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Is violence a disease? A public health model to prevent the “transmission” of violent crime

Is violence a disease? Beginning in 2000, violent crime in Trinidad & Tobago began to increase significantly. Over the past three years, however, the country has experienced an alarmingly sharp rise in homicides and shootings. By June 2018, local papers began speculating that the country was on track to record the highest number of murders since independence. As of September of this year, Trinidad & Tobago recorded 402 murders according to the TT Police Service, an 8.4% increase from the previous year over the same period. TT’s high homicide rate has important human costs. In addition, the rising insecurity affects the country’s overall economic competitiveness. In its 2018 Global Competitiveness Report, the  World Economic Forum ranked Trinidad & Tobago among the worst in the world for homicides – 134th out of 140 economies and fifth lowest in the LAC region.

The Government of Trinidad & Tobago has taken strong steps to curb violence and homicides over the past several years. Among important initiatives has been the implementation of hotspot policing, the development of a community-based policing model known as “Hearts and Minds”, and the recent approval of the National Crime Prevention Programme to involve government, private sector, and civil society at the municipal level in crime prevention efforts.  However, up to this point there was no evidence to show that these or any other Government program has been effective in reducing homicides.

Is violence a disease? The evidence behind public health models in fighting crime

A soon-to-be-published report from Arizona State University and the Inter-American Development Bank indicates that Trinidad & Tobago may shed some light on the topic.   The report is the result of an extensive, three-year evaluation of Project REASON, a local program that used the Cure Violence methodology to address homicides, woundings & shootings. The Cure Violence program uses a public health model to prevent the “transmission” of violent crime. The model works by (1) interrupting transmission of the disease, (2) reducing the risk of the highest risk, and (3) changing community norms.

“Up to this point there was no evidence on the effectiveness of community-based policing models in crime prevention efforts”

Project REASON was an intervention financed under the Ministry of National Security’s Citizen Security Programme (CSP), which worked to reduce crime and violence within 36 “high-needs” communities across the country. Focused exclusively in, and covering only, CSP’s East Port of Spain communities (Beetham Estate, Belmont, Eastern Port of Spain, Eastern Quarry, Gonzales, Laventille, Marie Road, Mon Repos, Morvant, Never Dirty, Picton, Port of Spain Proper, Romain Lands, Sea Lots, St. Barbs, and Upper Belmont), Project REASON began operation in July 2015 and ended in August 2017. It sought to:

  • Prevent harm and reduce injuries associated with firearm-related violence;
  • Proactively prevent the escalation of tension that is likely to lead to violence;
  • Reduce the likelihood that high-risk individuals will engage in criminal and antisocial behavior;
  • Improve public perceptions of safety; and
  • Improve coordination and collaboration among stakeholders to enhance efficiency in delivering violence prevention services.

Seven Violence Interrupters and five Outreach Workers were hired to cover the “intervention area.” Staff were selected based on their connection to the communities and their knowledge of the communities’ specific dynamics. Among staff’s most critical duties was preventing the cycle of violence by identifying potentially violent conflicts and mediating to prevent their escalation into violent acts.

A rigorous impact evaluation

The evaluation of Project REASON’s implementation consisted of three components: (i) a quasi-experimental impact evaluation, (ii) a multi-method process evaluation, and (iii) a cost-effectiveness analysis. The findings presented in the report are based on the analysis of qualitative and quantitative data collected before, during, and after the program’s 26-month implementation period. Among key findings are that:

  • Within one year of the launch of Project REASON, the violent crime rate in the treatment area was 45.1% lower than in the comparison area.
  • Calls to the Police for murders, shootings, and woundings decreased in the treatment area by 22.6%; while increasing by 10.4% in the comparison area over the same period.
  • Port of Spain General Hospital, the closest hospital to the intervention area, experienced a mean reduction of roughly 38.7% in the number of gunshot wound admissions at following implementation of Project REASON.

Taken together, these findings provide strong evidence that the Ministry of National Security’s implementation of the Cure Violence model was associated with a substantial reduction in the rate of violent crime in the intervention areas. Essentially when treating crime as a disease, success rates go up.

The findings of the process evaluation and the cost-effectiveness analysis are also very positive. According to the report, the Ministry of National Security implemented the pilot in accordance with the overall CureViolence model. Additionally, the approximate cost ($3,500 to $4,500) per serious crime averted is relatively low given the profound costs of violence in Trinidad & Tobago, in both human and economic terms. It also provides hope that not only can violence be prevented, but that effective solutions for preventing violence may actually be affordable.

The 2018 IDB publication “Better Spending for Better Lives: How Latin America and the Caribbean Can Do More with Less” forcefully argues that LAC countries must learn to spend better on reducing crime by investing in programs and policies that use “both preventive and punitive elements backed by scientific evidence of their impact on crime.” For Trinidad & Tobago, the findings of the Project REASON evaluation provide strong evidence that continuing to invest in implementing the Cure Violence methodology will be an efficient and effective way to reduce homicides, woundings and shootings in the country.

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