kevin keepper

Step 1: Create an Enabling Environment for Markets

Having family in Chicago myself, and having lived in a number of large cities, Nairobi included, I was excited to learn about the work that Dr. Gary Slutkin is doing to address and overcome violence in metropolitan areas. Dr. Slutkin is the Founder and CEO of CeaseFire, a Chicago-born and based nonprofit that successfully piloted and is now rolling out a proven method of violence treatment and prevention. The operating principles, interestingly, are based on the foundation of Dr. Slutkin’s experience and success in epidemic eradication in Africa. Below I am pleased to share a most interesting and inspiring discussion on this topic.

Kevin Keepper, Tell us a bit about your work in disease control.

Dr. Gary Slutkin: I’m a physician, trained in infectious disease control, and I’ve worked on epidemics for most of my career. Most of that work was in Africa with the World Health Organization (WHO). The epidemics I worked with are tuberculosis, cholera, and HIV/AIDS. I had the range of 13 countries in the middle of Africa as my responsibility with respect to the AIDS epidemic. Before WHO I worked in Somalia with refugees. These years grounded me in what was going on in these countries and also grounded me in the methods for disease control. Currently you are working on violence prevention in Chicago. Could you briefly connect the dots that led you into this line of work in this particular city?

Dr. Gary Slutkin: When I ejected myself from the WHO, I wanted to come back to the US to reconnect with my family and my culture. It presented a problem to me, however, as to what I would work on when I did return. I was grounded in epidemics and infectious disease, but I didn’t want to practice medicine in the States. Family connections drew me to Chicago. My personal interest drew me to gun violence. In Chicago, gun violence was the major issue (as it is in most major cities). I began to ask around to learn about what people were doing about this violence thing and what they told me did not make sense to me.

I understand violence to be a behavioral issue and know that punishment, for example, is not a good means by which to go about behavioral change, yet this was a prominent response mechanism. It really struck me that this was a problem that people were really going down the wrong track on over and over again. I suddenly saw a confluence in my search for the next project and the problem which persisted. I decided that by applying the methods from the WHO, I could treat the violence epidemic in Chicago. Could you please elaborate on just how you see violence to be a behavioral epidemic?

Dr. Gary Slutkin: Sure. We see the spread of violence all the time in many different contexts. Violence at soccer matches, for example, can easily outbreak into riots. It boils down to the fact that when one person hits another, the tendency is to hit back and, as it goes, one event leads to another. This is, in fact, the history of World War I. If you are looking for the root causes, as I am prone to do, quickly you recognize it to be an epidemic. Also, we are prone to developing behavior after modeling, and violence is no different.

By understanding violence in this new light and by applying what we know about epidemics and behavioral nature into a strategy that addresses violence as an epidemic and provokes behavioral change, CeaseFire is working to eradicate violence much like the eradication of TB or HIV/AIDS in Uganda I did some years ago. How would you go about changing the behavioral norms of a community?

Dr. Gary Slutkin: What we are doing at CeaseFire is taking what is intuitive and developing a system for it. You will see that most cities have ad hoc groups that attempt to address the violence or gang issues in their neighborhoods. To do things to effect, however, this work needs to be professionalized. For example, it isn’t enough just to have a cure for smallpox, you have to have a system to deliver the vaccine in which you identify vaccine deliverers, who gets it, what ages, how do you reach moms, etc.

Here is a brief breakdown of our operational strategy: we hire people from different “tribes” into a neutral organization and employ them as “interrupters” of violence. We also employ another group, who we call outreach workers, that does longer-term work with the highest-risk folks in the community to influence basic behavior change. Some of the larger norm-changing activities we undertake (health folks are always working on norm changes) are mobilizing community-wide reactions to a shooting (no matter who did it) or executing public education campaigns against violence which everyone participates in, just as you would in an immunization campaign, or a “no-smoking” campaign. Although I’m guessing our readers recognize the connection between your work and the role of peace in developing communities and for the BoP, I would like to chat for a minute about this issue. We know that an important catalyst for growth in all countries is an enabling environment. Paul Collier notes that war-torn countries are essentially subject to “development in reverse.” Could you share your thoughts on this subject?

Dr. Gary Slutkin: Paul Collier argues, and I’ve seen it myself, that there is no development happening where conflict is occurring. Conflict is at least one of the main “blocks” or “lids” on development. The other major factors he addresses – being landlocked, resource poor, etc. – might be there or not, but no one is imagining that the scores are going to get better until after the war stops.

Collier points out that it takes years to recover from war and this is absolutely the case. What we see is that war essentially morphs into crime. That’s what is going on in Gaza right now and that’s what has been going on in South Africa too (you’ve got higher rates of killing in South Africa now than during the civil war). And the question I believe is helpful to address is: why does this crime persist? The answer is that violence becomes an accepted behavior.

Currently there are no good means by which to address the persistence of violence following wartime. International prevention efforts, such as UN peacekeeping, have been sometimes very impressive in the short term, but they are simply not engaged with folks in the real hard spots. Furthermore, the traditional law enforcement systems are dysfunctional in developing countries and even in developed countries violence often occurs outside of the scope of the law enforcement camps. The more effective and appropriate way to address the issues here is to intervene at a community level. It is much better if the community itself can change its norms and, in a way, immunize itself. That is essentially what we are doing. What are some of the challenges or constraints that you have faced thus far in your work as you aim to grow your international portfolio?

Dr. Gary Slutkin: Our number one issue in trying to grow our operations internationally is finding groups and individuals with which to work. Besides building our own capacity, we are concerned with finding the organizations that are properly placed, properly situated, and sufficiently respected that are willing to or already are working on bringing peace to their communities.

CeaseFire International Growth Anticipating that some of the folks visiting this blog are amidst these post-conflict communities, what would be your advice to them in regards to getting involved or applying your lessons learned?

Dr. Gary Slutkin: In areas where there is a lot of violence – either from gang violence and crime or from low-intensity conflict – we are interested in hearing from those folks and finding those organizations that are doing some work in this area, or who want to be. We would like to be able to connect them with ourselves and with others who have the technology and capacity to help these groups cope with their situations. As you know, we are in Iraq, looking to Afghanistan, and certainly looking for the ways to be helpful to other places that have been suffering too long (Eastern DRC for sure, Israel, Palestine, etc.).

Our goal is to roll out our methods and deliver the technology to ultimately eradicate the epidemic of violence. Our part is small: we do the training, we get them to recruit and get workers and so on. We are simply implementing the transfer of technology. We are modeled after WHO in terms of the model of providing technical guidance, and hope that this lean structure will enable us to continue to scale our work and impact.