Q: What if we treat violence like an epidemic disease? A: We could put violence into the past!

By Gary Slutkin, M.D.

What if we, as public health professionals, approached violence as a public health problem in a serious way? What if we, as public health professionals, approached violence as a problem that we can treat with health interventions and prevent using science based solutions?

I asked myself those questions when we launched the Cure Violence model of violence reduction 15 years ago. Following more than 10 years of fighting health epidemics in Africa and Asia, I returned to the United States and began to notice parallels between the trajectory of violence plaguing U.S. cities and the trajectory of diseases plaguing the communities in which I previously worked abroad. You see, a cholera outbreak in Somalia shows the same epidemiological curve as the 1994 mass killings in Rwanda; killings in US cities, which appear as a wave sitting on top of a wave, resemble outbreaks of tuberculosis in Europe centuries ago.

Violence has the characteristics of an infectious disease in how it is transmitted from person-to-person and how it is spread neighborhood-to-neighborhood and community-by-community. Thus, we must physically interrupt violence before it takes hold of the minds and bodies of those affected by it, and also change thinking and attitudes to prevent the cycle of violence from repeating itself before the behaviors that trigger violence become cultural norms.

I came to realize that the issue of violence had been fundamentally misdiagnosed –having been seen as a moralistic issue with reduction strategies applied based upon totally outdated thinking. We had simply not taken into account how violence really behaves—as a contagious, or epidemic process, or disease. So, even those of us in the public health community who referred to violence  as a public health problem, had not yet applied specific epidemic control techniques.

Cure Violence now approaches violence in an entirely new way–we approach it like a disease. The Cure Violence model uses the same science-based strategies being used globally to fight other epidemic diseases. We train carefully selected members of the community — disease control workers who are trusted insiders — to anticipate where violence may occur and to intervene before it erupts—just like you might use health workers to find early cases of tuberculosis, SARS, or even bird flu. Other very highly trained health or epidemic control workers take on the specific tasks of behavior change, and changing norms. Transmission is averted and spread limited.

Street outreach workers/violence interrupters in action in Chicago. Photo: Robert Wood Johnson Foundation
Street outreach workers/violence interrupters in action in Chicago. Photo: Robert Wood Johnson Foundation

As it turns out, this approach, the epidemic control model, works. The Cure Violence method, our first application of this thinking, has now been statistically validated to reduce shootings, killings or both by 30 to 70 percent by three independent evaluations directed by the Department of Justice and Centers for Disease Control (CDC) in three major U.S. cities—Chicago, Baltimore and New York. This model is being replicated in more than 50 sites across the US and in 15 cities, and is being applied in seven other countries, with early results also showing great promise.

When we recognize violence as an epidemic disease it empowers us to treat and prevent it with  specific epidemic control methods. Doing this makes it possible for us to be much more effective in reducing the epidemic of violence. Like violence, prior epidemics from leprosy to typhus to plague, were treated moralistically for centuries. However, when their epidemic and contagious nature became identified and the strategies revised to conform to science, we were able to move these diseases into the past.

It is now up to us in the public health fields to do the same with violence.  It is time for health professionals, health departments, and hospitals to step up and work together with this and other epidemic control strategies to put violence into the past.

TEDMED 2013 speaker Dr. Gary Slutkin is an epidemiologist and the Founder/ Executive Director of Cure Violence, formerly known as CeaseFire.