The COVID-19 pandemic and America’s national conversation about race and police brutality are more connected than you may think.
In the 1980’s, public health experts began earnestly studying violence through a public health lens. Today, that approach is more relevant than ever.
How can studying violence as a public health issue help us to better understand and prevent violence?
First, it’s important to have a working definition of public health. The Center for Disease Control and Prevention uses Charles-Edward Amory Winslow’s definition: “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
Note that public health involves action at multiple levels, from individuals to society as a whole. Public health uses organized efforts to prolong lives and promote health. These methods can be applied to preventing violence.
History of public health and violence
I first learned about how violence as a public health issue when I visited the CDC museum this past March.* They had an exhibit about the first time that public health methods were used to study violence.
Between 1979 and 1981, there were 22 unsolved child homicides in Atlanta, Georgia. The CDC used epidemiological tools to better understand which children were more likely to be victims. According to the CDC website:
“CDC field investigators conducted a case-comparison analysis of the victims and a case– control study comparing victims with other children in the community. Victims shared similar characteristics (e.g., young [children], black, male, overrepresentation of death by asphyxiation) that were distinct from other child homicide victims; these findings suggested the deaths were a discrete cluster. Case-children were more likely than control children to run errands for money and spend time alone on the streets or in shopping centers, which suggested a single perpetrator who was local and knew the children were approachable.”
As a result of this analysis using public health methods, the community was better able to prevent violence:
Field epidemiologists helped law enforcement by determining that case-children were part of a unique cluster, the deaths were most likely linked to the same exposure (i.e., same perpetrator), and specific factors placed children at risk for abduction (i.e., being alone, running errands for money). The public health approach also informed local residents about measures for protecting children (e.g., early curfews, parental supervision) until an arrest could be made.
This is an early example of how public health tools have been used to prevent and deter violence. In 1979, the US Surgeon General identified violence as a health priority area for the nation. In a report, the Surgeon General said that as a preventable phenomenon, violence should be reduced to improve overall health.
The CDC continued to integrate violence prevention into its public health efforts. For example, the CDC established a Violence Epidemiology Branch in 1983 and the Division of Injury Epidemiology and Control in 1986.
As an approach to violence prevention, public health uses four steps: Define the problem, identify risk and protective factors, develop and test prevention strategies, and assure widespread adoption in communities.
Epidemiological methods are also used to study suicide, sexual violence, and intimate partner violence. Public health officials can identify common characteristics of those that these types of violence affect, and can tailor prevention methods to these subsets of the population.
Violence can be stopped like a virus
In an interview with The Hill, Dr. Gary Slutkin, an epidemiologist and founder of Cure Violence Global, described how public health methods can be used to combat violence.
“We tried out basic health epidemic control for violence, meaning we use health workers, the community themselves,” Slutkin said. “And in fact we got 40 percent to 70 percent drops in shootings and killings, treating violence just like any other community-based epidemic.”
Cure Violence Global uses violence interrupters, individuals in the community who intervene in volatile situations and ‘talk down’ those who may commit violent acts. This method has been used in cities like New York City and San Pedro Sula, Honduras, resulting in a 66 percent decrease in shootings in New York City and an 88 percent decrease in killings in San Pedro Sula, where homicide rates are among some of the highest in the world.
Dr. Slutkin says that stopping both a virus and violence requires behavior change. While practices like social distancing and wearing a mask can slow the spread of a virus, targeted action such as that of violence interrupters can change violent behavior.
Listen to Dr. Slutkin’s interview here.
How can public health methods be applied to police violence?
Dr. Slutkin points to violence interrupters as a potential alternative or complement to policing. This community-based model requires investment from the community to intervene in situations where there is potential for violence.
In Nashville, nonprofit Gideon’s Army uses violence interrupters to de-escalate situations that could become violent. Whereas trust in the police may be low in these communities, violence interrupters are more effective as community members. By intervening, violence interrupters disrupt the school-to-prison pipeline. Combined with restorative justice methods, the violence interruption approach is a potential alternative to traditional policing and criminal justice methods.
Ultimately, Dr. Slutkin points to the importance of community-level work in applying public health methods to violence.
“All epidemics are managed from the inside out. They’re not managed by police, they’re managed by the community themselves, people who are trusted, who can translate what needs to be done to the people who need to understand it in order to be able to shift what they’re doing, for it to make sense to them.”
*Yes, I literally went to the CDC museum over spring break.
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