In 2020, the U.S. experienced in gun-related homicides, with firearm deaths becoming the for children and adolescents. Four years later, in June 2024, Surgeon General Vivek Murthy, MD, MBA, declared gun violence a , following a year in which nearly 47,000 people died from firearm injuries. The leading causes of gun-related harm -- suicide, homicide, and unintentional injuries -- impact people of all ages, races, and communities, with significant psychological effects. , 21% have been threatened with a firearm, and 19% have had a family member killed by a firearm.
In response, the Biden administration has increased federal funding for violence reduction. The Department of Justice's Community-Based Violence Intervention and Prevention Initiative, launched in 2022, has distributed nearly $200 million in grants to support community-based violence interventions (CVIs), local governments, research and evaluation efforts, and other violence reduction initiatives. Notably, Murthy's advisory on firearm violence calls for increased implementation of CVIs.
As frontline witnesses to the effects of violence, clinicians too play a crucial role in prevention and advocacy.
The Impact of Community-Based Violence Interventions
CVIs encompass a broad spectrum of programs designed to implement evidence-based strategies and disrupt the cycle of violence in communities. These programs have proven to reduce medical costs and legal system fees, and save lives. For instance, hospital-based violence intervention programs (HVIPs) have shown they can save in incarceration and medical costs annually, with some programs reducing injury recidivism rates fourfold.
When an individual is admitted to a hospital due to violence, an HVIP specialist may conduct a needs assessment, develop a personalized safety plan, and connect the patient to essential resources like housing, mental health services, and job training. This ongoing case management ensures the patient's safety and progress while offering long-term support and regular check-ins. HVIPs, often run by a combination of medical staff and community partners, provide a direct opportunity for physicians to help reduce violence. Other CVIs, such as safe passage programs (which ensure students can commute safely), environmental redesign, and group violence interventions have also demonstrated significant success.
Beyond only the federal government, municipal governments have also increased funding for violence prevention. In 2023, Philadelphia boosted its anti-violence investments by $46 million, bringing the total to . Their plan, Philadelphia Roadmap to Safer Communities, funds various CVIs and allocates funds for summer and school year programs, community evening resource centers, and scholarships. This comprehensive approach placed Philadelphia at number two in the for 2023.
Disjointed Services
CVIs, by their nature, operate at the community level. However, while federal, state, and city funding is vital, the efficacy of CVIs hinges on collaboration among small, impactful programs. Unfortunately, these programs often operate independently, leading to diffuse grant funding, competition, and fragmented efforts. Without coordination, inefficient use of funds can lead to redundant services, missing opportunities to maximize their impact.
For example, CVIs often work with the same individuals. Imagine a 16-year-old who, after being admitted to the hospital, begins working with an HVIP team. The HVIP connects him with critical resources such as medical follow-up, mental health counseling, and social assistance with housing or education. They also help him develop a personalized safety plan, provide access to legal support, and connect him with job training programs -- essential tools for stabilizing his situation and rebuilding after trauma.
As he returns to his community, he might become involved in another conflict. This time, a street outreach program steps in. While the outreach workers focus on conflict mediation and community engagement, they might also offer him services similar to those provided by the HVIP. If the street outreach program is aware of his previous contact with the HVIP, they can better focus their efforts on navigating the resources he's already connected with, rather than duplicating what has already been done.
By collaborating, CVIs can prevent this overlap and instead build on existing efforts. This coordinated approach allows each CVI to hone in on their strengths -- HVIPs focusing on in-hospital resources and long-term planning, and street outreach teams excelling in community-based support and conflict resolution -- ultimately improving his chances of recovery and reducing the likelihood of future violence.
A Model for Coordination
To address the challenge of coordination, it's essential to consider successful strategies from other community-based programs. In Houston, the serves as the conductor of city programs to end homelessness. As a uniting body, CFTH ensures that over 100 community programs work together, sharing data and optimizing funding allocation. , it has housed over 32,000 people, had a 90% success rate in local housing programs, and directly coordinated $179 million in public funding for homelessness solutions in the previous fiscal year. CVIs may achieve similar success with coordination in place.
Violence reduction councils (VRCs) offer a comparable model to CFTH's project coordination. These councils bring together stakeholders, including law enforcement, public health officials, local residents, and CVIs, to coordinate efforts in reducing violence within a community. VRCs focus on identifying the root causes of violence, strategizing interventions, and fostering partnerships to implement comprehensive, evidence-based solutions.
Currently, the VRC model emphasizes data collection across community stakeholders after a homicidal or nonfatal shooting occurs. Council members then create a list of recommendations for prevention and implementation plans. The first VRC was established in Milwaukee nearly 20 years ago and in monthly homicides within the first 2 years. Violence reduction councils can serve as the central hub for not just CVIs but also other violence prevention agencies within a community. Given their centrality, cities may adapt such councils to help bring programs together and better outline the roles of CVIs to prevent redundancy. Additionally, through this coordination, CVIs can directly adopt the recommendations of the council. To encourage broader adoption, researchers at Johns Hopkins Bloomberg School of Public Health have for communities interested in forming VRCs.
Physicians, especially those involved in or interested in running HVIPs, can play a pivotal role in establishing and leading VRCs. Physicians can advocate for the creation of VRCs within their communities, help design and implement data-driven strategies, and ensure that medical and mental health services are fully integrated into the broader violence prevention efforts. By participating in or leading these councils, physicians can bridge the gap between healthcare and community-based interventions, promoting a more coordinated and comprehensive approach to violence reduction.
CVIs reduce violence within communities, but cities can maximize their impact with better coordination through violence reduction councils and support from physicians.
is a third-year medical student at Baylor College of Medicine in Houston.