More on treating violence and crime as a disease

I’m a big advocate for intervening in violence and crime as diseases. Sure, I’m biased because of my career in public health. But there’s a method to my madness, so to speak. I attended a series of presentations today on public health “observatories,” institutes and organizations dedicated to collect, analyze and distribute data on social and health indicators of communities. They exist all over the world, and many of them work independently of health departments or ministries. They often provide data with the intent of getting people and agencies to do something about a problem.

The thing is, there’s only one public health observatory in the United States, and it only just started at Hopkins. In place of these observatories here, there are groups dedicated to making sense out of all the data that is out there. In Baltimore, the 311 system has been in place for some years now, and it has coughed up a ton of information about the city. Because of it, we know where there are potholes or where trash hasn’t been picked up. Of course, there are other sources of data, and they all can be mined for some really good info.

One of these organizations is the Baltimore Neighborhood Indicators Alliance (BNIA), and most of the information they analyze and publish is pure gold if you want to do something about the social ailments of Baltimore. For example, look at this map:

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Notice that there are some neighborhoods where a lot of homes are not receiving mail. Those homes are likely empty, abandoned. Now, look at this map:

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It should be no surprise that there is an association between vacant housing and unemployment. And this should not surprise you, either:

Screen Shot 2014-06-20 at 12.06.39 PMPlaces with low employment have high crime and a high number of empty homes.

I’ve also told you before that the problem with observational epidemiology is that causation is not easy to nail down. Were these homes abandoned because of a wave of crime? Did people lose their jobs, then their homes, then turned to crime? Are cops less likely to patrol empty neighborhoods, so those are the neighborhoods with more crime?

Chicken-and-egg all the way.

That’s not to say that these data are to be ignored. There is plenty of evidence that improving the job market improves public safety. Improved housing also improves public safety. And people with jobs build and occupy better homes and nurture better neighborhoods. It’s all connected, and that is why these data should not be ignored.

Leaders at all levels in Baltimore must read these reports and let the data guide them in their decisions on how to address problems in the city. Residents should also read these reports and know what is going on around them so that they can help stave of trends towards bad outcomes. After all, it takes a village, right?

And it is in those trends that treating these problems as diseases comes into play. Epidemiological tools can be used to detect aberrations. Are more people that expected losing their jobs or being killed? Are the programs you put in place yielding lower-than-expected homicides and higher-than-expected employment? After all, some changes from year to year can be due to chance alone, so we must make sure that what we are seeing is not by chance, and that we accurately measure the impact of the things that we are doing.

This is new ground for epidemiologists, and something that new and future public health practitioners should keep in mind. Not only are these good jobs to have, but they are jobs that need to be done to improve things. No more throwing money at a problem without evidence that it was a problem to begin with, or that the money thrown is doing something. More than ever, we now have the ability to collect, analyze, and disseminate these data. The possibilities are exciting.