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From Chicago to Glasgow, treating violence like an infectious disease has had impressive results. Working as a maxillofacial surgeon in Glasgow in the early s, Christine Goodall treated hundreds, if not thousands, of patients with injuries to the neck, face, head and jaw.

Once, a young man came into the hospital in the middle of the night with a knife wound across his face. Goodall dreaded telling him that it would be impossible to reduce the appearance of the scar.

But his reaction surprised her. The incident has stayed with her as an indication of how bad the situation in her city had become. You might also like: In , the United Nations published a report declaring Scotland the most violent country in the developed world. More than 1, people a year required treatment for facial trauma alone. View image of A woman shows the knife she carries with her in Glasgow in Humans engage in a wide array of risky behaviours that can lead to serious health problems: It has long been the accepted wisdom that doctors should encourage patients to change their behaviour — give up smoking, go on a diet, use a condom — rather than wait to treat the emphysema, obesity-related heart attacks, or HIV that could result.

But when it comes to violence, the discussion is often underpinned by an assumption that this is an innate and immutable behaviour and that people engaging in it are beyond redemption.

More often than not, solutions have been sought in the criminal justice system, such as through tougher sentencing. Enforcement alone, however, often does not work. In , Karyn McCluskey, principal analyst for Strathclyde Police, wrote a report pointing out that traditional policing was not actually reducing violent crime.

Next, the team looked around the world to find and learn from pioneering programmes working to prevent violence. This refers to a whole school of thought that suggests that 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 their first being the victim of one. One of the primary indicators that someone will carry out an act of violence is being a victim of one beforehand.

The idea that violence spreads between people, reproducing itself and shifting group norms, explains why one area might see fewer stabbings or shootings than another — even if it has many of the same social problems.

View image of Photos and shoes of gun violence victims are exhibited. 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. In the s and early s, US epidemiologist Gary Slutkin was in Somalia, one of six doctors working across 40 refugee camps containing a million people. His focus was on containing the spread of tuberculosis TB and cholera.

Containing infectious diseases relies heavily on data. First, public health officials map out exactly where the most transmissions of the disease are occurring. Then they can focus on containing the spread in these areas. For instance, diarrhoeal disease is often in large part caused by poor sanitation and water supplies.

It takes a long time to improve plumbing systems. But in the meantime, thousands of lives can be saved by giving people oral rehydration solutions. View image of Quicker fixes — like oral rehydration salts — can save lives.

Slutkin followed these steps to contain outbreaks in the Somali refugee camps, and again later, when he worked for the WHO on Aids prevention. Whatever the exact nature of the infectious disease in question, the steps to contain it were roughly the same. Changing behavioural norms is far more effective than simply giving people information.

After more than a decade working overseas, Slutkin returned to his native Chicago in the late s. But he returned to a different kind of problem: Flu causes more flu, colds cause more colds, and violence causes more violence — Gary Slutkin. Wanting to tackle this, too, he gathered maps and data on gun violence in Chicago.

As he did so, the parallels with the maps of disease outbreaks he was accustomed to were unavoidable. 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. Behaviour is formed by modelling and copying. Chicago is deeply racially segregated. Most of these areas are severely socioeconomically deprived and have suffered years of state neglect. Homicide rates can be up to 10 times higher than in more affluent, predominantly white areas. But Slutkin emphasises that this clustering is less to do with race and more to do with patterns of behaviour — usually among a small section of the population, usually young and male — that are transmitted between people.

He argued that lives could be saved by changing the behaviour of individuals and shifting group norms. In , he launched a pilot project in the West Garfield neighbourhood of Chicago. More neighbourhoods were piloted. The approach began to be replicated in other cities. Versions of the programme run in New York, Baltimore and Los Angeles and other countries around the world.

A study at Northwestern University found that crime went down in all neighbourhoods examined where the programme was active. In , researchers at Johns Hopkins School of Public Health looked at four parts of Baltimore that were running the programme, and found that shootings and homicides fell in all four. The results are frequently striking. In San Pedro Sula, Honduras, the first five Cure Violence zones saw a drop from 98 shootings during January-May to just 12 in the same period in Demetrius Cole is 43, a gentle, softly-spoken man who spent 12 years in prison.

He grew up in an area of Chicago afflicted by violence and, at the age of 15, saw his best friend die in a shooting. Nonetheless, he had a stable home life and stayed out of gangs. He planned to join the Marines. When he was 19, a close friend bought a new car. In those few minutes, his life changed entirely. While his friend was left paralysed, unable to work again, Cole was sent to prison for his response.

He finds people in the same situation he was once in, and tries to persuade them to pause. Violence interrupters use numerous techniques, some borrowed from cognitive behavioural therapy: Many, like Cole, have served long prison sentences and can speak from experience. Most also have a close relationship with the local community. View image of A fight breaks out outside of a Chicago high school in Although it must always be adapted for each location, Cure Violence follows roughly the same steps when establishing itself in a new place.

First, map the violence to see where it clusters. Next, hire credible workers with a local connection. These interrupters patrol the streets on their beat, getting to know shopkeepers, neighbours — and building links with the young men and women deemed to be the highest risk. The centre employs 11 interrupters, who typically spend at least six of the eight hours in a shift out in their neighbourhoods, as well as four outreach workers, who interact with participants on a more long-term basis.

Over a period of six months to two years, outreach workers try to change attitudes to violence. They also connect people with job opportunities, counselling or education. While Slutkin emphasises how quickly this model can reduce homicides, and how it costs less than mass incarceration, there is no escaping the fact that it takes a lot of workers to get results. A violence interrupter respected in one area may be unknown, or even mistrusted, in another.

To work, there must be at least one interrupter with strong connections in each district, like Cole. This meant ramping up traditional penal measures — increased stop-and-search and stricter sentencing for knife possession — alongside preventive measures in line with the public health approach. Will Linden, the acting director of the VRU, argues that this was politically necessary. The VRU is run by the police force with support from the Scottish government.

But alongside police, a whole range of public officials — from doctors to social workers — are involved. In Glasgow, meanwhile, surgeon Christine Goodall decided she had to do something. In , with two other surgeons, she founded a charity called Medics Against Violence. The charity, which became a partner of the VRU, goes into schools to educate children about knife crime and to get them to think practically about how to respond if, for instance, a friend told them they had a knife.

View image of Knife attack survivor Samar Haroun shows the scars that remain on the back of her neck. After an initial conversation, the navigator follows up by helping the person get drug or alcohol treatment, job opportunities or therapy. They try to move quickly. To see a serious effect, this work needs massive levels of collaboration — and longer than a four- or five-year election cycle.

Linden notes that Scotland has an unusual level of political consensus, with successive governments funding this work. Despite the ever-growing bank of evidence, governments are sometimes reluctant to properly invest. He draws a parallel to Aids and the stigma attached to those who contracted it during the first outbreaks in the s.

On a sunny evening in downtown Chicago, I watch Slutkin speak to an audience of young professionals. When it returns, they drop. Critics argue that it is impossible to draw conclusions about causality due to other factors at play. This is the only epidemic health problem not being tackled by the health department. Thirteen years after it was established, the VRU has retained its flexibility and openness to new ideas.

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