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Treating violence as an epidemic disease

Gary Slutkin, MD Exec Director, Cure Violence Formerly World Health Organization Professor, Epidemiology and International Health UIC School of Public Health


3 independent evaluations Institute of Medicine U.S. Conference of Mayors National Leagues of Cities National Governor’s Association Department of Justice


3 Independent evaluations

National Institute of Justice Centers for Disease Control Johns Hopkins School of Public Health Bureau of Justice Assistance Center for Court Innovation


CURE VIOLENCE INTERNATIONAL ADAPTATION PARTNERS

CANADA ENGLAND UNITED STATES

ISRAEL/ PALESTINE

SYRIA IRAQ

EGYPT

JAMAICA

MEXICO

PUERTO RICO HONDURAS

YEMEN

TRINIDAD

COLOMBIA KENYA BRAZIL

ADAPTATION PARTNERS EXPLORING PARTNERSHIPS SOUTH AFRICA


No. 9


No. 9 No. 1


Funders U.S. Department of Justice Robert Wood Johnson Foundation John D. and Catherine T. MacArthur Foundation McCormick Foundation Interamerican Development Bank (IADB) USAID U.S. State Department Bernard Van Leer Foundation 15 others


New theory


New theory Violence is a contagious process


TRANSMISSION OF VIOLENCE

Exposure to Violence

Violence Source: Mullins et al. 2004; Devries et al. 2011


CONTAGIOUS VIOLENCE

GANG VIOLENCE URBAN CRIME RIOTS ETHNIC- RELIGIOUS CONFLICT CIVIL WAR GANG WARLORDISM GENOCIDE


• Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level


SCIENTIFIC UNDERSTANDING


Why is violence contagious?


Behavior


Behavior is


Behavior is contagious


Copying


FOLLOWING Social expectations


FOLLOWING

FOLLOWING Social expectations


FOLLOWING Social expectations


Excitation


TRANSMISSION OF VIOLENCE

Exposure to Violence

Violence Source: Mullins et al. 2004; Devries et al. 2011


MULTIPLE EXPOSURES

Exposures

COMMUNITY

Outcomes

MULTIPLE EVENTS


KILLING EPIDEMICS VIOLENCE BEHAVES EXACTLY LIKE A CONTAGIOUS DISEASE Country A

1950

Country C

2008

Country B Country Billings in Rwanda

4/1994

1960

2003

Country D

5/1994

1980

2003


New theory


New theory Violence is a contagious process


New practice Treating violence like an epidemic process


HOW ARE EPIDEMICS REVERSED?


STOPPING EPIDEMICS

1. Interrupt transmission 2. Prevent future spread

. Change group norms


Finding those most likely to shoot or be shot


Mapping 53


DETECTION AND INTERRUPTION Photograph by Ed Kashi


DETECTION AND INTERRUPTION


Identify and interrupt conflict


STOPPING EPIDEMICS

1. Interrupt transmission 2. Prevent future transmission


CHANGE BEHAVIOR of highest risk Photograph by Ed Kashi


CHANGE BEHAVIOR Photograph by Ed Kashi


CHANGE BEHAVIOR (OUTREACH WORKER TEAM)


CHANGE BEHAVIOR Photograph by Ed Kashi


IDENTIFY AND CHANGE THINKING

CHANGE BEHAVIOR


STOPPING EPIDEMICS

1. Interrupt transmission


STOPPING EPIDEMICS

1. Interrupt transmission 2. Prevent future transmission


STOPPING EPIDEMICS

1. Interrupt transmission

2. Prevent future transmission . Change norms


CHANGE GROUP NORMS INTERVENERS Street outreach

THE 3 VARIABLES

BEHAVIORAL OUTCOME

Norms

Clergy Community

Risk

Materials Police

Alternatives

No VIOLENCE


3. CHANGE NORMS Photograph by Ed Kashi


CHANGE NORMS


3.

CHANGE GROUP NORMS CHANGE NORMS Photograph by Ed Kashi


Group immunity

New norms Susceptible People

Exposure

Transmission (Spread)

Group immunity NO VIOLENCE


SYSTEM


Epidemic control

SYSTEM


SYSTEM


RESULTS


67%

shootings


Results – Logan Square Cure Violence Zone

8

CURE VIOLENCE

7

6

5

4

3

2

1

0 36281 36526 36770 37012 37257 37500 37742 37987 38231 38473 38718 38961 39203 39448 39692 39934 40179 40422 40664 40909 41153 36161 36404 36647 36892 37135 37377 37622 37865 38108 38353 38596 38838 39083 39326 39569 39814 40057 40299 40544 40787 41030


FIRST 6 CURE VIOLENCE COMMUNITIES, 2000–2004

* These results are all statistically significant with p<0.01 W. Garfield, W. Humboldt, Logan Square, SW Chicago, Auburn Gresham, Rogers Park

CUREVIOLENCE


RESULTS: 8 NEW COMMUNITIES, 2005â&#x20AC;&#x201C;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 NEXT COMMUNITIES, 2006â&#x20AC;&#x201C;2007

* Results are significant compared to neighboring (p<0.01)

* * Results are significant compared to the city (p<.05)

CUREVIOLENCE


CURE VIOLENCE â&#x20AC;&#x201C;Englewood, Chicago

Before Cure Violence

After Cure Violence


CURE VIOLENCE – Rogers Park Before

After


INDEPENDENT EVALUATIONS


Interruption 100% drop in retaliations CURE VIOLENCE

CONTROL

Auburn Gresham

-100%

-25%

Englewood

-100%

-100%

Logan Square

-100%

+100%

no change

n/a

Southwest

-100%

no change

West Garfield Park

-46%

+41%

West Humboldt Park

-50%

-57%

East Garfield Park

-100%

+60%

Rogers Park

Skogan, 2009


DOJ - EXTERNAL EVALUATION

↓ 41 – 73% ↓ 16- 34% ↓ 15 - 40% ↓ 100% 85-97%

shootings and killings (overall effect seen) shootings and killings (directly attributable) shooting density retaliation murders in 5 of 8 communities helped to jobs, school, out of gang

DEMONSTRATED EFFECTIVE TO REDUCE SHOOTINGS AND KILLINGS Skogan, 2009


CDC/Johns Hopkins Independent Evaluation (Baltimore replication)

34 â&#x20AC;&#x201C; 56% less shootings and killings 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

186

P1 Good implementation P2 Workers diverted

McElderry Park

- 53%*

None

4.0

48.7

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 begun April 2013

* Comparison 2011 to 2012, University of Puerto Rico


Africa Cape Town, South Africa

yles

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 Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

Interruption training begins in August, Northern region


New practice Treating violence like an epidemic process


Demonstrated effective !


• Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level


“…the approach that will come to prominence.”


CURE VIOLENCE U.S. PARTNER CITIES

ALBANY NIAGARA YONKERS

WAUKEGAN MAYWOOD ROCKFORD OAKLAND

CHICAGO CICERO

DECATUR

NEW YORK CI PHILADELPHIA BALTIMORE

KANSAS CITY EAST ST. LOUIS

NEW ORLEANS

ADAPTATION PARTNERS


CURE VIOLENCE INTERNATIONAL ADAPTATION PARTNERS

CANADA ENGLAND UNITED STATES

ISRAEL/ PALESTINE

SYRIA IRAQ

EGYPT

JAMAICA

MEXICO

PUERTO RICO HONDURAS

YEMEN

TRINIDAD

COLOMBIA KENYA BRAZIL

ADAPTATION PARTNERS EXPLORING PARTNERSHIPS SOUTH AFRICA


CURE VIOLENCE PRIORITIES

1. Changing the thinking 2. Assist with impact


CURE VIOLENCE PRIORITIES

1. Changing the thinking


OLD VIEW


OLD VIEW BAD PEOPLE


OLD VIEW BAD PEOPLE ENEMIES


OLD VIEW BAD PEOPLE ENEMIES


OLD VIEW BAD PEOPLE ENEMIES PUNISHMENT


OLD VIEW BAD PEOPLE ENEMIES PUNISHMENT

Modern View


OLD VIEW

Modern View

BAD PEOPLE ENEMIES

Contagious behavior

PUNISHMENT


OLD VIEW

Modern View

BAD PEOPLE ENEMIES

Contagious behavior

PUNISHMENT


OLD VIEW

Modern View

BAD PEOPLE ENEMIES

Contagious behavior

PUNISHMENT

Interrupt events


OLD VIEW

Modern View

BAD PEOPLE ENEMIES

Contagious behavior

PUNISHMENT

Interrupt events


OLD VIEW

Modern View

BAD PEOPLE ENEMIES

Contagious behavior

PUNISHMENT

Interrupt events Change behavior


OLD VIEW

Modern View

BAD PEOPLE ENEMIES

Contagious behavior

PUNISHMENT

Interrupt events Change behavior Change norms


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 URBAN CRIME ETHNIC- RELIGIOUS CONFLICT CIVIL WAR GANG WARLORDISM GENOCIDE WAR


SCIENTIFIC APPROACH


VIOLENCE AS A

CONTAGIOUS

DISEASE


Violence is a Disease


CURE VIOLENCE AND ADAPTATION PARTNERS

ALBANY NIAGARA YONKERS

WAUKEGAN MAYWOOD ROCKFORD OAKLAND

LOS ANGELES

CHICAGO CICERO

DECATUR KANSAS CITY EAST ST. LOUIS

NEW ORLEANS

ADAPTATION PARTNERS SIMILAR MODEL

PHILADELPHIA BALTIMORE

BOSTON

NEW YORK CITY Manhattan Brooklyn Queens

WASHINGTON DC


VIOLENCE

GANG VIOLENCE URBAN CRIME ETHNIC- RELIGIOUS CONFLICT CIVIL WAR GANG WARLORDISM GENOCIDE WAR


TRANSMISSION AND PROCESSING OF VIOLENCE

VIOLENCE TRANSMISSION Observing


TRANSMISSION AND PROCESSING OF VIOLENCE

VIOLENCE TRANSMISSION Observing Witnessing


TRANSMISSION AND PROCESSING OF VIOLENCE

VIOLENCE TRANSMISSION Observing Witnessing Trauma


London, England: Cookham Wood (Youth Detention Center)

• Violent incidents reduced • Click to edit Master text styles to lowest level since prison opened – Second level • Only center in UK to get – Third level level 3 (good) rating for • Fourth level pioneering approach and – Fifth level reduction • Evaluation planned


micides In Loiza, Puerto Rico (January â&#x20AC;&#x201C; April, 2011-2

14 12 10 8 6 4 2 0

2011

2012

2013


Capetown (Hanover Park), South Africa Shootings & Homicides (Jan â&#x20AC;&#x201C; May 2012-13) 16 14 12 10 8 6

67% Drop

4

79% Drop

2 0

2012

2013

Shootings

2012

2013

Homicides


Capetown (Hanover Park) , South Africa Shootings & Homicides (Jan - May 2010-13) 20 18 16 14 12 10 8 6

67% Drop

4

79% Drop 2 0

2010 2011 2012 2013 Shootings

2010 2011 2012 2013 Homicides


Homicides In Loiza, Puerto Rico (2011-2012) 45

52% Drop

40 35 30 25 20 15 10 5 0

2011

2012


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


Treating violence as an epidemic disease