Public health is under siege, not just with vaccine retrenchment and the gutting of the CDC, NIH and God knows how many research programs, but now with the deployment of armed national guard troops in our nation’s capitol.
Last week I participated in a working group whose purpose it is to design proposals for state legislatures to support community violence intervention programs (CVI). Our small group includes second amendment advocates and gun violence prevention activists. We are part of a larger group convened by the Tufts University School of Medicine and Public Health to design legislative proposals for states to reduce the level of gun violence. We have considered safe storage, dealer regulation, gun trafficking, suicide prevention, background checks, extreme risk protection orders. It is a tall order, a lot of work, some of it quite tedious. The twenty or so participants – from both sides of the gun debate – have been surprised by how much common ground we have claimed. We have taken a public health approach to the issue of guns.
CVI initiatives are not new, but they certainly aren’t very well known. And they have been remarkably effective. Most gunshot victims are triaged in hospital emergency rooms. Some are treated and released, some are whisked to operating rooms and still others are sent to the morgue. Hospital based Violence Intervention Programs (HVIPs) respond to the trauma experienced by the victim, the family and close-in relationships. There is a medical component to the treatment, to be sure, but there is a public health dimension to the event as well, which involves counselors inside and outside the medical center. Upon discharge, a transfer is made from the hospital to the neighborhood ambassador, who is trained to deal with the emotional trauma experienced by the family and the neighborhood. We were told in our working group that in the 15% of hospitals nationwide that have HVIPs, the gun violence recidivism rate goes down from 16% to 4%.
Many communities have invested in offices of Community Violence Intervention. Trained neighborhood workers build relationships among mostly young and male residents who live and hang around in the neighborhoods with the highest crime rates. With enough time and enough staff, the data demonstrates that these interventions reduce gun violence by over 50%. Trust gets built up, quality relationships are strengthened, neighborhoods become more stable, and the impulse to commitment violence is addressed and mitigated. These interventions work.
They also cost money. But not as much as the cost of medical treatment and the cascading financial costs to lost income of the victim and family, and a whole host of other expenses. Our working group is putting together an economic picture of the cost of HVIPs and CVIs over against the cost of gun violence.
The slow, tedious and effective work of Community Violence Intervention took a big hit on Monday when President Trump announced he is sending 800 National Guard troops into Washington D.C. to thwart “bloodthirsty criminals” and “roving mobs of wild youth”. Disregarding the fact that crime in DC is at a 30-year low while stoking racial animus (the population of Washington DC is just under 50% Black), disgorging soldiers in uniforms with guns will ratchet up fear, undermine if not destroy the slow process of building relationships – and will likely bring on more violence the deployment is supposed to prevent. It is an unnecessary distraction and a very dangerous spectacle. Nervous guardsmen and anxious teenagers with guns may find it harder to keep their fingers off the trigger when they are scared. It has happened before.
A wise mentor, the late Rev. Ed Rodman, who led the first high school civil rights demonstration in 1960, often said that there is nothing more dangerous than ignorance fraught with technicalities. The order of national guard troops is a hideous display of ignorance – of what is happening on the streets of DC, of the non-existent street cred of the national guard troops, of the misguided assumption that raw displays of power can stabilize a community. The ignorance of deploying troops is being wrapped in the technicality that troops on the ground may curb violence – for a day or two. Then the resentment will rise, fear will escalate, and instead of people pointing fingers at each other, they will be aiming guns. It is a virtual assault on community violence intervention.
Relationship building takes time. It involves risk. It also reflects a commitment to non-violence. Maso Tse Tung once said – political power comes out of the barrel of a gun. Trump’s order does indeed demonstrate political power. At the same time it is an egregious threat to public health.
