Treating violence as an epidemic disease
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Treating violence as an epidemic disease Gary Slutkin, MD Exec Director, Cure Violence Formerly World Health Organization Professor, Epidemiology and International Health UIC School of Public Health
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Treating violence as an epidemic disease
Transcript of Treating violence as an epidemic disease
Treating violence as an epidemic disease
Gary Slutkin, MDExec Director, Cure Violence Formerly World Health OrganizationProfessor, Epidemiology and International Health UIC School of Public Health
3 independent evaluationsInstitute of Medicine U.S. Conference of MayorsNational Leagues of Cities National Governor’s AssociationDepartment of Justice
3 Independent evaluations
National Institute of JusticeCenters for Disease ControlJohns Hopkins School of Public HealthBureau of Justice Assistance Center for Court Innovation
CANADA
MEXICO
BRAZIL
TRINIDADCOLOMBIA
SOUTH AFRICA
YEMEN
KENYA
EGYPTIRAQ
ENGLAND
JAMAICAPUERTO RICO
ISRAEL/PALESTINE
ADAPTATION PARTNERS
EXPLORING PARTNERSHIPS
HONDURAS
SYRIA
CURE VIOLENCE INTERNATIONAL ADAPTATION PARTNERS
UNITED STATES
No. 9
No. 9
No. 1
Funders
U.S. Department of Justice Robert Wood Johnson FoundationJohn D. and Catherine T. MacArthur FoundationMcCormick FoundationInteramerican Development Bank (IADB)USAIDU.S. State Department Bernard Van Leer Foundation15 others
New theory
New theory
Violence is a contagious process
Source: Mullins et al. 2004; Devries et al. 2011
TRANSMISSIONOF VIOLENCE
Exposure toViolence
Violence
CONTAGIOUS VIOLENCE
GANG VIOLENCE
URBAN CRIME
GANG WARLORDISM
CIVIL WAR
GENOCIDE
ETHNIC- RELIGIOUS CONFLICT
RIOTS
UNDERSTANDING SCIENTIFIC
Why is violence contagious?
Behavior
Behavior
is
Behavior
is
contagious
Copying
FOLLOWING Social expectations
FOLLOWING Social expectations
FOLLOWING
FOLLOWING Social
expectations
Excitation
Source: Mullins et al. 2004; Devries et al. 2011
TRANSMISSIONOF VIOLENCE
Exposure toViolence
Violence
MULTIPLE EXPOSURES
Exposures
COMMUNITY
Outcomes
MULTIPLE EVENTS
Country A
Country BCountry Billings in Rwanda
Country C
Country D
1950 2008 1960 2003
1980 20034/1994 5/1994
KILLING EPIDEMICSVIOLENCE BEHAVES EXACTLY LIKE A CONTAGIOUS DISEASE
New theory
New theory
Violence is a contagious process
New practice
Treating violence like an epidemic process
HOW ARE EPIDEMICS REVERSED?
STOPPING EPIDEMICS1. Interrupt transmission
2. Prevent future spread
3. Change group norms
Finding those most likelyto shoot or be shot
Mapping 53
Photograph by Ed Kashi
DETECTION AND INTERRUPTION
DETECTION AND INTERRUPTION
Identify and interrupt conflict 56
STOPPING EPIDEMICS1. Interrupt transmission
2. Prevent future transmission
CHANGE BEHAVIOR of highest risk
Photograph by Ed Kashi
Photograph by Ed Kashi
CHANGE BEHAVIOR
CHANGE BEHAVIOR (OUTREACH WORKER TEAM)
Photograph by Ed Kashi
CHANGE BEHAVIOR
IDENTIFY AND CHANGE THINKING CHANGE BEHAVIOR
STOPPING EPIDEMICS1. Interrupt transmission
STOPPING EPIDEMICS1. Interrupt transmission
2. Prevent future transmission
STOPPING EPIDEMICS1. Interrupt transmission
2. Prevent future transmission
3. Change norms
INTERVENERS THE 3 VARIABLES BEHAVIORAL OUTCOME
Norms
Alternatives
No VIOLENCE
Street outreach
Clergy
Community
Materials
Police
Risk
CHANGE GROUP NORMS
Photograph by Ed Kashi
3. CHANGE NORMS
CHANGE NORMS
CHANGE GROUP NORMS
Photograph by Ed Kashi
3. CHANGE NORMS
Group immunity New norms
Susceptible People Exposure Transmission
(Spread)Group immunityNOVIOLENCE
SYSTEM
Epidemic control
SYSTEM
SYSTEM
RESULTS
shootings
67%
01/99
06/99
11/99
04/00
09/00
02/01
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06/04
11/04
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Results – Logan Square Cure Violence Zone
CURE VIOLENCE
FIRST 6 CURE VIOLENCE COMMUNITIES, 2000–2004
* These results are all statistically significant with p<0.01W. Garfield, W. Humboldt, Logan Square, SW Chicago, Auburn Gresham, Rogers Park CUREVIOLENCE
RESULTS: 8 NEWCOMMUNITIES, 2005–2006
* These results are all statistically significant with p<.01 * * Results are significant with p<.05 Communities = Englewood, Brighton Park, E. Garfield, Albany Park, Little Village, Austin, Grand Boulevard, Woodlawn
CUREVIOLENCE
RESULTS: 4 NEXTCOMMUNITIES, 2006–2007
* Results are significant compared to neighboring (p<0.01) * * Results are significant compared to the city (p<.05) CUREVIOLENCE
Before Cure Violence After Cure Violence
CURE VIOLENCE –Englewood, Chicago
Before After
CURE VIOLENCE – Rogers Park
INDEPENDENT EVALUATIONS
INTERRUPTION 100% drop in retaliations
CUREVIOLENC
E CONTROL
Auburn Gresham -100% -25%
Englewood -100% -100%
Logan Square -100% +100%
Rogers Park no change n/a
Southwest -100% no change
West Garfield Park -46% +41%
West Humboldt Park -50% -57%
East Garfield Park -100% +60%
Skogan, 2009
DOJ - EXTERNAL EVALUATION
↓ 41 – 73% shootings and killings (overall effect seen)
↓ 16- 34% shootings and killings (directly attributable)
↓ 15 - 40% shooting density
↓ 100% retaliation murders in 5 of 8 communities
85-97% helped to jobs, school, out of gang
DEMONSTRATED EFFECTIVE TO REDUCE SHOOTINGS AND KILLINGS Skogan, 2009
Program Site Significant Outcomes Program Implementation
per Month Implementation Issues
Homicide Shootings Mediations Participants Contacts
Cherry Hill -56% -34% 3.2 40.9 143 Good Implementation
Madison-Eastend None -44% 1.2 37.8 157 Lower levels of mediations
Elwood Park None -34% 1.4 53.3 226 Lower levels of mediations
McElderry Park - 53%* None 4.0 48.7 186 P1 Good implementation P2 Workers diverted
34 – 56% less shootings and killings
CDC/Johns Hopkins Independent Evaluation (Baltimore replication)
Webster, 2012
CDC/JOHNS HOPKINS Independent Evaluation (Balt.)
34-56% drops in shootings and killings Webster, 2012
Latin America
Loiza, Puerto Rico Homicides 56%
San Pedro Sula, Honduras Interruption work begunApril 2013
* Comparison 2011 to 2012, University of Puerto Rico
Africa Cape Town, South Africa
Shootings 78%
Killings 66%
Kenya
Presidential election violence (Mar 2013) with PeaceTxt
* First 5 months of implementation (Jan-May 2013)
Middle East
Iraq - Bagdad and Basrah:962 interruptions>14,000 community trainings in violence interruption
Syria Interruption training begins in August, Northern region
New practice
Treating violence like an epidemic process
Demonstrated effective !
“…the approach that will come to prominence.”
OAKLAND
KANSAS CITY
NEW ORLEANS
EAST ST. LOUIS
BALTIMOREDECATUR
CHICAGOPHILADELPHIA
ADAPTATION PARTNERS
CICEROROCKFORDMAYWOOD
WAUKEGAN
ALBANY
YONKERSNIAGARA
NEW YORK CITY
CURE VIOLENCE U.S. PARTNER CITIES
CANADA
MEXICO
BRAZIL
TRINIDADCOLOMBIA
SOUTH AFRICA
YEMEN
KENYA
EGYPTIRAQ
ENGLAND
JAMAICAPUERTO RICO
ISRAEL/PALESTINE
ADAPTATION PARTNERS
EXPLORING PARTNERSHIPS
HONDURAS
SYRIA
CURE VIOLENCE INTERNATIONAL ADAPTATION PARTNERS
UNITED STATES
CURE VIOLENCE PRIORITIES
1. Changing the thinking
2. Assist with impact
CURE VIOLENCE PRIORITIES
1. Changing the thinking
OLD VIEW
BAD PEOPLE
OLD VIEW
BAD PEOPLEENEMIES
OLD VIEW
BAD PEOPLEENEMIES
OLD VIEW
BAD PEOPLEENEMIES
PUNISHMENT
OLD VIEW
BAD PEOPLEENEMIES
PUNISHMENT
ModernView
OLD VIEW
BAD PEOPLEENEMIES
Contagious behavior
PUNISHMENT
ModernView
OLD VIEW
BAD PEOPLEENEMIES
Contagious behavior
PUNISHMENT
ModernView
OLD VIEW
BAD PEOPLEENEMIES
Contagious behavior
PUNISHMENT Interrupt events
ModernView
OLD VIEW
BAD PEOPLEENEMIES
Contagious behavior
PUNISHMENT Interrupt events
ModernView
OLD VIEW
BAD PEOPLEENEMIES
Contagious behavior
PUNISHMENT Interrupt eventsChange behavior
ModernView
OLD VIEW
BAD PEOPLEENEMIES
Contagious behavior
PUNISHMENT Interrupt eventsChange behaviorChange norms
ModernView
OLD VIEW
CURE VIOLENCE PRIORITIES
1. Changing the thinking
CURE VIOLENCE PRIORITIES
1. Changing the thinking
2. Impact
CURE VIOLENCE PRIORITIES
Less violence
More Than a Metaphor
We Can Cure Violence
Extra slides
VIOLENCE
GANG VIOLENCE
WAR
URBAN CRIME
GANG WARLORDISM
CIVIL WAR
GENOCIDE
ETHNIC- RELIGIOUS CONFLICT
APPROACH SCIENTIFIC
VIOLENCEAS A CONTAGIOUS
DISEASE
Violence is a Disease
OAKLAND
KANSAS CITY
NEW ORLEANS
EAST ST. LOUIS
BALTIMOREDECATUR
CHICAGOPHILADELPHIA
CICEROROCKFORDMAYWOOD
WAUKEGAN
ALBANY
YONKERSNIAGARA
CURE VIOLENCE AND ADAPTATION PARTNERS
ADAPTATION PARTNERS
BOSTON
WASHINGTON DC
LOS ANGELES
SIMILAR MODEL
NEW YORK CITYBrooklynQueens
Manhattan
VIOLENCE
GANG VIOLENCE
WAR
URBAN CRIME
GANG WARLORDISM
CIVIL WAR
GENOCIDE
ETHNIC- RELIGIOUS CONFLICT
TRANSMISSION AND PROCESSING OF VIOLENCE
VIOLENCE TRANSMISSION
Observing
TRANSMISSION AND PROCESSING OF VIOLENCE
VIOLENCE TRANSMISSION
Observing Witnessing
TRANSMISSION AND PROCESSING OF VIOLENCE
VIOLENCE TRANSMISSION
ObservingWitnessing
Trauma
London, England: Cookham Wood (Youth Detention Center)
• Violent incidents reduced to lowest level since prison opened
• Only center in UK to get level 3 (good) rating for pioneering approach and reduction
• Evaluation planned
Homicides In Loiza, Puerto Rico (January – April, 2011-2013)
2011 2012 20130
2
4
6
8
10
12
14
Capetown (Hanover Park), South AfricaShootings & Homicides (Jan – May 2012-13)
Shootings Homicides0
2
4
6
8
10
12
14
16
2012 2013 2012 2013
79% Drop67% Drop
Shootings & Homicides (Jan - May 2010-13)
Shootings Homicides0
2
4
6
8
10
12
14
16
18
20
2012 201320112010 2012 201320112010
79% Drop67% Drop
Capetown (Hanover Park) , South Africa
2011 20120
5
10
15
20
25
30
35
40
45
Homicides In Loiza, Puerto Rico (2011-2012)
52% Drop
Capetown, South Africa Cure Violence Program Highlights
• 111 Conflict Mediations
• 45 Program Participants
• 79% reduction in shootings (Jan to May, 2013 vs 2012)
• 67% reduction in homicides (Jan to May, 2013 vs 2012)
• 49 consecutive days in 2013 without a shooting
