Dr. Gary Slutkin is eradicating and preventing gun violence in the most dangerous of urban areas through a unique model in which he treats violence as an infectious disease. His CeaseFire model, informed by over a decade of battling infectious diseases in Africa and honed by years of careful implementation in North America is significantly reducing the incidence of gun violence in the U.S. and also spreading internationally.
The New Idea
Gary is proving that violence can be prevented in the same way that one would prevent the spread of an infectious disease: by stopping the transmission at the source and by changing behavior patterns so that less people become infected in the first place. His CeaseFire program identifies those who have been most “infected” by urban violence and treats this core group, in order to stop the transmission of violence to others. CeaseFire’s treatment is based on a corps of “violence interrupters,” former perpetrators of violence now employed to disrupt armed conflicts and educate the community about the consequences of violent behavior. Their work is complemented by coordinated community action to change people’s mindsets about gun violence through mobilizing community leaders, clergy, parents, hospitals, and so on. Both elements of the approach reinforce each other, leading to a comprehensive strategy similar to the most successful methods in eradicating infectious diseases.
Being at its core a public health approach to violence, the model is informed by rigorous data analysis which, unlike most other attempts to quell urban violence, carefully measures the impact of its interruption and outreach work (and leads the field in doing so). CeaseFire maps and analyzes “hot spots (areas with high levels of violence) and concentrates its efforts on these most affected areas. Independent evaluations have found the CeaseFire model to be successful in decreasing shootings and killings, both in terms of quelling violent incidents as well as changing attitudes towards gun violence; these results have led to the White House designating CeaseFire as a model in violence prevention worth replicating, which is spurring its rapid spread across the country.
Across urban areas, gun violence has become a serious public health issue. Center for Disease Control statistics rank homicide by firearm as the second leading cause of death amongst youth aged 15 to 24 and the leading cause of death for young African American males in the United States. Chicago alone witnesses over 500 youth gun-related deaths per year, which is 75 percent of all its homicides. With such large numbers of youth killing and being killed, an unhealthy behavior pattern is perpetuated; violence becomes a norm. Gary has found that 90 percent of this behavior is group-based, i.e. influenced by the actions of peers and gangs. Thus, as more shootings take place, more people begin using guns as a way to resolve problems: the behavior spreads from person to person, like a disease.
Society clings to two common myths about violence, hindering attempts to eliminate it. The first of these myths is that violence is an insoluble problem, a timeless and permanent blister on humanity. However, as a species, we have eliminated or reduced the impact of many deadly diseases that were also once thought permanent. Even if we cannot eradicate violence completely, we can still reduce its threat to society. The second myth is the belief that punishment is the appropriate way to discourage violent behavior. While jail sentences might encourage perpetrators to avoid punishment, it does not necessarily persuade them to avoid violence; prisons themselves have become microcosms of life on the streets, complete with the existence of gangs, drugs, and murder. Law enforcement tactics also contribute to the problem: initiatives such as New York’s Zero Tolerance program, which expanded the city’s police force and mandated more stringent laws for prison sentences, fail to address behavioral change and rehabilitation. Importantly, law enforcement doesn’t address a prevailing street code that encourages settling problems with lethal force.
Across the U.S., violence is a major constraint to development in cities. Businesses stay out of violent areas, leading to poverty and unemployment. Fear is ubiquitous since most people have lost friends and family to gun violence by the time they are teenagers. In 70 cities across the U.S., violence is highly prevalent; in a further 60 cities, it is at 3 to 5 times the level as in Europe. Finally, the social and economic costs of gun violence are staggering; it costs an estimated $100B annually, with medical costs at $15,200 per gunshot injury treated and economic productivity loss at $308,000 per incident.
Like battling an infectious disease, Gary’s approach roots out the most infected individuals and moves to stop the transmission at its source. Since 8 percent of the population of males accounts for 60 to 85 percent of violence across the U.S., CeaseFire concentrates on these highest-risk individuals. After locating situations where gun violence is likely to occur, “violence interrupters” are then dispatched to calm down potential shooters. For instance, when the victim of a violent injury is admitted to the Advocate Christ Medical Center, the hospital contacts CeaseFire’s violence interrupters, who immediately arrive to “talk down” the victim and dissuade him from a vengeful attack. These violence interrupters are the core of CeaseFire’s model. Actively seeking street information, they are both an early warning and an early response system for violent activity. Often ex-felons and ex-gang members themselves, they are trained in conflict mediation and negotiation, and work around the clock to identify likely shooting incidents and arrive on the scene to mediate and discourage violence from escalating. Their ability to relate to and understand the “code” of the streets plays a huge role in calming down enraged individuals and dissuading a potentially fatal situation. They trade on their reputation of being former gang members well known within the community, which in turn earns them the community’s trust. For example, a mother whose 15-year-old son is loading up guns in the basement might never call the police; however, she will call a violence interrupter who can influence her son without turning him in to the police.
The violence interrupters’ street smarts and ability to relate to the thought process and behavior of potential shooters allows them to successfully discourage most perpetrators from using a gun. For instance, since the vast majority of perpetrators do not want to shoot someone else, but feel they have no choice, the violence interrupters provide them with ways out—one of the most effective is to remind them of the consequences their actions may have on their family and friends, even if they disregard their own lives. Other strategies for dealing with clients include engaging shooters in verbal crossfire, allowing them to vent their anger verbally; buying time using confusion and distraction tactics, and so on. The interrupters network weekly at formal CeaseFire meetings, where they discuss past and potential future episodes of violence and share their observations of emerging issues and trends within the communities. Through their work with CeaseFire, these formerly violent individuals have become community leaders, not only preventing violence in their communities, but also reducing their own likelihood of relapse and regression to past lifestyles. CeaseFire also gives violence interrupters the opportunity to attend the University of Chicago if they choose. Of the 300 violence interrupters hired in Chicago over the last decade, only 10 have relapsed and left the program. In the process, Gary is creating an entirely new profession. He hopes to professionalize the job of violence interruption; scaling up training programs and granting graduates “licenses”.
Building on the violence interrupters (i.e. stopping the transmission of violence at the source), the second element of CeaseFire’s model is reducing the incidence of violence by changing behavior. Gary is hoping to change the prevailing approach to violence from a moral issue (good vs. bad people) to a public health issue (healthy and unhealthy behaviors).Violence as an unhealthy behavior is a) learned from role models, b) caused by social forces (racism, poverty, etc), c) a cultural norm in specific sub-groups, and d) a series of events between disputants that escalates. Since it is a learned behavior, it can be “unlearned”. CeaseFire’s Outreach program aims to make gun violence socially unacceptable. For example, not very long ago it was considered normal to light up a cigarette in a meeting; today, smokers refrain from doing so partly because it is socially unacceptable. Since social norms rely upon one’s fear of disobeying them, if gun violence can become socially unacceptable in places where it is currently routine, we will see less people resolving problems with guns.
Behavioral changes have served as the strategy for other public health issues. There is no cure for AIDS; however transmission can be reduced by encouraging the use of condoms. In the same way, Gary is showing how violence can be significantly decreased through community awareness and outreach. Therefore, the violence interruption is complemented by CeaseFire’s Outreach Workers program, which mobilizes faith-based leaders, mothers, students, and gang members to implement the behavioral change necessary to put an end of violence. Anytime there is an outbreak of shooting in the neighborhood, CeaseFire outreach workers organize neighbors, friends, and family to stand in protest, asserting the idea that violence is simply not acceptable. By organizing the community in such a way, the response eventually becomes unconscious, shifting the entire norm. Evaluations of CeaseFire have found that the outreach worker often become the second most important person in their client’s lives, after the parents. Additionally, Youth Outreach workers pair trained individuals with high-risk youth within the community in order to set the youth on a more positive path. The Public Education strategy disseminates violence prevention material via flyers, leaflets, posters, yard signs, and T-shirts, utilizing the potential of print ads and media outlets to promote the behavior change needed to end gun violence. Another element of this strategy is Faith-Based Leader Involvement, in which CeaseFire collaborates with religious leaders to reach out to high-risk individuals and those affected by urban violence. The final component is the partnership with law enforcement through Criminal Justice Participation, driving a shift in how society addresses violence within communities. Rather than rushing in with force, police officers contact CeaseFire when there has been a shooting or a murder in the area, allowing CeaseFire to lead the community response that prevents further escalation. In Chicago, the police force also faxes CeaseFire a list of shootings, their time and location, on a daily basis, which allows CeaseFire to map out trends in violence over time.
This mapping reflects a broader emphasis at CeaseFire in using data as a key driver of its operations. All the neighborhoods in which CeaseFire works are meticulously mapped and gun violence tracked at the street level, leading to the emergence of patterns of violence as well as violence hot spots in which CeaseFire focuses its work. Impact is measured by comparing violence incidence in CeaseFire neighborhoods both with the years preceding the CeaseFire program and with “control” neighborhoods (those that border the CeaseFire areas as well as have similar rates of shootings). CeaseFire’s first year in Chicago was reflected in a 67 percent drop in shootings. Over the past four and a half years, CeaseFire has interrupted 1800 conflicts through over 40 violence interrupters and 70 outreach workers. Over four hundred clients gained employment after interacting with CeaseFire, and over three hundred enrolled in school. When CeaseFire began, Chicago was ranked #17 in city homicide rate. By 2006, that ranking had dropped to #40.
Impressed by these results, the Department of Justice commissioned an independent evaluation of CeaseFire’s work, choosing their own evaluators (national experts in the study of violence) and investing $1M over 3 years to conduct a thorough evaluation. The study found statistically significant declines in violence in Chicago attributable to CeaseFire’s work (a 16 percent to 27 percent reduction in the number of shootings or attempted shootings in the Chicago area). The study also found that CeaseFire was responsible for breaking down gang networks, reducing retaliatory homicides (a key objective), making hot spots cooler and neighborhoods safer. Preliminary evaluations of the program’s impact in Baltimore (known as The Safe Streets Program and funded by the Baltimore Health Department) have shown that in less than 18 months, the model is changing attitudes towards gun violence amongst high-risk individuals and leading to reductions in homicides. All these findings must be viewed in the larger context of violence prevention efforts, where most interventions fail to show measurable positive results at all, let alone in such a short time span.
Released in May 2008, the Department of Justice study cited the idea of violence interrupters as “groundbreaking” and the Obama Administration specifically named CeaseFire in the stimulus package as a model in violence prevention to be replicated in other cities. In addition to Baltimore and Chicago, there are currently CeaseFire programs in areas of Albany, Kansas City, Newark, and Mt. Vernon. New Orleans will soon be operational. The State of New York has adopted the model and is funding its replication to several cities including Buffalo, Syracuse, Rochester, and New York City. Many other cities have applied for stimulus package funding from Congress to adopt the CeaseFire model. Although so far focused on U.S.A. inner cities, the CeaseFire model is not unique to gun violence; in many ways, gangs are not very different from tribal or militia groups. Thus, CeaseFire is also working with the American Islamic Congress in Iraq and the Community Security Initiative in Trinidad, where violence interrupters and outreach workers are slowly changing the perception of violence as a norm. As of the middle of 2009, CeaseFire is also moving close to launching in Brazil, Mexico and Jamaica.
Gary’s father, a chemist, instilled in him a deep interest in science from an early age, eventually translating to a medical career after college. His ability as a doctor enabled Gary to rise to the position of Chief Resident at San Francisco General Hospital, one of the foremost hospitals in the country. At the hospital, Gary developed a tuberculosis prevention program in San Francisco, focusing on the treatment of a recent influx of refugees from Cambodia, Laos and Vietnam. Theorizing that it is most strategic to treat the most severely infected cases to prevent further transmission, he mobilized other Southeast Asians to help care for TB patients; these workers were able to identify with patients culturally and thus able to effectively instill in them an understanding of their responsibilities as TB patients. After two years of work in San Francisco, the TB cure rate was increased from 50 to 95 percent and cases of the infection dropped by over 50 percent.
At the height of his profession in the United States in the 1980s, Gary chose to move to Somalia and work in its refugee camps, which at the time were battling a deadly cholera epidemic. For several years, Gary sacrificed much of his personal life and professional trajectory to work with these desperately disadvantaged populations mired in chronic violence, deprivation and disease, eventually becoming an assistant to the Director of Primary Health Care for the country. During his years in Somalia, basic health services were expanded from 4 to 14 (of 18) regions. Gary then moved to the WHO to coordinate the global battle against HIV/AIDS, where he presided over the remarkable reversal of the AIDS epidemic in Uganda, the only country in Africa where this has been achieved. While in Africa, he developed sustainable medical evaluations and documentation methods for the spread of communicable diseases which are still used in over 90 countries today. In total, Gary spent 10 years in 15 countries in Africa and Europe as a major leader in the battle against infectious diseases.
Returning to the U.S. in 1995, Gary traced patterns between the trajectory of a disease and that of violence. He founded the Chicago Project for Violence Prevention, an outreach program aimed at fostering youth employment and education as a means to prevent violence. When he realized that this program was failing to reach the “most infectious people,” Gary shifted directions, empowering community members to handle and prevent the transmission of violence at its source. He was applying the lessons learnt from Southeast Asian TB workers and Ugandan AIDS patients about the role of social pressure in changing behavioral norms. Gary lives with his wife in Chicago.