Public Health Approaches to Reducing Community Gun Violence

Gun violence is the number one public safety priority for many U.S. cities. It extracts extraordinary human and economic costs: firearms were used in 14,414 homicides committed in the United States in 2019, accounting for 75 percent of all homicides.1 There were 283,503 nonfatal crimes of violence committed with firearms reported to the police in 2019, and many more gun crimes go unreported.2 Firearm homicides are the third-leading cause of death for persons twenty-five to thirty-four years old and the leading cause of death for Black males aged fifteen to thirty-four.3 One study estimated that costs related to medical treatment, disability, lost productivity, and criminal justice responses to gun violence totaled $229 billion annually.4 The impacts of gun violence go well beyond the people most directly involved in it. Fear of gun violence and the things we do to respond to that fear result in enormous costs to individuals and local governments. Economists at the Urban Institute found that surges in gun violence reduced neighborhood home values by 4 percent and decreased credit scores and home ownership in affected communities. A single gun homicide in a census tract in a year resulted in decreases in home values the following year of $22,000 in Minneapolis and $24,621 in Oakland, and decreases in home ownership by 3 percent in Washington, D.C., and 1 percent in Baton Rouge.5

Useful frameworks for addressing violence from a public health lens include efforts to advance policies that create environments that are less conducive to violence or that facilitate social conditions that constrain violence.6 Because of the wide availability of firearms and alcohol as well as blight characterized by vacant buildings and pervasive signs of physical decay and social disorder, public health scholars and advocates have sought to reduce community violence through policies that impact these conditions. Ineffective and unjust policing practices harm Black and brown individuals and communities not only with respect to over­incarceration and police violence, but also by creating environments in which law enforcement infrequently brings shooters to justice and victims’ needs go unmet. I contend that efforts to empower impacted communities to advocate successfully for needed reforms in policing and prosecution to promote more focused and balanced approaches to violence prevention–such as highly focused criminal justice deterrence coupled with services and supports for individuals most at risk for gun violence–is wholly in keeping with the public health tradition of improving the health and safety of communities by promoting systemic changes to correct prior injustices.7 Successful public health models for violence prevention also seek to support those at greatest risk of violence by addressing factors that elevate the risk of violence.

Most U.S. firearm policies are designed to reduce the availability of firearms to individuals who have been convicted of serious crimes or who the courts have deemed dangerous through the issuance of restraining orders or involuntary commitments for mental health treatment. The type of gun policy that is most strongly and consistently associated with reductions in homicides is mandatory licensing of handgun purchasers.8 This sort of licensing typically involves more robust systems for screening out prohibited purchasers, and studies indicate that these laws deter the diversion of guns for criminal use.9 Connecticut’s adoption of handgun purchaser licensing and Missouri’s repeal of its licensing law resulted in substantial changes in firearm homicide rates relative to forecasted counterfactuals.10

Restrictive licensing laws for the concealed carry of firearms, typically requiring applicants to have special reasons to justify the need to carry a firearm and no evidence of violence or law-breaking by the applicant, are also protective against violent crime, including homicides with firearms. The evidence of the protective effects comes from studies of laws that remove restrictions on the issuance of licenses to carry concealed guns, showing subsequent increases in violent crime relative to counterfactuals.11

In his book Bleeding Out: The Devastating Consequences of Urban Violence–and a Bold New Plan for Peace in the Streets, crime researcher Thomas Abt provides sage advice for tackling urban gun violence with evidence-based solutions and the keys to the most efficacious interventions.12 Abt underscores that approaches to urban gun violence should be focused, balanced, and fair. Focus is necessary because gun violence is highly concentrated among a very small percentage of the population and highly concentrated spatially even within neighborhoods with high rates of shootings. Balance refers to the use of social services and job opportunities along with effective enforcement that can deter gun violence. Fairness is important not only as a matter of justice, but research shows that compliance with laws and cooperation with law enforcement are highly dependent upon whether individuals view police and prosecutors as legitimate and fair.

Abt’s emphasis on strategies being highly focused, fair, and balanced should be applied to the enforcement of laws restricting gun possession and carrying. The enforcement of laws against carrying concealed firearms without a license and possession by a prohibited person pose challenges for balancing the desire to prevent the harms associated with unchecked concealed gun carrying–such as loss of life, serious injuries, and psychological trauma–against the harms resulting from often racially biased stop-and-search practices, arrests, and incarceration for illegal gun possession. The frequency and manner with which stop and search is used by police determines whether the tactic results in fewer shootings or promotes racially biased policing that threatens the safety of Black and brown people directly and indirectly through reducing residents’ trust in the police. The New York Police Department’s broadscale stop-and-search practices were found to be unconstitutional and detrimental to police-community relations while having a questionable impact on gun violence.13 But in cities with much higher rates of gun violence, there is some evidence that arrests for illegal gun possession can reduce shootings.14 Evaluations of specialized police units focused on deterring illegal gun possession in city “hot spots” for shootings have consistently shown that such efforts significantly reduce shootings, at least in the short term.15 Units that focused more on the small number of high-risk individuals than on high-risk places generally were most effective. To minimize harms and achieve the public safety benefits of the proactive enforcement of gun laws, it must be highly focused, not only with respect to place (hot spots), but with respect to individuals for whom there is good evidence indicating illegal gun possession and a history of violence.

Given the potential for abuse in proactive gun-law enforcement, police must have strong systems of internal and external accountability to ensure that practices are not only legal, but minimize harms and are acceptable to community members. Officers must be properly trained and incentivized to make only clearly justifiable stops and searches. Systems of accountability should be in place to identify and deter unconstitutional or otherwise unprofessional practices that can harm those who are subjected to the searches. Law enforcement leaders should track officers’ patterns for stopping and searching individuals, complaints, cases dismissed due to illegal searches, and whether evidence from gun-related arrests leads to convictions or guilty pleas. Aggregate data on these metrics should be shared with the public to promote accountability. Finally, there is great need to develop and evaluate alternatives to incarceration for those who are arrested for illegal gun possession, programs that offer social supports to reduce subsequent gun offending and have components similar to some of the successful interventions described below.

Abt’s ingredients of successful gun violence prevention can be seen in Oakland’s efforts to reduce gun violence in a manner that promotes safety and justice. A cornerstone of Oakland’s programs is its Ceasefire Strategy, which applies an approach known as Group Violence Intervention (GVI)–championed by the National Network for Safer Communities (NNSC)–that has an impressive track record of success.16 GVI begins with an extensive data collection process by law enforcement to identify the small number of individuals and groups within a community that are most at risk for involvement in gun violence, and to track ongoing conflicts and other activities involving these individuals that may contribute to the violence. In group meetings with these high-risk individuals, known as “call ins,” law enforcement officials, community members, and social service providers communicate that gun violence must stop. While early iterations of the program model focused on law enforcement leaders warning individuals about the prospect of harsh sanctions against gun crime, the current program model focuses on “the moral voice of the community” to persuade those engaged in gun violence to turn away from it and on fairness in the application of the law. City officials make promises to provide immediate assistance to those individuals who need help turning away from violence (such as intensive mentoring, employment and training services, housing, and drug treatment). Street outreach workers engage those who are the focus of the intervention to support them in their efforts to turn away from violence. Law enforcement leaders promise to bring to justice those who perpetrate gun violence, dedicating a special unit to carry out this task. Importantly, the GVI approach also involves considerable engagement by police with the impacted communities, reconciliation for past injustices, and a commitment to police reforms demanded by the communities. This process generally results in fewer arrests for minor infractions and greater police focus on gun violence and the individuals perpetrating it.

The legitimacy of the effort to promote positive change is evidenced by swift and relevant assistance to address key determinants of violence, including lack of jobs and insecurity about immediate needs for housing and food among those at highest risk. The outreach and case management challenges are considerable but manageable under a city agency responsible for violence prevention within a mayor’s office or health department. Researchers have estimated that Oakland’s Ceasefire Strategy has contributed to a citywide 31 percent drop in gun homicides and a 20 percent drop in nonfatal shootings.17 These findings are consistent with those from other studies of GVIs across a broad range of cities.18 Unfortunately, with rare exceptions,19 GVI evaluations have not reported the impact of the program on arrests and incarceration. As the NNSC has elevated the importance of policing and criminal justice reforms in its approach, future evaluations of GVI should measure the program’s impacts on incarceration.

The New York City’s Mayor’s Office for Gun Violence Prevention (MOGVP) builds upon the Cure Violence model that attempts to prevent gun violence without the direct involvement of law enforcement. Violence interrupters and outreach workers who are credible messengers are hired by community-based organizations from impacted communities to build trust with those at highest risk, mediate disputes, promote nonviolent alternatives to conflicts, and facilitate connections to social services and job opportunities. New York’s MOGVP established a crisis management system to ensure that necessary resources and services are delivered to high-risk individuals in a timely and supportive manner. Research that contrasted trends in gun violence in New York City’s intervention neighborhoods with those of similar neighborhoods indicates that New York’s program has reduced gun violence where it has been implemented.20 The program was also associated with a significant reduction in the degree to which youth report that gun violence is justified under various scenarios.21 Cure Violence interventions have also yielded some success in reducing gun violence in selected neighborhoods in Chicago and Philadelphia.22 In Baltimore, the program’s effects on gun violence have been inconsistent, with most sites failing to reduce gun violence.23

Other promising models for community gun violence prevention include Los Angeles’s Gang Reduction and Youth Development (GRYD) program, which invests in efforts to promote alternatives to gangs and established a system for coordinated and timely responses to prevent retaliatory gang violence by street outreach peacemakers and law enforcement. GRYD’s incident response system has greatly reduced retaliatory shootings involving gang members.24 Implementation of Operation Peacemaker Fellowship, now known as Advance Peace–a highly targeted program that invests in the health, well-being, and personal development of those involved in violence, including modest stipends to participants who meet program objectives–has contributed to a 55 percent decrease in gun violence in Richmond, California.

Alcohol abuse is an important contributor to interpersonal violence and specifically violence involving firearms.25 One study found that an individual’s history of alcohol-related offenses predicted both future crime committed with firearms and prior violent offending.26 Studies have consistently shown that the density of alcohol outlets is positively associated with violent crime after controlling for other neighborhood conditions.27 Thus, alcohol abuse is an appropriate target for interventions to reduce gun violence. There is a robust research literature on the effects of alcohol-focused interventions on violence; unfortunately, these studies rarely isolate violent incidents involving firearms.

Local restrictions on the number and density of alcohol outlets in neighborhoods as well as enhanced regulatory oversight of alcohol outlets have been shown to reduce violence.28 Shootings sometimes occur in response to altercations at bars and nightclubs. Restrictions on alcohol serving hours have been found to reduce violence, including lethal gun violence.29 While increased taxes on alcohol reduce violence, they must be substantial to achieve moderate protective effects.30 There are, of course, considerable political challenges to enacting tighter regulation over alcohol sales, yet the public health benefits of these actions extend beyond violence into fewer injuries and fatalities due to motor vehicle injuries. Indeed, a community intervention based on successful advocacy for changing alcohol laws and enhanced enforcement of alcohol laws that was primarily aimed at preventing deaths and injuries from drunk driving also had a strong protective effect in reducing injuries from assaults.31

Gun violence in cities is most common in areas with concentrated disadvantage, blight (vacant buildings and lots), and other signs of physical and social disorder. The connections between physical disorder, social disorder, and gun violence are both direct and indirect. Vacant buildings and lots filled with trash and overgrown with weeds are used to stash illegal guns and drugs. More indirectly, physical and social disorder sends signals that illegal behavior is tolerated and instills fear that prevents positive engagement to protect against violence.

Observational research has shown that demolition of vacant homes in blighted neighborhoods is associated with reductions in gun violence.32 Recent research using random assignment of dwellings and lots to treatment and control conditions has demonstrated that so-called cleaning and greening of vacant lots in low-income urban areas and making modest investments to maintain the revamped lots leads to a variety of public health benefits, including reducing violent crime and gun violence without displacement of the crime.33 Philadelphia began enforcing a “doors and windows ordinance” in 2011 that required property owners of abandoned buildings to install working doors and windows in all structural openings. Noncompliant owners can face significant fines. Researchers estimated the impact of this ordinance enforcement by comparing crime trends around buildings that were remediated as a result of the ordinance (n = 676 or 29 percent of cited buildings) and randomly matched control buildings that were not remediated (n = 676) or permitted for renovation (n = 964). Building remediations were associated with a 39 percent reduction in assaults with guns and a 13 percent reduction in nonfirearm assaults.34 This same study also assessed the effects of cleaning and greening vacant lots and estimated that those activities were associated with a 4.5 percent reduction in gun violence. Because the costs of gun violence to taxpayers and to society at large are substantial, these interventions in Philadelphia had impressive return on investment. Researchers estimated that over a forty-­six-month follow-up period, each dollar devoted to remediating an abandoned building yielded a $20 return to taxpayers due to lower rates of violence and a $256 savings from a societal perspective. Over that same period, for every $1 spent on vacant lot cleaning and greening, there were $77 in returns to taxpayers and $968 in returns from a societal perspective. Critically, these blight abatement interventions have been shown to have benefits beyond reducing gun violence, including increased perceptions of safety, greater use of outdoor space for socializing, and reduced stress.35

Successful public health efforts are data-driven, focused on unhealthy or unsafe environments as well as risky behaviors, and often intentional about reforming systems that are unjust and harm public safety. While laws and their enforcement can be important to advance public health and safety, including reducing gun violence, minimizing harms of exposure to the criminal justice system is also important. Research demonstrates that appropriately targeted efforts that invest in and support individuals and neighborhoods at greatest risk for involvement in gun violence can be successful in saving lives and reaping impressive return on investment.