Lessons in tackling the violence epidemic

American physician Gary Slutkin has travelled the world applying his medical expertise to the fight against some of the most deadly diseases – amongst his achievements he has helped reverse epidemics in Aids, TB and cholera throughout Africa and Asia.

But when he returned to his native Chicago in the mid-1990s, he found that his home town was also the victim of a major epidemic – not a conventional medical disease – but a culture of violence that carried with it an annual murder rate of more than 800.

The epidemiologist embarked on a journey to try and reverse the homicide rate and adopted a radical way of thinking that violence should not be treated as a moral catastrophe, but as a preventable disease.

He founded the organisation CeaseFire in 1995, which has helped bring the murder rate to its lowest level in Chicago since the 1960s.

The problem in Chicago is not unique, however, and one replicated over the world and indeed in Scotland. Home Office figures published in January showed Scotland has a higher murder rate than any other UK country, and one of the worst in Europe.

The CeaseFire approach to tackling violence is far from the conventional law and order method, and instead mirrors the techniques used to reverse medical epidemics. Like most epidemics, the group believes a change in behaviour is the key to stopping the spread of the disease.

The strategy uses trained ‘violence interrupters’, a group of ex-gang members who take their firsthand knowledge onto the streets with the goal of mediating street disputes. They are not police informers and do not pick sides, they are people who used to live by the gun and now fulfil the role of peacemakers.

Outreach workers also select and work with potential offenders and attempt to change their way of thinking. The group also works with entire communities to transform behavioural norms.

The first project was launched in Chicago’s West Garfield Park in 2000 and achieved a 67 per cent drop in shootings and killings in its first year. Over the next three years, four more projects produced 40- 45 per cent drops in shootings and killings.

And in 2004, the extent of CeaseFire’s coverage tripled in Chicago and the number of killings in the city dropped from 600 to 450.

The group is now working in 15 other US cities and in around half a dozen other countries.

In an interview with Holyrood, Slutkin said: “There are a lot of characteristics in violence that are very similar to other infectious diseases – most notably that one event leads to another, just like measles leads to another measles or flu leads to another flu.

“One violent event leads to another and it can carry on and perpetuate itself and spreads just like we saw in the London riots recently. The characteristics sometimes spread very fast, like in London, but sometimes it can be very slow and it picks up over decades.

“Some infectious diseases can move fast, like cholera, and some of them move slow, like TB, and like violence, it all depends on whether everyone is getting activated at the same time, whether it spreads from one person to another and whether it spreads from one generation to another.

“I saw that the problem of violence behaves just like an infectious disease and it is the behaviour itself that is in fact contagious. I decided to develop a new way of going at the problem and a new way of looking at the problem. We designed a system that works at violence the way we work at other infectious diseases.” So significant has the CeaseFire approach been that it recently became the subject of a criticallyacclaimed documentary, called The Interrupters.

Slutkin added: “One of the most important things is to detect potential events and keep them somehow from happening. That is what violence interrupters do, they find out what events may be happening and prevent them from occurring. So, for example, if there is a retaliation expected because someone has been shot, we have specialised workers who can intervene and prevent it from continuing.

“On top of that work, we have added the second science to the approach which is behaviour change, this is one of the most crucial aspects of the whole process. If you want to make a long-term change and to cut violence you need to change behaviours.” Slutkin insists the CeaseFire model does not replace more conventional forms of policing, but instead complements good law and order strategies.

He added: “There are law enforcement aspects that are very important, but there are also a lot of policing methods that have been counterproductive – like very highly aggressive arrest strategies which have made things worse in a lot of cases.

“What we are seeing now is we are actually able to stop people from offending instead of a previous approach of waiting for something to happen and then simply arresting a person.

“Where in the past some of the thinking was very aggressive, whether it’s police behaviour or other, it caused a lot of defiance and what you see quite often is violence is just something that is actually being copied.

“A lot of the people caught up in violence are young and when you’re young you don’t really think you are going to be caught, and in fact you may not even care if you’re caught. Young people can be much more driven by rewards than by consequences because you don’t really see consequences.

“It isn’t a matter of good people or bad people, young people are not really driven by consequences, but more by social pressure and peer pressure and that is really what we are working on.” He added: “The main cause of violence is violence – in other words, when someone commits a violent act people learn from it and some believe that is what is expected from them.

“You get very young children that are looking to their older brothers or other teenagers in the neighbourhood and they pick it up.

“Of course there are many surrounding issues like poverty and poor education and so on, but those things also exist in a lot of places without violence.

“I think there are two prevalent myths and one is that violence only happens when there is bad families, poor communities, lousy schools, fathers not present and so on – all those things are true and present in a lot of places, but there are very, very poor countries that don’t have violence.

“One of the other myths in the field is that punishment is going to solve the problem, and although it may make some people feel good that they see people going to jail, it doesn’t mean the problem is being solved.

“I think part of the challenge is not to look at it as though it is bad people, but to question why certain behaviours occur. That is a very important starting point because we have to realise that people have acquired this, behaviours are picked up visibly from each other.” Scotland’s reputation has for long been tainted by a knife-crime epidemic – a previous World Health Organisation report said that Scotland has one of the highest rates of violent crime in Europe. Despite this, there have been signs of improvement in recent years. The Violence Reduction Unit, based in Glasgow, has been widely praised for tackling violent crime since it was set up in 2005.

Three years ago, the unit set up the Community Initiative to Reduce Violence (CIRV), which was inspired by a similar project in Boston, and works by getting gangs to address their own behaviour.

Although the unit has been widely praised, and in fact was recently highlighted by Prime Minister David Cameron, it is clear there is still a long way to go. Figures released this month showed that although overall crime in Scotland fell to a 35-year low, violent crime increased by 2 per cent. A report earlier this year highlighted the murder and culpable homicide rate in the Strathclyde Police force area increased by almost 40 per cent in the past year.

Slutkin added: “I am aware of the Violence Reduction Unit and we have been in meetings together in DC. These are excellent people and they are running an excellent unit and it would be terrific to talk to them and work with them and try to help.” The epidemiologist insists that a range of other interventions are needed to cut violence.

He said: “The CeaseFire approach is just one part of it and there needs to be a complete picture. I think more does need to happen, like good policing strategies and education and so on. CeaseFire works alongside the other components and approaches the problem from a different angle.

“As a society we don’t have to be left with just fear and anger – we can do things more effectively if we are prepared to change the situation and the way we think. I think it is all about adopting a progressive attitude, one that matches the scale of the problem.”