Violence as Disease: New Approaches, Promising Solutions.

How I Changed My Focus from Infectious Diseases to Violence

As a physician trained in infectious diseases, I never expected that my focus would shift towards violence. But after working in Somalia and other countries with epidemics like tuberculosis and cholera, I realized that violence was behaving like a contagious disease.

Looking at maps and data, I saw that violence in most U.S. cities had clustering, similar to clustering in infectious epidemics. And what really predicts a case of violence is a preceding case of violence, just like how someone exposed to tuberculosis is at greater risk of getting the disease.

But there is good news: epidemics can be reversed by interrupting transmission, preventing further spread, and shifting norms. To apply this to violence, I designed a new category of worker called a violence interrupter, someone who can find first cases of violence and cool people down.

Our first experiment with this approach resulted in a 67% drop in shootings and killings in a Chicago neighborhood. Since then, this method has been replicated 20 times, with independent evaluations showing reductions in shootings and killings.

While we faced criticism and opposition for our approach, it has been hugged by many major cities in the U.S. and internationally. It’s an opportunity to replace some prisons with playgrounds or parks and to allow science to replace morality in addressing violence.

For me, this shift in focus was unexpected, but it was a matter of looking at maps, graphs, and asking questions to try new tools that have been used before for other things. Violence is a public health issue, and I hope this approach can help communities heal and thrive.

Lessons from Infectious Epidemics: Violence as a Contagious Disease

It may come as a surprise that violence can behave like a contagious disease. But as someone who has worked in infectious epidemics like tuberculosis and cholera, I can attest to the similarities.

Clustering is a common pattern in infectious epidemics, and the same holds true for violence in most U.S. cities. Additionally, the greatest predictor of a case of violence is a preceding case of violence, just like how someone exposed to tuberculosis is at greater risk of getting the disease.

However, this similarity also offers hope. Epidemics can be reversed by interrupting transmission, preventing further spread, and shifting norms. To apply this to violence, a new category of worker called a violence interrupter was designed. These individuals are trained in persuasion, cooling people down, and reframing situations.

The first experiment with this approach resulted in a 67% drop in shootings and killings in a Chicago neighborhood. Since then, this method has been replicated 20 times, with independent evaluations showing reductions in shootings and killings.

Despite criticism and opposition, this approach has been hugged by many major cities in the U.S. and internationally. It offers an opportunity to replace some prisons with playgrounds or parks and to allow science to replace morality in addressing violence.

Infectious epidemics have taught us the importance of detecting and finding first cases, preventing further spread, and shifting norms. Applying these lessons to violence can help communities heal and thrive. Violence is a public health issue, and we have the tools to address it.

New Categories of Workers and Behavior Change: A Revolutionary Approach to Violence

Violence has been a problem for society for centuries, and despite the efforts of law enforcement, the problem persists. Punishment has been the main driver of behavior change for a long time, but it is not always effective. It reminded me of ancient epidemics that were previously completely misunderstood because the science hadn’t been there before, epidemics of plague or typhus or leprosy, where the prevalent ideas were that there were bad people or bad humors or bad air, and widows were dragged around the moat, and dungeons were part of the solution.

Another solution suggested is to fix all of these things: the schools, the community, the homes, the families, everything. However, in treating other processes and problems, it has been realized that sometimes you don’t need to treat everything. A giant gap exists in the problem of violence, and a new approach was needed.

The problem of violence has historically been stuck, and this has been the case in many other issues, such as diarrheal diseases and malaria. Frequently, a strategy has to be rethought. New categories of workers and behavior change, along with public education, were the key to making a difference.

Interrupting transmission is the first step to reversing epidemics. In order to interrupt transmission, first cases must be detected and found. We designed a new category of worker, the violence interrupters, who might find first cases. In this case, it’s someone who’s very angry because someone looked at his girlfriend or owes him money, and you can find workers and train them into these specialized categories. The second step is to prevent further spread, which means finding who else has been exposed but may not be spreading so much right now, like someone with a smaller case of T.B., or someone who is just hanging out in the neighborhoods, but in the same group. Then they need to be managed as well, particular to the specific disease process.

The third step is shifting the norms, which means a whole bunch of community activities, remodeling, public education, and then you’ve got what you might call group immunity. And that combination of factors is how the AIDS epidemic in Uganda was very successfully reversed.

In the year 2000, a new approach was put together by hiring new categories of workers, the first being violence interrupters. These interrupters were hired from the same group, credibility, trust, access, just like the health workers in Somalia, but designed for a different category, and trained in persuasion, cooling people down, buying time, reframing. Another category of worker, the outreach workers, kept people on therapy for six to 24 months. The object was behavior change. A bunch of community activities were also designed for changing norms.

The first experiment of this resulted in a 67-percent drop in shootings and killings in the West Garfield neighborhood of Chicago. Since then, this approach has been replicated 20 times. Independent evaluations supported by the Justice Department and by the CDC and performed by Johns Hopkins have shown 30-to-50-percent and 40-to-70-percent reductions in shootings and killings using this new method.

This new approach is being hugged more by law enforcement than it had been years ago. Trauma centers and hospitals are doing their part in stepping up. Many of the major cities in the U.S., including New York City and Baltimore and Kansas City, their health departments are running this now. The U.S. Conference of Mayors has endorsed not only the approach but the specific model.

Where there’s really been uptake even faster is in the international environment, where there’s a 55-percent drop in the first neighborhood in Puerto Rico, where interruptions are

Interrupting Transmission, Preventing Further Spread, and Shifting Norms: The Three Keys to Reversing Epidemics

Interrupting transmission, preventing further spread, and shifting norms are the three keys to reversing epidemics, according to the experiences of a physician who worked in Somalia and later focused on violence prevention. The first step to interrupting transmission is to detect and find the first cases of violence, just like in the case of tuberculosis. This can be done by training new categories of workers, such as violence interrupters who are hired from the same group and are trusted and credible within their community.

Once the first cases of violence have been detected, the second step is to prevent further spread by finding those who have been exposed but are not yet spreading as much, such as those with a smaller case of TB. Outreach workers are essential in this step, as they can keep people on therapy for six to 24 months to encourage behavior change.

Finally, shifting norms is the third step, which involves community activities, public education, and remodeling to create group immunity. This combination of factors is how the AIDS epidemic in Uganda was successfully reversed.

The experiences of this physician have shown that violence behaves like a contagious disease, just like TB or the flu. By using the same strategies that have been successful in treating infectious diseases, new categories of workers can be trained and employed to interrupt transmission, prevent further spread, and shift norms to reverse the epidemic of violence. This approach has been successfully implemented in many cities in the US and internationally, resulting in significant reductions in shootings and killings.

The Success Story of Violence Interruption: A 67% Drop in Shootings and Killings

Violence interruption is a public health approach that treats violence like a contagious disease, interrupting its transmission and preventing further spread. In practice, this means training a team of violence interrupters, often individuals with lived experience in violence-prone communities, to intervene in conflicts and deescalate potentially violent situations.

This approach has seen remarkable success in reducing violence. In one study cited by the original speaker, violence interrupters were able to achieve a 67% drop in shootings and killings in their target community. This reduction in violence was sustained over time, demonstrating the long-term impact of violence interruption.

The success of violence interruption lies in its ability to shift cultural norms around violence. By showing individuals that violence is not the only solution to conflict, violence interrupters create a ripple effect that can change the overall culture of a community. As the original speaker notes, “changing behavior is the key to changing the culture.”

While violence interruption is not a panacea for all types of violence, it has shown great promise in reducing gun violence and other forms of interpersonal violence. As more communities adopt this approach, it is possible that we may see a significant reduction in violent crime across the country.

Transforming Criticism into Endorsement: The Rising Momentum of Addressing Violence as a Disease

There has been a growing shift in the way we think about violence prevention. What once was met with criticism is now gaining endorsement as an effective approach. Instead of solely relying on punishment and incarceration, more and more people are recognizing the value of treating violence as a contagious disease.

This approach involves identifying and interrupting the transmission of violence, preventing further spread, and changing social norms that condone violent behavior. By addressing the root causes of violence and treating it as a public health issue, we can create a safer and healthier community for everyone.

One example of this approach in action is the Cure Violence program, which has achieved remarkable success in reducing violence in some of the most dangerous neighborhoods. By training and deploying “violence interrupters,” who are trusted members of the community, they have been able to effectively disrupt potentially violent conflicts before they escalate.

As this movement gains momentum, more organizations and policymakers are recognizing the potential of this approach. It has the potential to transform our justice system and create a safer society for all.

Replacing Prisons with Playgrounds: How Addressing Violence as a Public Health Issue Can Transform Communities

Violence has long been viewed as a criminal justice issue, leading to an overreliance on punishment and incarceration as solutions. However, a growing movement sees violence as a public health issue, with prevention and treatment as the primary means to address it.

By addressing violence as a public health issue, we can shift the focus to prevention and intervention, rather than punishment. This approach recognizes the complex factors that contribute to violence, including poverty, trauma, and lack of access to resources.

One of the most exciting aspects of this approach is the potential to replace prisons with positive community resources. Instead of spending money on incarceration, we can invest in creating safe and supportive environments for people to thrive. This can include parks, community centers, and after-school programs, which have been shown to decrease violence and improve overall well-being.

However, this approach requires a significant shift in thinking and investment in resources. It also requires collaboration across sectors, including public health, education, and social services.

Ultimately, addressing violence as a public health issue offers an opportunity to transform communities and create a safer and more equitable society.

From Emotions to Science: A New Approach to Solving the Problem of Violence

For decades, violence has been viewed primarily as an emotional or moral issue, with little emphasis on the scientific aspects of the problem. But that is changing, as experts in public health, medicine, and other fields are beginning to look at violence as a public health issue that can be understood and addressed through scientific research.

By treating violence as a disease, researchers are using scientific methods to understand the causes and risk factors, as well as developing evidence-based interventions that can effectively interrupt the transmission of violence. This approach recognizes that violence is not simply a result of individual moral failures or character flaws, but rather a complex social and cultural phenomenon that can be studied and addressed through a scientific lens.

With this new approach, there is hope that violence can be prevented before it occurs, rather than merely punished after the fact. This means investing in early intervention programs that address the underlying causes of violence, such as poverty, trauma, and inequality, rather than relying solely on punitive measures like incarceration.

In conclusion, treating violence as a public health issue is a promising new approach that is beginning to gain traction in many communities. By combining science with empathy and understanding, we can create a safer and more just world for all.

Conclusion

Violence is a complex issue that has plagued societies for centuries. However, the traditional approach to tackling violence, which is based on punishment and law enforcement, has not been effective in reducing the problem. Instead, a new approach that treats violence as a public health issue has emerged. This approach, which is based on the idea that violence is a contagious disease that can be prevented, interrupted, and treated like any other disease, has shown promising results.

Through his work, Dr. Gary Slutkin has shown that violence can be addressed by adopting public health strategies. By using epidemiological methods to understand the spread of violence and applying the principles of infectious disease control, it is possible to prevent and reduce violence. Dr. Slutkin’s approach has been successful in many cities, including Chicago, where it has led to a significant reduction in shootings and killings.

The new approach to tackling violence as a public health issue provides an opportunity to replace prisons with playgrounds, as it recognizes that addressing the root causes of violence, such as poverty, unemployment, and lack of education, is essential to reducing the problem. Moreover, the new approach recognizes that emotions and science must be integrated to solve the problem of violence.

Overall, the new approach to tackling violence as a public health issue provides a ray of hope in addressing this complex problem. By adopting public health strategies and treating violence as a contagious disease, it is possible to prevent and reduce violence, and build safer and healthier communities.