Violence as an Infectious Disease? A Program That Worked

Roxanne Nelson

April 29, 2013

WASHINGTON, DC — Does violence spread like a disease? Epidemiologist Gary Slutkin, MD, began to think so when he returned home to his native Chicago after spending years in Africa battling epidemics.

Traditional methods of controlling street violence were yielding minimal results, so Dr. Slutkin, who is currently a research professor in epidemiology at the University of Illinois, Chicago, and founder and executive director of Cure Violence, decided to apply the lessons he learned fighting infectious diseases to a new public health model to reduce violence.

Dr. Slutkin delivered an inspiring and impassioned talk here at TEDMED 2013 about how he challenged the status quo and found new solutions to a prevailing public health issue.

Treat Violence Like the Plague

Ancient epidemics, like the plague, were largely misunderstood because the science wasn't there. The same is true for violence, Dr. Slutkin explained. "The problem of violence was stuck, and we needed a new strategy."

After working overseas for more than a decade, Dr. Slutkin was ready to come home and take a break from dealing with epidemics and death. As he readjusted to the modern conveniences of life in the United States, he was alarmed by the violence taking place on American streets.

"The sense I had was that there was a giant gap here and a strategy had to be rethought," he said. "I had no idea what it would be, but I realized that we would have to do something with new categories of workers, something with behavior change, and something with public education."

He noticed that patterns of violence were similar to those seen in an infectious disease epidemic; the incidence is clustered by location and it comes in waves. Dr. Slutkin then found that the most common predictor of violence was a preceding case of violence.

 
In a way, violence is behaving like a contagious process. Dr. Gary Slutkin
 

"This is similar to what happens with the flu, if you catch if from another person," he said. "So in a way, violence is behaving like a contagious process."

After several years of intensive study, and using the same principals he had applied to controlling infectious diseases, in 2000 Dr. Slutkin piloted CeaseFire (now known as Cure Violence) in West Garfield Park, a Chicago neighborhood with an extremely high rate of violence.

His program used the same tactics that public health organizations use to reverse epidemics: interrupting potential infectious events (shootings, for example), identifying the population at highest risk (such as gang members), and changing the behavior in the community related to the infection (such as treating violence as a way of life).

A class of specifically trained workers was developed, called "violence interrupters." They were trained in a manner similar to those who address a particular disease in the community, such as tuberculosis, Dr. Slutkin explained.

The interrupters are from the community and are generally known to the high-risk people (they might have been gang members or spent time in prison), but are committed to a life without crime. Having street credibility is crucial when reaching out to high-risk individuals, Dr. Slutkin emphasized.

They act as mediators, interrupting violence before it occurs by teaching nonviolent conflict resolution. In addition, outreach workers help high-risk individuals obtain crucial services, such as job training and drug-abuse counseling.

Dramatic Results

The program has achieved dramatic results. In the first year of the pilot program, there was a 67% reduction in shootings. An independent evaluation found that Cure Violence was specifically responsible for a 28% reduction in shootings and killings, a 22% reduction in shootings and attempted shootings, and a 24% reduction in the concentration of shootings.

During the next decade, "we saw similar results in 17 other neighborhoods," Dr. Slutkin reported. The program is now being replicated in other cities, including Baltimore, Maryland; New Orleans, Louisiana; New York City; and Oakland, California. It is also being embraced overseas, in places such as Honduras, Kenya, and South Africa.

Despite the success rates, not everyone was enthusiastic about the program. There was a lot of criticism and opposition to the program, and there was skepticism that violence should be treated as a contagion. "But my business friends said that if you are being criticized tremendously, you must be doing something right," Dr. Slutkin explained with a smile. "And the movement is growing."

The theory has been validated. "It is allowing us to come out of the Middle Ages, where I feel we've been. There is now the possibility of replacing prisons with parks and playgrounds, and the possibility of converting neighborhoods back into neighborhoods. Science is replacing morality," Dr. Slutkin said.

"I didn't mean to come up with this at all. I tried to get away from infectious diseases," Dr. Slutkin noted rather wistfully as he concluded his talk.

TEDMED 2013. Presented April 17, 2013.

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