Saturday, June 27, 2015

Violence prevention through public health methods

For a long time I've thought that public health perspectives and strategies were valuable in dealing with social problems -- or should be. Here's an excerpt in Salon from a book by Alexa Clay and Kyra Maya Phillips, which discusses Gary Slutkin's informed implementation of that idea.

He returned to the United States and soon found himself asking, “What next?” He started hearing about kids shooting each other. “I was reading these horrific stories of ten- and twelve-year-old kids killing each other in the streets, and I asked people what was being done about it.” It was a simple question, one that might be posed by any concerned citizen. But it was a question that Slutkin would spend the next fifteen years attempting to answer.

Slutkin was stunned and disappointed by the so-called solutions that existed for treating violence. “We knew that punishment wasn’t a main driver of behavior,” he told us.“This was a problem that was stuck.” Discouraged, Slutkin began to study patterns of violent outbreaks and made a startling observation: Violence spreads much like infectious disease. “What I saw in the maps of violence I studied was characteristic clustering— just like the maps that I had seen in other epidemics, such as cholera.” That was Slutkin’s “aha moment.” “I thought, what if we started treating violence as a contagion?”

One of the biggest and most insidious plagues on our society is violence. Yet too often the discourse focuses on labeling the violent individuals as deviants or “evil.” What if, Slutkin wondered, we removed the labels and the judgment and began to treat violence objectively—like a disease that is transmitted and spread, much like the common cold? He joked, “You can’t even see bad under the microscope. There is no place in science for the concept of bad or the concept of enemy.”

His leap from A to B was slow. It took him about five years to reframe the problem of violence in his own mind. He lost himself in debate and discussions about the drivers of violence. He read all the latest reports and white papers. He became obsessed with the topic and with the ways he thought he could bring a “cure” to the world. This kind of obsessive knowledge of the system you’re trying to fix is essential for any hacker. You need to understand the rules in order to know how to break them or pioneer something different. Having one foot in the system you’re trying to change, and one foot outside to maintain perspective, allows you to maintain an insider/outsider mind-set and approach.

Slutkin’s background in health and his immersion in the field of violence prevention allowed him a unique vantage point to see through the bias of the system. For example, a lot of existing practice focused on punishment as a solution to violence, but based on his work in the health field, Slutkin knew punishment was never used as a tool for behavior change. A lot of those who advocated punishment reminded Slutkin of a historic period in epidemic history when people didn’t have an understanding of diseases and thought things like plague, leprosy, and smallpox were caused by bad people or “bad humors.” Slutkin told us how these misunderstandings often led people to blame, exclude, and punish the victim of disease, which caused additional suffering.

Seeing violence outside a moralistic lens required a radically different approach. But compounding systemic problems of poverty, racism, drugs, and other chronic issues impacting violent communities wasn’t efficient or actionable. Even choosing to work with political systems to regulate gun control could take decades and hadn’t seen much success to date, at least in the United States. So rather than wait for a magical silver-bullet solution, Slutkin realized he could help stop the spread of violence, in much the same way that he had stopped the spread of disease in Somalia.

From there, Slutkin’s organization, Cure Violence, was framed around a simple hypothesis: The most critical thing is to disrupt the transmission of violence.

Slutkin then developed a community role for “violence interrupters”: outreach workers called in to delicate situations where violence could occur, much like the community outreach workers he employed in the refugee camps. So if people in a particular neighborhood hear about a potential retaliatory shooting or a conflict brewing between gangs, they can call in violence interrupters, who go into the neighborhood and attempt to prevent the violence from being transmitted.

For example, a mom in Chicago discovered that her teenage son was loading weapons with his friends in their house. She was frantic and didn’t know what to do because it was her son and his friends, and she wasn’t going to call the police on her kid. But she needed someone to do something. So she called Cure Violence, and they sent over a few interrupters to talk to the teenagers. Over the course of a few hours, they were able to calm the group of kids. The interrupters know how to buy time and allow people to cool down; most important, they listen. A lot of their method is about the art of persuasion.

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