Chicago, Baltimore, Ferguson, New York . . . Cities Torn Apart . . . How Can We Change?

To change our responses to a problem that repeats itself, we need to change the way we view the problem. Scientific studies, including those presented by the Institute of Medicine in a landmark 2013 report, have proven that violence is contagious and behaves just like a communicable virus. In light of the progress society has made in understanding the science around violence, we now have many reasons to see violence through a health lens. What we’ve learned is that people who commit an act of violence, as well as those who are injured or killed as a result of an act of violence, both have a health problem – one that is acute and likely chronic. Our responses should follow from this, and when they do, we are seeing significant reductions in violence.

Since August, 2014 we’ve seen wide-spread circulation of videos documenting shootings by police of predominantly African American and Latino young men in Chicago, Baltimore, Ferguson, Chamblee, Madison, Aurora, Los Angeles, Omaha, Pasco, Hummelstown, Denver, Decatur, Texarkana, Phoenix, Cleveland, Brooklyn, Indian Springs, St. Louis and Beavercreek. Although people march, demonstrate and even riot, our fundamental response to these shootings has not changed. Most people agree we desperately need criminal justice reform. However while that is most certainly needed, that alone will not solve the problem. This is because the premise of the criminal justice system is still largely that of bad people, and of bad people requiring punitive responses. Criminal justice reform is focused on the notion that the system needs to be fairer, but the lens remains the same. Instead, we need to see and understand violence as a health condition – fundamentally a health problem – as the science shows – and treat the people and the problem differently.

It’s obvious to most people, including law enforcement, that it is impossible for cities to arrest their way out of the problem of urban violence (or any problem) – in fact, one could argue persuasively that we have fully tried this idea. The theory of preventing violence through “overpowering” it reflects a misunderstanding of the nature of violence, specifically the value of punishment or force versus the disadvantages and harm that comes with this approach. And it also reflects a lack of understanding of how violence and contagion works and how it is successfully interrupted.

We’ve learned from the dozens of studies reviewed in the Institute of Medicine/National Research Council Report that violence itself is acquired in an unconscious, contagious manner. This is still relatively new information, evolving over the last 20 years; yet this theory offers many explanations for why and where violence increases and decreases that previous theories have not supplied, including why people exposed to community violence do more violence in the home, why people abused as children may abuse their own children when they are parents (which otherwise makes no sense), as well as why violence goes up and down when other forces such as the economy insufficiently predict trends.

Additionally we now know two other important elements relevant to creating the change we all want. First, research does show that distrust in police and government is associated with increases in violence – this is the part of the problem that can be addressed through criminal justice reform. Second – and of great importance to a more peace-filled future – we now have strong evidence that there is a much larger and important role for the community itself in stopping violence before it starts – when the health sector and community work together. It’s this latter approach – the health approach to violence prevention and the health way of seeing the people and the problem that is seriously underutilized.

Three scientifically proven ideas (1) that violence is contagious and transmitted often unconsciously through repeated and prolonged exposure, hence making violence responsive to health-based treatment; (2) that violence increases when distrust in police and government increases; and (3) that the community itself has a huge role in preventing violence, particularly when working side-by-side with the health sector – provide the underpinning for a societal shift in public policy towards new solutions.

In order to fully understand the contagion of violence, additional context and information has been provided as a result of research and study. First, science has shown that people who grow up with repeated and long-term exposure to violence by either witnessing it first hand or being traumatized by violent acts themselves – and who do not receive intervention and professional support to help them heal – are at very high-risk of perpetuating further transmission of violence – immediately as well as over weeks, months and even generations. This is how transmission occurs. The brain processes exposure to (and trauma from) violence, as the lungs process exposure to tuberculosis; i.e. to produce more and further transmit. A more detailed analysis of the mechanisms in the brain responsible for this can be found in the IOM report.

On a related note, most of us do not pause to consider the high levels of violence police officers in U.S. cities frequently witness, and therefore may not consider the notion that police officers are also traumatized by the violence they’ve been exposed to or been involved with. Besides flaws or omissions in some procedures and training which law enforcement is working to change, social norms within law enforcement are still largely based around force and punishment. Police officers themselves however, as with others who spend years living or working in violent neighborhoods, frequently do not receive regular, ongoing and needed professional crisis intervention and support to develop and maintain effective coping mechanisms around their own exposure to violence. As a result, higher suicide rates and shortened life spans due to stress-related conditions are also prevalent among those in law enforcement. They often have important health conditions which they are bearing as a result of their service.

Health based approaches to reducing violence in communities which incorporate standard and usual epidemic control outreach methods include the use of outreach workers and specialized violence interrupters (made famous in the award winning documentary “The Interrupters“) hired from the community itself. These methods have consistently and substantially reduced violence in many cities, but also relieve law enforcement of carrying all of the burden and their need to be everywhere at all times, something that is impossible, not always desired, and frequently results in unnecessary or unpredictable confrontations.

Health and community based methods more effectively reach the population in low income, minority or marginalized neighborhoods where trust is low – by using trusted and effective community messengers who are able to persuade and influence people to change behavior. This health based outreach approach hires these community based workers to serve as credible messengers to stop people who are angry or upset and who are likely to use violence; the health sector provides the workers with specialized training in epidemic control and behavior change. Beside all of these benefits of access and trust in high-risk communities, this approach has the added benefit of providing employment in neighborhoods where joblessness is the norm, not the exception.

To successfully stop violence in our communities, health–based approaches complement existing and improving law enforcement responses. Health based approaches improve our understanding and our response to those truly suffering in high-risk neighborhoods by providing all with new behavioral and social norm expectations. Too many times the value of human life appears to be diminished in high-risk communities, both by those likely to or engaged in perpetrating acts of violence as well as by the police seeking to protect the neighborhood, and even by society. Protecting and saving human lives should be our most sacred value, and all of us should hold this value highest.

Understanding violence as contagious and seeing violence as a health issue helps us truly help people, successfully treating and preventing violence from being further transmitted. The specific health approach most tested is based on three fundamental and scientific principles: (a) identification and interruption of potentially violent events (stopping events from happening), (b) effective and meaningful behavior change (stopping events even further in the future), and (c) eventually changing the very norms that perpetuate the violence and that will help keep the community safe for the longer time period. These are all proven areas of expertise of the health sector and areas in which outreach workers are extensively trained.

When existing problems persist, it is not because we don’t care or don’t have enough money that change does not happen. Sometimes our way of looking at a problem is incorrect. Violence is a health problem. Health based solutions are required. When combined with law enforcement and the changes that are now occurring and inevitable in law enforcement procedures and training, a health-based way of thinking and model helps us emerge from this dilemma of escalating neighborhood shootings. Reductions of 41% to 73% of shootings and killings in Chicago and a 34%-56% decrease in shootings and killings in Baltimore have been shown with these new health based outreach worker approaches. Twenty five cities from Los Angeles and Oakland to Kansas City and New York are now using these approaches successfully, but most not to sufficient scale. Hurt people, hurt people. (Trained) healthy people, heal people. The health view places the protection of human life as its highest priority – a value all of us do or can share. As a society, we are more than ready to make this transition to a new way of helping our communities heal.