ISIH S3 E19 / Gun Violence in America: A Tale of Two Cities

iTunes Google  SoundCloud  Spotify RadioPublic  Stitcher

Celine Gounder: Hi, everyone. This is Dr. Celine Gounder. I’m the host of this show, “In Sickness and in Health.” If you like the stories we bring you, do me a small favor. This week, tell one friend about the podcast. Just one. Not a big ask, right? It’ll help us bring you more stories… on the big health issues of the day. Thanks for listening. Now… on with the show.

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: In our last episode, we talked with criminologist David Kennedy about the Ceasefire model for violence reduction. It’s about identifying the small, high-risk groups of people responsible for most of the violence. It’s about telling them the consequences for their actions… and giving them the resources to change.

Celine Gounder: Cities throughout the country are grappling with how to address the gun violence on their streets. Many have turned to David’s Ceasefire program as a possible solution.

Celine Gounder: In this episode, we look at the experience of two different cities, Oakland and New Orleans… and see how each of them adapted Ceasefire to their cities… with varying results.

Vaughn Crandall: Prior to coming to California and forming this organization in 2012 with my partners at the California Partnership, I worked with David Kennedy at the National Network for Safe Communities actually launching and developing a national network out of the John Jay College of Criminal Justice.

Celine Gounder: This is Vaughn Crandall. He’s now the co-director of the California Partnership for Safe Communities and has been involved in violence prevention for a long time. The California Partnership for Safe Communities, or CPSC, is a nonprofit consulting group based out of Oakland. As Vaughn puts it, they work with cities:

Vaughn Crandall: …to advance a public safety, triple bottom line. That is to reduce gun violence on a community level to also improve outcomes and reduce recidivism for young people at the very highest risk of being involved in violence and to build police community trust.

Celine Gounder: The Ceasefire model had seen a lot of success. But Vaughn and his team noticed cities often faced significant challenges in their implementation. They’d often see significant reductions in violence in the near-term, but... they had a hard time keeping that momentum going... beyond two or three years… especially beyond five years.

Celine Gounder: Vaughn also wondered… how much did Ceasefire make the situation better for young people? versus just bringing about more arrests. Vaughn and his team at CPSC looked for a place where they could take Ceasefire to the next level.

Vaughn Crandall: In the cities of Oakland and Stockton, what we saw was two cities that were desperate enough and had enough of a political alignment and enough of a senior leadership commitment to give this thing the long-term investment that we thought it was going to take to realize its full potential.

Celine Gounder: To explain why, we’ve got to go back to what was happening in Oakland in the early two-thousands, well before CPSC got involved.

Celine Gounder: Oakland had long been struggling with violent crime. And then... between 1999 and 2003... the city experienced an 81% increase in homicides.

Barbara Lafitte-Oluwole: There was just all kind of stuff going on in Oakland at the time, and the murder rate was really high. That's when we started talking about that. There's a sickness in this city, and it needs a healing.

Celine Gounder: This is Barbara Lafitte-Oluwole. She is a mother, organizer, and bedrock of the West Oakland community.

Barbara Lafitte-Oluwole: Just to let you know, this is from a personal perspective. This is just like my story because I am on staff with the Oakland Community Organizations, but the majority of the work I did was as a leader with the organization as a community leader.

Celine Gounder: Barbara was tapped through her church to help organize members of her community, and over the years, she’s become more and more involved in local issues.

Barbara Lafitte-Oluwole: Well, my beginning with Oakland Community Organizations as a leader started before my son's murder in 2003.

Celine Gounder: In 2002, her son’s best friend was shot. Her son was there when it happened... and agreed to testify against the suspects. The following year… before he could testify… her son was shot and killed. The police never identified his murderer.

Celine Gounder: After her son’s death... Barbara and her husband became more and more involved in community organizing. Barbara joined a local organizing committee in the Lower Bottom neighborhood in West Oakland.

Barbara Lafitte-Oluwole: We actually worked on violence prevention. That was the issue that came up mostly for the majority of us who live in that area.

Celine Gounder: Oakland residents agreed that something had to be done to address the escalating violence.

Celine Gounder: In 2004, the city proposed The Violence Prevention & Public Safety Act… known as Measure Y… to raise the money for anti-violence efforts. At first… the plan... was to hire one hundred new cops for the Oakland Police Department.

Celine Gounder: But many community organizers… including Barbara… disagreed. They believed that a strategy based solely on law enforcement wouldn’t work. This wouldn’t address the root causes of violence, they thought… and they pushed back.

Barbara Lafitte-Oluwole: We asked them to put money towards at-risk youths and probationers, parolees so that there will be programs for them when they come out of jail that they're not going back to the same lifestyle because they don't have anything better to do and, also, have community police officers walking the beat and getting to know the community.

Celine Gounder: After a lot of advocacy, city officials changed their proposal, so that... if passed… 60% of the funds would go to law enforcement… and 40%... for social services.

Celine Gounder: With these changes in place, Barbara and others… threw their support behind it. They canvassed the neighborhood, and organized phone banking and voter registration drives.

Celine Gounder: Their efforts paid off, and in the end, voters approved Measure Y: $20 million in funding over 10 years. This was a big win.

Celine Gounder: Under Measure Y, the City of Oakland began implementing an anti-violence strategy that included both law enforcement and social services. But...

Barbara Lafitte-Oluwole: The programs were not working very well.

Celine Gounder: Measure Y allocated funding for the Oakland Police Department to hire what it called “problem-solving officers” to do community policing. The problem with the problem-solving officers was... nobody knew exactly what they were supposed to do. What problems should they be solving? What exactly is community policing? Measure Y provided little guidance.

Celine Gounder: Two years after Measure Y was passed, the Department had only hired half the number of problem-solving officers they were supposed to.

Celine Gounder: There were also problems with the social services side of the strategy.

Celine Gounder: Programs funded under Measure Y included diversion and reentry services for formerly incarcerated people... as well as employment and training services. But much of what Measure Y was funding… was directed at youth… mostly because it was a commonly-held belief at the time that juveniles were the primary drivers of serious violence in the city.

Celine Gounder: In the meantime… violence continued to rise in Oakland. By the end of 2006, there were 146 homicides in the city, marking a 10-year peak.

Celine Gounder: Barbara and others continued to search for solutions.

Celine Gounder: One day, community organizers came across the Ceasefire model. They were impressed by how the anti-violence strategy helped turnaround record levels of homicide in Boston during the 1990s, and had worked well in other cities.

Barbara Lafitte-Oluwole: …we learned about the strategies that David Kennedy and those guys were using and the Boston Miracle, and there was a call-in, in High Point, North Carolina that we saw a video on, and we were really intrigued by that. We said if we could do something like that here--

Celine Gounder: They wasted no time… and began meeting with city leaders and public officials, urging them to bring Ceasefire... to Oakland.

Celine Gounder: In 2007, a new Mayor came into office, and Oakland agreed to launch a homegrown version of Ceasefire.

Celine Gounder: In 2009, after years of planning, the city and the police department agreed to hold their first call-in meeting.

Celine Gounder: It wasn’t... very successful.

Barbara Lafitte-Oluwole: I think at the first call-in, there were only maybe two or three young men there. I can't remember exactly how many men were there…

Celine Gounder: They were expecting at least twenty. But this low turnout wasn’t the only problem. There wasn’t a strong community presence at the meeting. In fact… most of the people there were law enforcement officers… which isn’t exactly the Ceasefire way.

Celine Gounder: Many community and faith-based organizers saw this as a sign that city and law enforcement leaders weren’t fully committed to the Ceasefire model. They didn’t understand the range of partners, especially community partners, they needed to bring to the table… to be successful.

Celine Gounder: So, once again, community activists organized… this time to demand that public officials implement a revamped Ceasefire operation. And... they educated themselves.

Barbara Lafitte-Oluwole: When we brought the guys from the Boston model here and they found out about Measure Y, that we already had funds, they said, "You're really starting with a lot more than we had when we started, and you have an upper hand in this already.”

Celine Gounder: Encouraged, they continued their efforts... to create community and political support… working with congregations all over the city… and setting up countless meetings with public officials. They even bussed hundreds of citizens to a city council meeting… shutting it down… demanding a better version of Ceasefire.

Celine Gounder: In 2011, with the election of a new mayor… Jan Quan… and a new chief of police, the political climate finally changed.

Celine Gounder: A year later, in 2012, the Oakland City Council’s Public Safety Committee, the chief of police, and the mayor’s office... publicly acknowledged that the city’s earlier efforts to implement Ceasefire had been inadequate. The city and the police department pledged they would do better.

Celine Gounder: Once again, the efforts of community and faith-based organizers had paid off.

Vaughn Crandall: People often have ideas that are understandable but just fundamentally wrong.

Celine Gounder: That’s Vaughn Crandall again, from the California Partnership for Safe Community. CPSC partnered with Oakland in 2012... and one of the first things they did… was to analyze what was driving the violence in Oakland.

Celine Gounder: They looked at 170 homicides over a year and a half to understand where the violence was concentrated, and what was driving it.

Vaughn Crandall: At the time, the narrative in the public agencies including the police department and in the community and at the political level was our violence problem is driven by drug dealing and youth i.e people under the age of 18… it turned out that that was almost completely wrong.

Celine Gounder: What CPSC found instead was that...

Vaughn Crandall: …fewer than 10% of all those homicide had anyone as a victim or suspect who was under the age of 18, youth in 10 and fewer than 10% had any connection to drug dealing.

Celine Gounder: Sometimes drugs were involved in violent incidents, but more often than not, the violence wasn’t over drugs.

Vaughn Crandall: The initial shooting might have been tied to a drug but they're going to have seven, eight, nine, ten shootings that will follow an initial shooting that are not about the drugs, though that has evolved into a running conflict between two groups of people that now are just caught in this thing that they can't get out of.

Celine Gounder: CPSC also found that the number of people engaging in violence… at risk of being victims or perpetrators… was much smaller than had been thought.

Celine Gounder: In Oakland, there were approximately 50 violent groups or gangs, with an active membership of between 1000 and 1200 people… so about 0.3% of the population. And, only a small subset of them... were at high risk for engaging in serious violence at any given time.

Vaughn Crandall: 90% of your violence problem doesn't fit the public narratives.

Celine Gounder: Once the problem had been correctly identified, a revamped Ceasefire could be shaped to address it.

Celine Gounder: The first call-in after these changes... took place in October 2012. The Oakland version of the call-ins, Vaughn explains, is led by the community… the community where those at high risk for perpetrating violence are from… the community where those at high risk for being the victims of violence live:

Vaughn Crandall: They essentially say, “We’re here because we have good reason to believe that you, or those you are close to, are at imminent risk of being shot or shooting somebody. We don’t want that for you. We don’t want that for our community. Many of us here have been directly impacted by the issue of violence in the city, and we need your help in order to change this.”

Celine Gounder: They have community speakers... often a shooting victim, the parent of a murder victim, or a trauma nurse from one of the local hospitals… come talk about the impact of gun violence on their lives.

Celine Gounder: Law enforcement officers also explain the consequences if they’re involved in a violent crime.

Vaughn Crandall: They just walk through and say, “Look, guys, I just want you to understand, just so you’re informed, the risks that you and those you are close to take if you pick up a gun and use it to shoot somebody, to rob somebody.” …this is the kind of exposure that you face in the state system and in the federal system, and here are some other things about the federal system you might not know that you should know.

Celine Gounder: The call-ins were a key piece. They emphasized clear, direct communication with the highest risk individuals… but also showed how the community at large was affected… and cared.

Celine Gounder: Vaughn’s team at CPSC… all their in-depth analysis… helped the city of Oakland realize… they’d been targeting their social services… at the wrong people.

Celine Gounder: Instead of focusing so much on youth and school programs... they needed to target the people driving the violence now: older men who’d already had a lot of run-ins with the criminal justice system.

Vaughn Crandall: At-risk junior high school kids deserve support and they deserve a life of opportunity, but the thing is, they’re not the ones who are at risk of shooting somebody or getting shot this year.

Celine Gounder: Measure Y allowed the city to identify community partners and social service providers that addressed the root causes of violence… like untreated trauma… and the absence of economic and educational opportunities.

Celine Gounder: Now… with a better understanding of who the high-risk individuals were... Oakland restructured its social services program... funding fewer programs more generously.

Celine Gounder: In 2014, 10 years of Measure Y was coming to an end… and Measure Z was put on the ballot to renew and improve on it. Measure Z kept the same 60-40 funding split between law enforcement and social services… but focused the social services on those older men who’d been in and out of the justice system… and were most likely to be involved in the violence.

Celine Gounder: Activists and organizers had to... once again… make the case for those social services... but Measure Z eventually passed with overwhelming support. 77% of Oakland residents voted in favor of extending the tax… which would provide $27 million over the next 10 years.

Celine Gounder: Since Measure Z was passed, Oakland has seen nonfatal shootings drop… with every single year.

Celine Gounder: CPSC also helped refine the law enforcement side of Oakland’s Ceasefire strategy.

Celine Gounder: Previously, under Measure Y, the Oakland Police Department was focused on drug-related crimes and medium-risk, young people. It seemed like they were measuring success by the number of arrests made… not reductions in homicide.

Vaughn Crandall: The tactics that police agencies have tended to use in that engagement are very aggressive, zero tolerance, high arrest of strategies. Those both I think contribute to the incarceration of low and moderate risk people with little to no public safety benefit and a lot of harm.

Celine Gounder: A lot of damage to police-community relations, which had not been great in Oakland to begin with. The way CPSC sees it, the less people trust the police department… the more they handle things on their own... the more violence that creates.

Vaughn Crandall: If we can flip that… trust with the right guys in this network gets us at the minimum a couple of guys to stand down when they might otherwise pick up a gun. Even more than that occasionally helps us get some information that helps us save a life here and there…

Celine Gounder: Under Oakland Ceasefire 2.0, the Oakland PD created a Ceasefire section… dedicated units focused on addressing and solving violent crime… especially shootings and homicides... and working with the highest-risk individuals.

Celine Gounder: But this wasn’t just about addressing crime. It was also about rebuilding the community’s trust.

Celine Gounder: So, officers from the Ceasefire units... along with the department as a whole… received special training on procedural justice.

Vaughn Crandall: We found to be successful is really to appeal to officers' self-interest and experience. Which is to say to them, "You have, at this point, probably seen a lot of really bad things in your career. You've just been exposed to a lot of really human misery and suffering. You've also probably been in a number of situations where communities and community members who you're trying to help are really angry at you, and you may not understand why that happens. Part of what we want to do is help you, give you a set of tools that will help you manage your interactions with the community in a way that will be better for the community that will be making what we've called trust deposits, instead of trust withdrawals. That will help you to be safer, to be less stressed, to get more information and to be more effective.”

Celine Gounder: They also taught them about the history of police brutality against communities of color in Oakland.

Vaughn Crandall: The surprising thing is, officers, even those who've been working for a while, they don't necessarily know that stuff. It's particularly if they're not from Oakland, and many aren't… That's history that they just don't know. Part of it it's difficult for them to interpret and understand the response of community members in East and West Oakland and the Fruitvale if they don't have that context.

Celine Gounder: Something unique about these trainings… they were co-taught by members of the community. At first, Vaughn says the Oakland PD was hesitant… but as it turned out...

Vaughn Crandall: That was one of the aspects that all of the officer's uniformly said this was one of the best pieces of this class. We want more of it because it was a way that we could engage with the community… in an authentic way… We don't have this, there's no constructive space for us to actually work on them together.

Celine Gounder: But… as Vaughn points out… training alone isn’t enough.

Vaughn Crandall: The training in the classroom prepares people with a basic awareness of these concepts, but I think the work to be done is to take that into the field.

Celine Gounder: What Oakland Ceasefire also did... is it established a framework for supervisors to evaluate officers in the field… whether or not they are applying the concepts discussed in the classroom... with real-life citizens.

Vaughn Crandall: Does my sergeant have a clear protocol in management framework for the application and procedural justice in the context of the duties and scenarios that I will encounter… Are they evaluating my use of procedural justice in the context of my encounters with citizens in the community? Is that evaluation taken into account when I am promoted, or disciplined, or given feedback?

Celine Gounder: This internal restructuring, says Vaughn, was key to making the law-enforcement strategy more effective.

Celine Gounder: Another improvement in Oakland Ceasefire… was all the meetings. We usually think of meetings as a waste of time… something that gets in the way of the real work… but these… actually… work.

Celine Gounder: One meeting was to set up a constant feedback loop… by reviewing the shootings each week.

Vaughn Crandall: We didn’t invent this; we borrowed some stuff from Boston and Cincinnati and some other performance management work that we’d done, and developed a next version of it in Oakland…

Celine Gounder: Shooting reviews are meetings where the police department gets together to talk through all the shootings that have taken place in the last week or two. They look for patterns… to keep on top of shifting dynamics on the streets… and adjust their tactics accordingly.

Vaughn Crandall: Okay, maybe our violence dynamic is changed but what is it now? It's still going to be hyperconcentrated because that's just how it works, and what is it now, and how do we act on it now? If our strategy needs to evolve to track the reality of what our problem is now, then that's fine, but that's the work.

Celine Gounder: Shooting reviews give officers the opportunity to analyze the data, update it, and adjust their approach in real-time.

Celine Gounder: In addition to shooting reviews, there are coordination meetings between law enforcement and social service partners... to make sure that those at-risk...  or who’ve recently been involved in violence... receive timely services.

Vaughn Crandall: The things that we’ll tend to talk about is, “Okay, we had 15 shootings this week. 10 of them were hits, five of them were not, two of them were fatal.” We’ll say, “Okay, what’s going on with the funeral arrangements around the fatal shootings? Here’s what we know about the likelihood of retaliation. Here’s what we know about possible people who are connected into this.” … Are they still in the hospital? Have they had follow up from a violence interrupter or a hospital-based response worker? … In the near term, what we really need is we need to be able to directly engage with people and essentially convince them that it’s not worth shooting somebody.

Celine Gounder: And… there are performance reviews. City leaders and partners agreed from the beginning that Oakland Ceasefire should aim to reduce shootings and homicides by 10% each year. Performance reviews, led by the Mayor, hold people accountable.

Vaughn Crandall: There needs to be a mechanism by which people are held accountable to each other for delivering on their piece of work. Then, together, we need to be able to look and say, “Is this type of work at this scale reducing shootings at a community level?” If it’s not, what do we need to change? What do we need to do more or less of? What do we need to problem-solve around, or what do we need to change up?

Celine Gounder: These performance reviews, Vaughn says, where everyone knows there’s a meeting coming up... where their data is tallied and made public… is key to keeping folks focused on the work.

Celine Gounder: In 2018, there were 68 killings in Oakland… the city’s lowest in nearly two decades… and almost 50% less than six years before.

Barbara Lafitte-Oluwole: I was, we did all of this stuff together, and it helped both of us to forgive the person that killed our son and also to accept our son's death. … I know I still see my husband's teeth clench sometimes when they're talking about gun violence and stuff like that on TV, reporting something that happened, and his tradition-- he's Yoruba, he's from Nigeria, they don't bury their children. The parents don't attend the funeral services, they don't bury their child. So we never went to the services. We didn't go to the funeral home. We didn't go to the mass. We didn't go to the grave site, and we've never been, because they don't feel that parents should bury their children. Children should bury their parents.

Celine Gounder: For Barbara, like for thousands of community members in Oakland who’d been living with the threat of gun violence, the drop in homicides… has been a big win.

Barbara Lafitte-Oluwole: I'm very hopeful, I feel things are changing every day.

Celine Gounder: The story of Ceasefire in Oakland may have ripple effects far beyond the city limits. It’s caught the attention of national gun violence advocates.

Mike McLively: A lot of engagement and action on the issue of gun violence up until now has been focused around mass shootings.

Celine Gounder: That’s Mike McLively, an attorney at the Giffords Law Center. The Giffords Law Center is a national gun violence prevention organization named after Congresswoman Gabby GIffords, who was shot in 2011. I spoke with Mike about a report Giffords published earlier this year highlighting the anti-violence efforts in Oakland.

Celine Gounder: According to Mike, a lot of the gun violence prevention work at the national level...

Mike McLively: The work was focused very much on solutions to gun violence that had to do with regulating guns.

Celine Gounder: Universal background checks. Regulating access to military-style weapons. That kind of thing.

Celine Gounder: The problem, Mike says… is that many states have preemption laws that forbid cities within those states… from regulating guns.

Mike McLively: I think there are some advocates who see that and say, "Well, then there's not much we can do at the local level to address gun violence."

Celine Gounder: But Mike believes one of the lessons from the Oakland experience is that...

Mike McLively: ...there are actually some amazingly effective solutions out there, … there's a real concrete action plan they can follow to make sure that their leaders know about these solutions... and things like preemption laws or the Second Amendment… These strategies have nothing to do with regulating guns.

Celine Gounder: Because they’re not about gun regulation, programs like Ceasefire cleverly sidestep contentious debates over the Second Amendment… which means… cities still have tools to combat violence at the local level… without running afoul of state preemption laws.  

Celine Gounder: It also means local advocates may be able to muster political support for programs like Ceasefire... from both the left... and the right… since these solutions have nothing to do with gun rights.

Mike McLively: …they have to do with engaging with people at highest risk of being involved with violence, and so really it's just an issue of resources, committing resources to the right strategies and building up political support.

Celine Gounder: Of course, as we will see... all of this… is much easier said than done.

Charles West: …NOLA for Life was very much associated with the former mayoral administration, and a new mayor took office just a couple of weeks ago… early May.

Celine Gounder: This is Charles West. I spoke with him last spring. Charles was Director of Innovation with the Mayor’s Office in New Orleans. His job was to design and implement NOLA for Life… Mayor Mitch Landrieu’s signature homicide-reduction strategy.

Charles West: Under that umbrella and branding, it no longer exists even though some of the components still exist.

Celine Gounder: When Charles joined the innovation team in 2011, he began by pulling together everything the city knew about the shootings and murders in New Orleans.

Celine Gounder: What did you learn? What did you find with that exercise?

Charles West: By and large, we found trends that were consistent with a lot of other urban areas, which is that shootings and murders were concentrated in a few areas of the city.

Celine Gounder: New Orleans has long struggled with a very high murder rate… about ten times the national average.

Celine Gounder: In 2005, Hurricane Katrina devastated the city. Homicides went up in the two years after the hurricane… what some experts think is related to upheaval in the drug market after the storm.  Fewer people living in the city… due to evacuations and deaths… meant fewer customers. Dealers had to relocate… and new dealers entered the market… which meant... jockeying for turf. The end result? More violence and murders.

Celine Gounder: To make matters worse, the New Orleans PD had fewer officers to police the streets after Katrina. That… and recession-era budget cuts... meant even less manpower for the New Orleans PD…. which was already struggling... to ensure... public safety.

Celine Gounder: Like the city of Oakland, New Orleans looked to Ceasefire… as well as Gary Slutkin’s Cure Violence program, which we talked about in Episode 16… for ideas. And they focused on the people… at highest risk… for violence.

Charles West: It is exactly-- The Group Violence Reduction Strategy within NOLA for Life is his model. We started with the call-ins. We established the Multi-Agency Gang Unit based on some interest from the US attorney's office and in the district attorney's office.

Celine Gounder: New Orleans organized Ceasefire-style call-in meetings with at-risk individuals. They had a dedicated unit focused on gang violence. They had Cure Violence-like street outreach workers and violence interrupters… who went out and tried to resolve conflicts before they escalated.

Celine Gounder: The data Charles and his team were looking at... also confirmed that the most violent neighborhoods… not surprisingly… also had high levels of poverty and unemployment.

Charles West: We found that often those hotspot areas had higher incidences of many of the other social determinants of health… higher incidences of poor health outcomes, of low birth weight babies, of chronic disease, of all the other sorts of things that you tend to associate with neighborhoods of concentrated poverty, and often, disinvestment.

Celine Gounder: How did that shape the strategy?

Charles West: The biggest thing is that it told us that the strategy had to be comprehensive, We had to be addressing multiple conditions and multiple levels all at once.

Celine Gounder: And that’s why NOLA for Life was so comprehensive. But it was also… at times… confusing.

Charles West: When you look at our original strategy, there was a lot of misunderstanding. I think still, today, there's misunderstanding about, "Well, what is NOLA for Life?" because there are people… who worked within it, who would say that it was really just… a group and gang violence strategy, which isn't accurate. There are people who only knew it as CeaseFire or Cure Violence. There are people who said, "Oh, well, it's just Midnight Basketball thing… There are people who know it as the youth violence work, and it was all about school environments. The truth is, it was all those things and others, but that it did indeed, from the standpoint of communication, make it a lot more difficult.

Celine Gounder: Like the first iteration of Ceasefire in Oakland, NOLA for Life offered social services to the youth and families thought to be at highest risk: recreational programs like Midnight Basketball and summer camps… mentoring... family violence prevention… and behavioral health services.

Celine Gounder: NOLA for Life was looking beyond those directly involved in the violence… to broader social issues… like poverty and unemployment. 51% of African Americans in New Orleans are unemployed… so a key piece... was getting people jobs… especially those hardest to employ… like the formerly incarcerated.

Charles West: For instance, there's a new airport that was going to be built, so we worked with some of the contractors in the city to say, "What would it mean for someone to be ready to step into one of the jobs that you'll be hiring for at the airport?", and we worked with a local community college to create exactly that curriculum, to start it early enough that when it was time to start hiring, there were people who were participating in some of our NOLA for Life programs and others who were then ready to step into those jobs.

Celine Gounder: Yet, for all its scope and ambition, NOLA for Life had mixed results.

Celine Gounder: In 2013, one year after it launched, more than eight violent groups had been identified, and 100 people, indicted. But the homicide and violent crime rates… barely budged. And then... murders went up again. In 2016 and 2017, more people were shot and killed in New Orleans... than in the year before NOLA for Life started.

Celine Gounder: Today… New Orleans remains one of the top ten cities with the highest murder rates in the country.

Celine Gounder: Looking at the homicide rates in New Orleans, you see a decrease but then you see an increase more recently, how do you explain that more recent increase?

Charles West: …if you look at, for instance, the rate of call-ins as an indication of the fidelity of the implementation of, at least, the enforcement portion of NOLA for Life, is far fewer, and there are people who had said that, "Oh, the model doesn't work after a couple of years.” … I would say that the biggest determinant of the success of NOLA for Life was a combination of fidelity and resources being sustained over time.

Celine Gounder: Understanding the shifting dynamics of street violence can be challenging. That’s why in Oakland, they conduct shooting reviews every week or two… to keep their finger on the pulse.

Celine Gounder: The way the data is analyzed in New Orleans… just isn’t granular enough… to help officers stay on top of the landscape of street violence… to help them track who’s at highest risk for committing… or being the victim…  of violence… from day to day. And that level of detail is important… if you want to target your efforts… at the right people.

Charles West: I think, especially when it comes to the group and gang members, yes, some people's perception is that it's a small number of people, and we just need to go get that small number of people. …when it comes to groups and gangs, there's a constant churn of members and jacking for power, and groups forming and breaking apart, and all the rest. There's a constant changing environment and constant changing dynamics that you have to stay on top of.

Celine Gounder: While it might be a small group driving the violence at any given time, who’s in that group… changes.

Celine Gounder: Charles thinks NOLA for Life would have been a lot more successful if the public and city leaders had understood that it wasn’t a quick fix… that resources would be needed... for the long-haul. And this was a challenge… as new officials were elected… and policies shifted.

Celine Gounder: Oakland versus New Orleans. In one city… Ceasefire has worked wonders… and in the other… it hasn’t. Success… or not… has less to do with the strategy itself… and more to do with how it’s carried out. Do we know who’s most likely to be involved in the violence… today? not just yesterday… or a year ago? Are we calling in the right people? and offering them the right services? And is there ongoing political commitment and funding for all of this?

Celine Gounder: The community... has a lot... to do with it.

Mike McLively: Oakland community members really are role models for folks in other cities in terms of their tenacity.

Celine Gounder: Mike McLively, again, from the Giffords Law Center:

Mike McLively: This took several years, but they never gave up. Their bold advocacy, they were saying, "We're not taking no for an answer," and really their commitment to this over time. Once it was put in place, continuing to meet with new leaders to say, "This is our city's strategy, this is what the community wants…” I think it really illustrates that there is a lot that activists can do at the local level when it comes to gun violence prevention.

Celine Gounder: Oakland citizens held public officials and law enforcement accountable… and that… was crucial. Which means there’s hope. Where there’s the will… there is a way.

Celine Gounder: In our next episode, we’ll take a deeper look into the softer side... in the battle... against gun violence.

Celine Gounder: Did you find that it was more difficult to get funding for the social service pieces?

Charles West: Yes. Social services, especially for a high-risk population, the case management alone tends to be more intensive, and thus, often more resource intensive.

Celine Gounder: It’s often a lot easier to make the case for a law and order response to violence… but social services… are a tougher sell. So what’s the evidence for these approaches? There’s hard evidence.

Celine Gounder: That’s next time… on “In Sickness and in Health.”

Celine Gounder: Today’s episode of “In Sickness and in Health” was produced by Virginia Lora and me. Our theme music is by Allan Vest. Additional music by The Blue Dot Sessions.

Celine Gounder: 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!

Celine Gounder: 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.”