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

07/01

12/01

05/02

10/02

03/03

08/03

01/04

06/04

11/04

04/05

09/05

02/06

07/06

12/06

05/07

10/07

03/08

08/08

01/09

06/09

11/09

04/10

09/10

02/11

07/11

12/11

05/12

10/12

0

1

2

3

4

5

6

7

8

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

Thank youT

Thank you!

gslutkin@uic.edu karen@cureviolence-international.org

www.cureviolence.org

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