Firearms

Cure Violence: Approaching Violence as a Public Health Issue

The public health approach to gun violence is frequently – indeed, I might say, always – criticized by gun rights advocates. Indeed, the famous or infamous ban on federal funding for research on firearms injury promoted by the National Rifle Association explicitly targets the public health approach. Into that void has stepped anti-gun former NYC Mayor Michael Bloomberg, who has used his personal fortune to fund extensively the Johns Hopkins University Bloomberg School of Public Health, and in particular the Center for Gun Policy and Research. (Bloomberg wrote the foreword to the 2013 book, Reducing Gun Violence in America, that was edited by two scholars associated with this center.)

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The players involved suggest how contentious the public health approach is. Even as a neutral party in this war, I have found occasion to criticize some of the conclusions drawn by public health researchers.  At the same time, I am trained as a mainstream social scientist, so I do not dismiss out of hand public health, epidemiological, and similar approaches to the social world.

For these reasons, I was interested to hear what public health researcher Charlie Ransford was going to say about the “Cure Violence” approach to guns and violence at the annual meeting of the American Society of Criminology in November 2013.

“Effectively Implementing the Cure Violence Model for the Prevention of Community Violence,” by Charles Ransford, Candice Kane, and Gary Slutkin (all of the University of Illinois at Chicago)

According to Ransford, violence is transmitted like a disease, from person to person. Abused become abusers. Exposure to community violence makes people more likely to be violent.

The mechanisms for this transmission include social learning (modeling, mirror neurons), social norms (scripts), neurological effects (desensitization, hyper-aroused stress), and other modulating factors (“dose,” prior immunity, context, age).

Given these mechanisms, how does one go about stopping the violence? Ransford highlights three key steps: (1) interrupt transmission, (2) identify and change the thinking of the transmitters, and (3) change group norms.

I came away from the session quite impressed by this approach. Most notably, although the organization is certainly concerned with gun violence, the accent was always on the violence not the gun. To me this is a potential common ground. Very few in our society, after all, are pro-violence.

I was unfamiliar with Cure Violence prior to this session, but since then I have learned more about the organization from the documentary film, “The Interrupters,” as well as the group’s website (http://cureviolence.org).

On its website, Cure Violence presents its “model” like Ransford did at the ASC meeting: without explicit reference to guns. The problem is violence, and the fact that some people enact that violence with guns is in a sense incidental.

One of the most chilling moments in the documentary shows video Derrion Albert, a 16-year-old honors student, who was killed by being stomped and hit over the head with a wooden plank. This does not get coded as an instance of “blunt object violence.” In England, where a leading instrument of homicide is knives, they don’t lament their problem of “knife violence.”

The weapon is a vehicle; the root of the problem is violence. The fact that many who approach the issue of violence from a public health perspective do in fact target guns specifically (rather than violence generally) perhaps makes this paper the exception that proves the rule. But if those researchers did want to speak to those in the gun culture who feel they are being punished for the crimes of others, they would do well to emphasize their concern with violence over their concern with guns.

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21 thoughts on “Cure Violence: Approaching Violence as a Public Health Issue

  1. If they are going to approach it as a public health issue then they damn well need to take into account the thousands (probably hundreds of thousands) of lives saved by law abiding citizens with guns, and most often without ever firing a shot.

    Journal of Criminal Law and Criminology (Northwestern)
Guns and Violence Symposium,
vol. 86, no. 1, 1995: 150.

    ARMED RESISTANCE TO CRIME: THE PREVALENCE AND NATURE OF SELF-DEFENSE WITH A GUN
    Gary Kleck and Marc Gertz
    http://www.saf.org/lawreviews/kleckandgertz1.htm

    lwk

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  2. Fair point. Although Kleck and Gertz don’t tell us how many lives are saved in defensive gun uses, the right to self-defense and the ability to enact it are definitely an important issue to consider when looking at gun use.

    That public health researchers focus so much on GUN violence rather than VIOLENCE is my main point, but their seeming neglect of any positive role that guns could play is definitely part of the entire equation.

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    • “…Kleck and Gertz don’t tell us how many lives are saved in defensive gun uses…”

      I recollect that in the 1990s when they did the study they claimed 2.5 million defensive uses and 400,000 lives saved. Of course those numbers are only as accurate as the survey itself. From what I’ve read they did their best to get accurate results. The study should probably be repeated periodically with input on how to improve it.

      “That public health researchers focus so much on GUN violence rather than VIOLENCE is my main point…”

      Which pretty much tells you what they want to accomplish. They want to blame violence on guns and they little or not interest in the positive use of firearms (because they no doubt believe those are small and irrelevant – they don’t believe Kleck’s study). We need to keep plugging away at it, and when they ask Congress for money for these studies, there has to be inserted a demand that this aspect be an important part of any study.

      regards,

      lwk

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  3. The problem with the medical community approaching the gun violence problem as a public health issue is well covered in Don Kates (and several Doctors) 1994 Tennessee Law Review article –

    http://www.guncite.com/journals/tennmed.html

    This exhaustive work can be summarized with just one quote from it –

    “To use Florian Znaniecki’s frame of reference, the anti-gun health advocacy literature is a “sagecraft” literature in which partisan academic “sages” prostitute scholarship, systematically inventing, misinterpreting, selecting, or otherwise manipulating data to validate preordained political conclusions”

    And it has not gotten any better since 1994.

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    • Scott – THANKS for the comment. There is no doubt that preexisting political commitment shapes the approach of many/most public health researchers toward guns violence. Which is too bad because there are approaches to “curing” violence which are based on public health and other approaches that do not target guns in general. I just finished reading criminologist David Kennedy’s book “Don’t Shoot.” He has spent his whole career curing community violence and never talks about gun control. In fact, the Chicago program I mention is a variant of Kennedy’s approach.

      I would also add — and am interested in your thoughts on — my sense that the same “sagecraft” is true of pro-gun researchers: that their preexisting political commitment shapes their approach to the data. I wrote about this some earlier: https://gunculture2point0.wordpress.com/2013/04/04/pro-gun-culture-anti-gun-culture-and-the-impossibility-of-evidence-based-adjudication/

      Basically, data on guns is like a Rorschach test: people see what they want to see. What do you think?

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      • David. First I should have made clear that I wasn’t passing judgement on the group(s) you have been referring to. They may very well be fair looks at the issue.

        I wanted to point out though that the criticism of the medical communities gun-control advocacy is well supported.

        To your question. I’ve been reading, and writing, about the 2A for 41 years. As a junior in HS I won the district championship in oratory (8 minute prepared persuasive speech) with a topic of – you guessed it – gun control and the 2A. Going to back to school in mid-life to finish my BS in Acctg I wrote a term paper on it and 2 other works for different classes. I may not be an expert but I am definitly well read and haven’t met anybody in forums such as these that I can’t hold my own with. For the 2A at least. Despite my acctg background I’m not that intersted in the statistics ala Kleck etc. Besides being boring, that is a ‘utilitarian’ argument which is a little relevance to the main 2A question.

        Particularly, beggining with the Clinton efforts to ban so-called “assault weapons” I really got into it and found incredible amounts of scholarship on the subject. My 2A bookshelf now is about 3 feet of hard and softbound books, plus reams of electronic copies of other law review articles and other publications. I own Kleck, Cramer, even Bogus (but I wouldn’t contribute to the fraudulent gains of Bellesiles). Frankly, at least up to Heller in 2008 I there is not a significant 2A work that I have not read. I paid $175 for a 3 vol hard-bound set from the Rutgers Law School in about 1991 that included up to that point the leading works, both pro and con, on the subject. So, I think my opinion is pretty informed.

        Now, you can certainly find in letters to the editor, and blog comments, and sometimes a larger work, where pro-gun supporters have a poor grasp of history, terms, and arguments but in general the writings of pro-2A supporters in the law reviews and books are fairy fair and quite frequently make it embarrasing (almost hard to read) the opposing view.

        Of course, many, maybe most of the pro-2A writers in the last 30 years, like Kopel and Cramer are ‘partisan’. And they are certainly going to argue from their viewpoint. But I haven’t encountered one that I thought made a dishonest appeal. I can’t say that of the other side.

        In fact the Heller decsion is an excellent example. The majority opinion is logical and well substantiated (though as below I’m not happy with) where as Steven’s dissent is a rambling work full of conjecture and wishfull thinking. That is my opinion. But frankly, how anyone can honeslty argue the militia centric theory (or theories since there are variants) is hard for me to respect as they require a horrible twisting of language and history. And since Levinson, Van Alstyne, and Tribe (frankly there aren’t 3 higher “liberal” law professors) all have opined that it is an individual right, even ignoring Heller, an argument otherwise is almost laughable.

        Now, back to the majority. Frankly, I think Scalia had to make the central thrust of the 2A personal defense in order to get the decision on the side of the people (and that is a sad thought).

        Because the true answer is that the Fed gov’t has no “power” to regulate arms or arms bearing and that the 1934 NFA and 1968 GCA are un-Constitutional on their face. The purpose of the 2A was to state the preference for the miliia over a standing army, an argument the anti-federalists lost in 1787 and to expressly codify the prohibition on disarming the people. Remember, the stock Federalist answer to the anti-Federalists complaints, about almost everything, was that the Fed gov’t didn’t have the ‘power’ to do that (whatever it was the anti-Federalists were worried about).

        You might not know, but Hugo Black, who participated in the Miller decision made remarks in a address to a law school audience that Miller, as decided, stood for the proposition that the 2A only protected arms suitible for use by the militia, but as so construed the prohibition is ‘absolute’. That means that all typical firearms used by the military, which would typically have been supplied by militia themselves when called for service are protected. That means in today’s terms that the semi-auto sidearm, with 15 rd capcity, and the FULL-AUTO M-16, with 30 rd capacity would be protected.

        But then, the contrary argument would be that “in common use at the time” means in common use by the civilian/milita and not the militia/military. At the time of the founding there was no difference in arms (and individual militia weren’t expected to appear pulling their cannons or howitzers) but in modern times since FA weapons aren’t in “common use”, even in the 1930s (except mostly by gangsters) one could argue that FA weapons, even though the standard US Army weapon aren’t protected.

        But certainly, the semi-auto AR-15 with its standard capacity magazine of 30 rounds and the handgun with more than 7, or 10, rounds (as some states are trying to restrict them to) is protected.
        And protected ‘absolutely’, and of course also from state infringment.

        Don’t know if i answered you question, but thanks for giving me a forum to sound off in. I’ll go read your previous post to see if you reference a pro-gun work that is as dishonest as say, Henigans’ are.

        Cheers, look forward to your reply.

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      • Just read your post. Interesting, and I think you are somewhat correct in that for some pro-gun writers, but usually at very low levels, the facts don’t matter, and indeed will ignore evidence to the contrary (if there is any).

        I will state quite openly, and others too have made this point, that whether or not guns are a net benefit or a harzard is really not the point.

        In America it is about individual freedom, rights, and responsibilities (at least it used to be).

        If my wife’s gun protects her from being raped (which she and I think did once) it doesn’t really matter how many young black men in Chicago kill each other every month (hint, that is about 2 Sandy Hooks ea month) because their misbehaviour doesn’t give the state license to restrict my freedom.

        Even if i NEVER feel that I once ‘needed’ the firearm it still doesn’t matter. The US concept of freedom is not based on utilitarian balancing.

        There may be areas, such as cars for example, where greater regulation can be imposed, but to restrict core rights takes an over-whelming public interest, and in regards to guns I don’t think an over-whelming public interest argument can be made (except as to punishment after the fact).

        So for me too, at least as regards the crime statistics the facts don’t matter at all.

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      • Scott – Thanks for this further input. On your first comment I don’t disagree, though I would just say that the comment refers to legal argumentation as opposed to empirical research. I am NOT a legal scholar, but I understand that a new approach to 2A jurisprudence has arisen in the past few decades owing to the work of people like Kopel. I really like Adam WInkler’s book “Gunfight” on this topic.

        Your second comment, I think, really gets to the heart of the matter. I respect the honesty of saying: the data don’t matter. You don’t even need to compare self-defense to criminal gun violence in Chicago. You could come up with any fact or factoid about guns and come to the same conclusion.

        My interest is in when pro-gun people cherry pick data that supports a pro-gun argument. Like anyone who says John Lott published “More Guns, Less Crime,” so the empirical debate is settled. Lott’s work is significant, but it is also part of an ongoing and unsettled debate about the relationship between guns and crime. One that, honestly, given the complexity of the world and the fact that human beings have free will, will probably never be settled once and for all. So, to pretend as if it has, is not right.

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      • I’m not sure I satisfied you with my answer(s).

        So let me turn it around and ask you.

        Why do the statistics, on crime, matter?

        Or in other words, if one could prove that say, more guns does equal more crime, and that therefor fewer guns would mean less crime, and further that if one could prove that some or all of these “common sense” gun laws that supposedly everyone wants would actually reduce the rates of violence and crime would that justify –

        limiting the magazine capacity of sem-auto pistols to 7 rounds as in NY, or 10 rounds now as in CO and CT.

        or, “universal background checks” (that is every gun sale has to go thru a licensed dealer to get the FBI check on the purchaser),

        or, requiring the registration of or the banning of possession of so-called assault rifles.

        Lets use me as an example. If I lived in CT or CO now I would be criminal. I wasn’t one before those laws were passed but because I won’t comply with them now I would be. All because I committed a “victim-less” crime of owning a magizine above the arbritray limit (or possession of the evil “assault-rifle”).

        Or, as to “universal” background checks, I’ve “given” a rifle to my brother-in-law as a gift, and “loaned” him one for an extended period, without benefit of an FBI background check, so under the recently proposed universal background check law I would have been a criminal.

        So, if the crime statistics did indeed support that side of the argument would that justifly turning me, and millions more previously law-abiding gun-owners into criminals overnight?

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      • Scott – I do think I understand where you are coming from (I hope). You are making a legal/constitutional argument about the RKBA. Your point is that you have this right and that statistics about guns, gun violence, crime, and the causal relationships (if any) between these things do not supersede those rights. I understand that position 100%

        I believe the other side is doing something very similar: proposing all sorts of additional gun regulations that have not been shown anywhere to reduce gun violence or crime. I wrote about this and as a social scientist am particularly critical of it in those posts (I think).

        I don’t want to suggest that what you are doing and what the other side is doing are equivalent, but they are similar in that neither side really cares in the end what the statistics actually say.

        So, to the question you posed: Why do the statistics on crime matter? Well, in the first instance, for me at least, knowledge is good. Knowing about and trying to understand how the world works is a good in itself. And if that knowledge can help us make the world a better place, so much the better. Crime is not good. Understanding more about what makes crime more or less likely, what makes victimization more or less likely, these are important things to know, therefore.

        Does knowing answers to these empirical questions lead mechanically to public policy? Absolutely not! But ideally they might help inform public policy. Perhaps I am just being naive, though.

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      • David, thanks for the clarification.

        I think I understand you question a little better now, but –

        There is a difference in the 2 “sides”. For my side, for me a least, the facts don’t matter because whatever they are they wouldn’t trump my freedom and rights (more on that in a minute),

        But the other side, for a great many anyway, the facts don’t matter because at all costs they must get my gun away from me (or at the very least burden me with all sorts of “common sense regulations” that they foolishly believe will actually affect the criminal or accomplish the goals of safety etc).

        And of that group there are subsets,

        One subset honestly believes that fewer guns will mean less crime and so they want to believe and use the “statistics” to accomplish that goal. Trouble is they will let their honest desire cloud their judgement as to what statistics to believe and propogate. Probably the majority of my opponents fall into this group (along a sliding scale of desires and beliefs about the issue).

        The other group just wants to disarm the people and they will knowingly and with mal-intent push the statistics to further their push to do just that. These people want power, and/or, can’t stand to see common people as self-reliant (thats a fairly simple appraisal of course, I’m sure their psychology runs the gamut).

        Back to my “side”.

        Now there are some, and in the past I have been one, that tried to make the statistical argument to prevent the further erosion of gun-rights. The problem with that is there are a LOT on the other side that don’t care. They may claim it is just a utilitarian response to the problem but at root they really only bring out statistics (good ones or not) to make the argument for more gun control. And with them there will never be enough gun control. And, as Ayn Rand pointed out, in any compromise with evil, evil wins.

        So I began to realize there was no point in making that argument. And, of course, I came to realize that I didn’t need to make that argument anyway. Morally I have the better argument. Whether the rights to freedom, life (the defense of it anyway), and property come from G_d or are a natural right of mine (for those of the less religious persuasion) is a small matter. As a human being i have the right to defend my life, and, at very least, “arms” of the kind in “common use” are my birthright. Not only as a US Citizen but as a human being.

        Now, for those on my side who try to use the statistics to protect their freedom, even if they were to knowingly make a dishonest case they would still be defending their freedom.

        You can’t say that about the other side.

        So making ill-informed, or even dishonest appeals to statistics is not the same depending upon which side you are on.

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      • Scott – I think the points you make are very well stated. Thanks for taking the time to write them down. I hope others benefit from them as well.

        I am particularly taken with arguments that begin from the standpoint of a right to self-defense, upon which I think/believe/hope there is broad agreement.

        One point that I continued to wonder about, though, is your claim that “for those on my side who try to use the statistics to protect their freedom, even if they were to knowingly make a dishonest case they would still be defending their freedom.” I don’t know if it is ethically sustainable to purposely lie in order to achieve some higher good. I will have to talk to my philosopher/ethicist friends about this.

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      • David,

        Please note that I said “even, if . . .”, I’m not saying I advocate a dishonest use of statistics in the defense of freedom.

        I’m pointing out that even a dishonest used of statistics in the defense of freedom is far preferable to the dishonest use of statistics to deny freedom to your opponent.

        As Ayn Rand also said – “judge me not by my actions but by the motivations of my actions”.

        But this is really kind of silly.

        The “statistics” that we are talking about at best are neutral to the primary quesiton of whether or not further restrictions on guns would be a net benefit and at worst (for the other side) demonstrate quite clearly that more guns DON’T equal more crime – indeed it is now arguable that Lott’s thesis of more guns = less crime is plausible. Maybe the question will never be “settled” as an absolute (which is not even possible anyway) but what is certain is that those who would disarm the law-abiding will never quit trying to.

        So, more knowledge will be great. Maybe it will inform public policy to continue to restore the freedom to keep and bear arms to the average person.

        On that please note that a Washington DC man was just convicted of violating the DC laws because he had 1 spent shotgun shell in DC (all of his legal firearms were kept out of DC) – but David Gregory was given a pass to publicly break the DC firearms laws by flaunting a “high-capacity” magazine on national television. I think that both were felonies. But who got prosecuted and who didn’t? hmmmm? And which one was making a dishonest appeal?

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      • Well-said, and I think our positions are not far apart. In my experience, both sides invoke statistics which support their cause, and in the end, neither much cares what the statistics actually say. (And the statistics are not likely to say anything definitively one way or the other.) As you say, those who would disarm the law-abiding will never quit trying to, and those who would defend the RKBA will never quit either.

        I am not saying these are morally equivalent positions, but they do orient themselves to data in the same way.

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  4. I haven’t been impressed with the NRA successfully blocking the funding of research of research, as I assumed that the research was unbiased and was opposed because it did not support NRA goals. In spite of Mark Rosenberg’s embarrassing quote “We need to revolutionize the way we look at guns, like we did with cigarettes. Now it [sic] is dirty, deadly and banned”, I’m still not sure I’m entirely wrong.

    However, as pointed out here, the public health/contagion approach doesn’t make any allowance for positive aspects of gun ownership. Bloomberg columnist Paul M. Barrett recently made a similar point (http://www.businessweek.com/articles/2014-03-17/nra-opposition-may-scuttle-obamas-surgeon-general-choice#p1). The CDC itself defines the public health approach to violence (http://www.cdc.gov/violenceprevention/overview/publichealthapproach.html) as consisting of four steps: Define and Monitor the Problem, Identify Risk and Protective Factors, Develop and Test Prevention Strategies, and Assure Widespread Adoption. There is no possibility of balancing rights and benefits, only finding the most effective mitigation strategies and assuring their adoption. None of this is surprising, given that the public health approach was developed to stop the spread of pathogens.

    But the Bloomberg school, and perhaps others, seem to have crossed over from unbiased research to political advocacy. In that sense, in spite of an appeal to an “evidence-based approach” they use data the way the proverbial drunkard uses a lamppost: for support rather than illumination. Moreover, the public health approach does not rely simply on providing information. As Wikipedia notes “Research has found that behavior is more effectively changed by taking evolutionary motivations into consideration instead of only presenting information about health effects. Thus, the increased use of soap and handwashing to prevent diarrhea is much more effectively promoted if it’s lack of use is associated with the emotion of disgust.” (https://en.wikipedia.org/wiki/Public_health referenced 3/20/14) This seems disturbingly paternalistic and manipulative.

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    • JohnSmith223 – THANKS very much for taking the time to comment. I’m glad to learn about your own blog as well.

      It is absolutely true that many public health researchers do not allow for any positive aspects of gun ownership. To me that is part and parcel of their erroneous emphasis on GUN violence rather than focusing on gun VIOLENCE or, better yet, just VIOLENCE.

      Are guns per se a “risk factor” for violence? I don’t think so, though I am interested in looking more at research that investigates how people’s emotional states are affected by guns. For now, I have to conclude that criminal activity and intent, personal and group “beefs” and squabbles, perceived lack of opportunity and a culture of violence — these are risk factors for violence. I learned alot about this from criminologist David Kennedy’s book “Don’t Shoot.”

      Kennedy’s work also speaks to the issue of “disgust” you raise, in a way. In his approach to ending community violence (best known for the “Boston Miracle”), there needs to be a moral component in motivating violent people to stop being violent. They can’t just be threatened with punitive sanctions, but must also be — and CAN BE — motivated by moral claims like “what you are doing is wrong” and “you are hurting our community by doing this.” Basically, you should be ashamed of yourself!

      Is this motivation a form of manipulation? This may be a distinction without a meaningful difference for activities that have strong negative externalities — like violence and the spread of viruses/bacteria that cause diarrhea.

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