Beyond Thoughts and Prayers

By Dr. Rex Archer, Director of Health, Kansas City, Missouri Health Department

After the trauma of the events surrounding the Las Vegas mass shooting, stories of horror and heroism unfolded from that horrible act.  My compassion and prayers felt somewhat hollow.  I am in a position to move my compassion to actions that make a difference and to save many lives.  That is why I am in public health. Yet, the enormity of the challenge seems daunting.

I do not know what all the answers are for a situation like the Las Vegas massacre. What I do know is that on a typical day in America, 93 people are killed by gun violence, and although there have been 277 mass shootings in our country so far this year, most Americans who die of gun violence actually die of suicide, not at the hands of a mass murderer. We know that women are too often killed by their abusers, and that domestic violence increases the chance that a women is killed by a gun by five times. This is especially important to remember now, because October is Domestic Violence Awareness Month.

What I can tell you is that the health department I lead in Kansas City has viewed violence and trauma as a public health issue for a long time, and that treating the problem that way has created results.  Our Aim4Peace program works to prevent retaliatory acts of violence.  I hope the story of this program can help those who want to reduce gun violence by providing some of the puzzle pieces we need to come to a solution.

A decade ago, a commission made up of city officials decided to address violence as a contagious disease. In public health, we know a lot about stopping epidemics of many kinds, and we recognized this problem as having many of the same characteristics. We observed the cyclical nature of the gun violence in our city, where a young person would get killed or injured by a gun and one of their allies would often seek revenge. The cycle would repeat itself in perpetuity if nothing was done to interrupt it.

When we started to look at the problem through a public health lens, we found that the sections of the city with the highest violence rates were also those with some of the highest health disparities and inequities. We saw an association with preventable related issues, including family instability, poverty, domestic abuse, educational failure and substance abuse.

When we were designing the solution, we looked at the evidence and considered 50 different anti-violence programs worldwide. We focused on programs that had the potential to be replicable and that focused on cultivating interpersonal relationships.

Based on those criteria, Kansas City created Aim4Peace, which:

• Operates in the one-tenth of the city’s neighborhoods with the highest rates of killings and shootings.
• Looks at violence as a learned behavior, and sets out to rewire some of the learned behaviors by those who are most prone to retaliate after a violent act. It seeks to engage people in the community who are at the highest risk of spreading the “epidemic” by interrupting that process.   
• Sends “credible messengers,” respected individuals from the community, who can help to calm individuals after violence erupts and broker peace within high-risk neighborhoods.
• Uses a core group of 25 outreach workers and violence interrupters to be called upon to intervene. Aim4Peace workers also are embedded in the Truman Medical Center’s trauma team.
• Has a heavy focus on conflict resolution and mediation and does so via neighborhood outreach teams as well as the hospital prevention program.

Results:

• In addition to reducing homicides by 75 percent in the target zone, the citywide homicide rate fell 28 percent between 2010 and 2014.       
• Even though homicides have increased throughout the city in the last two years, homicides in the Aim4Peace target zone have continued to decline.
• The program has broad support in the community, and is funded in part by a voter-approved “Health Levy.” A 2013 Office of Juvenile Justice and Delinquency Prevention (OJJDP) grant is enabling the city to expand the program beyond the target area.

This success story does not provide all of the answers we need to tackle every kind of gun violence in America, but it shows us that when we apply all of the tools in our public health tool box to address violence and trauma, it is possible to make serious progress. 

Public health professionals are known for tackling other tough issues too. We know from other big health challenges that we can save lives if we stick to evidence-based approaches to help change behaviors for the better. We didn’t respond to high rates of lung cancer by just treating lung cancer more effectively.  We also went to the root cause of the problem: cigarettes.

With cigarettes, we raised the prices, reduced their advertising, determined how and where they could be sold, where people could light up, provided cessation options and incentives, health insurance disincentives, and used legal challenges to go toe-to-toe with the cigarette manufacturers and the lobbyists.  We applied the best minds, research, policy and evaluation to make a difference.  We still have a long way to go, but we made incredible progress. The smoking rate in America has been more than halved. 

The tragic events in Las Vegas were met with statements about “thoughts and prayers” in Washington – and little else. It is a shame that our national leaders have abdicated their responsibility to be part of the solution, but we don’t need to wait on the Capitol or the White House to lead the way. Many of the answers can be found in our own communities. I know that the stories I’ve shared are not the only ones that can help us reach for effective solutions to our gun violence epidemic in America. Congress may be in a deadlock on this issue, but I call on local leaders in states and cities all over America to share their stories of successfully fighting gun violence – and then to implement what we learn.