Treating Violence as a Disease

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CHICAGO — Diseases such as Tuberculosis, HIV, or influenza are widely known to be both deadly and contagious. However, what can be learned from approaching violence as a disease?

Gary Slutkin, MD is a leading physician in the field of violence treatment and prevention. Slutkin founded a group named “Cure Violence”, which was initially a pilot project in Chicago to reduce violent crime. The program has since spread to 15 cities and seven countries.

Slutkin spent many years of his medical career combating tuberculosis, cholera, and AIDS in Asia. Upon returning to the U.S., he began to notice how violence affects communities in a very similar way to other infectious diseases. However, unlike the treatment of these pathogenic diseases, health officials, politicians, lawmakers and law enforcement do not currently treat violence as a disease.

In a comprehensive introduction to the work of Cure Violence, Slutkin outlines how violence is poorly understood, much like the diseases that were common in Europe’s history such as the plague or leprosy. These diseases were not properly managed because our ancestors did not have the technology to discover the existence of microscopic organisms that were transmitting disease. This lead to widespread mistreatment and ostracizing of the victims with the diseases. After these microorganisms were detected and were correctly blamed for diseases, innovators produced more effective prevention and treatment techniques.

Despite staggering amounts of scientific data that illustrate how violence is clustered, how it spreads in a population, and how it is transmitted between individuals, interventions are still not tailored to implement scientifically proven methods of reduction. In communities where Cure Violence has been actualized, the overall reduction rates of homicides and shootings range from 41 – 73 percent. When compared to the global Tuberculosis reduction (a sector with U.S. $6.3 Billion in spending in 2014) rate of 45 percent from 1990 to 2013, the disease control to violence prevention seems incredibly effective.

Slutkin highlights how interventions must (1) detect and interrupt ongoing violence and “new infectious events”, (2) identify violence perpetrators and reduce their impact, and (3) modify the underlying cultural and behavioral norms, along with the environmental circumstances that perpetuate violence. The key players in enacting these changes are community health workers or “Interrupters”, who were praised for their work in a recent award-winning documentary aptly named The Interrupters.

A public health approach to treating violence as a disease has shown its efficacy on a localized scale, however, much work remains to be done on a global scale. For example, the U.S. has been able to decrease sexual abuse from 68 per 10,000 individuals in 1990 to 33 per 10,000 individuals in 2010. However, multiple World Health Organization (WHO) reports from the early 2000’s cited nearly 1.8 million deaths attributable to suicide, homicide, and war. Hundreds of thousands of women and girls are sold into slavery worldwide every year. In the 1990’s conflict in Bosnia, it is estimated that between 10,000 and 60,000 women and girls were raped as a weapon of war.

Global statistics may seem grim, but the possibility of a revolution in violence prevention exists. Perhaps the current situation can be best elucidated by one of the world’s greatest champion of peace, Nelson Mandela. In the first World Report on Health and Violence, he stated, “This suffering… is a legacy that reproduces itself, as new generations learn from the violence of generations past, as victims learn from victimizers, and as the social conditions that nurture violence are allowed to continue. No country, no city, no community is immune. But neither are we powerless against it”.

Patrick Tolosky

Photo: Flickr

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