1. Gary Slutkin, MD Founder and CEO, Cure Violence Formerly World Health Organization @Gslutkin / @CureViolence A New Lens and New Models for the Nation

2. Gary Slutkin, MD Founder and CEO, Cure Violence Formerly World Health Organization @Gslutkin / @CureViolence A New Lens and New Models for the Nation

3. Summary 1. Wrong course

4. Summary 1. Wrong course 2. Problems can be stuck

5. Summary 1. Wrong course 2. Problems can be stuck - wrong diagnosis

6. Summary 1. Wrong course 2. Problems can be stuck - wrong diagnosis 3. Re-understand our problems 4. Create new models

7. Summary 1. Wrong course 2. Problems can be stuck - wrong diagnosis 3. Re-understand our problems 4. Create new models 5. Change – can be immediate, sustained 6. Movement(s) required too

8. Reconsider what we “know”... what we do

10. 10

14. dysfunctional communities poverty poor schools family disorders absent fathers broken homes and more The everything theory

15. SCIENCE

16. APPROACH SCIENTIFIC

17. Violence

18. 19502000 EPIDEMIC WAVES (S) of VIOLENCE (Killings in the U.S. )

21. New theory

22. Contagious

23. VIOLENCE Epidemic waves Clustering Transmission AS CONTAGIOUS Disease

24. Contagious (Dorland’s medical dictionary, 2011) “capable of being transmitted”

26. New theory

27. Explains things

28. Contagion theory explains Ups and downs Perpetuation of child abuse Violence increases after war ends Suicide clusters Copycat murders, mass shootings Extremist recruitment

29. How is violence transmitted?

31. From Jeannerod M in Gallagher S. Brainstorming 2008 BRIAN CIRCUITS FOR COPYING

32. VIOLENCE Observing Witnessing TRANSMISSION Exposure

33. Transmission Acquired Modeled Copied Imitated

34. Transmission Acquired Modeled Copied Imitated Very strong (and invisible) force

35. in pictures...

39. Copying

45. The Result Image: istockphoto.com

47. VIOLENCE Observing Vicitimized TRANSMISSION Exposure

48. VIOLENCE Observing Victimized BRAIN PROCESSING TRANSMISSION Cortical Dopamine Pain centers

49. VIOLENCE Observing Vicitimized Trauma BRAIN PROCESSING TRANSMISSION Cortical Dopamine Limbic Pain centers

51. Trauma Acceleration

52. Trauma Acceleration hypervigilance hyperarousal other

53. Trauma Acceleration Other awful health effects

54. Exposure to violence - effects on health : - Heart diseaseLung disease StrokeHepatitis CancerAsthma Diabetes

55. Exposure to violence effects on health : - Heart diseaseLung disease StrokeHepatitis CancerAsthma Diabetes Violence

56. Source: Mullins et al. 2004; Devries et al. 2011 TRANSMISSION OF VIOLENCE Exposure to Violence

57. MULTIPLE EXPOSURES Exposures COMMUNITY Outcomes MULTIPLE EVENTS

58. Country A Country B Country Billings in Rwanda Country C Country D 1950200819602003 198020034/19945/1994 KILLING EPIDEMICS VIOLENCE BEHAVES EXACTLY LIKE A CONTAGIOUS DISEASE

60. Transmission across syndromes community family spousal child suicide war

61. HOW TO STOP EPIDEMICS

62. How to Stop Epidemics 1. Interrupt transmission 2.Prevent future spread 3. Change group norms

67. New categories of workers

72. NEW NORMS

73. Mapping 73

74. Photograph by Ed Kashi Violence interrupters

75. Hospital responders

76. Photograph by Ed Kashi Behavioral outreach workers

77. Photograph by Ed Kashi Community outreach

78. Health - Community System

79. RESULTS

80. shootings 67%

81. Results – Logan Square Cure Violence CURE VIOLENCE

82. Health approach “Immediate” Skogan, DOJ Evaluation Report, 2008

83. Results – Logan Square Cure Violence CURE VIOLENCE

84. DOJ - EXTERNAL EVALUATION ↓ 41 – 73% shootings and killings (overall effect seen) ↓ 1 6 - 28% shootings and killings (directly attributable) ↓ 15 - 40% shooting density ↓ 100% retaliation murders in 5 of 8 communities 85-97% helped to jobs, school, out of gang DEMONSTRATED EFFECTIVE TO REDUCE SHOOTINGS AND KILLINGS Skogan, 2009

85. OAKLAND KANSAS CITY NEW ORLEANS EAST ST. LOUIS BALTIMORE CHICAGO PHILADELPHIA ROCKFORD MAYWOOD NORTH CHICAGO ALBANY YONKERS HEALTH APPROACH May 2015 (incomplete) NEW YORK CITY SPRINGFIELD BUFFALO ROCHESTER SYRACUSE SAN ANTONIO WILMINGTON CAMDEN Loiza, PR MT VERNON CICERO TROY HEMPSTEAD HEALTH APPROACH ST. LOUIS MIAMI SAN FRANCISCO RICHMOND LOS ANGELES SEATTLE MILWAUKEE BOSTON MINNEAPOLIS

86. CANADA MEXICO BRAZIL TRINIDAD COLOMBIA SOUTH AFRICA KENYA IRAQ ENGLAND JAMAICA PUERTO RICO ISRAEL/ WEST BANK HONDURAS SYRIA UNITED STATES GUATEMAL A CURRENT PARTNER EXPLORING PARTNERSHIP PAST PARTNERSHIP EL SALVADOR EGYPT Cure Violence international adaptations Apr 2015

87. Current situation (U.S.)

88. Some dysfunctional models

89. Wrong theory(ies)

90. Wrong lens(es)

91. Wrong language

92. Harm

93. Middle Ages Has happened before

94. Harm

95. BAD PEOPLE ENEMIES Contagious behavior PUNISHMENT Interrupt events Change behavior Change norms Modern View OLD VIEW

96. New language exposure transmission susceptible contagious behavior trauma social pressure interruption norms G. Slutkin, 2010

97. New language exposure transmission susceptible contagious behavior trauma social pressure interruption norms G. Slutkin, 2010

98. More about words...

99. Criminal X

100. Justice

101. fairness

102. Justice fairness equity

103. Community systems for solving problems

104. New community models Violence rare People (re)educated - trauma, care, self care, etc. People skilled – don’t traumatize others, de-escalation, etc. Harmony praised, enjoyed Punishment and prisons in the past Care valued – care jobs Health and community care and culture Trillions saved, re-distributed

105. Movement New policies practices language trainings systems culture

106. Movement (partnerships) New policies practices language trainings systems culture

107. Movement (partnerships) New policies practices language trainings systems culture

108. Summary 1. Wrong courses happen 2. Problems can be stuck (wrong diagnoses) 3. Re-understand 4. New models 5. Change – can be immediate, sustained 6. Movement(s) required too

109. Buckminster Fuller “You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.”

111. Thank youT Thank you! gslutkin@uic.edu www.cureviolence.org @CureViolence