What Is Needed to End Violence

Because of its pervasiveness and far-reaching effects, violence is one of the most devastating global challenges. Violence not only causes injury and death, it also erodes the physical, psychological, social, and economic health and development of nearly everyone in affected communities, reducing life expectancy, inflicting trauma, limiting opportunity and achievement, and further entrenching inequities [1-9]. These extensive effects of violence make it absolutely necessary to address violence as a first step, to avoid investments in other areas from being undermined and potentially wasted.

What is needed

Recent scientific advances have demonstrated that violence behaves like other contagious epidemics [10], yet violence is the only health epidemic not primarily managed by the health sector, and in which we are not the principal spokespersons or policy advocates. While health and public health methods for stopping violence exist and have been proven effective, they are greatly underutilized and under-resourced [11].

New methods are now available for stopping the spread of violence that are tailored to its disease-like characteristics. The public health sector has a strong record of effective disease prevention, changing norms and behaviors, and reaching high-risk populations, including in stopping epidemic disease. The epidemic control approach to reducing epidemic violence will be highly recognizable to those who have worked in infectious disease and epidemic control. Community-based health workers are selected, trained, supervised and supported, under the guidance of and working closely with the health sector. Health workers map out areas of highest transmission and symptom manifestation, reach out to and intervene with those displaying clinical signs to reduce further transmission (in this case future violent events) using methods tailored to the infectious problem at play, detect close contacts and others with emergent symptoms or at highest risk of future contraction, and render all those at highest risk less symptomatic and likely to transmit. Through these methods, health workers reduce spread of the contagion and reverse the epidemic process. As with other contagious health problems such as AIDS and Ebola, new protective behaviors and norms are then further promoted and supported at the community level [12].

Over the last 15 years, Cure Violence and other organizations and agencies have used these epidemic disease control methods to prevent and reduce community violence in dozens of communities around the world [13-14]. The Cure Violence approach works to prevent violence by using violence interrupters, outreach workers, and hospital responders to prevent violent events and retaliations, reduce risk among those most likely to become violent, and shift norms to discourage the use of violence. Violence interrupters work to detect and interrupt conflicts to prevent the conflicts from escalating into potentially fatal violence.  Outreach workers focus on identifying those at highest risk for involvement in violence and work to decrease their risk by addressing their risk factors.  Hospital responders focus on responding to victims of violence that come to a hospital for treatment of injuries, and work to prevent retaliation or subsequent re-injury and address associated mental trauma from the exposure to violence.  Each of these workers is hired for their credibility with those at highest risk, which enables them to communicate effectively with those at risk.  Each worker is extensively trained in the techniques needed for the work, including the methods of detecting and mediating conflicts, epidemic control techniques, and mapping of events and high-risk individuals.

Independent multi-site evaluations of programs using this approach have found significant reductions in shootings and killings. An evaluation conducted in Chicago found the approach was associated with an up to 70 percent reduction in shootings and killings and an up to 100 percent reduction in retaliatory homicides [15], and an evaluation in New York city found reductions in shootings as high as 63%. In Honduras, after the implementation of Cure Violence, shootings and killings dropped by 88% across five areas of San Pedro Sula [16]. Similar results are being reported in several other cities in the US and abroad [17].

More than a model and the use of credible workers, the use of the health approach to preventing violence is about a paradigm shift in how we understand and approach violence – for all types of violence, in all sectors, and across all geographic areas.  To accomplish this, the Cure Violence organization is working to build out training networks to help guide the approach to violence prevention in all areas of the world, and have begun to create a network of organizations and individuals involved in violence interruption and behavior and norm change for all forms of violence, including community violence, sectarian violence, domestic violence, violent extremism, and intra- and interstate conflicts.  This work is centered on guiding the world towards the use of existing infrastructures to the use of methods for keeping violence at bay using health and public health methods.

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8.      Delaney-Black, V., Covington, C., Ondersma, S. J., Nordstrom-Klee, B., Templin, T., Ager, J., ... & Sokol, R. J. (2002). Violence exposure, trauma, and IQ and/or reading deficits among urban children. Archives of pediatrics & adolescent medicine, 156(3), 280-285.

9.      Bai, Yasemin Irvin-Erickson Bing, Annie Gurvis, and Edward Mohr. "The Effect of Gun Violence on Local Economies." (2016).

10.  Slutkin G. Violence is a contagious disease. In: Patel DM, Simon MA, Taylor RM, eds. Contagion of Violence: Workshop Summary. Washington DC; National Academies Press; 2012:94-111. https://www.nap.edu/read/13489/chapter/8#94. Accessed September 11, 2017.

11.  Ransford C, Slutkin G. Seeing and treating violence as a health issue. In: Brookman F, Maguire ER, Maguire M, eds. The Handbook of Homicide. Chichester, West Sussex, England: Wiley-Blackwell; 2017:601-625.

12.  Slutkin, Gary, et al. "How Uganda reversed its HIV epidemic." AIDS and Behavior 10.4 (2006): 351-360.

13.  Butts, Jeffrey A., et al. "Cure violence: a public health model to reduce gun violence." Annual review of public health 36 (2015): 39-53.

14.  Slutkin G, Ransford C, Decker RB. Cure violence: treating violence as a contagious disease. In: Maltz MD, Rice SK. Envisioning Criminology: Researchers on Research as a Process of Discovery. Cham, Switzerland: Springer International Publishing; 2015:43-56.

15.  Skogan WG, Hartnett SM, Bump N, Dubois J. Evaluation of CeaseFire-Chicago. Evanston, IL: Institute for Policy Research, Northwestern University : 2008. https://www.ncjrs.gov/pdffiles1/nij/grants/227181.pdf. Accessed September 11, 2017.

16.  Delgado, Sheyla A., Laila Alsabahi, Kevin Wolff, Nicole Alexander, Patricia Cobar, and Jeffrey A. Butts (2017). The Effects of Cure Violence in the South Bronx and East New York, Brooklyn. In Denormalizing Violence: A Series of Reports From the John Jay College Evaluation of Cure Violence Programs in New York City. New York, NY: Research and Evaluation Center, John Jay College of Criminal Justice, City University of New York.

17.  Ransford, Charles, et al. "El modelo Cure Violence: reducción de la violencia en San Pedro Sula (Honduras)." Revista CIDOB d'Afers Internacionals 116 (2018): 179-206.

18.  For a list of results and upcoming studies, see: Cure Violence. Summary of the findings on Cure Violence. http://cureviolence.org/results/summary-of-findings/. Accessed September 11, 2017.