Addressing Urban Violence: The “Cure Violence” Public Health Approach

BY SOPHIA KECSKES

This July, in response to the tragic killing of a seven-year-old boy in Chicago, Mayor Rahm Emanuel said, “adults here are letting the children down—from failures of the criminal justice system to the immoral nature of street gangs. You have a time and place where you have too many guns on the street, too many people repeatedly using those guns, and too little values.”¹

In 2012, 500 people were murdered in Chicago, making it the city with the largest number of homicides in the country that year.² This is not unusual, as Chicago has been one of the top three cities with the most murders every year since 1985.² However, substantial improvement has occurred over the last fifteen years – the city’s murder rate peaked at 928 murders in 1998.² Chicago has a murder rate of 18.5 murders per 100,000 people. While in comparison to cities such as Flint, Michigan where the rate is 62 murders per 100,000 people, Chicago’s rate might seem low, it is still four times the national average.² Chicago’s murder rate as of September 2015 was up 21% from the previous year, with the non-fatal shooting rate 20% higher than at the same point in 2014.³ Clearly, change is necessary to promote safer lives in the Windy City.

Theories Regarding Urban Violence

Young, black men who live in certain neighborhoods are the most likely to be victims of gun violence.⁴ However, to then conclude that all young, black men in those areas are at risk is a gross oversimplification. Elijah Anderson describes the societal tendency to group blacks together and make assumptions, relegating a large group of people to one role in society.⁵ The assumption that having certain risk factors—such as being a young black man who lives in a certain neighborhood – substantially increases your risk for gun violence is a broad-sweeping claim that neglects to acknowledge the complexity of urban violence. Simply analyzing risk factors leaves out a significant piece of the explanation, even if the risk factors considered are more comprehensive and include characteristics such as dropping out of high school, being unemployed, using drugs and alcohol, or being impoverished.⁴

Yale sociologist Andrew Papachristos (2014) argues that an individual’s social networks can predict the likelihood of getting shot.⁶ He notes that gun violence is transmitted in a very similar manner to public health epidemics such as HIV/AIDS or cholera; therefore, we should “treat gun homicide like a blood-borne pathogen, something that is transmitted from person to person through risky behaviors.”⁷ Further, he stresses that it is not just your friends’ risky behaviors that increase your risk, it is also your friends’ friends’ behaviors. Papachristos further suggests that our strategies to combat gun violence should not be wide reaching policies that touch a large proportion of the population (such as “stop and frisk” in New York City), but instead should target specific, high-risk individuals.⁷

While Papachristos’ research is unique in that it explicitly and quantitatively links gun violence to social networks, the conception of gun violence as a public health epidemic has been prominent for 15 years. Gary Slutkin, an infectious disease physician who spent the beginning of his life working with the World Health Organization to fight HIV/AIDS and tuberculosis in Africa, moved to Chicago in the late 1990s and was moved to action by the city’s high murder rate. He made a key discovery when he began to analyze the challenge of gun violence using an epidemiological lens. By analyzing patterns of violence he discovered two things: first, that violence is predictable, and second, that it spreads person-to-person, similarly to a contagious disease.⁸

Applying a public health approach to the epidemic, Slutkin determined that the best strategy to combat gun violence is to interrupt transmission. Slutkin started a program initially called CeaseFire, now called Cure Violence, which does just this. The program collaborates with trusted community members, many of whom are ex-gang members themselves, to act as mediators at the “epicenter of violent behavior.”⁸ The key role of these “interrupters” is to “move out of judgment [and] into understanding,” much like a public health official or doctor in an emergency room.⁸

Applying Theory to Practice: “Cure Violence” Program Description

Cure Violence was founded in Chicago in 1999. This program targets three key causal factors that are believed to be the major determinants of violence: community norms, limited knowledge about the available alternatives to violence, and underestimating the severe consequences of violence for the community.⁹ These causal factors are addressed through five central strategies: “Street-level outreach, public education, community mobilization, faith leader (clergy) involvement, and police and prosecutor participation.”⁹ The graphic to the right depicts the program’s theory of change.¹⁰  In short, through community collaboration and engagement with respected community leaders, Cure Violence encourages a dialogue with young people around shifting social norms away from violence as a conflict resolution strategy, as well as highlighting the costs of violence. The program also provides immediate, on-the-ground mediation of conflicts to diffuse situations and encourage alternative solutions. Violence “interrupters,” who are trusted community leaders, work in pairs or alone directly in the aftermath of a shooting – either on the street or in hospitals when gunshot victims are brought in – to talk with distraught family members, friends, and gang leaders to de-escalate situations and stop the cascade of retaliatory shootings that often occur following an initial tragic incident.⁹ The program in Chicago is largely funded by the state of Illinois and carries a high cost—$11 million of funding from 2004 – 2006.¹¹

Collaboration with the Chicago Police Department is vital to the Cure Violence model. When a shooting occurs, the police department notifies interrupters immediately so they arrive on the scene with enough time to evoke a behavior change. This program operates alongside other police initiatives, including an increased emphasis in Chicago on community policing and efforts to build trust between communities and law enforcement officers. In some ways, the Cure Violence initiative has helped to promote better police-community collaboration, as local individuals appreciate the program’s utilization of local assets (trusted community leaders) to save their children’s lives. This success, and the perceived trust of local leaders, has opened avenues for police-community dialogue which otherwise may not exist.¹²

Positive Impacts of “Cure Violence” in Chicago

To investigate the efficacy of the Cure Violence program, several independent evaluations have been conducted. One evaluation, conducted in 2007 by Northwestern University, examined eight communities where Cure Violence operated. It found statistically significant reductions in shootings and killings varying from 41% to 73%, reductions in shooting hot spots of up to 40%, and a 100% elimination of retaliations killings in five of the eight neighborhoods.¹⁰ In these eight communities, Cure Violence caseworkers were involved with 660 youth, 84% of whom were very high risk. More than 70% were Black and 26% were Hispanic. In addition to violence de-escalation work, 86% of the youth reported that Cure Violence had helped them find a job.¹⁰

A qualitative study conducted in 2013 by the McCormick Foundation and University of Chicago found similar results. Notably, the study found that the Cure Violence initiative has an additive effect on the reductions in violence precipitated by police actions, therefore accelerating the development of safer neighborhoods. Many youth explained that they trusted Cure Violence representatives because they had had similar life experiences, with one youth explaining that he trusted his representative because “they lived the life I live.” The study discovered that the program served to counteract the severe isolation felt by at-risk youth. One young man said, “Ceasefire [the former name for Cure Violence] taught me that life is more than the block. I can be bigger than the block.” Finally, this study reported that reductions in violence (greater than can be attributed to a general decrease in Chicago crime) occurred within just one month of program initiation.¹³

Following the successes demonstrated in Chicago, an excellent publicity strategy, and the release of the award-winning documentary The Interrupters, the Cure Violence model has expanded throughout the United States and overseas. While the direct focus of this analysis is implementation in Chicago, the statistics provided to give a snapshot of the program’s broader impact.

Criticisms and Limitations of the Cure Violence Model

Despite noteworthy successes, there are important criticisms of the Cure Violence program. One controversial aspect of this program is the effort to recruit and employ community members whom young people respect. The program hires many people who have previous records of incarceration and illegal behavior. Some people praise the program for hiring those who may otherwise not have found stable work, with one minister saying, “It’s nice that they have jobs. That’s the best part of the program. I would support it just for that.”⁹ However, others criticize the program for this very reason. For example, one Illinois State Senator said, “The over $18.5 million given to Operation CeaseFire has done more to legitimize gang leaders’ portfolios than actually stopping violence.”⁹

It was challenging for Cure Violence to find staff members who were sufficiently respected and connected with gang members and those involved with the drug trade, but who were not involved in these activities themselves. In fact, according to Tio Hardiman, Cure Violence’s Illinois Director, six of their 300 outreach workers had returned to crime after being hired.¹⁵ This caused tense relationships between law enforcement officials and the outreach workers, as the policemen were wary of working with individuals who they’d arrested in the past. Similarly, some policemen criticize the interrupters for not alerting them when illegal behavior occurs and for not allowing policemen to talk to those involved in a shooting immediately afterward because the interrupters are working to de-escalate a heated conflict.

To address some potential challenges with hiring individuals who have been incarcerated in the past, the organization imposes strict standards for employment, which include routine drug checks for all employees. These, in conjunction with unstable funding, result in high staff turnover. This hinders the organization’s ability to build trustworthy relationships over a long period of time with community members.⁹ Community relationships are also tense because hires are conducted by an external panel, not by community members, and some site directors are perceived to be “political” hires, not based on merit—for example, one state representative appointed his former chief of staff as a site director without a public comment process and without considering any other candidates.⁹

Other key challenges to the violence interrupters work include that they are awarded one 900-hour contract at a time, and often they have to stop working between contracts. This is disruptive at times to community relationships and on-going mediations between gangs.⁹ Similarly, the program depends on yearly fund appropriations from the state government, funds that were decreased during the recession, and are unreliable year-to-year. One particularly critical Chicago Tribune article highlighted that problem shortly after Cure Violence’s budget was reduced. The article noted that after Cure Violence ended operations in several neighborhoods, five young men were shot in or just next to these same neighborhoods, thus suggesting that long-term partnership with communities is key and that abruptly terminating the program can have consequences.¹⁶

Conclusion

While there are certainly areas where Cure Violence can improve, the program has demonstrated significant success in changing social norms about violence as a conflict-resolution strategy. Thanks to these cross-community dialogues, in addition to other community development strategies such as job placement, Cure Violence has made a substantial and long lasting positive impact on the neighborhoods in which it operates. Improvements could certainly come through more reliable funding from the state government and re-doubled efforts to hire individuals who are not involved in gang behavior or use drugs, but the underlying theory of change associated with this program appears to be effective. By viewing gun violence as an epidemic spread person-to-person, and by targeting specific individuals who are at the highest risk of shooting or being shot, the Cure Violence initiative utilizes a conceptualization of gun violence as spreading through networks to “interrupt” violence after a first incidence and stop retaliatory killings. This public health based strategy to combat gun violence is incredibly effective; continuing to promote similar creative thinking and problem solving is vital for continued progress on pressing challenges.

Sophia Kecskes is a senior Political Science major in Pierson College. She is in the 5-year Accelerated BA/MPH studying health policy at the Yale School of Public Health. She is a Global Health Scholar and a Global Health Justice Partnership Fellow. Sophia can be contacted at sophia.kecskes@yale.edu.

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References

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