These networks of shootings help explain why the Cure Violence approach is possible. Let’s start with the fact that we can study the networks at all: if we want to control an outbreak, it helps if we can identify potential routes of transmission. Slutkin has compared violence interruption to the methods used to control smallpox outbreaks. As smallpox was nearing eradication in the 1970s, epidemiologists used ‘ring vaccination’ to stamp out the final few sparks of infection. When a new disease case appeared, teams would track down people the infected may have come into contact with, such as family members and neighbours, as well as these people’s contacts. They would then vaccinate people within this ‘ring’, preventing the smallpox virus spreading any further.[24]
Smallpox had two features that worked in health teams’ favour. To spread from one person to another, the disease generally required fairly long face-to-face interactions. This meant teams could identify who was most at risk. In addition, the generation time for smallpox was a couple of weeks; when a new case was reported, teams had enough time to go and vaccinate before more cases appeared. The spread of gun violence shares these features: violence is often transmitted through known social links, and the gap between one shooting and the next is long enough for interrupters to intervene. If shootings were more random, or the gap between them was always much shorter, violence interruption wouldn’t be so effective.
An independent evaluation of Cure Violence by the US National Institute for Justice found a substantial drop in shootings in areas where the programme had been introduced. It can be tough to assess the precise impact of anti-violence programmes, because violence may have already been declining for some other reason. But violence hadn’t declined as much in comparable areas of Chicago, suggesting that Cure Violence was in fact behind the reduction in shootings in many locations. In 2007, Cure Violence started working in Baltimore. When researchers at Johns Hopkins University later assessed the results, they estimated that in its first two years, the programme had prevented around thirty-five shootings and five homicides. Other studies have found similar reductions after the introduction of Cure Violence methods.[25]
Even so, the Cure Violence approach has not been free from criticism. Much of the scepticism has come from those in charge of existing approaches; in the past, there have been complaints from Chicago police about a lack of co-operation from interrupters. There have also been instances of violence interrupters being charged with other crimes. Such challenges are perhaps inevitable, given that the programme relies on having interrupters that are part of the communities at risk, rather than another branch of the police.[26] Then there’s the timescale of social change. While stopping retaliatory attacks can have an immediate effect on violence, tackling the underlying social issues may take years.[27] The same is true with infectious diseases: we might be able to stop outbreaks, but we also need to think about underlying weaknesses in health systems that enabled them in the first place.
Building on their early work in Chicago, Cure Violence has expanded to other US cities, including Los Angeles and New York, as well as launching projects in countries like Iraq and Honduras. Public health approaches would also inspire a ‘Violence Reduction Unit’ in Glasgow, Scotland. Back in 2005, the city was named the murder capital of Europe. There were dozens of knife attacks a week, including numerous incidents of notorious ‘Glasgow smiles’ being slashed into people’s cheeks. What’s more, the violence was far more widespread than police figures suggested. When Karyn McCluskey, head of intelligence analysis at Strathclyde Police, looked at hospital records, it became clear that most incidents weren’t even being reported.[28]
McCluskey’s findings – and accompanying recommendations – led to the creation of the Violence Reduction Unit, which she would head up for the following decade. Borrowing techniques from Cure Violence and other US projects, such as Boston’s Operation Ceasefire, the unit introduced a range of public health ideas to tackle the spread of violence.[29] This included interruption approaches, like monitoring A&E departments for victims of violence to discourage potential revenge attacks. It also involved helping gang members move into training and employment, while taking a tough stance against those who chose to continue with violence. There were longer-term measures too, like providing support for vulnerable children to halt the transmission of violence from generation to the next. Although there is still more to be done, the initial results have been promising; following its introduction, the unit has been linked with a major drop in violent crime.[30]
Since 2018, London has been working on a similar initiative to tackle what has been described as an ‘epidemic’ of knife crime in the city. If it is to succeed like Glasgow, it will require strong links between police, communities, teachers, health services, social workers, and the media. It will also need continued investment, given the often complex, deep-rooted nature of the problem. ‘It’s about putting money where your mouth is in terms of prevention, and understanding that you may not see a really quick return on it,’ McCluskey told The Independent shortly before the London project launched.[31]
Sustaining investment can be tough for public health approaches. Despite growing acceptance elsewhere, funding for the original Cure Violence programme in Chicago has remained sporadic, with several cutbacks over the years. Slutkin said attitudes to violence are changing in many places, but not as easily as he would hope. ‘It’s frustratingly slow,’ he said.
One of the biggest challenges in public health is convincing people. It’s not just a matter of showing a new approach works better than existing methods. It’s also about advocating for that approach, presenting a compelling argument that can help turn statistical evidence into action.
In the world of public health advocacy, few have been as effective – or as pioneering – as Florence Nightingale. While
