The number of homicides in Baltimore exceeded 300 for the third year in a row. In Chicago, in October alone, 51 people were killed. In the United States, 84 people were killed in the last 35 days in mass shootings.

The death totals, reported by the Baltimore Sun and the Chicago Tribune, are part of what Charlie Ransford, spokesman for Cure Violence, calls an infectious disease.

“Violence is very much an epidemic,” Ransford said.

That’s the model that his organization uses to try to stop rising homicide rates: Treat people killing people like a virus attacking a person’s immune system, and look at ways to prevent violence in the community and in hospitals. For the members of Cure Violence, violence is as much a disease as the flu, and it’s contagious.

Somewhere in the 1990s, violence became an issue for the judicial system and less so for public health. But now that is changing.

“It transfers from individual to individual. It clusters in areas,” Ransford said.

The organization, founded by Dr. Gary Slutkin, an epidemiologist, looks to bring a public health approach to preventing violence.

When an assault happens, there’s a high likelihood that the victim will become revictimized or that the person or their friends will take retaliatory action, Ransford said. In hospitals, the organization works with treatment teams to keep the person and friends from committing further violent acts.

The organization also works on the ground, trying to identify what communities might be more susceptible to violence as well as the people most likely to catch it, according to the organization’s website.

Cure Violence’s Safe Streets are in at least four locations in Baltimore and one in Chicago, Ransford said. In Baltimore’s Cherry Hill neighborhood, one of the Safe Streets locations, there were reductions in homicides by 50 percent and non-fatal shootings by 34 percent between 2007 and 2010, according to a study by the Johns Hopkins University’s School of Public Health.

The idea of taking a public health approach to violence isn’t exactly new. The Centers for Disease Control Prevention established the Division of Violence Prevention within its National Center for Injury Prevention and Control in 1993, according to the CDC’s website.

But Ransford said that somewhere in the 1990s, violence became an issue for the judicial system and less so for public health. The shift toward looking at violence through a public health lens, instead of seeing it as purely judicial issue, is similar to how the opioid epidemic is now treated, he said.

Dr. Linda Dahlberg, who advises the director of the violence prevention division at the CDC, did not respond to multiple requests for comment in time of publication.

Damien Williams, a lecturer at St. Andrews in Scotland, said a preventative approach toward violence should involve both the public health sector and the judicial system. It could resemble how doctors treat bacterial or viral disease, as Cure Violence’s process does, but he would not call violence an illness.

After speaking with social psychologists, Williams said that violence superficially looks like it is spreading from person to person, but it lacks a defined contagion, something that would make the disease spread, like Slutkin proposes.

“By saying violence is not a disease does not mean that it is not something that public health or even the health sector and health policy should not be engaged with,” Williams said.

Williams suggests looking at a person’s history for vulnerabilities, such as an exposure to weapons or certain groups, and searching for the tipping point. There’s work to be done in the communities to make people feel like they are part of a group and in control of their own health. And when people come together in these groups, like the Black Lives Matter movement, there needs to be political will to start addressing structural issues like poverty or racism, he said.

“When you think about the prevalence of violence in communities, you can trace it back through various vulnerabilities that may reside in a different sector of society,” Williams said. Ransford and Williams both agreed that while communities are an important component, healthcare professionals have a place too. For Williams, they can help break the cycle of violence, but they are also an overburdened safety net.

“However, the very fact that people are going through the emergency room doors or going into the clinic, it demonstrates that something somewhere already failed,” he said.

Photo credit: Shane T. McCoy / US Marshals / Flickr (CC BY 2.0)

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