The novel approach to a rather serious problem was an interesting read... It might even work!
Professor of Epidemiology and CeaseFire Director Gary Slutkin with First Lady Laura Bush at roundtable at the Logan Square CeaseFire Project Site in Chicago PERSON OF INTEREST
Treating violence as an infectious disease
CeaseFire Director Gary Slutkin says understanding illnesses offers insight and direction into quelling urban brutality
By Johnathon E. Briggs
a Tribune staff reporter
Published April 9, 2006
chicagotribune.com >> Editorials
Dr. Gary Slutkin has tackled AIDS in Uganda, cholera in Somalia and tuberculosis in San Francisco. Now he views violence as an infectious disease and treats it like other epidemics, by trying to alter behavior. Last week at the annual Richard J. Daley Urban Forum at the University of Illinois at Chicago, the Chicago epidemiologist told civic leaders that nothing makes urban life more fragile than violence.
Slutkin was lauded last month by the fourth annual Volvo for life Awards for his CeaseFire antiviolence program, which has helped reduce shootings in some of Chicago's more dangerous neighborhoods by 50 to 75 percent. He will be in New York Wednesday, when one overall winner will be crowned "America's Greatest Hometown Hero," although he says CeaseFire outreach workers truly deserve the title.
Q. How does violence undermine a city's progress?
A. It's only if you don't live there [that] you would not realize that the violence is overwhelming the education, the possibility for business, your housing price and your daily life. This is the No. 1 reason why teachers quit our schools. It's a constant cause of serious concentration problems that little children have. These two little girls [killed last month] in Englewood, what do you think the rest of the children in Englewood are thinking about right now? Are they thinking about their homework? Improving schools is the main issue of Chicago, correctly so, but it may be the case that we will not succeed in this arena until we have cooled down the neighborhoods first.
Q. How can we understand violence as a disease?
A. First off, it is the No. 1 cause of death of persons in the 1 to 35 age group in Chicago and many U.S. cities, so it's kind of like the heart disease and cancer of young people. Second, it involves hospitals, emergency rooms, anesthesiologists, surgeons and chest tubes. But the principal reason is that the results are a result of behavior.
Q. How are violent behaviors formed?
A. Well, they're learned by modeling what's around you. In other words, what is expected of you if someone shows you disrespect, or looks at your girlfriend or owes you money or insults you? If the expectation is that you should shoot, then that's what you do.
Q. Like a disease, can violence be transmitted from person to person?
A. Violence behaves almost completely like an infectious disease. There are fast epidemics like a soccer riot where there's no violence, then suddenly there is. That kind of looks like cholera. The massacre in Rwanda was a sudden epidemic, 800,000 people killed in three to four months. There are slower epidemics [such as those] that occurred in most U.S. cities starting in the '60s, '70s, '80s and building up into the '90s.
Q. To borrow a public-health term, who is at high risk to be violent?
A. It's someone who grows up in a neighborhood in which violence is common. For example, for a flu or for measles, if someone gives [it] to you, then you can give it to somebody else. Likewise, if someone has done violence to you, that's the largest predictor, scientifically, that you will do violence back to that person. There's the story of the boss who screams at the man who hits his wife who hits the kid who hits the dog. That's the inverse of the kid who gets a cold in school and brings it back to the mom who gives it to the dad who brings it to work.
Q. So what is the vaccine?
A. To break the chain of transmission by changing the thinking. What we're really trying to do is to change norms like how we changed the norms for cigarette smoking.
Q. Why are CeaseFire workers effective?
A. It's because they're credible, because they come from the same group. We use ex-offenders to talk to people who are currently involved [in violence] because it's a public-health technology.
Q. How do you change the social norm?
A. First off, there's a general view of violence as individual crime, whereas we see this as a group behavior and preventable. The reality is that none of these people were born bad. They were all little babies who laughed and cried and smiled and the behavior was formed. The best way to change it is social pressure, peer pressure. Peer pressure is more powerful than law enforcement for changing norms.
Q. How do you respond to people who say that once poverty is reduced violence will follow?
A. People have said this for every problem that I've worked on. When we worked in refugee camps in Somalia, they said that you're not going to get rid of diarrhea disease until you improve the nutrition and get the water clean and improve the sanitation. In fact, we directly addressed the diarrhea and provided education to the moms and we reduced the diarrhea deaths. When you begin to deal with the problem directly, all kinds of other things become easier to deal with. It's almost the opposite of what the [conventional wisdom] is.
Q. Wouldn't getting guns off the streets also solve the problem?
A. Guns are not the essential problem. If we could get rid of all the guns, we could reduce the violence most dramatically. However, the "if" is too large right now. So far there has not been success globally in interrupting the flow of a product that is in demand whether it is legal or illegal. If they don't get their guns in Illinois, they will get them in Indiana; if they don't get them in Indiana, they'll get them from Mississippi.
--an edited transcript
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jebriggs@tribune.com
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