A still from the 2011 documentary "The Interrupters" (Kartemquin Films)

Violence is contagious: Stopping its transmission became the mission of the man who'd fought TB and cholera in Somalia

Gary Slutkin figured out that violence spread like infectious disease. Here's what he's doing to "interrupt" it


Alexa ClayKyra Maya Phillips
June 28, 2015 1:00AM (UTC)

A RELUCTANT HACKER, A LATE-BLOOMING MISFIT

Gary Slutkin, M.D., was never a misfit. A physician by training, a “very conventional training,” he added, Dr. Slutkin had devoted himself to designing behavior change and epidemic control programs. As a chief resident at the prestigious San Francisco General Hospital, Slutkin worked on a tuberculosis prevention program. After two years, new cases of TB infection in the surrounding area dropped by over 50 percent, and the rate of those completing TB therapy increased from 50 to 95 percent.

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Next stop was Somalia. When Slutkin told his mentor at San Francisco General Hospital where he was going, his mentor told him it was the biggest mistake he could ever make, that he was jeopardizing his career.

In Somalia, Slutkin worked for the country’s director of primary health care and assisted in preventing the spread of tuberculosis and a deadly cholera outbreak. He landed in the middle of a dire situation, with more than a million refugees occupying forty camps. Because his team had limited resources, they ended up recruiting and training refugees to become specialized health workers. Similar to Florence Nightingale’s introduction of the nursing profession, this approach introduced a new category of worker into health systems: the indigenous worker who already had the access and trust of the local population.

After three years in Somalia, Slutkin took a position at the World Health Organization, where he worked to fight the HIV/AIDS epidemic in Uganda. Overall, Slutkin spent nearly ten years in fifteen countries in Africa and Europe as a major leader in the battle against infectious disease.

His personal life and professional life suffered. After ten years on high alert, he was exhausted, physically and mentally, and feeling emotionally isolated. But he was gratified to see extraordinary breakthroughs.

He returned to the United States and soon found himself asking, “What next?” He started hearing about kids shooting each other. “I was reading these horrific stories of ten- and twelve-year-old kids killing each other in the streets, and I asked people what was being done about it.” It was a simple question, one that might be posed by any concerned citizen. But it was a question that Slutkin would spend the next fifteen years attempting to answer.

Slutkin was stunned and disappointed by the so-called solutions that existed for treating violence. “We knew that punishment wasn’t a main driver of behavior,” he told us.“This was a problem that was stuck.” Discouraged, Slutkin began to study patterns of violent outbreaks and made a startling observation: Violence spreads much like infectious disease. “What I saw in the maps of violence I studied was characteristic clustering— just like the maps that I had seen in other epidemics, such as cholera.” That was Slutkin’s “aha moment.” “I thought, what if we started treating violence as a contagion?”

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One of the biggest and most insidious plagues on our society is violence. Yet too often the discourse focuses on labeling the violent individuals as deviants or “evil.” What if, Slutkin wondered, we removed the labels and the judgment and began to treat violence objectively—like a disease that is transmitted and spread, much like the common cold? He joked, “You can’t even see bad under the microscope. There is no place in science for the concept of bad or the concept of enemy.”

His leap from A to B was slow. It took him about five years to reframe the problem of violence in his own mind. He lost himself in debate and discussions about the drivers of violence. He read all the latest reports and white papers. He became obsessed with the topic and with the ways he thought he could bring a “cure” to the world. This kind of obsessive knowledge of the system you’re trying to fix is essential for any hacker. You need to understand the rules in order to know how to break them or pioneer something different. Having one foot in the system you’re trying to change, and one foot outside to maintain perspective, allows you to maintain an insider/outsider mind-set and approach.

Slutkin’s background in health and his immersion in the field of violence prevention allowed him a unique vantage point to see through the bias of the system. For example, a lot of existing practice focused on punishment as a solution to violence, but based on his work in the health field, Slutkin knew punishment was never used as a tool for behavior change. A lot of those who advocated punishment reminded Slutkin of a historic period in epidemic history when people didn’t have an understanding of diseases and thought things like plague, leprosy, and smallpox were caused by bad people or “bad humors.” Slutkin told us how these misunderstandings often led people to blame, exclude, and punish the victim of disease, which caused additional suffering.

Seeing violence outside a moralistic lens required a radically different approach. But compounding systemic problems of poverty, racism, drugs, and other chronic issues impacting violent communities wasn’t efficient or actionable. Even choosing to work with political systems to regulate gun control could take decades and hadn’t seen much success to date, at least in the United States. So rather than wait for a magical silver-bullet solution, Slutkin realized he could help stop the spread of violence, in much the same way that he had stopped the spread of disease in Somalia.

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From there, Slutkin’s organization, Cure Violence, was framed around a simple hypothesis: The most critical thing is to disrupt the transmission of violence.

Slutkin then developed a community role for “violence interrupters”: outreach workers called in to delicate situations where violence could occur, much like the community outreach workers he employed in the refugee camps. So if people in a particular neighborhood hear about a potential retaliatory shooting or a conflict brewing between gangs, they can call in violence interrupters, who go into the neighborhood and attempt to prevent the violence from being transmitted.

For example, a mom in Chicago discovered that her teenage son was loading weapons with his friends in their house. She was frantic and didn’t know what to do because it was her son and his friends, and she wasn’t going to call the police on her kid. But she needed someone to do something. So she called Cure Violence, and they sent over a few interrupters to talk to the teenagers. Over the course of a few hours, they were able to calm the group of kids. The interrupters know how to buy time and allow people to cool down; most important, they listen. A lot of their method is about the art of persuasion.

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These interrupters are often from the communities where the violent outbreaks are occurring. Many of them have been in prison or had their own experiences with violence. As a result, communities trust and believe in them, which allows them to be much more effective than the police force.

One violence interrupter Slutkin told us about was working with a group preparing for a revenge killing when he got a call about another conflict building nearby. He asked the first set of guys to go over and help him with the other group. He solicited their advice in getting the second group to calm down. He got their minds totally fixed on helping the second group— and forgetting about their own problems. In employing them to help with the second group and listen to their problems, he also got them to disassociate from what they were dealing with and adopt a different perspective.

Another intervention by Cure Violence related to a teenager who was hiding out in the basement of his parents’ house in Chicago because a peer had told him that he would be killed if he went back to school. He hid in the basement for six months. His parents finally called a violence interrupter, who went into the school and called in a favor from the student who had issued the threat. Because the interrupters have community credibility, access, and trust, they can be powerful mechanisms of persuasion in these situations.

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The year Cure Violence was implemented, the West Garfield neighborhood of Chicago saw a 67 percent drop in shootings, while comparable areas saw a reduction of 20 percent. In fact, there were long stretches of time—as long as ninety days—without any shootings, which was previously unheard of. With the help of a senator from Illinois, Cure Violence was able to scale up to other neighborhoods. These communities showed a 42 percent drop in shootings in the first year, with comparable areas experiencing only a 15 percent reduction.

Fifteen years later, Slutkin is leading the charge to transform how we diagnose and treat violence. Cure Violence is scaling up across the United States, now operating in twenty-two cities. New York City recently announced that it plans to invest $12.7 million to roll out the program. And Slutkin’s methods are being used not just in the United States but also in places like Iraq, where Cure Violence has interrupted more than 500 incidents of violence to date.

Cure Violence has reduced killings by up to 56 percent and shootings by 44 percent in communities where it operates. The organization is also changing the norms around violence. In communities where Cure Violence has a presence, people are four times more likely to show little or no support for gun use.

Mainstreaming this misfit approach to violence wasn’t easy. “I never thought there would be pushback,” Slutkin told us. “We were never trying to cause a disruption or hack a system. I’m not coming from that background. All that I was doing from a health perspective was trying to design something that filled an obvious gap. In health, everyone wants a better treatment. But working with violence, what surprised me was that people found that this was disruptive and threatening. And that’s when I started feeling like more of a hacker.”

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Slutkin told us that Cure Violence faced pushback from federal agencies, academia, law enforcement, prison systems, and competitors working on violence reduction. Because Slutkin didn’t have a background in violence prevention, he was dismissed. “I wasn’t part of the club,” he told us. “So many of the initial proposals I put together were rejected.” If you are hacking a system from the outside, it’s often important to build allies within the system who can champion your cause. This is something Slutkin learned with time.

Another big issue with the solution was a moralistic mind-set. “The idea that those who commit violence aren’t bad really disrupts people’s ideas. So many actors are addicted to this good-guy-versus-bad-guy script. And a lot of the press is in the same realm.”

What has allowed Slutkin to be successful is focusing on continuously getting results. The science keeps getting better and better, he told us. It is becoming more recognized that violence is a contagious process. That is helping people realize that you “can’t arrest and imprison your way out of this prob lem,” Slutkin said.

Over time, Slutkin has been able to provide an alternative to how we go about treating violence. He hacked the system by challenging entrenched views on violence and its perpetuators; he then prototyped a solution for how to end violence. His network of violence interrupters are the “hack” that he wants the system to adopt.

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The success of hacks like Slutkin’s depend on experimentation—the capacity for improvisation—as well as the ability to infect the mainstream or package your “hack” so that it can be embedded into the rules and norms of the establishment.

Slutkin is trying to get his solution adopted by local governments, police forces, and community outreach networks. But Cure Violence doesn’t scale through strict replication. Rather, the organization builds partnerships with city groups and other organizations to transfer their methods. They apply more open-source principles for spreading their methods, and host training initiatives to share their learning.

In this way, Slutkin embodies the hacker mind-set, believing that Cure Violence’s methods should be open and available to all, with an invitation to make your own improvements. In hacking, nothing is ever the end product. With the conviction that a system can always be improved upon, hackers see their projects as living organisms that, without attention and constant work, will die. Cure Violence is perfectly aligned with this approach. “It’s a bit like an open-source network,” Slutkin told us. “The intervention is not complete—it needs to continue to evolve. We keep tweaking the model and making it more powerful and effective and create a network where learning can be shared.”

When we asked Slutkin what his strategy has been for hacking the system, he confessed that he isn’t an aggressive hacker. “I don’t like fighting,” he said. “I avoid naysayers and let the results of the program speak for itself. Over time, we’re finding that more people are able to speak for this movement.” For example, justice departments are now spreading the word. And Slutkin hopes that international organizations like the World Health Organization will begin talking more about violence as a contagion and seeing it as a health issue. “For this solution to really tip, we need the health sector to step up and explain it: to say that a lot of violent behaviors are acquired unconsciously; that they are addictive, just like smoking.”

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In the future, Slutkin imagines that every health department will have a robust violence reduction unit, that these units will work with select community organizations to dispatch networks of interrupters and that these networks will be coordinated with hospitals. So when you see patients in the emergency rooms, there will be regular dispatching to prevent retaliation and effectively treat those who have been wounded. “Not just treat their wounds,” Slutkin says, “but treat them psychologically, so when they leave the hospital, they aren’t at risk of spreading and transmitting violence on the streets.”

THE HACKER MENTALITY RUNS STRONGLY THROUGHOUT THE MISFIT ECONOMY:

A burning desire to take on the establishment. A commitment to the free sharing of information, which can enable collaborative innovation. An itch to fix or improve. An aspiration to gain a deep understanding of a system (and all its components) so it can be rebuilt or enhanced. These are all principles that can be applied to great effect in the formal economy, as we seek to improve the organizations, the systems, and the institutions that surround us.

From "THE MISFIT ECONOMY: LESSONS IN CREATIVITY FROM PIRATES, HACKERS, GANGSTERS AND OTHER INFORMAL ENTREPRENEURS" by Alexa Clay and Kyra Maya Phillips. Copyright © 2015 by Alexa Clay and Kyra Maya Phillips.  Published by Simon & Schuster, Inc. Reprinted by permission.

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Alexa Clay

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Books Cure Violence Gary Slutkin Science The Interrupters Violence

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