Violence, National Gun Violence Awareness Day
Denise Tucker, right, Imani Parker, center, and Michael Abraham Jr., left, hold up cards during the End Gun Violence Candlelight Vigil in New York. AP / Julie Jacobson)

The rate of violence in the United States is staggering, leaving many of our largest cities at crisis level. Just last month, homicides in Chicago broke a 20-year record at 90 killings. In addition, the number of mass shootings and gun-related fatalities have risen tremendously between 2015 and 2016, according to the Major Cities Chiefs Association. These statistics tell us that the problem with violence is getting too loud to ignore.

While the national conversation centers on gun-control and the role of law enforcement in reducing instances of crime and violence, but there can be a more narrowly focused approach. We should start treating violence as a preventable and curable disease that can be tackled through analyzing existing evidence, identifying risk factors and preventative measures and creating grassroots programs at the community level.



In order to develop a prescription for change, it’s important that we understand individual factors responsible for the increase in violence. We all know that both victims and perpetrators of gun-related homicides are more likely to be male, according to the Institute of Medicine and the National Research Council. In the vast majority of instances for which the relationship is known, the victim is acquainted with the offender. Mental health challenges, daily stress and lack of job and educational opportunities are also key factors that increase the prevalence of violence.

Shifting the focus to improvements in education, health equity and the environment around us – or, “built environment” – we can begin to engage community members from a variety of sectors to get involved in solutions. Prior studies have shown that residential segregation, income inequality and the built environment around neighborhoods explain most or all the racial differences in violence and homicide. These factors make it difficult for various groups in one city or county to cooperate with each other and share a spirit of community.

One way to curb a situation from escalating to violence is ensuring that individuals understand alternative methods to resolve conflicts. Arguments and disputes often erupt into violent behavior because parties have not developed the skills or opportunities to calmly address and de-escalate a situation. Resources are typically poured into the criminal justice system rather than conflict resolution – a necessary life skill and a crucial prevention tactic. We should be saying to those most susceptible to violent behavior that it’s okay to disagree, but never okay to resolve an issue with violence.

Community programs and resources should equip individuals with the knowledge and skillsets to handle conflict resolution peacefully without law enforcement or violence. One such program being run out of the Kansas City Missouri Health Department is doing just that. The initiative uses the evidence-based Aim4Peace program, a boots-on-the ground approach in which members facilitate conflict resolution sessions that lead to peaceful outcomes. The effort’s successes have been recently recognized by the Aetna Foundation’s “Healthiest Cities & Counties Challenge.” 

Another way to tackle the issue of violence is by looking at it through the lens of health. When individuals don’t have access to essential health resources at the right time, we see an increase in substance abuse disorder, behavioral disorders and mental illness – all factors that influence violent behavior. Unfortunately, these health disparities sometime mean that when help is finally available, it’s too late. By the time help arrives, someone is either incarcerated or hurt.

In places like Rhode Island and others, organizations are providing essential medicine and primary care in efforts to lower the rate of prison reentry. This approach can be leveraged more often, with health providers inserted into the equation sooner and connected with those most at-risk of displaying violent behavior to provide better medical care.   

Finally, we have to tackle what is known in the public health world as the “built environment.” This is essentially everything that makes up the surroundings where people live, work and play. Too often in our country, zip code or neighborhood impact a person’s right to live a healthy life in an area where they feel safe. Those who reside in urban communities or live in poverty are too often forced to accept this as their fate.

In public health, we are reframing how communities think about and react to violence from the environmental perspective. For example, in West Virginia, benchmark data was collected and analyzed that suggests violence and areas of poverty are intertwined and impact an individual’s health. In the last two decades, I’ve seen the built environment present a new set of issues and we must now solve problems like higher rates of violence caused by poor living conditions and unsafe community spaces. To do this, we need community programs that ensure parks are safe for children to play, trails are available for people to walk and run, and public housing infrastructures are in the best conditions – in all areas of a city. 

This approach to curbing violence in our country might seem aspirational. But small, community-based programs are chipping away at the problem using the notion that violence can be cured just like any other chronic disease. Through education, we can offer critical conflict resolution skills that help individuals get through tough situations without resorting to violence. If we are deliberate about addressing health disparities, we can improve economic circumstances that provide better access to health resources.

When we improve the built environment, community structures and spaces become safer places.

Violence is a complicated issue. One that starts long before a gun is ever bought or 911 is called. And it exists for reasons much more complex than what’s being reported in media stories every day. Therefore, it will take innovative and collaborative efforts, from the top of our society down to the grassroots, to set in motion a chain reaction that inspires the rest of the nation to rethink how we approach violence.

Dr. Garth Graham is president of the Aetna Foundation, a cardiologist and former deputy assistant secretary at the Department of Health and Human Services. Visit www.healthiestcities.org



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