Friday, May 2, 2008

Violence as a Public Health Issue

In Blocking the Transmission of Violence , Alex Kotlowitz ( takes an in-depth look at innovative efforts to curb violence by treating it not as an ethical issue but as an infectious disease:

CeaseFire’s founder, Gary Slutkin, is an epidemiologist and a physician who
for 10 years battled infectious diseases in Africa. He says that violence directly mimics infections like tuberculosis and AIDS, and so, he suggests, the treatment ought to mimic the regimen applied to these diseases: go after the most infected, and stop the infection at its source. “For violence, we’re trying to interrupt the next event, the next transmission, the next violent activity,” Slutkin told me recently. “And the violent activity predicts the next violent activity like H.I.V. predicts the next H.I.V. and TB predicts the next TB.” Slutkin wants to shift how we think about violence from a moral issue (good and bad people) to a public health one (healthful and unhealthful behavior). ...

In his book “The Bottom Billion,” Paul Collier argues that one of the characteristics of many developing countries that suffer from entrenched poverty is what he calls the conflict trap, the inability to escape a cycle of violence, usually in the guise of civil wars. Could the same be true in our inner cities, where the ubiquity of guns and gunplay pushes businesses and residents out and leaves behind those who can’t leave, the most impoverished?

Slutkin sees a direct parallel to the early history of seemingly incurable infectious diseases. “Chinatown, San Francisco in the 1880s,” Slutkin says. “Three ghosts: malaria, smallpox and leprosy. No one wanted to go there. Everybody blamed the people. Dirty. Bad habits. Something about their race. Not only is everybody afraid to go there, but the people there themselves are afraid at all times because people are dying a lot and nobody really knows what to do about it. And people come up with all kinds of other ideas that are not scientifically grounded — like putting people away, closing the place down, pushing the people out of town. Sound familiar?”

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