I'm not usually a big reader of magazines, unless I'm stuck at the airport. Then I can usually be found with piles of them in my arms as I hunker down for the long wait. Last week found me with a copy of the science magazine, Discovery. The bright yellow shiny cover had something of particular interest on it: a gun. The caption: Inside the Public Health Crisis of Gun Violence.
Inside were brief mentions of different public health approaches to gun violence, as well as some references to studies that sounded potentially interesting. What struck me though - and it struck me again in a later conversation with my friend, Natalie Hiltz - is that if we're going to use the disease metaphor to understand gun violence, then it's not enough to start throwing out terms like 'public health model' as though suddenly invoking this is a panacea to the problems faced. Public health approaches range from mass inoculation campaigns, to identifying and targeting community-level risk factors to doing the same at individual or groups levels. So, if you're going to do public health, let's start by asking: what's the target?
Here criminologists might be able to help out a bit. And, ironically, the approach is not dissimilar to one used in public health: identify those few individuals who not only
cause the most 'harm', but are also the most influential within their social networks. In public health language, they could be thought of as disease vectors or disease carriers but, since I can already feel the grimaces and squeamishness of some of my colleagues, let's go with the criminology term: the "power few."
The term 'power few' was coined by Larry Sherman (2007) to refer to "the small percentage of places, victims, offenders ... in any distribution of crime or injustice which produces the greatest amount of harm." Just as ‘crime concentrates' in particular spaces, we similarly find that a small number of offenders, victims, and so on are typically over-represented within criminal justice and other statistics. Thus, targeting these ‘power few individuals’ and their ‘power few spaces’ is likely to reveal significant information about how best to reduce the volume of offenders and offenses. A similar point has been made by Robinson (2017) who said that efforts aimed at identifying any power few, along with investments in resources aimed at reducing the harms produced by or to them, “will pay dividends in terms of harm reduction”. You see this in cities like Chicago where they use social network analysis to not only identify the 'power few', but also to predict who within the same or rival gangs might be a target of a retaliatory violence.
I realize this flies in the face of what a lot of other criminologists are calling for in response to the latest spike in gun violence, which is addressing community-level risk factors, like poverty and affordable housing. However, if you're going to label something as a crisis, and people are dying, tackling poverty and affordable housing are long-term initiatives that will not save lives in the short-term. I recently quoted Thomas Abt from his book Bleeding Out, who I think expresses it best by using the metaphor of someone in an ER, who has just been shot. What does the doctor do? Does she deal with the systemic factors that lead to the violence? Does she try to address his poverty? Does she try to fund after-school programs for kids? Or try to tackle housing issues? She does not. She tries to stop the bleeding.
So, what do we do? Let's use the infectious disease of Typhus as another example. In the early 1900s typhoid fever suddenly emerged within family groups in New York. What made
its appearance unusual is that it was largely unknown in some of the communities in which it appeared. A researcher tracing the spread of this disease observed that each
family had one thing in common: a cook named Mary Mallon. He believed she was an asymptomatic carrier but her lack of cooperation meant it was only a theory. In 1907 the New York City Health Department finally stepped in and ordered Mallon tested. Once proven a carrier, she was quarantined. Later released, typhus outbreaks reappeared in New York City. Identifying and quarantining "Typhoid Mary" stopped the outbreaks again.
Now, what has largely prevented Typhus from reemerging as a systemic health issue, at least in North America, is the provision of clean drinking water and proper sanitation, as well as social education on the importance of hand washing. Vaccination and antibiotics haven't hurt either. So identify those power few who are generating outbreaks, let's take them out of the equation to arrest an outbreak, and then let's get serious about long-term preventative measures. Oh, and while we're at it: let's stop treating everything like it's an EITHER-OR situation. It's usually an AND situation.