Combating Gun Trafficking and Reducing Violence in Chicago

Senate Judiciary Committee

Witness: Debra Houry, MD, MPH

Chairman Durbin, Ranking Member Grassley, and distinguished members of the committee, it is an honor to appear before you today to discuss the Centers for Disease Control and Prevention’s ongoing response to community violence.  I am grateful for this opportunity to share CDC’s important work in violence prevention.

Community violence, defined as interpersonal violence between individuals who are unrelated, and who may or may not know each other, generally taking place outside the home, is a significant public health problem that affects thousands of individuals, families, schools, and communities across our nation each day.  Crime data from the FBI’s Uniform Crime Report indicate that there was a 12 percent increase in aggravated assault offenses in 2020.  Homicide rates increased by 30 percent from 2019-2020 in the United States – and these increases have been even more dramatic in many urban communities across the country.^1,2 In addition, more than 1.5 million people are treated in emergency departments for assaults every year.³ Though the data do not explain why this is happening, multiple explanations have been proposed, including but not limited to economic stressors and disruptions in social connections and community programs related to the pandemic.  Importantly, violence has significant short- and long-term negative impacts on individuals of all ages across the lifespan.

Community violence can result in significant physical injuries and mental health effects such as depression, anxiety, and PTSD, and can increase risk for substance use. Violence directly or indirectly harms everyone in a community by contributing to fear of engaging in neighborhood activities, preventing businesses from growing and prospering, and financially straining education, justice, and health and social services systems and thereby reducing community resources to achieve other community goals.

America’s youth are particularly vulnerable to community violence. Youth violence is a leading cause of death and nonfatal injuries, and a significant contributor to community violence, including firearm injuries and deaths. Sadly, homicide is a leading cause of death among youth and young adults aged 10 – 34 and homicide continues to be the leading cause of death for young Black males in the United States. The homicide rate among Black males 15-34 years old is 17 times higher than among non-Hispanic White males.⁴ A 2019 CDC report demonstrated that Black and brown Americans are disproportionately harmed by the direct and indirect consequences of gun violence.

Youth and adolescents who experience violence as victims, perpetrators, or witnesses have experienced what is referred to as an adverse childhood experience or ACE. People who experience ACEs are more likely to have short-term and chronic physical and mental health conditions and behavioral difficulties, including future experiences with violence, smoking, substance use and substance use disorders, obesity, high-risk sexual behavior, depression, academic difficulties, school dropout, and suicidal behavior. Some of these consequences are also risk factors for other leading causes of death including suicide, opioid and other drug overdose, and heart disease.  These facts underscore the reality that community violence has long lasting effects on those most vulnerable, children.

CDC’s National Center for Injury Prevention and Control has studied violence—and its lifelong impacts—for nearly 30 years. CDC is the nation’s leading public health authority on violence prevention, providing data to inform action, conduct research, apply science to identify effective solutions, and promote multi-sector collaboration to keep people and communities safe and healthy. CDC’s broad expertise includes prevention scientists, program analysts, physicians, data analysts and communication specialists; and includes specializations in medicine, epidemiology, sociology, psychology, criminology, law, communication, policy, education, public health, and economics.

CDC uses data to understand when and why violence and injuries occur and how to prevent them. For example, we have made recent investments in syndromic surveillance for non-fatal firearm injuries through the Firearm Injury Surveillance Through Emergency Rooms (FASTER) initiative.  FASTER supports 10 state health departments to identify geographic clusters or hotspots of nonfatal firearm injuries, and thereby improve state and local ability to respond.  To gather data to help us understand and reduce violent deaths, the National Violent Death Reporting System (NVDRS) is a state-based surveillance system (in all 50 states, the District of Columbia and Puerto Rico) pooling more than 600 unique data elements from multiple sources into a usable, anonymous database, on all types of violent deaths, in all settings, for all age groups.  NVDRS helps to explain the context, including potential risk and precipitating factors, mode of death, etc., of a violent death, assisting in determining what prevention efforts would be most appropriate.

CDC uses its expertise to support academic institutions and local health departments and works alongside community organizations and local communities to prevent violence.  In addition, CDC directly supports violence prevention activities in communities and provides guidance to help communities understand what works best and build expertise within those communities.

Since 2000, CDC has funded the National Centers of Excellence in Youth Violence Prevention (Youth Violence Prevention Centers — YVPCs). Each center is an academic-community collaboration to advance the science and practice of youth violence prevention research and build the evidence base for what works best in communities. Through local partnerships, the YVPCs develop, implement, and rigorously evaluate innovative strategies to prevent violence and create safer, healthier family and community environments for youth.

For example, the Chicago Center for Youth Violence Prevention, based at the University of Chicago, has been a long time YVPC and partner of CDC.  It is in the final year of a CDC funded project collaborating with Bright Star Community Outreach, Northwestern University, and other community organizations to prevent violence in Bronzeville, a southeast Chicago neighborhood long impacted by violence. This academic-community partnership is implementing and evaluating the impact of the Communities That Care (CTC) model to build a community prevention approach by empowering residents to combine resources and form partnerships. This is one of the first evaluations of this model in an urban environment. One of the communities implementing this model implementing this model, Humbolt Park, saw a 17 percent decrease in homicides, as a result of comprehensive youth violence prevention strategies. During this five-year period, by contrast, homicides increased by 10 percent in similar communities and 9% across the city.⁵

In addition, the Michigan YVPC has developed community collaborations that have resulted in the healthy development of youth in neighborhoods in Flint, MI. An evaluation of a comprehensive set of six prevention strategies documented a 38 percent decrease in youth assault-related injuries from those seeking treatment in a local emergency department, and a 25 percent decrease in youths’ likelihood of being victims of a violent assault in the intervention area compared to those in a comparison area over a five-year period.⁶

The most recently funded cohort of YVPCs include University of Colorado, University of Kansas, University of Michigan, Tulane University, and Virginia Commonwealth University. This cohort was funded in September of this year and their projects are for five years.

CDC has also supported cities and local health departments to engage in youth violence prevention activities for over 15 years.  Local health departments are well-positioned to support violence prevention efforts due to their access to data, relationships with the communities they serve, partnerships across multiple sectors, and experience working with young people. The most recent program, Preventing Violence Affecting Young Lives, or PREVAYL, was launched in September 2021 and is funding local communities disproportionately impacted by violence. PREVAYL recipients are using evidence-based violence prevention strategies to address risk factors such as social determinants of health, including concentrated poverty, limited educational or employment opportunities, and racial inequity, to prevent multiple forms of violence.  For example, the Minneapolis City Health Department implemented Coaching Boys into Men (CBIM), which encourages nonviolent problem-solving skills through sports such as football, baseball, basketball, and track in schools and community organizations.  After year four of the program, students improved 36 percent in recognizing abuse, and 47 percent in likelihood to intervene in violent situations. Furthermore, in this time, violent crime arrests decreased 20 percent among youth in the implementation area in North Minneapolis.

Through these investments, CDC helps to create safe communities by meeting communities where they are, based on the needs and priorities they identify, and assisting them to implement proven prevention strategies shown to reduce serious and lethal violence, arrests, aggression, substance use, and other behavioral risks. An example of this CDC-funded work includes the University of Pennsylvania Injury Science Center’s groundbreaking experimental research on the impact of low-cost repairs to abandoned buildings and vacant lot greening on residents’ health, safety, and quality of life. City-wide, areas around remediated abandoned buildings had a 39 percent drop in gun assaults, 19 percent drop in other assaults, and a 16 percent drop in nuisance crimes.⁷ Vacant lot greening also led to significant, long-term reductions in gun violence (8 percent drop) and vandalism, and residents’ reporting less stress and more exercise. Every dollar invested in these remediation programs returned anywhere from $5–$333 in violence related-costs that were averted. These interventions are quickly implemented, easy to scale and adapt to many different urban environments and can have a big impact on community safety.  Another example is the CDC-funded University of Iowa Injury Prevention Research Center which serves as an international resource and contributes to our nation’s understanding of rural versus urban injury disparities.

We know what works to prevent community violence. Preventing community violence can be done with proven programs, policies, and practices that are currently available. This best available evidence is found in CDC’s Youth Violence Prevention Technical Package, a free online resource that compiles a core set of strategies and approaches for preventing youth violence to inform decision-making in communities.  Examples of strategies that we know work to prevent community violence include:

• Engaging community members and organizations, local health departments, and academic institutions to provide data to inform action, conduct research, apply science to identify effective solutions, and promote multi-sector collaboration for short- and long-term solutions
• Addressing underlying physical and behavioral health needs and increasing protective factors.
• Changing social norms through street outreach/violence interruption programs.
• Changing the physical environment through community greening approaches.
• Preventing future risk and lessening the harms of violence exposure through hospital-community partnerships, and treatment services.
• Strengthening economic supports through job training and summer jobs programs.
• Connecting youth to caring adults and activities such as mentoring and after-school programs.
• Strengthening youth’s skills through universal school-based programs to help youth develop skills to prevent violence and engage in healthy behaviors.

Because community violence results from multiple individual, family, and environmental factors that can accumulate over time, the use of one strategy will have limited effects on sustained decreases in the level of violence in a community. A comprehensive public health approach that simultaneously targets multiple risk and protective factors across the social ecology and focuses on both short-term and long-term solutions and outcomes is critical to reducing community violence.

Looking to the future, CDC is following emerging trends in violence and violence prevention practice closely and helping to lead the way in developing new solutions and adapting and implementing solutions to new populations, environments, and contexts.  With the possibility of increased community violence prevention resources as proposed in the FY22 budget request, we will continue to leverage the violence prevention expertise at CDC, in communities, and with partners to fund communities to implement and evaluate novel and innovative programs, policies, and practices and share what works so communities can tailor prevention efforts to meet their needs. CDC will also continue to build the evidence base and share with communities as the evidence grows and evolves.  We remain dedicated to preventing, and reducing all forms of violence and we thank you for your time and interest in CDC’s violence prevention work.