About Those Guns…This Time, Some Better News (Part 2 of 2)

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Treating Gun Violence as a Public Health Epidemic

There’s broad agreement, as noted in Part 1 of this post, that gun violence (indeed, all violence) should be viewed as a public health issue.

That idea was clearly stated by Dr. Gary Slutkin, an epidemiologist trained in infectious diseases, when he returned to the US after a decade spent in Somalia, Uganda, and other countries where epidemics of such diseases as cholera, tuberculosis, and AIDs were common. In his final assignment before coming home, he was tasked to design interventions.

As he describes in a 2013 TEDMED talk, he was looking for something to do when he began hearing stories of children shooting other children.

When he asked friends how America was addressing this issue, one response was through punishment.

But, he said, “We who had worked in behavior know that punishment was something…that was highly overvalued” because it wasn’t a main driver of either behavior or behavior change.

What’s more, it reminded him of responses to epidemics long ago—before science cast better light on issues.

The other response was what he called the “‘everything’ theory, or EOE: Everything on Earth:” fix the schools, home, community, family, etc. He said he realized from treating other problems that you don’t always need to treat everything.

Assuming violence behaves like a contagious disease, Slutkin describes three things necessary to counter it.

First: interrupt transmission by detecting and finding the first cases, which includes identifying and training special workers to locate those cases, eg, “someone who’s very angry because someone looked at his girlfriend or owes him money.”

Second: “to prevent further spread…find out who else has been exposed,” but not as severely, and manage them as well.

Third: “shift the norms.” This is an extensive effort involving community activities, public education, helping people improve communication and resolve their conflicts peacefully.

Slutkin notes:

“And then you’ve got what you might call group immunity. And that combination of factors is how the AIDS epidemic in Uganda was very successfully reversed.”

Slutkin and his colleagues put all these ideas together in 2000, and tried them out in the West Garfield neighborhood in Chicago—“the worst police district in the United States at the time.” The result: a 67% drop in shootings and killings.

What Slutkin began in Chicago became an organization originally called “CeaseFire,” but more optimistically renamed “Cure Violence.” It’s now a national model, with local groups operating under various names.

And several of those local groups are in the California Bay Area, which is the subject of the year-long examination that Lois Beckett and her colleagues at The Guardian have undertaken. (See Part 1 of this post.)

The reduction in violence in this region from 2007 to 2017 is remarkable—even more so because it occurred while homelessness caused by gentrification has been rising.

Due to the impact of Silicon Valley, writes The Guardian,

“For each new millionaire household the San Francisco Bay area has produced, there are at least four new people living below the poverty level.”

Nevertheless, gun homicide was down substantially in the ten-year period in more than 100 cities throughout the region. In Oakland, a 44% decrease. In San Francisco, 49%. In Richmond, 67%. With Stockton as an outlier (98% increase), the overall drop in the region was 30%.

Writes The Guardian:

“There’s early evidence that local violence prevention strategies—including a refocused, more community-driven ‘Ceasefire’ policing strategy, and intensive support programs that do not involve law enforcement at all—were a ‘key change’ contributing to these huge decreases.” 

Lest anyone conclude that gentrification resulted in the reduced gun violence, it’s noteworthy that there was no uptick in violence in the suburbs to which the people forced out of the city moved.

One local activist noted:

“The idea that gentrification is more responsible for the reduction in shootings and homicides is offensive to the hundreds of outreach workers, community members and practitioners on the frontlines actually doing this work daily.”

As Slutkin had observed, pinpointing the source of the infection is critical to containing it. The Guardian quotes experts:

“Longtime community outreach workers and violence interrupters, many of whom are formerly incarcerated, are crucial to making these public health strategies effective.” 

A Richmond official, DeVone Boggan, who’s developed a nationally recognized fellowship program for men at highest risk for violence, says:

“We have to extend the idea of what public safety is beyond policing and incarceration, to include these things like intervention, outreach, and neighborhood empowerment.”

In line with using data wisely, Oakland did a 2017 study of every homicide over 1-1/2 years and found that 0.16% of Oakland’s population (about 700 men) were responsible for the majority of the homicides. That enabled more effective interventions.

Here’s something both fascinating and integral to program success: Boggan says some credit must go to the shooters who are no longer shooting, who are now making “healthier decisions…I think these individuals have to be a productive part of the solution. They have to be embraced and brought into the discussion.”

One young man, now a college graduate entering business school, sounded remarkably like Slutkin, the epidemiologist.

“Gun violence is pretty much a form of disease. Once it starts affecting one person, it starts spreading.”

He’d never considered carrying a gun until he was shot listening to fireworks one July 4th. He went to jail for illegal possession, but later entered Boggan’s fellowship program “with other young men caught up in the long-running cycle of local fights and retaliations,” writes The Guardian.

Says this young man:

“To have somebody who believes in you, and knows you’ve got the potential to go for it, stuff like that makes you want to keep going right.”

The situation isn’t nirvana at present. Throughout the region, black residents are 22 times more likely to be killed with a gun than white residents, and many residents, black and white, still don’t feel safe. Property crime has risen significantly.

But the improvements are dramatic, and the cluster of approaches seems to work.

These programs can cost tens of millions of dollars—and they require sustained attention. But consider that amount when compared with the costs of the damage done by gun violence.

Sadly, as of 2017, Cure Violence was woefully underfunded in Chicago, the city where it began, existing on just a few grants. That meant a dearth of Violence Interrupters. The group’s leaders attributed an increase in Chicago’s violence to that drop in funding, reported The Trace.

I’m not sure the program exists at all any more, though Chicago neighborhoods are in such ongoing crisis that one would think the funding could be found.

Congressman Danny Davis, testifying just days ago (September 26, 2019) before a Congressional subcommittee hearing on The Public Health Consequences & Costs of Gun Violence, cited a University of Chicago Crime Lab estimate that gun violence costs Chicago and its residents $2.5 billion a year.

He stated:

“Despite the high cost of gun violence, not one penny of the approximately $624 million raised by federal taxes on guns and ammunition in 2018 went to gun violence prevention. Rather, all gun and ammunition excise taxes go to fish and wildlife conservation.”

I’m all for fish and wildlife conservation, but there seems to be a huge disconnect here.

Hospital Emergency Departments and the “Teachable Moment”

One of the most promising developments in breaking the cycle of violence is Hospital-based Violence Intervention Programs.

Originating in the 1990s in community groups in Oakland, California, and Milwaukee, Wisconsin, they resulted from hospital medical staffs’ recognition that, from their location on the “front lines,” they could work with “trusted community-based partners who were well-positioned to provide intervention to violently injured youth after hospitalization.”

The umbrella group is now called The Health Alliance for Violence Intervention. I’m quoting from their White Paper, which I found extremely valuable.

Based on the premise that victims of interpersonal violence may well then retaliate as a “natural response borne out of societal pressure,” the programs begin when the youth is hospitalized and continue well after release.

Trained Intervention Specialists serve as mentors at the “teachable moment”—a time when the youths are believed most receptive to changing their behaviors and making changes in their lives.

Follow-up includes mental health care when needed to address the psychological traumas, and broad additional assistance: academic, vocational, housing, and help in honing in on the youths’ skills and interests to guide them toward productive careers.

A number of studies have documented the effectiveness of these efforts in reducing violence and costs that result from it.

“Collaborating With Gun Owners on Suicide Prevention”

Just as Cure Violence collaborates with actual shooters to turn them away from gun violence, a program based in Salt Lake City, Utah collaborates with gun owners on suicide prevention as part of a public health approach to reducing gun deaths.

As noted in Part 1 of this post, nearly 2/3 of gun violence consists of suicides, and we know the presence of guns exponentially increases the lethality of these attempts.

In Utah, reports Morissa Henn, Community Health Program Director at Intermountain Healthcare, that rate is 85%. Henn also testified at the September 26, 2019 Congressional subcommittee hearing.

The number has increased since 1999, when Surgeon General David Satcher called for the US to “address suicide as a significant public health problem.”

Henn says the high rate is due to the country’s failure to address “the inextricable link between suicide and firearms.” Although there’s not much evidence in support of most existing suicide prevention programs, she says,

“One of the only empirically based, high-impact suicide prevention strategies is reducing access to lethal means—which, in the United States, means reducing access to firearms for people who are at risk for suicide.”

Although lethal means reduction isn’t widely discussed in the US, awareness has grown since Surgeon General Regina Benjamin called for it in a 2012 National Strategy tied to a public health approach to suicide prevention in individuals at high risk.

Henn is part of a coalition of health professionals, gun owners, and others seeking to prevent suicide by firearms in Utah. Of this unlikely partnership, she says:

“In my experience, building productive and trusting relationships with gun owners on suicide has made us all think bigger, rooted the efforts in real-world context, and connected the data with culturally relevant messages and best-positioned messengers.

“Over time, I have learned that advancing these non-traditional partnerships is not only possible, but is a critical step if we are going to move the dial on gun death in America.”

“Similar to the way that shifts in social norms around drunk driving did not require all-out bans on cars or alcohol, a shift in voluntarily putting space and time between a suicidal impulse and a gun is framed in our coalition as a preventive, not prohibitive strategy. That small shift in framing opens the door to dialogue.”

Some accomplishments:

*an emergency department study found that among gun-owning parents of suicidal youth, 33% had unlocked guns at home before training; none did after training.

*with bipartisan support from the coalition, the state legislature passed a Suicide Prevention and Gun study that has gathered important data being applied to prevention. “It exemplifies how gun-related research can bring people and data together to drive collective action.”

*they developed a suicide prevention module for firearm instructors that the state adopted for permit seekers that’s won support from 79% of concealed carry instructors.

*a Safe Harbor Law permits gun owners or those they live with to temporarily store firearms with law enforcement for free if they believe someone in the home is a danger to self or others.

*They’ve joined with government, faith, business, and firearm stakeholders in a statewide media and education campaign with private dollars matched by public funds to extend awareness of suicide and lethal means reduction.

Though they don’t yet have impact data, they are optimistic because of the momentum they’ve built and what they’ve accomplished to date—and Henn recommends similar steps on the federal level. She believes it’s important to:

“Create political space in Congress for more open dialogue—engaging firearm owners and non-firearm owners in trusting partnerships can help us advance life-saving messages and behaviors.”

Sandy Hook Promise (SHP)

Our country was struck to its core by the horror of Sandy Hook, the 2012 mass shooting that killed 20 6- and 7-year-olds, as well as 6 adults. Some of those grief-stricken parents have built an enduring legacy to their children by trying to prevent similar violence through identifying people at risk and getting them help before they act.

It’s an extensive program, and I can’t do justice to it here. I encourage you to explore the website.

SHP calls itself a “modest, above-the-politics organization that supports sensible program and policy solutions that address the ‘human side’ of gun violence by preventing individuals from ever getting to the point of picking up a firearm to hurt themselves or others.”

On the website, a March 22, 2019 press release describes the impact of SHP’s “Say Something” program.

When students at a Connecticut Middle School, who had just received the training, “saw disconcerting information and behaviors coming from one of their peers“ they averted a potentially violent situation in their school.

The Missing Piece…

After discussing the hopelessness that so many Americans feel about gun violence in Part 1 of this post, I felt the need to shed light on some programs that are, in fact, preventing gun violence.

But none of this should detract from what I—and the vast majority of Americans—feel is an imperative: the passage and enforcement of meaningful federal gun safety legislation.

All the above programs may well be more effective—and less urgently needed—if we can enact sensible laws to reduce the carnage that has affected individuals, families, and our society so deeply.

I thank my friend Dennis—one of the untold numbers of volunteers and staff in gun violence prevention organizations and elsewhere who are working so hard to keep us safe by bringing such laws to fruition. Dennis has directed me to a number of the sources that I’ve used here.

Annie

13 thoughts on “About Those Guns…This Time, Some Better News (Part 2 of 2)

  1. Thank you so much for this informative survey of things that are being done to address gun violence in America! Some of these programs sound excellent, Annie, and it is so encouraging to see that, in many cities where they are implemented, the gun violence rate dropped. I like the fact that there is so much outreach and support at the heart of these programs. We always say that in order for at-risk individuals to interact positively with others they need to feel that they are connected, capable and contributing. It is disheartening that there isn’t more funding available for these programs.

    I read somewhere the other day that the vast majority of Americans are in favour of reform of gun laws. It is voices like yours that will help reach this goal, Annie.

    Liked by 1 person

    1. Thank you, Janine! Yes, even many gun owners support common-sense gun legislation. At present, the Senate Majority Leader, who is now known as “Moscow Mitch,” will not bring a bill that passed the House to the floor for a vote. He says he’s waiting to see what the President will do—and though it was highly unlikely the President would defy the NRA before, with the impeachment investigation under way, he’s certainly not going to agree now.

      I’ve been thinking about your point about press suicide coverage guidelines—I’m trying to figure out whom to approach about such a thing re: coverage of mass shootings.
      So glad to have your observations!
      Best regards.

      Liked by 1 person

  2. There are some excellent points made here. I was chagrined, though, to see two areas unexamined. First, governments have done a poor job over the last generation with mental health care. They emptied out residential facilities and closed many of them. We now leave folks to fend for themselves with minimal supervision and in the real world it is a chore to get someone who is a danger to self or others committed somewhere.
    Second has been family breakdown on an epidemic scale. The family has been the most basic unit of society for many millennia. Outside of our upper middle class bubble where most families are reasonably stable, the traditional family (mother father children as a matched set) is virtually extinct. Men and women move in and out of each other’s lives (with their drugs) and whatever children come along are left to navigate the wreckage. We cannot expect kids who grow up in this kind of toxic societal soup to be as well adjusted as we who are in this discussion.
    What’s the answer? Heckifiknow. But government won’t be able to solve it. (Though they can probably make it worse).

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    1. With all due respect, JP, the two areas you say were unexamined were not within the scope of my inquiry. I was focused on programs that have succeeded in lowering the incidence of gun violence.

      I am attaching a link to former Surgeon General David Satcher’s recent testimony before the same House subcommittee that I cite in the report. In response to your comments about mental illness, he points out that mentally ill people are far more often the victims of violence than the perpetrators. And though I know your bias against government spending, he includes statistics that I believe are important factors in this discussion.

      https://waysandmeans.house.gov/legislation/hearings/public-health-consequences-and-costs-gun-violence

      As to your issue about families, there are many kinds of supportive families that aren’t the traditional mother/father pairings of years ago. And many single moms—and dads—often do very good jobs of raising kids under difficult circumstances.

      You may also want to go back to the comments in Part 1. Your loyal respondent DougD had some relevant comments about several of the issues you raised about what you perceive to be causes of violence.

      Liked by 1 person

      1. I did not mean to pick at you for the aspects of the topic you chose for your focus. My comment was directed at the experts on whom you relied.

        And I certainly don’t denigrate single mothers who do the best they can – I was raised by one of them. But I have also spent years talking with men and women on the bottom rungs of society and let me tell you there is a widespread level of instability in their lives that gives me concern.

        As for the mentally ill, I do not doubt what you say. But while very few of the mentally ill are mass shooters, almost all of the mass shooters are mentally ill.

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      2. Perhaps I need to clarify: I wanted to write about programs that work. I did some research, and my friend suggested other sources that I thought were exactly what I was looking for. If the cites had not met my criteria, I would not have used them. I did not use ones that I regarded as off-topic, which is what I felt the two points you raised were. Nobody led me astray.

        I wanted this piece to focus for the most part on the programs that are not getting the press coverage that mass shootings do. And although we would probably intuitively think that almost all mass shooters are mentally ill, I think the question of mental incompetence is invariably raised (when the shooters survive), and that question is not always answered in the affirmative. These are complicated cases, and those who don’t want any form of gun control find it easier to talk about mental illness.

        Our basic differences—yours and mine—concern what the role of government should be. That’s why I Included the former Surgeon General’s testimony for you to read.

        Liked by 1 person

  3. Annie — having some computer issues, so probably the last I posted didn’t work? Grrrr. Anyway, wanted to thank you for your careful thinking. I love how you lay it out, fact by fact, so logical, so sequential, quite persuasive. I really appreciate your science brain on this stuff too. Not emotional. Just the facts. Bravo and thanks for enlightening me yet again on matters so very important to all of us. D.

    Liked by 1 person

    1. Hi, Denise–

      So sorry for your computer issues; it shouldn’t be so hard to leave a comment! But thanks very much for persevering.

      And thanks, too, my Loyal Reader, for your very generous comments. I am most appreciative.

      Cheers,

      Annie

      Like

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