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Physician and epidemiologist Gary Slutkin has worked in more than 20 countries, fighting infectious diseases like cholera, HIV/AIDS and tuberculosis. After a decade abroad, he returned to the United States in 1994 and found an acute problem here: gun violence. He began to study the issue and saw familiar patterns: "I just said, 'This is behaving exactly like an infectious disease.' This is the same kind of map, same kind of clustering. Someone has picked this up from someone else, and they pass it on to someone else, and pass it on to someone else."

Slutkin decided to approach gun violence the same way he curbed cholera and AIDS — by convincing people to change their behaviors. And that doesn't happen by threatening to punish them: "You're not going to punish people out of AIDS." Rather, he found that training community members to spread the message about safe behavior could get people to rethink risky behaviors.


He decided to try the same approach to curb violence in the U.S. In 2000, he started CeaseFire (later renamed 

), which trains and deploys outreach workers, or "violence interrupters," in high-risk communities. The program has also been used in Honduras, Iraq, Mexico and 

 and profiled in the acclaimed 2011 documentary, 

About 10 years ago, Slutkin met church leader Autry Phillips, who says his inner-city Chicago community was seeing upward of 50 shootings a year. The pair has worked closely together since then; we spoke to them about violence interruption.

If I'm a young man with a gun, and I've just seen my best friend shot down by a guy, what do you say to make me stop shooting that guy?

Phillips: The best thing we can do is remind you of the consequences of pulling that trigger. Think past right now, and it's two hours later. You've pulled the trigger. Someone else is dead, and now the police are looking for you.

So what I want you to do is think about mama right now; what would Mama have you to do? Would Dad be pleased with you right now? More importantly, how is this going to affect you two hours from now? I know you're mad, but let's take a walk right now, and let's get away from the situation.

What if the response is: "But I don't see much opportunity for me. All I want to do is kill this guy. I'm angry."

Phillips: I'm not going to stand here and tell you that there's a better day ahead. But right now, I need you to walk with me and continue to talk to me about how you're feeling. You're angry. We all are. But I'm happy to be here right now, you know why? Because I get to talk to you. I get to keep you alive one more day. Your mom, she won't have to be crying tomorrow. Your dad, he doesn't have to bury you. My mission is to make sure that you get home tonight.

Slutkin: That's the nuts and bolts of it. [Autry's] buying time, he's validating your concerns, he's listening to you, probably talking to your friends that might help you. It can be that brief of an interaction, but sometimes there is going to be a lot of swearing, and that's going to go on for hours or days. That person or that person's group might need to be — what the guys on the street call — "baby sat" for months.

Some people don't believe that gun violence is like a disease, that killing people involves perpetrators and victims.

Slutkin: Victims and perpetrators are all victims. Someone who has active tuberculosis passes it on to his son. Is there a perpetrator and a victim in that case? That guy, he got the TB years ago from his friend, so was it conscious or unconscious?

You have people now in Iraq who are 15 years old, and for them, there's always violence. Same thing in Afghanistan. And people who grow up seeing violence, they don't know that it has anything to do with enemies or war or gangs. Violence is just normal, just like for some people, going to school is normal. But it's only because that's what you were exposed to. It's not because it's the only way.

You've brought the idea of interrupting violence to other countries. Is it working?

Slutkin: What are gangs in some U.S. cities might be called cartels in Latin America or tribes or militias in southern Iraq. But the principles are the same. There's us and them, we're wired that way. It's only "us" that can cool "us" down.

Slutkin: You have people from within the same tribe or cartel who are cooling down their own, because the trust is there and they know they're not going to be betrayed. An interrupter knows how to buy time, cool people down.

And that really makes a difference, when someone from your group tells you not to be violent?

Slutkin: It's the most important force in behavior — what you think your friends expect of you. I learned this in HIV/AIDS research. The principle predictors of whether [individuals] used a condom or practiced other safe practices was what they thought their friends thought. It wasn't whether they knew a lot about the disease. It was related to what they thought their friends did or expected of them. But when you ask them [if that's a factor], they deny it.

So really, they just want approval from their peers to change their behavior.

Slutkin: It's deeper than that. Social disapproval is more dangerous in their mind than even death. They're hooked on social consequences. When you're not doing what your friends expect of you, one of the two pain centers in the brain lights up.

Are you seeing changes in levels of violence in other countries where Cure Violence is being implemented?

Slutkin: In Honduras, data from four communities shows a 50 to 70 percent drop in shootings and killings. There was a prominent leader at a community event who said, "I've always wanted my sons to have a different life than I've led. But I never knew how this could happen. But this [program] is the first thing that allows me to see that life can be different for them."

This interview has been edited for length and clarity, and comes from the podcast 

, which is hosted by Amy Costello and produced by Amy Ta and Stephanie Kuo, with additional material from an interview with Gary Slutkin by Marc Silver of NPR. Tiny Spark is made possible by a grant from the William and Flora Hewlett Foundation.

Crime, Law and Justice

Health

Amy Costello

Author

Epidemiologist Gary Slutkin has taken the lessons he's learned fighting TB and HIV/AIDS and applied them to stop the spread of gun violence. Because like those diseases, violence is contagious.

Doctor: You can stop gun violence the same way you stop AIDS or TB

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