Epidemiologist interrupts contagion of violence

June 15, 2014

Paramedics barrel into the emergency room with a shooting victim who is critical and unstable. Staff strains to save a fading life, but loses the fight.

In the waiting room, relatives and friends of the victim gather in frenzied emotion. Some wail, others curse. Some plot revenge.

A day or so later, maybe only hours later, another gun-shot victim is in-bound.

Can anyone make it stop?

Dr. Gary Slutkin of Chicago is trying. An epidemiologist, Slutkin equates urban violence with contagious disease. Cure Violence, the nonprofit organization he founded, acts to interrupt the transmission of violence by anticipating where outbreaks will occur and intervening with the individuals "most infected" with violence. Slutkin will talk about this epidemiological approach to preventing shooting contagion during a keynote at the Catholic Health Assembly, June 22-24, in Chicago.

"I want health practitioners and hospitals to develop a better understanding of this problem and begin to play larger roles in reducing violence," he said. "I want the health sector to step up."

Violence interrupters
Cure Violence taps reformed ex-cons and former gang members to work as "street interrupters." One of their primary jobs is to persuade families and friends of shooting victims not to shoot back. They use their connections and street smarts to find brewing conflicts and employ mediation skills acquired in Cure Violence training to intervene before conflicts become lethal. Street interrupters work to change the behaviors of individuals "most infected" with violence. They do so in part by showing there are alternatives to a violent life — paths that may start with job training and drug abuse counseling.

Slutkin has worked closely with police officials in more than a dozen cities for nearly two decades. The best of them, he said, know that police work can solve murders, not the reasons why people commit them. However, the Cure Violence model and its methods are not uniformly embraced by police officers, some of whom don't trust people they once locked up.

But in communities where violence has become the norm, the unconventional and up-close approach employed by Cure Violence has shown promise. Slutkin said that viewing violence as a health issue "can transform the way we look at violence and change results. The truth is that violence acts like a contagious disease. So you use resources to keep it from spreading."

Violence vectors
Slutkin developed his program and contagion theory of violence upon returning to Chicago after 15 years fighting communicable diseases around the world, beginning with tuberculosis during his residency at San Francisco General Hospital in 1981. His service with the World Health Organization took him to 20 countries, including Somalia to reduce cholera and tuberculosis and Uganda to fight AIDS.

He started his first local antiviolence program in Chicago in 2000 as CeaseFire. The name was later changed to Cure Violence. A network now comprises 15 cities including Baltimore; Oakland, Calif.; New York; New Orleans and Kansas City, Mo., and programs in other countries, including Honduras, Great Britain and Iraq. Police, community organizations, social agencies and hospitals and health agencies may take part in the programs. All concentrate their resources in high-crime neighborhoods.

That provides an opportunity for study, which Slutkin said can show what's possible on larger scales. A study of the Safe Streets Baltimore program by Johns Hopkins University said its efforts cut homicides by 54 percent in one of the city's most violent neighborhoods in 2009 and 2010. In Chicago, a study by the U.S. Department of Justice in 2008 found "statistically significant declines" in shootings in participating neighborhoods, ranging from 41 percent to 73 percent over the previous four years.

But in those years, the number of all homicides in Chicago still ranged from 451 to 513. The size of the program and its target zones have varied over the years, subject to the vagaries of public funding and grants.

Culture clash
In 2012, the culture clash between Cure Violence and some in law enforcement was expressed during a speech by Chicago Police Superintendent Garry McCarthy, who said he was "not a big fan." He accused the program of "undercutting" police by persuading crime victims and gang members to talk to interrupters, not police investigators.

Slutkin said Cure Violence staff members cannot be effective if they are perceived as a civilian arm of detective bureaus. He said recruiting interrupters from the ranks of former gang members is necessary to reach people who still think violence is a solution.

"When you are doing health outreach, you need refugees to reach refugees, sex workers to talk with sex workers, moms to appeal to moms," he said. "The police always have their snitch networks. We're doing something different from that."

Wounded communities
Among police officials who defend Cure Violence is Kansas City Maj. Anthony Ell, a 29-year veteran who works with Aim4Peace, that city's program. It operates in a high-crime part of Kansas City and claims to have reduced homicides by 56 percent in its concentration zones from 2012 to 2013, compared to a 1 percent increase citywide.

"This program has had a significant impact in reducing overall violence in those areas," Ell said. "It does not interfere with law enforcement. And the truth is that we in law enforcement cannot just lock up the problem."

Aim4Peace is managed by the Kansas City Health Department, which Slutkin considers the ideal sponsorship for a health-based program. It works in partnership with Truman Medical Center Hospital Hill, the city's main trauma hospital. Ell is the police department's program liaison. Aim4Peace has a $1 million budget, which covers 14 full-time positions, is a mix of grants and public money, including funding from the police department.

Ell said he believes in Slutkin's health thesis. "Homicide traumatizes families and neighborhoods," he said. "You get a wounded, unhealthy community."

He also said he understands some of the reservations held by fellow officers.

Hospital responders
Another strong supporter is Dr. James Doherty, director of the trauma division at Advocate Christ Medical Center in Oak Lawn, a near suburb of Chicago and the first hospital partner of Cure Violence. In addition to working with the programs on the city's South Side, Advocate Christ also has its own staff of three street-smart counselors, known as hospital responders, who go out and talk with victims of violence in the same fashion as the street interrupters.

"When tempers are flaring and people are out for blood, having someone who can delve into the situation and with authority say, 'Hey, revenge isn't going to make it
better' — that has real impact," said Doherty. "White doctors from the suburbs don't have that kind of credibility. The police can try, but I don't think it has the same power. This makes a lot of sense, and it is an extension of our mission to prevent injury."

It also works, Doherty said. A study by hospital staff members that was presented at a health symposium in January shows that victims of violence who had been served by the hospital responders were half as likely as others to return to the hospital as victims of another violent incident. The study compared hospital records from 2003-05 to 2005-07.


Copyright © 2014 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.

Copyright © 2014 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.