm background checks, preventing mass shooters requires identifying escalating predatory behavior and personality disorders such as psychopathy,” Post says.

Though her work covers weighty topics spanning from female genital mutilation to elder abuse and other types of violence, Post manages to stay positive.

“You can think of it as sad work,” she admits. “But it’s also been wonderful to make a difference. I get to travel the world collaborating with academics and civil rights lawyers; it’s gratifying to see the application of my work on developing effective policy and to make positive social changes.”

In her free time, Post focuses on her family: husband, Tim, a health economist who she met over a cadaver in that forensics class in London, and their four children, who live across the United States pursuing careers and education in art, filmmaking, sports and math theory.

“I’m a big believer in following your passions at all costs, so I’m always pushing my kids to be risk takers,” she says. “I think it would be horrible to come to the end of your life and say ‘I wish I had done that.’”