Can the Spread of Violent Crime Be Prevented?

Samira Shackle


Usually, facial trauma doesn’t kill you, but it can cause significant disfigurement. Working as a maxillofacial surgeon in Glasgow in the early 2000s, Christine Goodall treated hundreds, if not thousands, of patients with injuries to the neck, face, head and jaw.


Sometimes, the injuries were caused by a baseball bat, with shattered bones and bruising as bad as that from a car accident. More often than not, it was a knife. A slash across the forehead or cheek, leaving a scar etched across the face; a machete wound to the jaw, slicing through the skin and breaking the bone underneath.


One young man came into the hospital in the middle of the night, with a knife wound across his face. Goodall dreaded the morning ward round the next day, when she would have to tell him that it would be impossible to reduce the appearance of the scar. But his reaction surprised her. “He was very offhand about it,” she says. “Some of his friends came to see him later that afternoon and I realized why it wasn’t going to be a problem for him – because they all had one. He’d just joined the club.” The incident has stayed with her, an indication of how bad the situation in her city had become.


In 2005, the United Nations published a report declaring Scotland the most violent country in the developed world. The same year, a study by the World Health Organization of crime figures in 21 European countries showed that Glasgow was the “murder capital” of Europe. More than 1,000 people a year required treatment for facial trauma alone, many of them as the result of violence.


Goodall, who has spent most of her life living and working in Glasgow, would stitch up the wounds and work to repair the damaged tissue. But for most patients, the problems continued long after they were discharged. Chronic pain, post-traumatic stress disorder, self-medication with alcohol and drugs.


Often, the same people would come back through the accident and emergency departments again and again, repeated victims and perpetrators of violent attacks. “We were really good at patching injuries up,” says Goodall. “But I started to think: What can we do to prevent them coming here in the first place?”


Humans engage in a wide array of risky behaviors that can lead to serious health problems: smoking, overeating, sex without protection. It has long been the accepted wisdom that doctors should encourage patients to change their behavior – give up smoking, go on a diet, use a condom – rather than wait to treat the emphysema, obesity-related heart attacks, or HIV that could be the result.


Yet when it comes to violence, the discussion is often underpinned by an assumption that this is an innate and immutable behavior and that people engaging in it are beyond redemption. More often than not, solutions have been sought in the criminal justice system – through tougher sentencing, or increasing stop-and-search (despite substantial evidence that it is ineffective in reducing crime). Is enforcement the wrong tactic altogether?


In 2005, Karyn McCluskey, principal analyst for Strathclyde Police, wrote a report pointing out that traditional policing was not actually reducing violence. These reports always include a list of recommendations. “One was tongue-in-cheek,” recalls Will Linden, who worked for McCluskey as an analyst at the time. “‘Do something different.’ I don’t think it was meant to stay in there. But the chief constable said, ‘Okay, go do something different.’”


McCluskey’s team, led by her and her colleague John Carnochan, started by pulling together evidence on the drivers of violence. “Particularly in Scotland, it was poverty, inequality, things like toxic masculinity, alcohol use, all these factors – most of which were outside the bounds of policing,” says Linden.



Next, they looked around the world to find and learn from pioneering programs working to prevent violence. This was the foundation of the Violence Reduction Unit (VRU), of which Linden is now the acting director. It took elements of those programs and focused on garnering support from a range of Scottish agencies – the health service, addiction support, job centers and a host of others. Since the VRU was launched in 2005, the murder rate in Glasgow has dropped by 60 percent.


The number of facial trauma patients passing through Glasgow’s hospitals has halved, Goodall says, and now stands at around 500 a year.


The VRU’s strategy is described as a “public health” approach to preventing violence. This refers to a whole school of thought that suggests that beyond the obvious health problems that result from violence – the psychological trauma and physical injuries – the violent behavior itself is an epidemic that spreads from person to person.


One of the primary indicators that someone will carry out an act of violence is first being the victim of one. The idea that violence spreads between people, reproducing itself and shifting group norms, explains why one locality might see more stabbings or shootings than another area with many of the same social problems.


“Despite the fact that violence has always been present, the world does not have to accept it as an inevitable part of the human condition,” says the WHO guidance on violence prevention.


It says that “violence can be prevented and its impact reduced, in the same way that public health efforts have prevented and reduced pregnancy-related complications, workplace injuries, infectious diseases, and illness resulting from contaminated food and water in many parts of the world. The factors that contribute to violent responses – whether they are factors of attitude and behavior or related to larger social, economic, political and cultural conditions – can be changed.”


But across much of the world, being tough on crime is a vote winner, which makes this a hard sell. How did Glasgow do it? As they investigated what it actually means to treat violence as a health problem, the VRU looked first to Chicago.


In the 1980s and early 1990s, American epidemiologist Gary Slutkin was in Somalia, one of six doctors working across 40 refugee camps containing a million people. His focus was on containing the spread of tuberculosis and cholera.


Containing infectious diseases relies heavily on data. First, public health officials map out exactly where the most transmissions of the disease are occurring. Then they can focus on containing the spread in these areas. Often, this containment happens by getting people to change their behavior so that a rapid effect can be seen even when larger structural factors can’t be tackled.


For instance, diarrhoeal disease is often in large part caused by poor sanitation and water supplies. It takes a long time to improve plumbing systems – but in the meantime, thousands of lives can be saved by giving people oral rehydration solutions.



Slutkin followed these steps to contain outbreaks in the Somali refugee camps, and again later, when he worked for the WHO on AIDS prevention. Whatever the exact nature of the infectious disease in question, the steps to contain it were roughly the same. “What do they have in common? All of these things spread,” Slutkin tells me in his office in Chicago. “Heart disease doesn’t spread, strokes don’t spread.”


Changing behavioral norms is far more effective than simply giving people information. To change behavior – whether it’s using rehydration solutions, avoiding dirty water or using condoms – credible messengers are essential.


“In all of these outbreaks, we used outreach workers from the same group [as the target population],” says Slutkin. “Refugees in Somalia to reach refugees with TB or cholera, sex workers to reach sex workers with AIDS, moms to reach moms on breastfeeding and diarrhoeal management.”


After more than a decade working overseas, Slutkin returned to his native Chicago in the late 1990s, exhausted from the perpetual travel and constant exposure to death. “I wanted a break from all these epidemics,” he says. It hadn’t occurred to him that America had difficulties, too. He had been consumed, for years, by the panic of epidemics and the struggles of poorly developed countries. But he returned to a different kind of problem: a skyrocketing homicide rate.


His ideas about tackling this problem began as a nerdy project, born of the obsession with graphs and charts he had developed abroad: He gathered maps and data on gun violence in Chicago. As he did so, the parallels with the maps of disease outbreaks he was accustomed to were unavoidable. “The epidemic curves are the same, the clustering. In fact, one event leads to another, which is diagnostic of a contagious process. Flu causes more flu, colds cause more colds, and violence causes more violence.”


This was a radical departure from mainstream thinking about violence at the time, which primarily focused on enforcement. “The idea that’s wrong is that these people are ‘bad’ and we know what to do with them, which is punish them,” says Slutkin. “That’s fundamentally a misunderstanding of the human. Behavior is formed by modeling and copying. When you’re in a health lens, you don’t blame. You try to understand, and you aim for solutions.”


He spent the next few years trying to gather funding for a pilot project that would use the same steps against violence as the WHO takes to control outbreaks of cholera, TB or HIV. It would have three main prongs: interrupt transmission, prevent future spread, and change group norms.


In 2000, it launched in the West Garfield Park neighborhood of Chicago. Within the first year, there was a 67 percent drop in shootings. More funding came, more neighborhoods were piloted. Everywhere it launched, violence dropped by at least 40 percent. The approach began to be replicated in other cities.


“When we were trying to control outbreaks of HIV, it was all about changing your thinking about whether you’d have risky sexual behaviour,” says Slutkin. “That’s much harder to change than violent behavior. People don’t want to change sexual behavior, but they don’t actually want to have violent behavior.” Although there were many deeper structural factors contributing to Chicago’s violence – poverty, lack of jobs, exclusion, racism and segregation – Slutkin argued that lives could be saved by changing the behavior of individuals and shifting group norms.


As in many places, discussion of violence in Chicago often takes on a highly racialized tone. The city is deeply racially segregated. Many South Side neighborhoods are over 95 percent African American; others are more than 95 percent Mexican American. Most of these areas are severely socioeconomically deprived and have suffered years of state neglect. Homicide rates can be up to 10 times higher than in more affluent, predominantly white areas of Chicago.



But Slutkin emphasizes that this clustering is less to do with race and more to do with patterns of behavior – usually among a small section of the population, usually young and male – that are transmitted between people. “Language dictates the way people respond, so we don’t use words like ‘criminal’ or ‘gang’ or ‘thug’ – we talk about contagion, transmission, health,” he says.


Today, Slutkin’s organization, Cure Violence, is based in the public health department of the University of Illinois, Chicago. A poster in the corridor bears a photo of a young boy, with the slogan “Don’t shoot. I want to grow up” underneath.


The organization now works in 13 Chicago neighborhoods, and versions of the program run in New York, Baltimore and Los Angeles, as well as in other countries around the world. It trains local organizations  that then find credible people in the area to do the work.


Although there is a level of debate about Cure Violence’s use of statistics, the method’s overall effectiveness has been shown by numerous academic studies. A 2009 study at Northwestern University found that crime went down in all neighborhoods examined where the program was active.


In 2012, researchers at Johns Hopkins School of Public Health looked at four parts of Baltimore that were running the program, and found that shootings and homicides fell in all four. The results are frequently striking. In San Pedro Sula, Honduras, the first five Cure Violence zones saw a drop from 98 shootings during January–May 2014 to just 12 in the same period in 2015.


Demetrius Cole is 43, a gentle, softly-spoken man who spent 12 years in prison. He grew up in an area of Chicago afflicted by violence and, at the age of 15, saw his best friend die in a shooting. Nonetheless, he had a stable home life and stayed out of gangs. He planned to join the Marines.


When he was 19, a close friend bought a new car. Some other boys from the neighborhood tried to steal the car, and they shot Cole’s friend. Cole didn’t stop to think. He retaliated. In those few minutes, his life changed entirely. While his friend was left paralyzed, unable to work again, Cole was sent to prison for his response.


“I reacted off emotion like you see out here today,” he says. Since October 2017, he has been working for Cure Violence in West Englewood, a South Side district of Chicago. He finds people in the same situation he was once in, and tries to persuade them to pause. “We try to show them it is a dead end. I tell them, there’s only two ways this thing is going to end. You’re going to go to jail or you’re going to die.”


Cole works as a “violence interrupter,” employed by Cure Violence to intervene in the aftermath of a shooting to prevent retaliations, and to calm people down before a dispute escalates to violence.


“My job is to interrupt transmissions,” Cole tells me. “We try to come up with different kinds of ways to deter these kids from the ways they’re used to thinking, and give them a different outlook.”



Violence interrupters use numerous techniques, some borrowed from cognitive behavioral therapy. Cole reels them off. “Constructive shadowing”, which means echoing people’s words back to them; “babysitting,” which is simply staying with someone until they have cooled down; and emphasizing consequences. “A lot of kids don’t know where their next meal is coming from, their mother’s getting high,” says Cole. “People say everything is common sense. No. Sense is not common to a lot of people.”


Interrupters’ ability to be effective depends on their credibility. Many, like Cole, have served long prison sentences and can speak from experience. Most also have a close relationship with the local community. They can respond when a shooting takes place, for instance by convincing loved ones not to retaliate. But they are also aware if conflict is brewing between two individuals or rival groups, and can move to defuse the tension or suggest peaceful alternatives.


“We may not be able to reach everybody, but for the few people we do reach, it’s a beautiful thing,” says Cole. He laughs as he talks about a young man he’s been working with. “He was a mess. All the other little guys looked up to him. He was the man over there, always fighting. His transformation was just – now all the other guys see him working, and they want to come into the center to get a job.”


Grand Crossing, another South Side area, is the site of one of Cure Violence’s newest centers. Opened in December 2017, it sits on a busy street, a nondescript shop front deliberately chosen as a neutral space for different rival groups.


When I visit one spring afternoon, a boy in his late teens with a visible facial scar sits in the reception. In the office, staff are playing dominoes, the baseball game on the TV in the background. Young men from the area pass in and out to speak to their outreach workers and use the computers.


Demeatreas Whatley, the site supervisor, is catching up on paperwork in the back office. Whatley has been working for Cure Violence on and off since 2008, when he got out of prison after 17 years and decided he needed to do something different with his life. His first assignment was in Woodlawn, the area he grew up in.


Ignoring the protestations of his family, he moved onto the block worst afflicted by gang tension, and worked day and night to build up “peace treaties” between the feuding groups of young people. This entailed initially convincing the two groups to stay out of each other’s way, and then gradually working on individuals to shift their views about violence and help them to find work or get back into education. “I knew I was making a difference when I saw the old folks back out on the porch again drinking their coffees,” he says.


Although it must always be adapted for each location, Cure Violence follows roughly the same steps when establishing itself in a new place.


First, map the violence to see where it clusters. Whatley shows me an A4 photocopy of a map of Grand Crossing, with specks indicating where homicides were taking place. The streets and blocks where the specks cluster are the main focus. Next, hire credible workers with a local connection. “The type of guys we look for are respected in the community, and might already be stopping fights, trying to help guys calm down their nonsense,” he says.


These interrupters patrol the streets on their beat, getting to know shopkeepers, neighbors – and building links with the young men and women deemed to be the highest risk. “They’re able to know if it’s been a fight or if there’s a fight brewing,” says Whatley. “That’s what makes violence interrupters successful. You have to be there.”


This is an excerpt from an article originally published in Mosaic. It is republished here with permission under a Creative Commons license.


Highbrow Magazine


Image Sources:

--Pxfuel (Creative Commons)

--J. Schikaneder painting, 1800s (Wikimedia, Creative Commons)

--Guy Percival (publicdomainpictures, Creative Commons)

--John H. White (Flickr, Creative Commons)

--Geralt (Pixabay, Creative Commons)


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