ISIH S3 E16 / Gun Violence in America: Violence Is Contagious

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Celine Gounder: Hi, everyone. This is Dr. Celine Gounder, the host of this show, In Sickness and in Health. If you like our approach to public health storytelling, do me a small favor. This week tell one friend about our show. The more listeners we get, the more ambitious our shows will be about some of the biggest stories in public health. Thanks for listening. Now, here’s the show.

Tomás Ortiz: How does violence get transmitted? …it's like a disease.

Andrew Papachristos: …a lot of the work that I've been looking at has been trying to sort of stop these chains of transmission. But if you can stop some of these cascades, we can probably also stop subsequent shootings.

Desmond Patton: …if I'm disrespected and I'm following the code of the street, I need to let everyone know on my social media that this will not happen again, that I will do something about it.

Celine Gounder: Welcome back to “In Sickness and in Health,” a podcast about health and social justice. I’m Dr. Celine Gounder. This season we’re looking at gun violence in America.

Celine Gounder: Chicago has a reputation for gun violence.

Jeff Glor: Chicago faces an epidemic of gun violence. This year alone more than 2,100 people have been shot, more than 400 killed

Lester Holt: And also in Chicago, the Fourth of July holiday, once again, erupted in gun violence. Homicides so far this year already up nearly 50% over last year.

Donald Trump: What’s going on in Chicago? I said the other day, “What the hell is going on?”

Celine Gounder: No, Chicago isn’t the nation’s murder capital. It actually trails a lot of other cities in homicide rates, like St. Louis, Baltimore, Detroit, New Orleans and Kansas City. But Chicago does have a lot of gun violence, and a lot of that violence is happening in neighborhoods like Humboldt Park. That’s where Tomás Ortiz grew up with his mom and grandmother.

Tomás Ortiz: …it was tough. … A lot of people that know about Humboldt Park, they know it was supposedly "terrible place" to—a lot of high-risk activities going on in Humboldt Park—a lot of shootings, killings. Just a lot of high-risk activities, a lot of gang banging.

Celine Gounder: Tomás says the violence was something people in his neighborhood got used to. Something they felt was normal.

Tomás Ortiz: This is something that you grow up seeing every day, it's a norm for you, you hear shots in the morning, you might hear shots before you go to sleep, late at night, four, five, six in the morning. These are things that is every day, this is something that’s happening every day, you see violence.

Celine Gounder: This is something Tomás had first hand experience with. He was in a gang called the Latin Kings.

Tomás Ortiz: Uh, how can I put this… [laughs] I was “known” by a lot of people.

Celine Gounder: Tomás says he didn’t have a good reason for joining the gang. It just happened.

Tomás Ortiz: It was more like just hanging with friends, family, having an extended family away from family.

Celine Gounder: He got pretty high up in the gang, too, before a charge for guns landed him in federal prison. We’ll catch up with Tomás’ story in a little bit. But I wanted to introduce him to you to get a feel for the places we’re talking about when we say urban gun violence. It’d be easy to hear about Tomás and say bad neighborhoods, bad people, bad decisions—right? What else is there to know? But what if we take a step back and don’t try to moralize the violence.

Gary Slutkin: We have to get off of thinking about bad people or scary words or all that stuff. This boils down to really the reframing of when you hear the word "violence," think health issue.

Celine Gounder: What if we looked at it as if it were a contagious disease?

Andrew Papachristos: Diseases can be transmitted from multiple handshakes away across time, and the same is true, of course, with other sorts of pathogens, but the same is true of certain types of goods, whether you're talking about cars or guns. They get transmitted and passed along through these sorts of networks.

Celine Gounder: And not just a disease… but a preventable disease.

Desmond Patton: …this is the idea that violence is a communicable disease and that we need people to stop the transmission of violence.

Celine Gounder: In today’s show, we’re going to meet some of the people working in neighborhoods like Humboldt Park to change the way we think about gun violence. And then we’ll meet some of the people who are administering the cure to violence.

Andrew Papachristos: My name is Andrew Papachristos, and I'm a professor of sociology at Northwestern University.

Celine Gounder: Andrew studies gun violence in Chicago. He believes that gun violence operates like a virus. It needs a vector, a way to pass from person to person.

Andrew Papachristos: We have to understand the pathways through which things are transmitted. So if it were like a common cold, then you would catch a bullet like you caught a cold. Then it would be as if every time somebody sneezed there would be a rash of shootings. There are absolutely random victims in gun violence, and it happens often, right? So somebody who was walking to school or was sitting in their living room, and they get shot, but the vast majority of victims of gun violence in our cities, and here we're talking about gun assaults and gun homicides really, they’re people who are connected, and they are actually transmitted less than by sort of a sneeze and more by something akin to sharing needles, which are— it's an actual behavior that connects and links these events.

Celine Gounder: The vectors for violence are the people around you. Your friends and family; your neighbors and schoolmates. Guns pass from person to person just like a virus.

Andrew Papachristos: Guns are durable goods, and the way people get guns, especially if people are prohibited from buying guns in the legal market, they get them through their personal networks. So I'll have to ask someone if I don't have a gun, "Hey, Celine, can you help me get a gun?" and you'll say, "Okay, but let me ask my brother or my cousin or my sister," and then you'll get a gun and then you'll pass it to me. And all of a sudden, the gun has changed two sets of hands to get to somebody who might want to use it, like myself, because it is actually something that gets passed around, stolen, traded, bartered, bought.

Celine Gounder: So now the guns are around you. You’re exposed to them.

Andrew Papachristos: For example… we go to a party, and your cousin at the party gets into a dispute, and someone pulls out a gun, there's a chance that I could be injured even as a “innocent bystander,” as someone who's not the intended target. Simply being in a network or a situation where guns are at play puts you at risk, just at simple exposure to gun violence.

Celine Gounder: So now let’s say you were the victim of gun violence. According to the public health approach to gun violence, you’ve been “infected.”

Andrew Papachristos: This is the perverse risk situation we talked about within a gang. So if I get shot, what I really want to do is be around people I know who are going to have my back, right? If I've been victimized, I'm going to lean on and rely on the guys I know who will be there for me if a fight happens.

Celine Gounder: For some people, this is going to mean joining a gang for protection. But within the gang, the virus of gun violence spreads: from person to person, victim to victim. And this is just as true on social media as it is at a party or on the street.

Desmond Patton: We've done some focus groups in Chicago, and one of the young men said very clearly, “Facebook is life. Social media is life.”

Celine Gounder: This is Desmond Patton. He’s a professor at Columbia University in New York.

Desmond Patton: He said, We trust the things that are said on social media before we trust the things that happen offline, so that's a big change in communication modalities, in how we think about virtual versus physical spaces. …and for young people that are born in the digital era where social media has been a large part of their life, those distinctions aren't very clear.

Celine Gounder: Desmond runs the Safe Lab at Columbia. At the Safe Lab, computer scientists, sociologists, and community members come together to track how the roots of violence can start online, specifically Twitter.  

Desmond Patton: …one of the things that emerged from that review is that we began to see a pattern or pathway to violence that actually started with expressions or responses to grief on Twitter.

Celine Gounder: Desmond started thinking about social media as a vector for gun violence back in 2014 when he was at the University of Michigan.

Desmond Patton: I was sitting at my desk, and I saw this headline come crashing across my screen as the "gun-toting gang girl of Chicago."

Celine Gounder: Gakirah Barnes.

Desmond Patton: She had a host of trauma and loss before she was 13 years old. Probably more loss than many of us experience in a lifetime. And as she got older, the local gang and cliques became of interest to her because they provided a sense of community and support. … By the time she was 17, she had allegedly shot or killed up to 20 people.

Celine Gounder: It turned out that she was on Twitter… a lot. She had 5,000 followers and more than 27,000 tweets in 2014. One day, a close friend of hers was shot to death. His name was Tyquan.

Desmond Patton: Gakirah after Tyquan's death created a Twitter handle, @TyquanAssassin, which does two things. One it memorializes Tyquan. It kind of highlights her relationship to him and how she felt about him. But this additional piece, "assassin," also indicates how she thinks he died and what she plans to do about his death.

Celine Gounder: Then, another friend of Gakirah’s was killed. This time allegedly by the police.

Desmond Patton: And during that time, March 27, 2014, she took to Twitter to respond to that grief. And you saw this young woman who was gang involved, who had allegedly shot and killed up to 20 people, grieve and mourn, and was clearly in a lot of pain from that death.

Desmond Patton: And then two weeks later, unfortunately, Gakirah Barnes was shot and killed, allegedly by a rival gang.

Celine Gounder: Desmond started looking back at the Twitter feed to see how Gakirah had been tweeting up to her death.

Desmond Patton: Again the initial response when someone dies is grief, and how, over time, as people, as audience members, as the network begins to chime in and respond and say disrespectful comments and make retaliatory remarks, then the conversations, the dialogue evolves into something that's more aggressive and threatening. … what we haven't really explored… is kind of this duality of responses to grief and the connection to aggression and threats, particularly within an urban context. How do people hold constant deep pain and trauma related to grief and responding to grief, but also in the same kind of moments, plan and have a clear idea about retaliation.

Celine Gounder: Desmond says his research doesn’t say that social media causes violence. His lab is looking at social media as a place where conversations about grief and violence happen. But there was an interesting finding that could have very real world impacts for gun violence prevention.

Desmond Patton: Expressions of grief come about two days before aggressive tweets in our Chicago-based Twitter dataset. So it's really clear that there is an opportunity or a window of opportunity to think carefully about the pathway of aggression based on responses to grief and loss on Twitter.

Celine Gounder: Desmond hopes this research will give people the tools to stop the spread of violence during this critical window of time.

Desmond Patton: Our goal is to provide outreach workers social workers and clinicians with real time social media data to have, to be able to utilize social media, that data point in assessing violence and treating violence. … And so we now have outreach workers of violence interrupters that are looking into things that are happening on social media. So there is the E-Responders’ program here in New York City that have taken those outreach workers and put them online, and they're now monitoring social media and trying to do the exact same things, but in an online space.

Celine Gounder: And there are people mediating these same kinds of conflicts on the streets, too. Remember Tomás from the top of the show? He went from gang banger to violence interrupter.

Tomás Ortiz: I look at it like giving back in a sense for the damage I’ve maybe done in the streets. … I was part of the problem, now I'm part of the solution.

Celine Gounder: When I first spoke to Tomás in 2018, he was working with a Chicago-based group called Cure Violence. Now he works for another group called Acclivus, doing the same thing. Tomás went to federal prison on a gun charge. That time in prison changed his outlook.

Tomás Ortiz: I was introduced to Cure Violence when I came home after the seven years of the fed. I was like 38, 39 years old now. Came home, got introduced to Cure Violence. And, uh, it was like, "Man, there's a job for you. A lot of guys listen to you. They look up to you. You can do this. We can stop a lot of stuff from happening that shouldn't happen." I came to one of the meetings, I was like, "Okay, volunteer a little bit.” I liked it, been here ever since I've been home. And that's more than eight years now.

Celine Gounder: Tomás’s ties to the community, as a former local gang member, helps him diffuse a fight before it happens.

Tomás Ortiz: So them knowing who I am, what I've been through, where I come from, a lot of people know me in that sense as well. That's where my credibility comes in. That's because they're familiar with who I am. They know why I am, they can trust me, they can confide in me, they know I won't turn them in or turn my back on them, so to speak.  

Celine Gounder: The police never enter the picture.

Tomás Ortiz: I have a level of respect for them, first and foremost. I'm doing a job, and I respect the job that they do. So, I really don't try to interact while I'm doing interruptions like that on streets. … Because if you're seen interacting with the police in the neighborhood, then they're like, "You talk to the police, you're giving police information." So that kills my credibility to talk to the young people.

Celine Gounder: The goal of programs like Cure Violence is to try to slow down the time between the offense and the retaliation.

Tomás Ortiz: The thing is to give them that second thought and hopefully, they won’t act on it. You give them time. It’s like you’re buying time so that their anger can wear down and their feeling for retaliation or even just to do something will be detoured. … It’ll be a fight maybe, a fist fight, but it will be something after that no longer. It wouldn’t be a situation any more.

Celine Gounder: If someone like Tomás can get in there and convince someone to stop and think, he might save someone’s life.

Tomás Ortiz: I had a kid that was doing good. He was going to job corps, and he got shot… I was able to talk to him while I was at the hospital as a responder, and the kid was telling me, I’m going to get my uncles, I’m gonna do this, I’m gonna do that. … I’m in school trying to do the right thing. How could this happen to me?

Tomás Ortiz: So I was able to talk to him and let him know the consequences of even getting the uncles. You are still considered an accomplice by even calling somebody to do something on your behalf. …that means you screw everything you’ve worked for; down the drain. You might be going to prison for what happened, if something happens… You’re here with us. Something we learn. … And I can understand how you feel, but doing what they did to you in retaliation, I don’t think would be a smart move because it could still affect you. …from that day forward, he finished school. We were actually together in a college class, and then he became an entrepreneur selling tickets for boat cruises and things of that sort.

Celine Gounder: Are you still in touch with this young man today?

Tomás Ortiz: Yeah, as far as I know he’s doing well… I believe he’s doing good, and I’m glad you reminded me, I’m going to have to reach out to him. [laugh]

Celine Gounder: [laugh] I’m glad to hear it.

Celine Gounder: Studies show this kind of intervention works.

Gary Slutkin: It's been shown repeatedly that Chicago's violence can drop 40%, 50%, 70%.

Celine Gounder: This is Gary Slutkin. He’s a professor of public health at the University of Illinois. Like me, Gary is an infectious disease doctor and epidemiologist, and like me, Gary spent many years fighting diseases like tuberculosis and HIV in Africa. After a decade working overseas, Gary was exhausted. He’d seen a lot of death. He wanted to come home, and home was Chicago. Gary wasn’t sure what he was going to do next, but friends began telling him about gun violence at home, about kids shooting other kids with guns.

Celine Gounder: Gary did what he’d always done when confronted with a public health problem: he looked at maps, graphs and data. And what he saw was that gun violence behaved a lot like the infectious diseases he’d been fighting in Africa. And so, Gary turned the page and started a new chapter. He founded Cure Violence.

Gary Slutkin: …understand violence as an epidemic process with one violent event leading to another, leading to another, until it becomes normal. And there are methods for reducing violence epidemics as there are for other epidemics that the community itself applies with guidance and training from the health sector and from other important things as well. It's no more refractory in Chicago than it is in any other place. There is a requirement for consistent application of effective intervention to sufficient scale, and where we see this, we see reductions in any city, and where we don't, we see violence take over as any epidemic does.

Celine Gounder: The kind of violence interruption work that Tomás was doing with Cure Violence has been applied to cities all over the U.S. and even the world.

Gary Slutkin: In several neighborhoods in New York and Baltimore, I think about a dozen, have gone to zero shootings and killings.  

Celine Gounder: Zero deaths from gun violence. So if there is a solution out there that’s saving lives, why haven’t more people heard of this?

Gary Slutkin: It's been shown repeatedly that Chicago's violence can drop 40%, 50%, 70% in a neighborhood, in multiple neighborhoods. …the whole city dropped 25% many years ago, and the Cure Violence neighborhoods dropped 50%, and twice in ’07-’08 and ’11-’12, when Cure Violence was defunded, violence went up, and when it was refunded, it went down. Then, when it was defunded the violence went up.

Celine Gounder: Gary says this is like having an infection and then abruptly stopping treatment. The infection roars back, and the patient sees all the bad symptoms return. In public health, we call this the “U-shaped curve of concern.” This “U-shaped curve” is actually why I quit my job leading tuberculosis control for New York City almost seven years ago. We were facing massive budget cuts, and I was tasked with stripping down the program. The last time this happened, in the ’70s and ’80s, TB came roaring back. It cost the City a billion dollars in the early ’90s to bring it back under control. It’s no coincidence that after the most recent budget cuts, TB cases are up again in NYC, for the first time in over 25 years.

Celine Gounder: This is also why the “cure” in Gary Slutkin’s Cure Violence may be a misnomer. Interrupting violence doesn’t make the disease of gun violence go away for good. The reality is that these kinds of public health programs—whether it’s to control tuberculosis or gun violence—need sustained commitment and investment to work. While violence interruption has proven effective at reducing gun-related deaths, it’s also only the beginning of the solution.

Andrew Papachristos: What that doesn't do is it doesn't change the things that created the networks in the first place which is, of course, are things like segregation, poverty, racism, poor education, neighborhood infrastructure, and all of those other things. That’s the big stuff.

Celine Gounder: Andrew Papachristos again.

Andrew Papachristos: To give you an example, when we talk about, say the obesity epidemic, to try to make a parallel, when somebody comes into the ER for a heart attack, the doctor uses the best medicine available to save that patient's life, and then hopefully, down the road, a primary care physician is going to say, "Let's talk about your diet and exercise. And, oh yeah, maybe you should stop smoking," and at the same time, cities and states are going to look at things like the nutritional value in school lunches and what types of food deserts are there that we can eliminate to make people have access to food. And at the same time, you're going to see movements about trying to get young people to get fit and move and talking about the benefits of certain types of fruits and vegetables. All of those things go to attack the obesity epidemic, the here and now as well as the big picture stuff, and that's what you need in the realm of gun violence.

Celine Gounder: The now… and the big picture, the long-term. We talked about this in our last season on the opioid overdose crisis. People need to be alive to move forward. But to make real change, you can’t just give them a bridge to nowhere. The same applies to the problem of gun violence.

Celine Gounder: Understanding gun violence as a contagious disease helps us understand why the question of whether guns kill people or people kill people just doesn’t make sense. It’s both... and more. It’s also the gun manufacturers, gun dealers and gun shows, that make guns available. It’s the social networks through which guns exchange hands… the same networks that also transmit anger, fear, jealousy and vengeance. And it’s the environment in which gun violence propagates—neighborhoods that have long been plagued by poverty, joblessness and hopelessness. There’s no one “cure” to the violence. It’s got to be attacked on all fronts.

Celine Gounder: In our next episode, we’ll talk about how guns are transmitted… from person-to-person… how they make their way from legal sources… into the hands of criminals… and how we can block their transmission. That’s next time, on “In Sickness and in Health.”

Celine Gounder: Today’s episode of “In Sickness and in Health” was produced by Zach Dyer and me. Our theme music is by Allan Vest. Additional music by The Blue Dot Sessions. If you enjoy the show, please tell a friend about it today. And if you haven’t already done so, leave us a review on Apple Podcasts. It helps more people find out about the show! You can learn more about this podcast and how to engage with us on social media at insicknessandinhealthpodcast.com. That’s insicknessandinhealthpodcast.com. I’m Dr. Celine Gounder. This is “In Sickness and in Health.”