The costs of treating urban violence as a ‘public health’ problem

The costs of treating urban violence as a ‘public health’ problem

Malte Riemann

Public-health-based approaches to violent crime prevention are increasingly endorsed by governmental agencies in the UK, in an attempt to address the recent upsurge in violent crime.  The example of the USA based Curve Violence initiative highlights, however, the societal and political costs of such an approach.      

The recent, so called violence epidemic is making headlines in the United Kingdom. To tackle this surge in urban violence, politicians, academics and policy makers are increasingly advertising a public health approach. Such an approach treats violence as an infectious disease that can be cured via preventative methods used in disease control. In placing emphasis on prevention, it is remarkably different from a law enforcement model based on punishment and deterrence. The Violence Reduction Unit of Police Scotland has utilized this approach with great success since 2005, as demonstrated by the sharp decline in violent crime. Mayor of London, Sadiq Khan, and home secretary Sajid Javid, have both endorsed public health approaches to address urban violence and set up models based on this approach in response.

That a strict law and order-based reaction to surging violent crime does not yield solutions has been aptly demonstrated by recent violent crime figures. Being open to new ways of addressing this problem is therefore in itself an important step. This, however, should not distract from the risks that a public health model carries.

In a recent study, I analyse the North American based Cure Violence (CV) initiative, which provided the inspiration for Scotland’s Violence Reduction Unit. This project, headed by former WHO epidemiologist Gary Slutkin, launched in 2000 in the Chicago area with the aim to reduce gun crime. To date, its public health method is being replicated in 23 US cities with offshoots in multiple countries, such as South Africa, Morocco, Honduras, Argentina, and now also the UK. CV operates on the premise that violence is a contagious disease, arguing that violence can be controlled and contained via epidemiological methods and strategies that are applied in infectious disease control. But what are the costs of treating violence as a disease?

First, CV makes violence the object of natural science as it presupposes the superiority of a quantitative, evidence-based epidemiology over other approaches to prevent violence. Other solutions to violence, Slutkin explains, do not correctly understand the problem scientifically, leading ‘to ineffective and even counterproductive treatments and control strategies’. CV thereby changes the terms of the debate away from contingent sociological factors to the seemingly timeless forces of nature and biology. In doing so, CV constructs, to borrow a concept from French philosopher Michel Foucault, regimes of truth that delegitimize alternative existing regimes which purport disconfirming explanations, such as those based  on sociological, political, and economic analysis.

Second, by replacing political solutions with medical diagnosis and treatment models, violence becomes disentangled from socio-economic inequalities and explained by reference to individual pathology alone. An implication of this is the separation of socio-economic inequalities from the analysis of violence. For CV, violence leads to economic underdevelopment, but economic inequalities are not considered to be the cause of violence but only modulating factors. Violence can thus no longer be read as a result of, or response to, socio-economic inequalities but rest within the infected individual. This is in line with neoliberal practices that aim to erode the political in favour of the market, because by reducing violence to individual factors, any form of structural critique becomes void and the relationship between austerity and violence can be disguised.

Third, in order to identify at-risk populations, CV’s epidemiological approach is centrally concerned with the articulation of specific categories into which disease and population types could be set. Although the use of statistical analysis to identify at-risk populations is treated by CV as a purely descriptive act, these groups are not ‘naturally’ existing, but created through the very process of their epidemiological identification. Epidemiological research is therefore not merely a neutral and descriptive act, but, as Amand Führer and Friederieke Eichner have shown, a productive process that has the potential to create social identities and realities’. In the case of CV, the two identities produced are grounded in race. This is evidenced by images on its website, which reveal that the color of susceptibility and lack of resistance to the violence virus is the ‘non-white’. In the visual language of CV, no people of color are represented as anything other than victims, potential perpetrators, or high-risk individuals. In contrast, the health professionals ‘in charge’, whether scientist, doctor, or state representative, are only white.

CV, therefore, produces two sets of identities in which, on the one hand, white subjects are in charge and able to find a solution to violence, while on the other, people of color are either perpetrators or passive victims of violence. By drawing the line between the ‘normal’ and the ‘pathological’ according to markers of ‘race’, negative stereotypes are reinforced and marginalized individuals living within zones ‘contaminated’ by violence are stigmatized. CV, therefore, hides a racialized discourse behind the supposedly value-free scientific language it deploys. By classifying already marginalized groups as ‘at risk-populations’, and depicting white professionals as the solution, CV produces a narrative of white hegemony as one of its key effects.

CV shows that the medicalization of violence needs to be critically questioned, as it delegitimizes alternative explanation to violence, locates violence biologically within the individual thereby reducing violence to apolitical factors and actions, and draws boundaries between the ‘normal’ and the ‘pathological’ according to markers of race. The CV model therefore brings to our attention some of the costs and trade-offs that need to be considered when thinking about implementing a public-health-based approach to violence prevention.


Malte Riemann is a senior lecturer in the Department of Defence and International Affairs at the Royal Military Academy Sandhurst. His fields of interest include the privatisation of war, the medicalization of security, and the historicity of non-state actors.

Disclaimer: The views expressed here are the author’s and do not necessarily reflect the opinions of the Royal Military Academy Sandhurst, the Ministry of Defence, or any other United Kingdom government agency.