REBROADCAST / American Diagnosis / Violence Is Contagious

Hi everyone, I'm Dr. Celine Gounder. I'm the host of The Epidemic Podcast. Thanks for listening to the show. We're on break this month, but we'll be back with new episodes after Labor Day. In the meantime, we're replaying some episodes of our sister podcast, American Diagnosis. Formerly known as In Sickness and in Health. Gun violence has spiked during the pandemic. In this episode, we'll look at the theory that gun violence spreads like a virus. We're going to look at how triggers for violence spread online and in the real world. And we'll hear from former gang members about how they're trying to stop the spread. Thanks for listening. Here's the show.

How does violence get transmitted? It's like a disease.

A lot of the work that I've been looking at has been trying to sort of stop these chains of transmission. If you can stop some of these cascades, we can probably also stop subsequent shootings.

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 We'll do something about it.

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. Chicago has a reputation for gun violence.

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

And also in Chicago, the Fourth of July holiday once Chicago once again erupted in gun violence.

Homicides so far this year already up nearly 50% over last year.

What's going on in Chicago? I said the other day, what the hell is going on?

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 Tomas Ortiz lives. Peace grew up with his mom and grandmother.

It was tough. I was, you know, a lot of people that know about Humboldt Park, they know it was a supposedly quote-unquote terrible place. A lot of high-risk activity going on in Humboldt Park, a lot of shootings, killings, uh, just a lot of high-risk activity, a lot of gang banging.

Tomas says the violence was something people in his neighborhood got used to, something they felt was normal.

It's something you grow up seeing every day. It's a norm to you. You hear shots in the morning. You might hear shots before you go to sleep, late at night, 4, 5, 6 in the morning. You know, these are things that is every day. There's something happening every day. You see violence.

This is something Tamaz had firsthand experience with. He was in a gang called the Latin Kings.

How can I put this?

I was known by a lot of people Tomas says he didn't have a good reason for joining the gang. It just happened.

It was more like just, you know, hanging with friends, family, having an extended family away from family.

He got pretty high up in the gang, too, before a charge for guns landed him in federal prison. We'll catch up with Tomas's 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 Tomas 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?

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

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

Diseases can be transmitted, you know, 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. You know, they get transmitted and passed along through these sorts of networks.

And not just a disease, but a preventable disease.

This is the idea that violence is a communicable a disease, and that we need people to stop the transmission of violence.

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.

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

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.

We have to understand the pathways through which things are transmitted. So if it were like a common cold, then you could— you would catch a bullet like you caught a cold. Then it would be as if every time somebody sneezed, there would be a sort of rash of shootings. And there are absolutely sort of random victims in gun violence, and it happens 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— 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.

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.

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 network. 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, well, 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, a gun has changed two sort of 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.

So now the guns are around you. You're exposed to them.

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, you know, a quote, innocent bystander, right? 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 a simple exposure to gun violence.

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.

This is sort of 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? So 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.

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.

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

This is Desmond Patton. He's a professor at Columbia University in New York.

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 and in how we think about virtual versus physical spaces. And for young people that are born in a digital era where social media has been a large part of their life, those distinctions aren't very very clear.

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.

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.

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

I was sitting at my desk, and I saw this headline crashing across my screen that said, "The gun-toting gang girl of Chicago." Jakira Barnes. 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 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.

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.

Ja'Kyra, after Tyquan's death, created a Twitter handle, um, Tyquan Assassin, which does two things. One, it memorializes "Taekwon," and 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.

Then another friend of Jakhira's was killed, this time allegedly by the police.

And during that time, March 27th, 2014, she took to Twitter to respond to that grief. And you saw this young woman who was gang-involved, who had allegedly shot or killed up to 20 people, grief and mourn and was clearly in a lot of pain from that death. And then 2 weeks later, unfortunately, Ja'Kyra Barnes was shot and killed, allegedly by a rival gang.

Desmond started looking back at the Twitter feed to see how Ja'Kyra had been tweeting up to her death.

Again, the initial response when someone dies is grief, and how over time is 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 threat. Violence, 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 moment plan and have a clear idea about retaliation?

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. But there was an interesting finding that could have very real-world impacts for gun violence prevention.

Expressions of grief come about 2 days before aggressive tweets in our Chicago-based Twitter dataset. So it's really clear that there's an opportunity or a window of opportunity to think carefully about the pathway of aggression based on responses to grief and loss on Twitter.

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

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 as a data point in assessing violence and treating violence. And so we now have outreach workers or violence interrupters that are looking into things that are happening acting on social media. So there's the e-responders program here in New York City that have taken those outreach workers and put them online, and they are now monitoring social media and trying to do the exact same things but in the online space.

And there are people mediating these same kinds of conflicts on the streets too. Remember Tomas from the top of the show? He went from gangbanger to violence interrupter.

To me, I look at it like giving back in a sense for maybe the damage I've probably done in the streets. I was part of the problem, now I'm part of the solution.

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

I was introduced to Cure Violence when I came home after the 7 years of the fed bid. I was like 38, 39 years old now. Came home, got introduced to Cure Violence, and they was like, man, this is 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, volunteered a little bit. I liked it. Been here ever since I've been home. And that's going on 8 years now.

Tamaz's ties to the community as a former local gang member helps him defuse a fight before it happens.

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

The police never enter the picture.

I have a little— I have a level of respect for everyone, first and foremost. I'm doing the job and I respect the job that they do. So I really don't try to interact when I'm doing interruptions like that on the streets. Because if you're seen interacting with the police in the neighborhood, then they're like, oh, you talk to the police, you're giving police information. So that kills my credibility to talk to the young people.

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

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 it's The anger can wear down and their feeling for retaliation or even to do something would, you know, be detoured. And they probably end up— it'll be a fight, maybe a fistfight, but it would be something after that. No longer, you know, it wouldn't be a situation anymore.

If someone like Tomas can get in there and convince someone to stop and think he might save someone's life.

I had a kid that was doing good, going to— the kid was going to Job Corps, and he got shot. I was able to talk to him while I was in the hospital as a responder, and the kid was telling me he was very angry. I'm gonna 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? So I was able to talk to him and let him know the consequences of even getting their uncles. You are still considered an accomplice by even calling somebody to do something on your behalf. That means your school, everything you work for goes down the drain. You may be going to prison for what happened if something happens. You're here with us, something we learned, and I can understand how you feel, but doing what they did to you in retaliation, I don't think it would be a smart idea 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.

Are you still in touch with this young man today?

Yeah, as far as I know, he's doing well. I believe he's doing good. And I'm glad you reminded me. I might have to reach out to him.

I'm glad to hear it. Studies show this kind of intervention works.

I mean, it's been shown repeatedly that Chicago's violence can drop 40%, 50%, 70%.

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. 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.

You know, 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. And that it's no more refractory in Chicago than it is in any other place. It's there, you know, 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.

The kind of violence interruption work that Tomas was doing with Cure Violence has been applied to cities all over the US and even the world.

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

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?

I mean, 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, The violence went up, and when it was refunded, it went down. And then when it was defunded, the violence went up.

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 7 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 New York City for the first time in over 25 years. This is also why the cure and 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.

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

Andrew Papachristos again.

I'm going 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 from a heart attack, you know, 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 with food. And at the same time, you're going to see movements about trying to get young people to get fit and move and talk talking about the, the benefits of certain types of fruits and vegetables. All of those things go to attack the obesity epidemic, the sort of the here and now as well as the big picture stuff. And that's sort of what you need in the realm of gun violence.

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 change, you can't just give them a bridge to nowhere. The same applies to the problem of gun violence. 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 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. In our next episode, we'll talk about how guns are transmitted from person to person. 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. Today's episode of In Sickness and in Health was produced by Zack Dyer and me. Our theme music is by Alan 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 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. Céline Gounder. This is In Sickness and in Health.