Treating Violence as a Contagious Disease

    • June 16, 2003
Gary Slutkin, M.D., Executive Director, CeaseFire Chicago

By Elizabeth Austin
Photos by Nolan Wells

The atmosphere in the stark university conference room was solemn. CeaseFire Chicago, a public health group working to reduce gun violence, was holding its monthly steering committee meeting. The assembled community leaders, gathered around a long, bare table, were facing the grim realities of Illnois' looming budget cuts.

"This is a defensive year," one young woman announced resolutely. "We need to put together our bullet points to take to the governor."

"Talking points," someone across the table corrected gently.

It may sound like minor quibbling. But CeaseFire's executive director, Gary Slutkin, M.D., believes that minds must change before behavior can change. And if people become sensitive to the symbolic weight of the words they choose, they can help to create a new, anti-violent culture that could help to save thousands of lives.

About CeaseFire

Gary Slutkin, M.D., an epidemiologist, founded CeaseFire as part of the Chicago Project for Violence Prevention in 1995. He had just returned to the United States after living in Africa for 10 years—first working to fight tuberculosis and cholera epidemics in Somalian refugee camps, then joining the World Health Organization's AIDS program in Uganda. His experience in battling infectious diseases overseas helped him to see gun violence in America as a true epidemic. "Violence behaves like a contagious disease," Slutkin says. "One person shoots someone, and someone else retaliates: It's like an infection, spreading, spreading, spreading. But the infectious agent is invisible; it's in the mind."

In the past, Slutkin says, experts had viewed urban violence as a sociological problem, the unavoidable result of racism, poverty and hopelessness. "Those are things that are irrelevant," Slutkin insists. "Violent behavior is just a behavior, like smoking or drunk driving. So it should respond to strategies that we know will work to change behavior."

To fight the epidemic, Slutkin first identified the infectious agent—the idea that shooting someone is an acceptable action. He then met with community leaders to come up with new, effective interventions to stop the spread of gun violence. The result was CeaseFire, a model program that combines a public education campaign to change social norms about gun violence with outreach workers providing on-the-spot alternatives to shooting.

The program's public health-based approach has attracted a variety of funders, including the Robert Wood Johnson Foundation, which awarded CeaseFire a $470,874 four-year grant under the Local Funding Partnerships program.

So far, the model program seems to work: In the neighborhoods where the full CeaseFire program is in place, the number of shootings has dropped 25 to 72 percent.

Why Chicago?

The CeaseFire statistics are even more dramatic when considered against the background of Chicago's seemingly stubborn crime problem. Although other major cities have seen their homicide rates drop dramatically, Chicago reported 647 homicides in 2002— 22.3 killings per 100,000 population, four times the national average. That made Chicago's homicide rate the highest of the nation's nine largest cities.

No one is sure why Chicago's homicide rate remains so high. Partly, Slutkin believes, that may reflect the city's position as a drug traffic crossroads, or its high level of gang activity (although Slutkin is swift to stress that gang membership is not illegal, and that not all gang members are violent.) But the city's intractable rate of gun violence makes it a perfect incubator for CeaseFire's anti-epidemic intervention program.

Air War, Ground War

Slutkin divides the CeaseFire program into two components, the "air war" and the "ground war" -- strong words for a man so conscious of verbal nuance.

"The "air war" is the public education effort, led by thousands of glossy posters proclaiming, "Stop. Killing. People." The message might seem simplistic, even unnecessary. After all, most people do know that killing is both illegal and immoral. But Slutkin argues that the straightforward message is necessary to counterbalance the extraordinary level of violence in CeaseFire communities. "You have to think about this from the point of view of someone who's grown up with shooting happening all the time," he says. "If you grow up with shooting all the time, shooting is normal." He points out that there are six or seven non-fatal shootings for every homicide. In some neighborhoods, he contends, 80 percent of children witness at least one act of serious violence by the time they're 18.

But the posters, along with the coordinated flyers, buttons, brochures, pens and T-shirts, do more than preach the CeaseFire message. They also give legitimacy to the outreach workers—the "ground troops"—who hit the streets to halt shootings before they happen.

Some outreach workers are former gang members themselves, using their contacts to head off violence before it starts. For example, Slutkin says, outreach workers might hear of that a couple of guys were planning to rob a neighbor. Some would confront the would-be robbers. "They'd say, 'Why are you going to do this?'" Slutkin explains. Others would head off the intended victim— and might even reprimand him for making himself an easy target: "What are you wearing all those gold chains for?"

Other outreach workers take a different tack. In one neighborhood, a third of the outreach staff are women. Slutkin tells of one, a woman whose 21-year-old son was shot to death. She now faces down other young men who are teetering on the edge of deadly violence. "I'm not losing another single one of you," she states flatly. "I'm the mom tonight."

Sometimes, the outreach workers simply lend a sane and sympathetic ear. After a neighborhood shooting, they can sometimes avoid a retaliation killing simply by listening to an angry, vengeful young man pour out his frustration and grief.

The outreach workers rely on the posters to give them legitimacy, to prove that they represent the entire community. "It makes them feel they have something behind them," Slutkin says, referring proudly to the half million pieces of public education materials CeaseFire has distributed so far. "It gives them enormous credibility."

Changing the Police

It's not enough to target high-risk individuals on the street. CeaseFire also works from the top down, helping to persuade police that violence doesn't have to be part of the status quo in impoverished inner-city neighborhoods.

To demonstrate to both police and residents that CeaseFire zones no longer tolerate shooting, the project has created a "Rapid Response" plan. Whenever a shooting does happen, the police district commander immediately sends a fax giving the details of the crime to a "lead community organization." That organization immediately alerts churches, schools and residents to organize a swift, strategic response. Within a day or two, community leaders and police are at the scene, demonstrating against the crime and driving home the message that violence will no longer be tolerated.

Afterward, CeaseFire and other community groups meet with the police to figure out what happened, and to come up with new strategies to prevent similar crimes in the future.

"The community's role is to respond to every shooting, to make a big deal about it and send the message, 'This is totally unacceptable,'" Slutkin says. Before CeaseFire, police responded to shootings by "trying to find 'the person' who did it," he says. But that traditional approach, focusing on a single guilty individual, did nothing to address the community's role in preventing violence. By joining together with the police, a community can take action against crime—and can remind police officers that the majority community members are law-abiding, concerned citizens, even in "bad" neighborhoods.

Getting God on Their Side

In many ways, the CeaseFire message can be boiled down to a single biblical imperative: "Thou shalt not kill." But while that message has been handed down from inner-city pulpits for generations, that simple injunction alone has failed to stem the epidemic of violence. To make local priests and ministers active partners, CeaseFire has created a Covenant for Peace in Action, asking clergy to proclaim that their communities simply will no longer tolerate shootings. As part of the covenant, local clergy members are asked to preach against violence on the first weekend of every month, and pray for peace both within their sanctuaries and out on the streets.

Congregations are expected to show up in force in response to every shooting in CeaseFire zones, and to rally against guns and gun trafficking. In addition, churches are asked to create after-school programs and safe havens for community youth, offering positive—and attractive—alternatives to violence.

Not every member of the clergy is a useful partner, Slutkin admits. Some longtime ministers have lost hope, believing that violence is simply inevitable. But others—many of them younger—have responded vigorously. In fact, in one neighborhood, all of the outreach workers are clergy members.

Results

It's not easy to prove that CeaseFire works. A virus doesn't cause violence, so Slutkin can't construct a double-blinded, gold standard research study to prove that he's created an effective anti-assault vaccine. Instead, the group relies on an impressive array of crime statistics to prove that their intervention really works. In the CeaseFire Zone in the West Garfield Park neighborhood, the number of shootings dropped from 43 in 1999, when the program was first put in place, to 14 in 2001. In the Grand Boulevard zone, the number of shootings dropped from 89 in 2000 to 57 in 2001.

Slutkin and his staff have carefully tracked the shootings in surrounding neighborhoods as well. They found that CeaseFire, like violence itself, seems to be contagious; communities adjoining CeaseFire zones have shown lower rates of gun violence, even as more distant neighborhoods with similar demographics and base crime rates saw an increase in the number of shootings.

Hearts and Minds

While crime statistics may impress state legislators and foundations, the real test of CeaseFire is its impact on minds and hearts. "We're trying to get out the message that violence is old and dumb, and makes everything worse," Slutkin says.

Slowly, that message seems to be taking hold, he believes. He retells one heartening story, heard from an outreach worker who was at a city nightclub late one Saturday night when someone suddenly pulled out a gun. "The whole place froze, and everybody stood there and looked at him with real social disapproval, as if to say: 'What are you, stupid?'" And the offender, embarrassed, put his gun away.