The United States is in the midst of not one but two pandemics: COVID-19 and gun violence. Our country has seen the highest increase in per capita homicides in modern history since the start of the COVID-19 pandemic. (Federal Bureau of Investigation; https://bit.ly/3EE0jbM.) This translates to 21,570 people being victims of homicide in 2020, a 30% increase from the previous year. We are collectively conditioned to assume that Congress will sit idly by, but that assumption may prove wrong this time.
Congress is about to make perhaps the biggest investment in violence prevention in our nation’s history. President Biden’s $1.7 trillion jobs and social safety net bill — called the Build Back Better Act — includes a $5 billion investment in community violence prevention and response, which would be split equally between the Centers for Disease Control and Prevention and the Department of Justice. This new funding, if passed by Congress, would enable dozens of cities experiencing the highest levels of violence to deploy evidence-based strategies to break the cycle of violence.
The ability to disburse funds widely across the United States is essential. Most people think that big cities are the source of most of the violence, but the distribution of violence in this country is much more nuanced and no region is spared. (CBS News. April 19, 2021; https://cbsn.ws/3ow0X5D.) It’s no surprise to see Baltimore near the top of a list of America’s 20 cities with the highest homicide rates, but that list also includes cities as diverse as San Bernardino, Calif.; Birmingham, AL; and Dayton, Ohio. Clearly, a national solution is warranted.
What would such a solution look like? It would maintain a particular focus on preventing violence among those most at risk of becoming victims or perpetrators. We know that violence tends to be concentrated not just in certain cities, but in certain neighborhoods. Only one percent of people living in these high-risk areas are most at risk of engaging in serious violence at any given time, and public health approaches can be deployed by identifying these people.
The public health approach is found in many models of violence intervention. Some key examples identified in President Biden’s plan are hospital-based violence intervention programs, targeted trauma-informed care using cognitive behavioral therapy, and street outreach and violence interruption. . (Biden-Harris Community Violence Response Fact Sheet. April 7, 2021; https://bit.ly/3oAtl6T.)
Research has demonstrated that not only are these interventions effective (John Jay Research and Evaluation Center. November 9, 2021; https://bit.ly/3IwldMx), but their health-focused community approach allows them to avoid the traditional partisan deadlock that surrounds Second Amendment issues.
Critical role of EPs
These models have differences, but they share basic elements. They focus on those most at risk and deploy crisis interventions when violence is imminent; they provide intensive, long-term community care that treats physical and psychological injuries; they incorporate comprehensive case management by culturally competent workers who provide links to community services, mentoring and medical care; and they work upstream to act on the social determinants of health.
This proposed investment may be new to many, but emergency physicians have played a vital role in the development and advancement of many of these solutions. One example is the Health Alliance for Violence Intervention (HAVI), the national organization representing hospital violence intervention programs. Four of HAVI’s seven founding member programs were led by emergency physicians when it launched in 2009. The model has spread nationally since then and now has 50 members and 40 other new and developing programs. (The Health Alliance for Violence Intervention. www.thehavi.org.)
Our specialty societies have also supported these approaches. The American College of Emergency Physicians Council passed a resolution in 2013 on establishing hospital-based violence intervention programs and more recently supported the Bipartisan Solution to Cycle Violence Act of 2021 introduced by Reps. Dutch Ruppersberger (D-MD) and Adam Kinzinger (R-IL). (https://bit.ly/3oBZLOm.) It is much smaller than the investment included in the Build Back Better Act, but this legislation is supported by organizations as diverse as the National Association of District Attorneys, the Fraternal Order of Police, the Association National for the Advancement of Colored People, and a variety of health organizations.
The $5 billion investment has passed the House of Representatives and is awaiting a vote by the US Senate, as of this writing in December. Its final adoption is uncertain, but the proposal represents the power of public health in preventing violence. Physicians, public health professionals and communities have developed these programs, studied their effectiveness and championed them as solutions to violence for many years. Now it’s up to Congress to seize this historic opportunity to save lives by funding them.
Dr. Fischeris a Clinical Assistant Professor at the University of Maryland School of Medicine, where he is Fellowship Director of the Health Policy and Leadership Fellowship Program. He is also the policy director of the Health Alliance for Violence Intervention..