Can we decrease gun violence by treating it like an infectious disease? Signs point to yes

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Marco Werman: I’m Marco Werman with The World. I don’t know if you’re keeping count, but you know there’s been a disturbing number of news stories about guns and violence here in the US recently. In Charleston, in Chattanooga, and in Lafeyette, Louisiana, all high profile incidents. But much of the gun violence that goes on in this country actually gets very little attention, it’s community-based. We’re going to hear about a program now that’s been showing success in reducing gun violence in urban communities. It’s led by a doctor who spent years in Africa and Asia trying to curb the spread of tuberculosis and HIV.  Here’s more from our colleague, Amy Costello, host of the Tiny Spark podcast.


Amy Costello: Autry Phillips is a church leader and community activist in Chicago. About a decade ago, the neighborhood where he was working was consumed by gun violence.


Autry Phillips: Looking at upwards of 50 shootings a year. The community was in a uproar and one of the things that clergy was trying to do was go out on the corners and try to resolve problems that we knew nothing about, honestly. So when we met the doc, it was honestly more of an eye-opening for most of us.


Costello: The doc he’s talking about is Gary Slutkin, a physician and epidemiologist trained in infectious disease. He fought cholera and tuberculosis in Somalia during the 1980s, and later AIDS in Uganda. He also worked at the World Health Organization and after a decade abroad, he moved back home.


Gary Slutkin: When I returned to the United States and I began to see about kids shooting each other and began asking people questions, “Well, okay, what are you guys doing about it?” and nothing was making sense that they were saying, I then recognized this as what we at World Health would call a stuck problem because there were too many answers and none of them made sense and none of them were working.


Costello: So Slutkin started looking for patterns. He pulled out charts, graphs, and maps. After a while, the epidemiologist saw something about gun violence in America that looked eerily familiar.


Slutkin: This is the same kind of graph that I’ve been dealing with my whole life. This is the same kind of map, same kind of clustering. I just said, “This is behaving exactly like an infectious disease.”


Costello: Wait a second--gun violence as an infectious disease? Slutkin says it helps if you look at it that way rather than as a crime with a victim and a perpetrator.


Slutkin: I don’t like victim and perpetrator language at all. Someone who has active tuberculosis and passes it on to his son, is there a perpetrator in there, and a victim? But this guy, he got the TB years ago from his best friend, so was it conscious or unconscious? Was it controlled? Because objectively that’s what’s happening in violence, is someone has picked this up from someone else and they pass it on to someone else and pass it on to someone else.


Costello: To stop people from killing each other with guns, Slutkin would reach into the same toolkit he’d used combatting TB and AIDS, namely find local leaders, train them, and have them teach the community how to stop the deaths plaguing their neighborhoods. The program used to be called Ceasefire and now goes by Cure Violence. It’s been featured in the documentary, The Interrupters. Cure Violence has been active in 25 cities around the world, including in Iraq and Honduras, and there’s evidence that it works. According to an independent study, gun homicides were reduced by half in one Baltimore neighborhood after the program stepped in. Another evaluation showed the program reduced gun violence in high crime neighborhoods in Chicago.


Phillips: It wasn’t about trying to stop people from shooting but it was more about changing the norms of individuals.


Costello: Autry Phillips says he’s seen the changes. Cure Violence brings together teams of people who go into neighborhoods after a gang-related shooting. Phillps’ colleagues have gone out in the middle of the night to talk to an armed man bent on killing a rival. Here’s how they would urge someone to choose another route.


Phillips: The best thing that we can do for that individual is remind him of the consequences of pulling that trigger. We asked him to think past right now and it’s two hours later. “You’ve pulled the trigger, someone else is dead and now the police is looking for you. Right now, what I want you to do is think about mama right now. What would mama have you to do? Would dad be pleased with you right now? But more importantly, how is this going to affect you two hours from now?”


Costello: Sometimes, says Slutkin, these kinds of negotiations go on not just for hours or days but for months. Kind of like any success in global health, real change occurs through hard work not over days but years. For The World, I’m Amy Costello.


Werman: Amy mentioned that the group Cure Violence has been active in Iraq and we wanted to know more about that, so we called up Brent Decker. He’s worked with Cure Violence since 2003 and he’s the guy who helped get the Iraq program off the ground. Decker says that when Gary Slutkin brought up the idea of applying violence interruption in Iraq, he was skeptical.


Brent Decker: When Gary first approached me about it, I was like, “This guy must be crazy.” That was kind of my first response to it.


Werman: But Decker says they went ahead and adapted the program. They trained local people to do the interventions and translated training materials into Arabic. The project started in Basra, in the south of Iraq, in 2008. It’s a largely Shiite city, but Decker says they also worked with Sunni and Christian community leaders. The idea remained the same as here in the US: bring in local people who can tell when violence is about to break out and who have the credibility to intervene and stop it. Decker says, yes, there were cultural differences between Basra and Baltimore. For one thing, tribes play a big role in Iraq, so the teams engage with tribal leaders. In the end though, he says what really surprised him was how similar things were. Violence would erupt over the simplest things.


Decker: It could have been anywhere. It was fights about--in Basra, there was only power on for four hours, so people had their private generators, and so it’d be something like someone plugging into a generator, or over things like “someone looking at my woman the wrong way.” I mean, it was very minor things but I think in the context of some of the large conflicts they quickly would ignite.


Werman: He says sometimes they would mediate in cases that involved sectarian tensions and militia violence, but the focus was largely on community conflicts. Cure Violence wrapped up their work in Iraq in 2013 after US funding ran out, though Decker says the local group still used some of the group’s techniques. Since Iraq, Cure Violence has branched out into other countries. Their focus now is on interrupting violence in communities in Mexico and Central America.