Violence breaks down communities. But, often, these communities are already broken down by poverty, joblessness, and inequality. When violence breaks out, people – and businesses – don’t want to move in. That means there are more school closings, more foreclosures, and fewer options for lower-income youth. Violence creates the conditions that make it thrive. Or maybe it’s the other way around. It’s hard to tell where it started. But some people have been trying to figure out how to make it stop.
“Violence is a crime issue, it is a social problem, it is a human rights problem, it is also a public health problem,” said James Mercy, the Special Advisor for Global Activities in the Division of Violence Protection at the CDC.
Now it’s obvious why violence is a public health problem. But it hasn’t always been this way. Mercy and Linda Dahlberg give us the play-by-play in a 2009 report for the CDC. There are two main reasons. First, there was a dramatic burst in homicide and suicide rates in the 1980s. Second, we started to accept behavioral factors as targets in disease prevention.
“There’s no one solution,” Mercy said. “These types of problems, like heart disease, require interventions on multiple levels. In general, what seems to be most effective, are early-type interventions. Interventions around parenting, and the environments that children are in.”
There are also interventions that try to stop violence as it starts. This has become known as violence interruption, which came out of Gary Slutkin’s anti-violence initiative, CeaseFire (now known as Cure Violence). Founded in the West Garfield neighborhood of Chicago in 1995, the project uses outreach workers, often former gang members, to conduct mediation. In 2011, Steve James filmed a documentary on the program, The Interrupters.
“Gun violence in particular acts very much like a social contagion. It spreads like a virus,” said Daniel Webster, Director of the Center for Gun Policy and Research at Johns Hopkins. “It spreads over time and place and among social networks, just as a virus might. So Slutkin thought about what was effective in controlling HIV and TB and other infectious diseases. A lot of times it boils down to what is the most proximate key behavior.”
Violence interruption hasn’t only been used in Chicago. By 2012, the Robert Wood Johnson Foundation set up 15 more sites to implement violence interruption. Webster and Jennifer Whitehill brought the program to Baltimore’s violent neighborhoods as Safe Streets. They reported much success: “5.4 fewer homicide incidents and 34.6 fewer nonfatal shooting incidents, on average, across all program sites during 112 months of observation.” They also seemed to break the social support for violence as a solution.
“What these violence interrupters do is help people realize that the social norms have not been serving them or their communities particularly well. They give people an excuse to walk away from situations they might otherwise feel like the social code is ‘I have to respond with violence’,” Webster said.
But where is the violence coming from? I spoke with Rebecca Levin, the Director of Strengthening Chicago’s Youth (SCY), to try to understand. Created by Lurie Children’s Hospital of Chicago, SCY brings together public and private stakeholders to tackle youth violence. They created a “Focus on Five” actions that everyone can take to prevent gun violence.
“One of the items on there is about access to firearms and gun violence prevention policy,” Levin said. “But you could get rid of every gun in Chicago, that would get rid of our gun violence problem. But that wouldn’t get rid of all our underlying issues and all the other pieces related to the gun violence issue.”
For Levin, the root cause of gun violence is related to structural violence.
“If you look at the cities that are experiencing more success with violence prevention, with cities with less success, slower declines are more segregated,” Levin explained. A recent New York Times report (“A Chicago Divided by Killings”) backs Levin up: “residents living near homicides in the last 12 years were much more likely to be black, earn less money and lack a college degree.”
Previously on this blog, I wrote about the health impact of racial residential segregation. Consider Chicago. We know Chicago remains one of the most segregated cities in the United States. We also know that we see dramatic differences in life expectancy, when we move from a predominantly white to a predominantly black neighborhood.
Segregation causes, as the sociologist William Julius Wilson might call it, an “accumulation of disadvantages.” Segregate a population and they get decreased access to resources, increased poverty and joblessness, and more constraints on their life chances. Concentrated poverty creates an environment for violence. But violence, also, creates more poverty: fewer businesses want to invest in an area, which depresses property values and decreases civil services, and keeps people disconnected from job networks. Gun violence is a public health problem that causes more public health problems.
“It is noteworthy how these conditions overlap. Substance abuse, violence, those are the particularly key ones that are quite concentrated in social disadvantage,” Webster said. “If you can reverse those determinants, you could stand to benefit not only with respect to violence but other health outcomes as well.”