Today’s Managing Health Care Costs Number is 5,947
Highly public shootings, like the (terrorist) attack on Planned Parenthood in Colorado Springs on Friday, make many of us think of the public health imperative of decreasing gun deaths. It seems there is news of a mass shooting almost daily – and these shootings have a powerful narrative force. They happen in places (malls, colleges, clinics) where we have been – and they are random. The victims of these shootings could easily be us or our loved ones or our friends.
Propublicapublished a powerful piece this weekend pointing out that our approach to pushing gun control as a response to these tragic shootings is focused on these shootings where victims are often white. But these types of shootings represent a small fraction of that ~12,000 homicides in the US each year. Half of the victims of these homicides (5947 in 2012) are black males, who represent just 6% of the population.
We are missing the opportunity to spend trifling sums of money to implement community programs that have been shown to substantially reduce the number of young black men murdered each year. The Propublica article focuses on the Boston Ceasefire program.
Under Ceasefire, police teamed up with community leaders to identify the young men most at risk of shooting someone or being shot, talked to them directly about the risks they faced, offered them support, and promised a tough crackdown on the groups that continued shooting. In Boston, the city that developed Ceasefire, the average monthly number of youth homicides dropped by 63 percent in the two years after it was launched.
Ceasefire programs have dramatically reduced the rate of gun-related homicides in 7 of the 8 cities where this has been implemented. The cost is not zero – it’s a few hundred thousand dollars a city. Hiring a competent and street-wise manager is key, as is support from the police, politicians and the community. The programs require continual tending – even the much ballyhooed Boston program ended when its police lead was promoted.
This American Life covered another approach that has proven successful at reducing gang violence. The crime-ridden city of Richmond California inaugurated an Office of Neighborhood Safety – which identified that 17 young men were responsible for 70% of all the crime in the city – a city that had 42 homicides in 2006 before the program started. The intervention – they paid these young men between $300 and $1000 a month to be law-abiding. This is not nearly as much as they could make dealing drugs –but enough to lower the murder rate by 2/3. 80% of the participants in this program have not had an arrest – a wild success.
These programs cost little for every life saved, and they would not likely face the withering opposition of the NRA. But still they have not been aggressively promoted by the Obama administration. The funds the Obama administration requested have been slashed by Congress.
In medicine, as in life, we often focus on events with narrative arc – an epidemic of Ebola, or the devastation of brain cancer. These are important – but sometimes a small investment in social services can save a huge number of lives. In this case, as the Propublica article emphasizes, the lives saved would be black lives. Funding these programs is part of how we need to show that black lives really do matter.
