An Epidemic of Violence: Treating a Contagious Health Problem

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Past exposure to violence increases the risk of future violence.
Past exposure to violence increases the risk of future violence.

In an opinion piece published in the AMA Journal of Ethics, author Gary Slutkin, MD, professor of epidemiology at the University of Illinois Chicago School of Public Health, and colleagues argue that violence is best understood and treated as an epidemic health problem.1  

The authors point to the ways in which violence acts like a contagious epidemic. “Violence meets the dictionary definition of the disease (characteristic signs and symptoms causing morbidity and mortality) and of contagious (transmissible, causing more of itself),” they wrote. Furthermore, violence exhibits the population and individual characteristics of contagious epidemics — clustering, geo-temporal spreading and person-to-person transmission.

As with a disease, past exposure to violent events increases the risk for future violence. Studies have shown that exposure to violence from either victimization or direct visual experience increases the risk for chronic violent behavior thirtyfold.2 These mechanisms of transmission are thought to be responsible for contagions of child abuse, intimate partner violence, street violence, suicide, mass shootings, riots, and terrorism. The authors argue that, “[t]hese types of violence should be understood as syndromes of the same disease process that differ by context.”

The authors suggest that the best approach to preventing violence is to use epidemic control, including the use of community-based health workers selected, trained, supervised, and supported under the guidance of the health sector. Areas of highest transmission and symptom manifestation should be mapped out, and outreach and intervention to those displaying clinical signs of violence should be implemented to reduce further transmission. 

Cure Violence,3,4 an organization with which the authors are affiliated, has used epidemic control methods over the last 15 years to successfully reduce community violence in dozens of communities in the United States and around the world. The authors note that, “[a]n evaluation of the Cure Violence approach implemented in Chicago found that the Chicago program was associated with an up to almost 70% reduction in shootings and killings in some areas, and an up to 100% reduction in retaliatory homicides across 7 sites over a 33-79 month period.”5

“Now is the time for our nation's health care and public health systems to work with communities and other sectors to stop this epidemic,” concluded Dr Slutkin and colleagues. “Each of us has a role in making this happen.”

References

  1. Slutkin G, Ransford C, Zvetina D. How the health sector can reduce violence by treating it as a contagion. AMA J Ethics. 2018;20(1):47-55.
  2. Spano R, Rivera C, Bolland JM. Are chronic exposure to violence and chronic violent behavior closely related developmental processes during adolescence? Crim Justice Behav. 2010;37(10):1160-1179.
  3. Butts JA, Rouman CG, Bostwick L, Porter JR. Cure Violence: A public health model to reduce gun violence. Annu Rev Public Health. 2015;36:39-53.
  4. Slutkin G, Ransford C, Decker RB. Cure Violence: treating violence as a contagious disease. In: Maltz M, Rice S, eds. Envisioning Criminology. Cham, Switzerland: Springer Nature; 2015;43-56.
  5. Skogan WG, Hartnett SM, Bump N, Dubois J. Evaluation of CeaseFire-Chicago. Evanston, IL: Northwestern University Institute for Policy Research. https://www.ncjrs.gov/pdffiles1/nij/grants/227181.pdf. 2008. Accessed February 12, 2018.

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