The original way to combat the "virus of violence" that helps reduce it in different cities around the world – BBC News

What if the violence was an epidemic that was transferred from one person to another?

Smoking, overeating, having unprotected sex … People adopt a wide range of risky behaviors that can cause serious health problems.

It is always said that doctors should advise patients to change their habits, such as stopping smoking, following a diet or using protection instead of waiting for treatment for emphysema, heart attacks related to obesity or obesity. AIDS.

but When it comes to violence, it is usually assumed that it is an innate and unchangeable behavior and that those who fall into it can not attain redemption. So, often the solution to this evil in the legal system is sought by hardening sentences.

However, the law does not always work in the fight against violent crimes, so many cities in the world have adopted a new way to approach this problem in recent years: seeing it as a public health problem.

An infectious disease

After working abroad for more than a decade, American epidemiologist Gary Slutkin returned to his native Chicago in the late 1990s because he wanted to "rest" from diseases such as tuberculosis or cholera.

To combat infectious diseases, you depend a lot on the data. First, the health authorities locate foci on maps more infection and can then concentrate on reducing contamination in these areas.

Hand with knife
A woman shows the knife she wears in Glasgow in 2005, the year in which the city was named the most violent in Europe.

Often the transfer is controlled by making people change your habits so you can see a quick effect, even if there are structural factors that can not be addressed.

For example, diarrhea is usually caused by poor sanitation and water supply. The improvement of sanitation systems takes a long time, but in the short term thousands of lives can be saved if the population receives oral rehydration solutions.

These steps were used by Slutkin to combat the outbreaks that took place in the 40 Somali refugee camps he attended. They were also useful when he worked for the World Health Organization (WHO) in 2003 the appearance of AIDS. Whatever the exact nature of the virus to be treated, the steps to fight against it were the same.

"What do they all have in common, that they spread," he says. "Heart attacks and coronary diseases do not spread."

Change behavior patterns It is much more effective than just giving information to people. To achieve this, it is essential that the messengers have credibility.

"With all these outbreaks, we use outreach personnel belonging to the same group" of the target group, he explains. "Somali refugees to reach Somali refugees with tuberculosis or cholera, sex workers to reach sex workers with AIDS, mothers to reach mothers with breast-fed diarrhea".

So when he returned to Chicago and discovered that the murder rate went up enormously, he decided to apply the method he knew so well.

Photos & # 39; s of victims next to their shoes
Photos & shoes of the victims of armed violence shown in a protest against weapons in Philadelphia in 2018.

He collected maps and data on armed violence in his city and saw how the parallels with the maps of the contagious outbreaks became inevitable. "The curves of the epidemics are the same, the group – in fact, one event indicated another on foot, which is indicative of an infectious process. A flu causes more flu, colds cause more colds and violence causes more violence, "says the expert.

At that time, this was a radical departure from the widespread conception of violence, which focused primarily on justice. The popular idea was "these people are bad & # 39; and we know what to do with them: they punish", says Slutkin. "That is, fundamentally, not understanding humans properly. Behavior is formed by an example and imitation".

Patterns of violence

Chicago is deeply separated by race. Many neighborhoods in the South Side district have a 95% African American population; in other countries more than 95% of the inhabitants are of Mexican origin. Most are socially economically very disadvantaged areas and have suffered for years from neglect by the state. Murder rates can be up to 10 times higher than in predominantly white and rich populations.

But Slutkin emphasizes that this group does less to do with races and more with behavioral patterns (usually, between a smaller proportion of the population that is usually young and male) that are passed on between people. According to him, lives can be saved by changing this behavior in individuals and group norms.

In 2000, it launched a pilot project in the West Garfield district that replicated the same steps the WHO is applying to outbreaks of cholera, tuberculosis and AIDS: sidewalk transfer, prevention of future contamination and change of group standards.

Woman feeding child carrying another woman
Long-term solutions are needed to combat epidemics, but there are also quick ways, such as oral rehydration salts, that can save lives in the meantime.

The first year was one Decline in murders by 67%. The program was extended to other neighborhoods and, where applicable, the killings decreased by at least 40%. Other cities began copying this approach.

At the moment, the organization of Slutkin, Heal Violence, is working in 13 neighborhoods in Chicago. There are versions of the program in New York, Baltimore and Los Angeles and in other cities around the world.

Although the use of statistics on Curing Violence is called into question, several academic studies have shown the effectiveness of the method.

A 2009 study by Northwestern University showed that crime in the neighborhoods surveyed declined where the project was active. In 2012, researchers from the Johns Hopkins School of Public Health studied four areas in Baltimore where the program was applied and found that shootings and killings had all subsided.

The results are usually surprising. in San Pedro Sula, in Honduras, the first five zones in which Curar la Violencia was implemented registered a decrease of the number of admissions by 98% between January and May 2014 and the same period in 2015, when there were only 12.

Minutes that change lives

Demetrius Cole, 43, is a friendly, gentle man who spent 12 years in prison. He grew up in a violence-ridden area in Chicago and at the age of 15 he saw his best friend die during a firefight. Yet he had a stable family life and he stayed away from gangs. He planned to go to the navy.

When I was 19, a good friend bought a new car. Some neighborhood boys tried to steal it and shot down Cole's friend. The latter did not think twice and carried out a counterattack. Those few minutes have completely changed his life. His friend was left with a paralysis which meant he could no longer work and Cole was sent to prison.

Girl washing her hands
Some girls wash their hands at a school in Malawi: an example of how changes in habits can save lives.

Cole has been working on Heal Violence in Chicago since October 2017. He is looking for people who are in the same situation as he was and trying to persuade them to stop. "We try to teach them that it is a dead end, I tell them there are only two possible endings for them: going to prison or dying."

Cole works like a "violence switch", used by Curar la Violencia to intervene after a shootout to prevent retaliation and to calm people before a dispute escalates to a violent level.

The reversals of violence use numerous techniques, some of which are derived from cognitive behavioral therapy: "constructive shadowing", which consists of repeating people's own words; "Beware", which means guiding someone until they have calmed down and emphasize what the consequences are if they take any action.

The ability of switches to be effectively depends on your credibility. Like Cole, many have served long prison sentences and can speak from experience. Many also have a close relationship with the community.

The Cure Violence program must be adapted to each area, but the general parameters are maintained. First, violent acts are on a map to see where they are concentrated. Then, employees are accepted with credibility and a local connection. Then these switches patrol the streets they have been assigned to meet neighbors and merchants and thus establish a bond with those neighbors young people who are more at risk.

The center employs 11 switches, which usually spend at least six of their eight hours on the street. It also employs four outreach staff who have more interaction with the participants in the long term.

This outreach staff tries to change the attitude towards violence in a period of six months to two years. They also contact people with vacancies, advice or training.

It is a model that, as emphasized by Slutkin, fast, effective and cheaper than detention. Although it requires a lot of staff because it works on a very local level.

"I've experienced that and it's hard to return to society after I've been in prison," says Cole. "If people know you and know your past, you can stop many things with shooting and killing, I can show someone that they can, that they can change."

The Scottish case

Christine Goodall was a maxillofacial surgeon in Glasgow, Scotland, where she treated hundreds of patients with neck, face, head and jaw injuries in the early 2000s.

Scotland was the most violent developed country in 2005, according to the United Nations, and Glasgow, the "European capital of murder", according to a WHO study that collected data from 21 states in that continent.

More than 1,000 people had to be treated every year for facial injuries, so Goodall wondered if there was a way to prevent these injuries.

This is how he, in 2008, together with two other surgeons, the Doctors against violence, who visits schools to inform children about knife crime and makes them think in practical ways about how to react when a friend says that they have a knife.

Doctors against violence is a partner in the Reduction Unit (VRU) of the Scottish police. Right away "public health" strategy for the prevention of violence, since its inception in 2005, the murder rate in Glasgow has plummeted by 60%. The number of patients with facial injuries in hospitals has also decreased, with 50% according to Goodall.

The VRU was instructed to investigate how the problem of violence in other parts of the world was treated to design a solution that would work for Glasgow. His conclusion was the combination of two approaches, that of Gary Slutkin in Chicago and that of David Kennedy, a criminologist living in Boston.

Gangster covered with his face
Crime in San Pedro Sula, Honduras, are among the highest in the world. But violence fell in the areas where the Cure Violence strategy was implemented.

Kennedy's model began working in Boston in the 1990s and consists of bringing gang members together and give them a choice: that they change the violence for education or work, or that they undergo great hardships. This meant increasing the traditional punitive measures (increasing arrests and house searches and tightening the penalties for possession of a knife) and preventive measures in accordance with the public health approach.

Will Linden, the temporary director of the VRU, argues that this was necessary at the political level. "Before we could offer services to let them do things differently, we had to show that the police did the best they could, but that was not enough," he says.

The VRU is a police force that gets help from the Scottish government, something very unusual: Scotland has the only police force that has formally adopted a public health model.

In Chicago, Curing Violence works through the university, while similar programs in New York and Baltimore are managed through the health departments of those cities. But, together with the police, a large variety of officials is involved (from doctors to social workers).

Moreover, as Linden points out, Scotland has an unusual level of political consensus and successive governments that have retained funding for their work. This is important because in order to achieve a serious effect, this is necessary huge levels of collaboration that go beyond the four or five years that a government can sustain.

For example, physicians against violence hire & # 39; navigators & # 39; in which, like Chicago, intervene immediately after a violent incident to reduce tensions and help people find support.

These are not assigned to a specific location, but work in accident and emergency departments and are addressed to those who attend these services after a violent incident. "Many people come to the emergency room revenge plans and it's very important that they leave without having completed it, "Goodall explains.

In the violence prevention industry this would be an "affordable and open time for teaching" because the person is more receptive to help offers. "Pain is an incredible motivator for change"says Linden.

After a first interview, the navigator follows the help by having the person treated for drug or alcohol addiction, job offers or therapy. They try to do it quickly. "When someone wants to change, you have to be able to adapt and move," says Linden.

"In six or twelve weeks your attitude will be different, we make sure that when we send someone to a service, they do not have to queue." Hence the need for cooperation between different institutions.

"Limit to to say that violence is a disease and that we have to interrupt the flow, it will not stop"says Linden." Call it a public health or prevention approach, it does not matter if you do not use data-based approaches to solve the real problem. "

Invest in the long term

The WHO recognizes the avoidable nature of violence in its guide on how to prevent this: "Although violence has always been present, the world does not have to accept it as an inevitable part of the human condition … can be prevented and its consequences, reduced in the same way that public health efforts have been prevented and reduced complications in pregnancy, workplace injuries. "

But despite more and more evidence of this, governments are often reluctant to invest in these strategies.

"The problem is not in reducing violence, but in the way people understand the problem," says Slutkin, who draws a parallel with AIDS and the stigma of those who contracted it in the outbreaks that occurred in the 1980s.

In Scotland, however, the VRU is open to new ideas 13 years after its founding. In 2012, one of his agents, Iain Murray, traveled to Los Angeles to visit Homeboy Industries, one ctotering that hires expands for a year while providing advice, psychotherapy and other types of help.

Prisoners in the courtyard of a prison
"Massive confinement lacks good data, but gets funding," says Gary Slutkin.

Murray came back inspired and as a result, Braveheart Industries was born, a social enterprise managed by the VRU. His main activity is Street and Arrow, a food truck parked in a part of Glasgow called Partick. There he offers his seasoned chicken burgers and fish tacos.

To be hired, a criminal record is required, refrain from drugs and alcohol and be prepared to change.

"We need to understand what the problems are," says Murray. "For years the police were experts in arresting and implementing the law. I would rather sit on the top of the cliff to place a fence and prevent someone from jumping down, waiting for them to fall. That is, in my opinion, an approach to public health. You tackle the problems instead of waiting for them to happen. "

Allen, 27, has been working on Street and Arrow for three months. He says he lost sight of the time he spent in prison. According to Murray he came in about 27 times. "I chose the wrong path: alcohol, drugs, violence, chaos, prison … That was my life, it's hard to escape once you've started," Allen admits.

When he left the prison, he went to rehabilitation. Someone told him about Street and Arrow, he applied and he was very surprised when they gave him the job. "I came here with nothing and I do not want to say anything," he recalls. "But the further I got away from the chaos, my life improved."

"Now I see people in their cars and … that was not something that I had imagined, now I'm planning to get my driver's license, I just want a peaceful life," he says. "I never wanted that before, I just wanted to stun myself."

Things that are in appearance Simple is a challenge for the majority of participants: punctuality, wear a uniform. The navigators help them so that they are ready to work anywhere at the end of the year. At the same time there are echoes of the Chicago switches, because browsers are also responsible for entering into a relationship with the participants to help them change how they respond to the conflict.

The program has been reasonably successful, 80% of the participants stayed outside the prison and got a job. Murray notes how Allen has changed: "Thanks to my old positions in the police, I know that I could have arrested this man ten times in a row and that this would not have changed his behavior." By supporting him and connecting him to himself, I can bring about sustainable and sustainable change. "

"I can not believe how good he is, I can not let him leave work, it is extraordinary. You start to love them and they start to love each other for himself, "he concludes.

You can read the original note in English on BBC Future here.

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