Community violence, mass shootings, terrorism, hate crimes, regional conflicts and war remain major worldwide problems, but our current reactions to them – from policing to military intervention – frequently perpetuate violence rather than interrupt its spread. In the next ten years, we should instead see and address violence in the same way we do other health epidemics.
Over the past 20 years, many scientific studies – highlighted in a landmark 2013 report by the US Institute of Medicine – have shown that violence behaves exactly like a contagious disease. As with other contagions, the biggest predictor of violent behaviour (and its perpetuation) is exposure and what one (unconsciously) thinks one's peers think and do. Studies have also shown that violence responds dramatically to being managed in the same way as other health epidemics.
Only 150 years ago, contagious diseases such as smallpox and leprosy were seen and treated as demonic, maladies of morality or character. We blamed those affected and frequently administered punitive "remedies". Only through improved scientific understanding of contagious-disease processes and the development of epidemic-control methods have we reduced or eliminated these epidemics. Control methods vary by disease – immunisation, for example, for smallpox, or impregnated bed nets for malaria – but they share a standard set of strategies: detection and interruption of spread through credible workers who have access to those at highest risk; public health campaigns to raise awareness; and methods for changing behaviours that increase transmission risk.
When I was working with the World Health Organisation’s Global Programme on AIDS in the late 1980s and early 1990s, I had a shocking epiphany. We conducted research across the world and found that the greatest predictor of whether someone used a condom or not was not their knowledge about HIV and AIDS, or fear of their potentially deadly consequences, but whether people believed their friends used them. The same, it turns out, is true of many violent behaviours including possession and use of a weapon, be it a knife or a gun.
In 2000, I worked with local community groups to pilot an epidemic-control approach to gun violence in Chicago, and we saw a 67 per cent drop in shootings and killings in the first year. Subsequently, we established Cure Violence – a public health anti-violence programme – which has now trained and partnered with more than 100 communities in 16 countries.
Numerous independent evaluations have documented the effectiveness of this approach. The method uses highly trained local, credible peer messengers – “violence interrupters” and outreach workers – to change behaviours and norms about violence, in the same way as epidemic control works for contagious diseases such as cholera, ebola and HIV/AIDS. This approach has achieved 40 to 90 per cent drops in shootings and killings in places as varied as the US, Mexico, Honduras, South Africa and the UK, and it is now being applied in the Middle East. We now need to make this the standard approach to violence.
Over the next 10 years, we should take the following actions:
Rapidly re-educate the public
We need to educate policymakers and the public on our new scientific understanding of violence and, as in other paradigm shifts, change the language used to characterise it. Our public discussion about violence must reflect an understanding of its contagious nature, the brain processes underpinning this and the effectiveness of epidemic-control strategies. Terms such as “outbreaks”, “transmission”, “interruption” and “outreach” must replace harmful and unhelpful language such as “criminals”, “gangs” and “enemies”.
Build epidemic-control infrastructures
Dramatic reductions in violence have been achieved and sustained in communities and cities that have established and expanded a network of violence interrupters – highly trained and trusted individuals from "the inside" who can intervene with people at risk of committing or being a victim of violence. These infrastructures should be developed first in the most endemic and at-risk situations. Similar infrastructures have reduced and eradicated other contagious diseases.
Create new norms
In medicine, epidemics are caused by invisible microorganisms, affecting different organs. With violence, their equivalent are invisible behavioural norms operating through brain-mediated circuits. We can not only interrupt their spread, but also create new norms through health-based outreach and public education, just as we have for smoking, drunk driving and risky sexual behavior.
Recruit political and philanthropic champions
We must urgently encourage investment from funders in health and other sectors whose main concern is saving lives, and recruit skilled leaders to champion epidemic health approaches to preventing violence.
This health approach can be applied in almost every situation where violence can occur. Although it is true that overall rates of violence have decreased through human history, we have also seen unexpected and catastrophic outbreaks occur. At a time of relative peace, for example, the killing of two people in 1914 led to a world war that left 20 million dead. And, like disease, the effect of local outbreaks of violence can be felt globally. Today, ongoing violence in the Middle East and Central America is causing dangerous political and economic upheavals in many other parts of the world through an ever-burgeoning refugee crisis.
In the next ten years, we should radically shift our view and approach to violence. Just as public-health and epidemic-control methods have brought an end to other deadly health epidemics, transformative investment in their application to violence can do the same.
Gary Slutkin is a physician and the founder and CEO of Cure Violence and professor of epidemiology and global health at the University of Illinois at Chicago School of Public Health
This article was originally published by WIRED UK
