One of my favorite questions discussed during my tenure hosting the oldest continuous Socrates Cafés came at the end of 2010. The question was: How would an absence of Free Will change our legal system? Reading Samira Shackle’s Should we treat crime as something to be cured rather than punished? for The Guardian, took me back to that evening. She begins:
Usually, facial trauma doesn’t kill you, but it can cause significant disfigurement. Working as a surgeon in Glasgow in the early 2000s, Christine Goodall treated hundreds, if not thousands, of patients with injuries to the neck, face, head and jaw. Sometimes, the injuries were caused by a baseball bat, with shattered bones and bruising as bad as from a car accident. More often than not, it was a knife. A slash across the forehead or cheek, leaving a scar etched across the face; a machete wound to the jaw, slicing through the skin and breaking the bone underneath.
One young man came into the hospital in the middle of the night with a knife wound across his face. Goodall dreaded the morning ward round the next day, when she would have to tell him that it would be impossible to avoid a serious scar. But his reaction surprised her. “He was very offhand about it,” she says. “Some of his friends came to see him later that afternoon and I realised why it wasn’t going to be a problem for him – because they all had one. He’d just joined the club.” The incident has stayed with her, an indication of how bad the situation in her city had become.
So, how do you stop, or at least severely curtail, the violence? We know this: you don’t curb the violence by doing more of what you’ve been doing.
In 2005, Karyn McCluskey, principal analyst for Strathclyde police, wrote a report pointing out that traditional policing was not actually reducing violence. These reports always include a list of recommendations. “One was tongue-in-cheek,” recalls Will Linden, who worked for McCluskey as an analyst at the time. “‘Do something different.’ I don’t think it was meant to stay in there. But the chief constable said: ‘OK, go do something different.’”
McCluskey’s team, led by her and her colleague John Carnochan, started by pulling together evidence on the factors driving violence. “Particularly in Scotland, it was poverty, inequality, things like toxic masculinity, alcohol use – most of which were outside the bounds of policing,” says Linden. Next, they looked around the world to find and learn from pioneering programmes working to prevent violence. This was the foundation of the Violence Reduction Unit, of which Linden is now the acting director. It took elements of those programmes and focused on garnering support from a range of Scottish agencies – the health service, addiction support, job centres and others. Since the VRU was launched in 2005, the murder rate in Glasgow has dropped by 60%. The number of facial trauma patients passing through the city’s hospitals has halved, Goodall says, and is now around 500 a year.
The VRU’s strategy is described as a “public health” approach to preventing violence
Yesterday I listened to what may have been the best Sound of Ideas conversation yet. Mike McIntyre guide his guests on the topic: Tackling Youth Violence In Cleveland. I can well imagine Goodall and McCluskey nodding vigorously if they had tuned in.
The VRU’s public health approach suggests that:
[B]eyond the obvious health problems resulting from violence–the physical injuries and psychological trauma–the violent behaviour itself is an epidemic that spreads from person to person. One of the primary indicators that someone will carry out an act of violence is first being the victim of one. The idea that violence spreads between people, reproducing itself and shifting group norms, explains why one locality might see more stabbings or shootings than another area with many of the same social problems.
“Despite the fact that violence has always been present, the world does not have to accept it as an inevitable part of the human condition,” says the WHO guidance on violence prevention. It says: “Violence can be prevented and its impact reduced, in the same way that public health efforts have prevented and reduced pregnancy-related complications, workplace injuries, infectious diseases, and illness resulting from contaminated food and water in many parts of the world. The factors that contribute to violent responses–whether they are factors of attitude and behaviour or related to larger social, economic, political and cultural conditions–can be changed.”
But across much of the world, being tough on crime is a vote-winner, which makes this a hard sell. How did Glasgow do it? As they investigated what it actually means to treat violence as a health problem, the VRU looked first to Chicago.
Some 20 years before 66 people were shot and 12 killed in a single weekend, American epidemiologist Gary Slutkin returned to Chicago from Ethiopia and found his hometown in the grip of a skyrocketing homicide rate. In talking about the recent murderous weekend of violence, our president, with his always ready hyperbole, described the situation as an absolute and total disaster. Slutkin wouldn’t disagree, but his solutions were world’s apart from those of the president.
His ideas about tackling the problem began as a personal project: he gathered maps and data on gun violence in Chicago. The parallels with the maps of disease outbreaks he was accustomed to were unavoidable. “The epidemic curves are the same, the clustering,” he says. “In fact, one event leads to another, which is diagnostic of a contagious process. Flu causes more flu, colds cause more colds, and violence causes more violence.”
This was a radical departure from mainstream thinking about violence at the time, which primarily focused on enforcement. “The idea that’s wrong is that these people are ‘bad’ and we know what to do with them, which is punish them,” says Slutkin. “That’s fundamentally a misunderstanding of the human. Behaviour is formed by modelling and copying. When you’re [looking through] a health lens, you don’t blame. You try to understand, and you aim for solutions.”
He spent the next few years trying to gather funding for a pilot project that would use the same steps against violence as the WHO takes to control outbreaks of cholera, TB or HIV. It would have three main prongs: interrupt transmission, prevent future spread, and change group norms. In 2000, it launched in the West Garfield Park neighbourhood of Chicago. Within the first year, there was a 67% drop in homicides. More funding came, more neighbourhoods were piloted. Everywhere it launched, homicides dropped by at least 40%. The approach began to be replicated in other cities.
“When we were trying to control outbreaks of HIV, it was all about changing your thinking about risky sexual behaviour,” says Slutkin. “That’s much harder to change than violent behaviour. People don’t want to change sexual behaviour – but they don’t actually want to have violent behaviour.” Although there were many deeper structural factors contributing to Chicago’s violence – poverty, lack of jobs, exclusion, racism and segregation–Slutkin argued that lives could be saved by changing the behaviour of individuals and shifting group norms.
So what went wrong? How did gun violence kill 12 and wound 66 more? Do you have to ask? The money ran out. Or, more correctly, the money was shifted to programs that benefited big corporations like those that run private prisons. Shackle continues:
On a sunny evening in downtown Chicago, I watch Slutkin give a talk to an audience of young professionals. In Chicago, homicides reached a 20-year high in 2016, and the following year President Donald Trump threatened to “send in the feds”. Slutkin presents graphs showing that every time Cure Violence’s funding is cut in a certain area, shootings spike, and when it returns, they drop. (Critics argue that it is impossible to draw conclusions about causality, due to other factors at play.) “Despite massive amounts of data, it’s hard to get funding for this,” Slutkin tells the audience. “Mass imprisonment has no good data–but it’s funded. This is the only epidemic health problem not being tackled by the health department.”
Why would we expect empirical evidence to beat out profits?