Booster Shot

The CeaseFire program treats violence like a disease – and it works.

Gary Slutkin, far right, and other CeaseFire workers gather with residents of Chicago’s West Side. Slutkin’s mission – to examine the causes of violence and how to prevent it, just as one would do in combating disease – has led to marked drops in dangerous incidents in the cities that have adopted the CeaseFire program. Photo: Jon Lowenstein / NOOR
The CeaseFire program treats violence like a disease – and it works.

It was late 1980s Somalia, a country writhing in the death throes of an indiscriminate disease, and Gary Slutkin ’71 LAS had stood uncomfortably in the midst of it for three years. Two decades later, the memories remain hauntingly real.

“One of the more devastating images that comes to my mind regularly is that of hundreds of horrified Somali women screaming in high-pitched, howling cries into the night sky while standing among dozens of newly dug makeshift graves in the desert – new graves of their buried friends, relatives and children,” said Slutkin, an epidemiologist and physician.

The stockpiling of the dead was the result of a cholera epidemic sweeping through Somalia’s refugee camps.

“I felt like I was in an indescribable horror, one that could have taken place hundreds or thousands of years ago, and which was otherwise hidden from the world in a very eerie, distant time and space.”

He and his colleagues “worked and then cried, worked and cried, trying to come to terms with a too-fast-moving epidemic. Some things I don’t want to remember. Somalia was very hard. I was affected by it greatly and am affected by it still.”

While he prefers not to elaborate on how deeply those experiences embedded themselves in his emotions, this much is clear: Slutkin has devoted his life to eradicating infectious diseases that kill people in alarming numbers and destroy communities. The infectious disease he has spent the past 16 years attempting to tame, however, might surprise some people – the scourge of violence.

“Violence is like AIDS or tuberculosis or cholera,” Slutkin said. “It’s a disease, it’s transmittable, and it’s reversible.

“Violence,” he emphasized, “is an epidemic.”

Slutkin, a professor of epidemiology and international health at the University of Illinois at Chicago and senior adviser to the World Health Organization, is the founder and executive director of CeaseFire, a program administered by the Chicago Project for Violence Prevention and operated out of UIC’s School of Public Health.

The groundwork research for CeaseFire began when Slutkin returned to Chicago in 1995. After battling infectious diseases overseas for 10 years, he was looking for another challenge in the public-health field and zeroed in on urban violence, thought by some to be a hopelessly intractable problem.

“Most of what was being used or suggested to combat violence in the U.S. – for example, tougher punishments or non-specific community measures – didn’t make sense to me from the point of view of behavior and strategy,” Slutkin said. “Part of it is because I was trained at the World Health Organization in doing strategy. We did not take ideological solutions to problems. We were looking for scientific, practical and data-based solutions to problems.”

He believed that violence could be arrested like any other infectious disease and devised a strategy based on behavior change and epidemic-control methods: minimize the transmission of violence and block retaliation.

“CeaseFire is an evidence-based, scientifically proven intervention, a movement, and a campaign to change the thinking,” said Slutkin, who launched the program in Chicago in 2000.

The CeaseFire model relies on two sets of workers: trained violence interrupters to intervene in and defuse conflicts, and outreach personnel to promote alternatives to violence (by changing the accepted “norm” of retaliatory violence, primarily shootings). Supported by local, state and federal funds and the philanthropic world, CeaseFire hires men and women who at one time were gripped by violence themselves and can communicate with those who seek to resolve grievances with a gun. The interrupter’s job is to “talk down” a potential shooter. An outreach worker then steps in to guide that person’s long-term behavior away from deadly force.

“Violence is like AIDS or tuberculosis or cholera,” Slutkin said. “It’s a disease, it’s transmittable, and it’s reversible.”

Regarding the blood-for-blood cycle of violence, Tio Hardiman reads headlines like these far too often: “5 dead, 25 hurt in Chicago shootings in 36 hours” or “Toddler fatally shot in the head on Chicago’s South Side.” Growing up in some of the poorest, most dangerous South Side and West Side neighborhoods in Chicago, Hardiman never did time in the penitentiary, but he says he “saw it all. I’ve been involved in violence. I’ve seen people get hurt. I’ve hurt people. But I turned my life around.”

Hardiman, who earned a master’s degree in inner city studies from Northeastern Illinois University and is now director of CeaseFire Illinois, was a community organizer when he met Slutkin in 1999.

“He talked to me about some of his plans to address violence by treating it as an infectious disease,” said Hardiman. “I thought he was from another planet. In the neighborhoods [where] I grew up, we never looked at violence as being a disease or an epidemic. It was a way of life.”

Hardiman thought that while outreach workers were proving effective in counseling youths and young adults on the value of school and helping them get jobs, they weren’t reaching the hardest cases – those most likely to commit violence, like Hardiman himself at one time. In 2004, he suggested to Slutkin the idea of using interrupters to reach those most reluctant to put down their guns, some of them “stone-cold killers.”

According to Hardiman, CeaseFire workers have made more than 1,300 interruptions since then. He estimated that 30 percent of those interruptions prevented retaliations (someone got shot, but interrupters prevented the victim or the victim’s relatives or friends from retaliating) and 35 percent prevented shootings on the front end (meaning that no one got shot to begin with).

“Somewhere along the way we have to break the cycle for generations to come,” Hardiman said. “With CeaseFire, we’re winning one person at a time.”

An independent study funded by the U.S. Department of Justice and released in 2008 revealed a 41 percent to 73 percent drop in shootings in CeaseFire zones overall; of those drops, CeaseFire is credited with directly affecting 16 percent to 34 percent of them in four neighborhoods. In addition, five of eight Chicago neighborhoods showed a 100 percent success rate in reducing retaliatory killings.Those are the kind of results CeaseFire’s supporters had hoped to see.

“We try to fund breakthrough ideas that take on what often looks like an intractable problem and propose a different solution,” said Jane Isaacs Lowe at the Robert Wood Johnson Foundation, a major funder of CeaseFire, whose annual budget is approximately $6 million to $8 million. “Changing the pattern of violence and thinking of it as a public-health issue is a breakthrough idea.”

Photo: Roberta Dupuis-Devlin

Photo: Roberta Dupuis-Devlin

When Slutkin worked with the World Health Organization to combat the spread of AIDS and cholera, he and his colleagues searched for the “invisible” that allowed an epidemic to feed off itself. When mothers in Somalia learned to hydrate their children, Slutkin said, mortality rates from cholera dropped by 50 percent to 80 percent.

“The ‘invisible’ with violence is observational learning or modeling,” said Slutkin, sitting in his 10th-floor office at UIC, not far from some of Chicago’s troubled streets. “One question we’ve asked is, ‘Where does the behavior come from?’ To say it comes from poverty is not right. There are plenty of poor places without violence.

“Where violent behavior comes from is the same place that language behavior or eating behavior or bike-riding behavior comes from. They basically come from observational learning or modeling.”

That is, seeing violence around you may impel you to imitate that behavior.

Experts in the field of violence believe that the epidemiologist is on the right track.

“I don’t think there’s another program that has proven as effective,” said Barry Krisberg at the University of California, Berkeley School of Law who has studied CeaseFire’s methods. “Simply throwing law enforcement resources at violence hasn’t curtailed it very much. If I were sitting in the Department of Justice right now or running a major foundation, I’d be looking to replicate CeaseFire in every major city.

“It’s by far the best program out there.”

More than a dozen cities throughout the United States are already in the process of replicating CeaseFire, and representatives from 40 other U.S. cities and 30 countries have visited with Slutkin and his staff over the past five years to learn how to adopt the program in their communities. Early findings in Baltimore and Kansas City, Mo., have shown success; the program is also being used in Iraq and Trinidad.

Slutkin, who earned his medical degree from the University of Chicago Pritzker School of Medicine, began his work in infectious disease control in the early 1980s in San Francisco, where an influx of refugees from Southeast Asia caused an outbreak of tuberculosis. He helped increase the cure rate from 50 percent to 95 percent and drop the number of cases by more than 50 percent.

In 1985, he moved to Somalia, where he worked on cholera and tuberculosis epidemics among refugees. When Somalia edged toward civil war in 1987, Slutkin left the country and joined the World Health Organization. There he was assigned responsibility for combating the Uganda AIDS epidemic.

Uganda became the only country in Africa where the AIDS epidemic has been reversed, meaning that rates changed course from going up to going down, and with significant reductions.

By 1995, Slutkin was worn out. He experienced “a tremendous amount of highs and lows” over the years and felt it was time to return to Chicago, the hometown he had left behind as a teenager as he set out for the U of I.

(Not surprising for the son of a research chemist, he had been an undergraduate in love with science. “Even from childhood,” he said, “I was trying to figure out how the eye works, how the mind works. What is the brain? What’s in the body? What’s the difference between a duck and squirrel and a person? How do things work? What is reality?”)

After returning to the U.S., Slutkin married Marla Anderson, whom he describes as a yoga practitioner and, like himself, “a thoughtful explorer of the mind.” He regards himself as an introspective man who, when he’s not attending meetings or traveling for CeaseFire – which is rare – likes to find quiet time for himself to sit in the sun, read the latest journal article about brain research or play his guitar.

“I am a private person, and I guess it’s true that I don’t talk about myself,” he said. “I think I learned that in the international environment. People in most other cultures don’t talk about themselves so much.”

Slutkin prefers to talk about CeaseFire and how he is trying to change the way we commonly think about violence – that it is committed only by bad people and that violent behavior requires additional punishment and legal sentencing to discourage similar actions.

Crucial to long-term success is CeaseFire’s ability to change not only the thinking on the streets but the mindset of people who have never been the victim of violence, who have never had a gun held to their heads or had a family member or friend shot.

“It’s critical to everybody that solutions be found,” Slutkin said. “I don’t want to sell, ‘It can happen to you,’ but violence does happen to individuals and groups unexpectedly, and it’s the worst thing that can happen to anyone in your family.

“The additional issue is that this is really sucking up money.”

He estimated that violence costs Chicago taxpayers more than $2 billion a year.

“Just look at your tax bill and see how much is going to the court system, the prison system, to Medicaid,” Slutkin said. “There are enormous economic development constraints. Nothing is developing in these neighborhoods because of the violence, so there’s a lack of tax revenues. The school systems are not improving. It isn’t only a matter of teachers or whether the school building is good or not. The kids have chronic-stress disorders from having experienced or witnessed violence.

“It’s a matter of transforming someone’s thinking from, ‘I would do violence that’s expected of me’ to ‘I wouldn’t do it; it’s expected that I don’t do it,’” he said. “That’s social pressure.”

For Slutkin, preventing violence remains his “main thing” for the foreseeable future. He is a realist and knows that reversing an epidemic doesn’t happen overnight. But with behavioral and community norms already changing in CeaseFire neighborhoods, Slutkin believes we can now begin to think of violence in a different way: as solvable, preventable and reversible.

In the future, he said, “There will still be sporadic events and occasional small outbreaks of violence, but they’ll be containable.

“Like other epidemics, violence can be put in the past.”

Wieczorek is a freelance writer and editor in the Chicago area.

Editor’s note: “The Interrupters,” a documentary about the CeaseFire program, premiered at the Sundance Film Festival in Park City, Utah, in January and took the top prize at the Sheffield Doc/Fest in the United Kingdom in June. The film is set to air on PBS’ “Frontline” television program in early 2012.