In the wake of a mass shooting that killed 17 students in a high school in Parkland, Florida, a year ago, a group of parents—some of whom had lost children in the attack—cast about for a way to address the epidemic of gun violence in the United States. Early in their research, the group reached out to an organization with a history of results: Cure Violence. In just the first year of Cure Violence's operation in West Garfield Park, one of Chicago's most violent neighborhoods, the neighborhood had seen a 67 percent drop in the number of shootings.
Founded by Gary Slutkin, the former head of the World Health Organization's Intervention Development Unit, Cure Violence had a unique approach to gun violence: It treated it like a contagious disease. And, just like one would cure a disease, the organization held that the best way to address gun violence was through public-health approaches.
Since its founding at the turn of the century, the Cure Violence model has been adopted by 50 cities across the U.S., as well as countries rife with chronic violence, including El Salvador, Iraq, and Syria. Like the first experiment in West Garfield Park, many of the new areas applying the model saw violence decrease in their communities by massive proportions—shootings dropped 44 percent in Baltimore and by 30 percent in Philadelphia; in San Pedro Sula, a city in Honduras, killings fell by 88 percent.
One of the more prominent Parkland survivors has been effusive about the organization's work. In May of 2018, David Hogg told the Guardian about his interest in the Cure Violence model. He's not just curious about its efficacy, but also its non-partisan status. While gun control remains hotly contested, using public-health approaches to deal with gun violence remains politically neutral.
Could the public-health approach work to reduce mass shootings?
Though Cure Violence began in 2000, the origin of its "contagion" model and public-health approach go back more than 40 years. In the second half of the 20th century, American doctors and public-health officials were fresh off the defeat of two of the era's greatest scourges, Tuberculosis and pneumonia, once the U.S.'s first and second leading causes of death. However, year after year, as illnesses decreased, homicide was rising to the top of the leading causes of death in the country.
In the late 1970s, researchers at the Center for Disease Control and Prevention (CDC) began to track incidence of violence, noting who was affected by it, who committed it, and where it occurred. As they mapped their data, the CDC researchers realized something astounding. On the map, violence was spreading like contagious diseases, and, like them, demonstrated three characteristics: It clustered in certain areas, spread out over time, and had a clear vector of transmission between people. It looked, in other words, as if it spread through direct exposure. People who were exposed to violence were much more likely to commit violence themselves.
"It makes absolutely no sense if you think about it rationally: That if a person experiences the thing, and then goes on and does it to other people," says Charles Ransford, the senior director of science and policy at Cure Violence. "But when you understand it as a contagion, something that is being passed on from exposure, then it starts to make sense."
Compelled by the researchers' findings, the CDC opened its Violence Epidemiology Branch in 1983 to try to use the models of epidemiology (the study of diseases and their spread) to address violence. However, as Ransford explains, even as public-health officials began to recognize violence as a public-health issue—with a potential public-health solution—most elected officials in the country, like the voting public, continued to consider violence as a kind of moral failing: a bad thing bad people do. The policy solution, then, was punishment and increasing policing and sentencing.
There is no vaccine for violence. But Ransford is clear that it can be treated identically to diseases. Consider H.I.V., for instance: There is no vaccine, so, to curb the spread of the disease, epidemiologists worked to change the public's behavior, encouraging protected sex and frequent testing. (There have been promising results: New infections in the U.S., which had risen rapidly to a peak of 150,000 per year in the mid-1980s, have declined to an estimated 40,000 per year since 1992.) For violence, changing behavior means helping individuals who are at a high risk of committing violence find healthy and safe ways to address and cope with their urges.
Organizations like Cure Violence send in outreach workers—trained individuals, who are also credible members of the community they're going into—to meet with people who are at risk and connect them with the resources they need, be it therapy, family intervention, help with money, or something else. Ransford says needs vary by individual, but, from a bird's-eye view, there are a discrete set of things people at risk of violence generally need help dealing with, like pressures to join a gang or unresolved family trauma.
But how does one identify individuals who are at a high risk of committing violence before they commit violence? Experts explain that, with epidemiological approaches, a statistical analysis of certain indicators can help pinpoint individuals with a high degree of accuracy. The No. 1 indicator for future violence is prior experience of violence (not, as some might erroneously assume, mental illness). According to some studies, individuals who have experienced violence are themselves up to three times more likely to commit violence against other people.
Anne Marks, the executive director of Youth Alive!, an Oakland-based organization that uses a healing, intervention approach to addressing gun deaths and gang violence, puts it simply: "I have yet to come across someone who has done violence who has not themselves been subject to violence."
Because of this, some of the best spots for intervention are hospitals. In 1994, the organization Marks now leads helped found the National Network of Hospital-based Violence Intervention Programs, a group of organizations—including Cure Violence—that base their operations out of emergency rooms.
"People understand that 'hurt people hurt people,'" says Fatimah Muhammad, the executive director of the NNHVIP. "But we like to say 'healed people heal people.'"
Could the public-health approach help stop mass shootings?
The Cure Violence approach has thus far proven most successful in addressing cycles of violence in neighborhoods affected by plights like chronic gang violence. However, Ransford thinks that the model is applicable to school shootings too.
One draw of the public-health model is that outreach workers can do what police cannot: attend to someone who has not yet committed a crime, but is at high risk of committing violence. In the Parkland incident, the shooter—who had reportedly experienced corporeal punishment at home—had multiple run-ins with the police before his attack on the school. He was known for exhibiting violent behaviors, and the other sort of telltale signs that the Cure Violence model could've pinpointed. However, police did not have the training or authority to provide assistance to the soon-to-be shooter, and they could not arrest someone who had not yet committed a crime and did not yet have a material plan to do so.
Ransford envisions a world where every school and district could have violence prevention specialists, who would use the public-health approach to discover students and community members who are at high risk of committing violence, and then use proven outreach and mediation techniques to help them resist their urges.
"It might seem like a needle in a haystack," Ransford says, when it comes to locating people who might commit mass shootings. But he says that Cure Violence's model has proven effective in locating those people at the highest risk of committing violence.
"We would only be dealing with and helping people at the highest level of risk," he says. "It's hard to say 100 percent that we would be able to stop shootings—you can't be 100 percent sure about these things. But I feel confident that we could."