Epidemiologist: Violence is like a contagious disease — and our current president is a super-spreader

Adoctor who has long advocated using an epidemiological approach to treat violence says his group's efforts to respond to gang violence can be replicated to deal with the growing threat of violence in American politics — including from President Trump's supporters.

Dr. Gary Slutkin is an epidemiologist who spent years working with the World Health Organization to respond to the AIDS crisis and epidemics in Africa and Latin America. After returning to the United States in the 1990s, he "saw the problem that the U.S. was having with violence." He soon launched a project that eventually became Cure Violence, a non-governmental organization that "stops the spread of violence in communities by using the methods and strategies associated with disease control."

Slutkin said in an interview with Salon that a dangerous "contagion" stemming from the White House has "empowered" certain groups to commit acts of violence. Slutkin, who avoided discussing Trump and the Republican Party by name, said that the election and the president's impending departure from the White House are critical in reducing "exposure" to the rhetoric that has fueled anger around the country, but that it will require significant "intervention" to reduce the threat of violence that the country has seen in cities like Washington, D.C., Portland, Oregon, and Kenosha, Wisconsin.

Slutkin spoke to Salon about how Cure Violence has helped reduce violence in cities by responding to the problem as a contagious disease, and how that approach can be replicated to prevent political violence.

Talk about why you launched Cure Violence?

I saw how much violence the country has in the communities and I asked people questions like, "What are you doing about it?" Nothing anyone said made any sense to me at all. They're talking about punishment and they were talking about having to solve every problem. I started to look at charts and graphs and maps of violence, just like any epidemiologist would. They looked to me exactly like the charts and graphs of maps of any epidemic disease, so I began to explore treating it like an epidemic or contagious disease. The first time we tried this was in West Garfield Park in Chicago, which was the worst police district in the country at the time. We had a 67% drop in shootings and killings through a non-policing intervention, through outreach workers which we hired from West Garfield.

The funders said, "Well, sure, it must be a fluke. Do it again." We did it five more times, got an average of 45% drop in shootings and killings. Since then, we've been working in a hundred communities in the U.S., Latin America, a little bit of Africa, a little bit of Europe, and we've had about eight or 10 independent evaluations of this method of treating violence like any epidemic health problem through, essentially, behavior change and outreach of community, people doing the work themselves, since all epidemics are managed in this way. It was a 40 to 70% drop in shootings and killings.

There are no other interventions that get this degree of effectiveness this reliably. It's hard work on the part of the workers. So the workers are what we call violence interrupters, outreach workers, behavior change agents, hospital responders. So that's the essence of it. So I formed an NGO. And almost simultaneous with the starting of the new NGO, just about a year and a half later, I brought all my team over, all our contracts, and then COVID came, then the social protests came, and now the social divisions of the U.S. became even more disastrously apparent. But we've had a rough year, as everybody has. We are listed as one of the top 10 NGOs in the world, along with Save the Children, Oxfam, Transparency, CARE. We never sought to have that kind of designation, but we had it for about five years straight, and we're listed higher than any other organization on being able to reduce violence.

You've spent weeks warning of post-election violence on social media. We saw some clashes in D.C. after that MAGA March over the weekend. Was that the sort of violence you were concerned about, or are you more worried about something more dangerous?

Well, we're not just worried about it, we're working to prevent it and stop it. We have a number of partners for this. We are working with several other organizations and peace teams to keep cities calmer. We've done about 10 trainings on de-escalation and management of protests, on prevention of sabotage of protests, on staying safe. You can go to our website and see some of those trainings. So for the last two or three months, we've been training. We've been highly focused on Portland, D.C. and Atlanta.

I should tell you that we were expecting this as of two years ago, because of the political fragility of the country, because of the levels of inequity, the very deep sense of poor well-being, poor health, poor wages and the increases in rage-killings. All of those inflection points, the things I just mentioned and a few other things, began in the 1970s, but they've been invisibly kind of simmering, just as COVID was invisibly simmering, and now it's on an escalating part of the curve.

It's been a slower curve than COVID because it's been simmering for decades, whereas COVID really was just simmering for a few weeks, but it's been on a bad trajectory for the last several months. The election is just a dot on the graph of the deterioration in these indices and their gradual increasing in social divisions.

So post-election violence is part of a much larger threat.

Yeah. It's been rough. I mean, the rage-killings, with these shootings in churches and synagogues, public places and Walmarts, and the social divisions, the hate speech, the level of anger. And then, of course the empowerment of groups that threaten or do violence publicly. The arming of the country that's been going on for a while. But certainly elections, not just this election, often spark violence around the world.

All violence is contagious, and one event leads to another leads to another, just like one event of COVID leads to another, and leads to another. Violence behaves exactly like a contagious disease related to exposure and what your friends are doing. The best summary of this is probably the Institute of Medicine workshop called Contagion of Violence. I mean, violence has been misdiagnosed as more or less the problem, which obviously it looks like, just like leprosy and plague and other infectious processes were thought of as moral failings, but it's largely contagious. But it's contagious through the brain.

We have coping mechanisms in our brain and we do what other people do. Then, of course, trauma is an accelerator. So we hope to interrupt the spread of it through what we call violence interrupters. Basically, people can be cooled down. They can be, in a way, made to feel like it's not the right thing to do, and they're grateful to be assisted in getting a way out from whatever it is they were imagining doing, if they're reached by people who they know are talking to them in their own interests, people who have access and credibility and trust. Vehavior change is the essence of this. It's the essence of epidemic control, and it works. This is what I learned at the WHO.

So your group works in regional areas, primarily with gang violence. I'm wondering if these approaches would be applicable to responding to, let's say, the growing recruitment of militias or some of these sort of dangerous groups like QAnon. Is it possible to replicate that on a larger scale with political ideologies that may lean into violence?

Yeah, we expect so. Everything we know about violence is that people are doing what their friends are doing, and there are reasons and explanations and beliefs that people adhere to that they give as the reasons, explanations and beliefs for their doing it. But essentially they really don't want to be doing it and they don't want it done to them, but they can be incited and riled up. It can be cooled down with people who can talk with people. It's not a matter of arresting or hurting people or betraying their ideas or beliefs or anything like that. It's just helping to cool down that particular behavior of the violence associated with it and, to a certain extent, the speech, which is relevant because they're related.

It seems like the reverse is actually more effective right now, because you have a lot of election misinformation being amplified by people's echo chambers on social media, and the same thing with coronavirus misinformation.

Yeah, you're exactly right. What you're touching on is susceptibility. So for any infectious process, let's say there's three main elements. One is exposure: So how much exposure do you have to COVID? You walk into someone who's coughing right in your face, or at more of a distance. Or you're wearing a mask or not. So what is the exposure? What is your exposure to violence? What is your exposure to misinformation?

And then, secondly: What is your susceptibility? Well, if you're not wearing a mask, or if, let's say, you did get infected, but you're old or you have underlying conditions, you're more susceptible to getting a severe form of disease. There's susceptibilities for all of these things, for Ebola or cholera or anything. So the susceptibility here has a lot to do with your needs. What is your need? For acknowledgment or to belong. And I mean, not everyone would be happy to hear this, but how much does the anger help you? In other words, it's therapeutic to be angry rather than dreadful or sad or something like that. So there's a susceptibility, and again, that relates to your proximity to others who are doing this, whether it's on social media because this is what your feed is giving you, or whether it's your friends.

So then there's the bit of both exposure and susceptibility relating to each other. So you have these two variables. And here I'm staying with infectious disease, not because it's a metaphor, but because it's actually scientific, the way it's working. And the third variable, beyond exposure and susceptibility, is whether there's intervention. Something that blocks the transmission and kind of alleviates or cools things down. So in the case of COVID, that would be the mask or the distance that people have from each other, which of course would be assisted by anybody talking to you and educating you as to why you would want to wear a mask or keep the distance.

And then, for violence, that intervention is largely about violence interrupters who can help you cool down from your anger, buy some time and then start to get into your rational brain, as well as giving you a different and better understanding, and who also allow you to get the credit and acknowledgment for the strong move of not doing the violence, and the acknowledgment by someone who matters to you, in real time. A violence interrupter who you respect and you would like to get their credit as well. So this is the way that infectious diseases work: exposure, susceptibility and the interruption of transmission. For every event where you interrupting its transmission, you're preventing the knock-on transmissions, the additional transmissions, where what might have been one or two cases become 20 or 50.

How much of a role do you think Trump plays in fueling the misinformation that can fuels this violence? Do you think this situation might improve without him driving the national conversation?

This is a really good question. So our starting point is: We don't talk about people or groups. We don't name them. We're talking about the process. But one particular side is a lot more — has a lot of incitement and approval of harsh speech and dangerous speech, the kind of speech that does lead to violence. There have been direct cases of violent events where the person has repeated something that was said from a high political place. So it's shifted the norm towards violence being more normal, and groups now feel more empowered to do it publicly, to say it publicly, and to do things publicly they weren't before. So there's a contagion that has been going on from speech from the White House. Whether it's from the White House or from anyone, it's dangerous and harmful and negative.

No matter what you want politically or financially or socially, we all should recognize that speech that promotes violence is likely to cause violence. Speech has an effect on behavior. We know that. But to your point, if in the future there is less exposure to this speech, that's a very positive thing, because it's just like if you're less exposed to COVID so there's less exposure in the community, less people are going to get it. If there's less exposure to cholera as the water is cleaned up, less people are going to get it. And if there's less exposure to bias-promoting speech, this country is going to be better off. Everyone will be better off if there is less exposure to bias-promoting speech. It's so clear that's so scientifically, precisely the case in understanding the contagion of violence.

This interview was lightly edited for length and clarity.