Monday, December 28, 2015

When gun violence felt like a disease, a US city turned to the CDC

 DECEMBER 25, 2015

WILMINGTON (Delaware) — When epidemiologists from the Centers for Disease Control and Prevention came to this city, they were not here to track an outbreak of meningitis or study the effectiveness of a particular vaccine.

They were here to examine gun violence.

This city of about 70,000 had a 45 per cent jump in shootings from 2011 to 2013, and the violence has remained stubbornly high; 25 shooting deaths have been reported this year, slightly more than last year, according to the mayor’s office.

A city councillor, Dr Hanifa G N Shabazz, said the violence felt like an illness, so city and state leaders turned to the nation’s best-known disease specialists for help investigating it.

“Just like any other epidemic,” Dr Shabazz said, “we need to be quarantined, categorised by severity, infused with nutrients, healthy substance, programmes and healed.”

The study has been received here with a measure of enthusiasm and questions about what to do next. And it has caught the attention of researchers around the country, who call it a fairly rare look at gun violence by an agency that they say has been effectively limited for nearly two decades in pursuing that line of inquiry by its congressional appropriation.

“To me, it’s a reminder of what CDC can do,” said Dr Garen Wintemute, an emergency room physician and the director of the Violence Prevention Research Program at the University of California, Davis School of Medicine.

But he added: “This is one study in one city. It falls far, far short of what they can do, what they are trained to do.”

The final report, which has been submitted to the state, reached a conclusion that many here said they already knew: That there are certain patterns in the lives of many who commit gun violence.

“The majority of individuals involved in urban firearm violence are young men with substantial violence involvement preceding the more serious offence of a firearm crime,” the report said. “Our findings suggest that integrating data systems could help these individuals better receive the early, comprehensive help that they need to prevent violence involvement.”

Researchers analysed data on 569 people charged with firearm crimes from 2009 to May 21 last year, and looked for certain risk factors in their lives, such as whether they had been unemployed, had received help from assistance programs, had been possible victims of child abuse, or had been shot or stabbed. The idea was to show that linking such data could create a better understanding of who might need help before becoming involved in violence.

“The CDC’s research helped show that its analysis can help identify persons most at risk of perpetrating or being victimised by gun violence,” Ms Rita Landgraf, the state’s secretary of health and social services, said in a statement.

“However, the CDC report is not meant to be an operational plan for reaching those individuals and turning their lives around,” Ms Landgraf said, adding that she planned to lead a community advisory board on intervention. Local leaders are also calling for a renewed focus on intervention.

Wilmington, a city better known for chemicals and corporations than crime, is grappling with a level of violence that has brought fear even to trusted community pillars here.

“You’ve got maybe a few hundred holding the city hostage,” a county councilman, Mr Jea P Street, said.

Take the West Center City Early Learning Center at West Sixth and North Madison Streets, which has been in the neighbourhood for decades, in a grid of brick row houses, churches and the odd corner store. This stretch of the neighbourhood has become a gallery for shootings, and bullets pock the fence around the playground.

The children there “come back to you talking like, ‘Somebody got shot outside my school’,” said Ms Sharon Tolbert, 46, a cosmetologist with four children and five grandchildren who attended the day-care centre. She added, “You’re always on edge, you’re always on pins and needles.”

The centre made the wrenching decision this year to move to another part of the city, even though it means taking a vital source of support out of the neighbourhood.

“You could not continue to allow those kids to be in danger, right in the path of bullets flying,” said Mr LaMontz Hayman, 46, a mortgage broker who attended the day care himself and is now on its board.

Researchers like Dr Wintemute, as well as the Obama administration, say gun violence is an issue of public health that would benefit from epidemiological study and rigorous data analysis. The agency was a key player in such research until the mid-1990s, when, after pressure from gun lobbyists, Congress stripped US$2.6 million (S$3.7 million) — which the agency had been spending on gun violence research — from the CDC’s budget, and stipulated that none of the agency’s funding “may be used to advocate or promote gun control”.

It is not an outright prohibition, and while there has been some work done with available data, researchers and former CDC officials say those measures effectively discouraged the agency from funding research specifically on gun violence and “shifted the kind of proposals that we were submitting”, said Dr Matthew Miller, the co-director of the Harvard Injury Control Research Center.

In 2013, President Barack Obama called for new funding for agencies like the CDC to study gun violence, but no appropriation was made. Officials like Ms Nancy Pelosi, the House minority leader and a Democrat, and even Mr Jay Dickey, the former Republican representative from Arkansas who wrote the restrictive language, say such research should be funded.

But the language — and the lack of appropriations — remained in the spending bill that Congress passed last week.

Experts said the request from leaders in Wilmington seemed to have created a specific opportunity for a small group of researchers at the Epidemic Intelligence Service, the CDC division that might investigate a disease outbreak or the aftermath of a disaster, to look at the causes of gun violence.

“Our investigation was not focused on the mechanism of injury,” said Ms Courtney Lenard, a spokeswoman for the agency, “but rather on understanding opportunities to intervene on more root causes of violence such as prior exposure to violence, family disruption, and limited educational attainment.”

The Wilmington research sidestepped the funding restrictions, because it was a response to a request and because “it doesn’t focus as much on the issue of guns themselves, it really focuses on these other risk factors and ways to intervene,” said Dr Linda Degutis, the former director of the National Center for Injury Prevention and Control at the CDC. She added that it was frustrating to be unable to do an extensive study on gun violence while she was there.

Mr David Hemenway, a director of the Harvard Injury Control Research Center, said that could be a shortcoming of an effort to look at gun violence. “Unfortunately they feel like they can only talk about part of the problem, they can’t talk about the gun part of the problem,” Mr Hemenway said, adding, “Looking at the supply side — how do they get these destructive weapons?”

Questions remain about whether the focus on risk factors before a shooting amounts to profiling people who have not committed a crime, and how exactly to coordinate data, social, health and educational services that could help intervene. Still, public health experts say it is a methodically sound and instructive study, if limited.

“If there were adequate funding on firearm-related research, there would have been papers out on this a decade ago, not just in Wilmington, but in many other large cities,” Dr Miller said.


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