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You are a trauma surgeon,

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working in the midnight shift
in an inner city emergency room.

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A young man is wheeled in before you,

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lying unconscious on a gurney.

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He's been shot in the leg
and is bleeding profusely.

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Judging from the entry and exit wounds,

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as well as the amount of hemorrhaging,

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the bullet most likely
clipped the femoral artery,

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one of the largest
blood vessels in the body.

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As the young man's doctor,
what should you do?

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Or more precisely,
what should you do first?

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You look at the young man's clothes,
which seem old and worn.

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He may be jobless, homeless,

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lacking a decent education.

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Do you start treatment
by finding him a job,

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getting him an apartment

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or helping him earn his GED?

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On the other hand,

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this young man has been involved
in some sort of conflict

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and may be dangerous.

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Before he wakes up,

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do you place him in restraints,

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alert hospital security or call 911?

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Most of us wouldn't do
any of these things.

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And instead, we would take
the only sensible

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and humane course of action
available at the time.

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First, we would stop the bleeding.

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Because unless we stop the bleeding,

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nothing else matters.

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What's true in the emergency room
is true for cities all around the country.

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When it comes to urban violence,
the first priority is to save lives.

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Treating that violence
with the same urgency

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that we would treat
a gunshot wound in the ER.

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What are we talking about
when we say "urban violence"?

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Urban violence is the lethal
or potentially lethal violence

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that happens on the streets of our cities.

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It goes by many names:

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street violence, youth violence,

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gang violence, gun violence.

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Urban violence happens

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among the most disadvantaged
and disenfranchised among us.

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Mostly young men,

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without a lot of options or much hope.

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I have spent hundreds of hours
with these young men.

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I've taught them at a high school
in Washington DC,

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where one of my students was murdered.

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I've stood across form them
in courtrooms in New York City,

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where I worked as a prosecutor.

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And finally,

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I've gone from city to city
as a policymaker and as a researcher,

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meeting with these young men

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and exchanging ideas
on how to make our communities safer.

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Why should we care about these young men?

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Why does urban violence matter?

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Urban violence matters,

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because it causes more deaths
here in the United States

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than any other form of violence.

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Urban violence also matters

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because we can actually do
something about it.

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Controlling it is not the impossible,
intractable challenge

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that many believe it to be.

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In fact, there are a number
of solutions available today

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that are proven to work.

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And what these solutions have in common
is one key ingredient.

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They all recognize
that urban violence is sticky,

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meaning that it clusters together

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among a surprisingly small number
of people and places.

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In New Orleans, for instance,

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a network of fewer than 700 individuals

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accounts for the majority
of the city's lethal violence.

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Some call these individuals "hot people."

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Here in Boston,

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70 percent of shootings

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are concentrated on blocks and corners
covering just five percent of the city.

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These locations
are often known as "hot spots."

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In city after city,

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a small number of hot people and hot spots

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account for the clear majority
of lethal violence.

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In fact, this finding
has been replicated so many times

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that researchers now call this phenomenon
the law of crime concentration.

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When we look at the science,
we see that sticky solutions work best.

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To put it bluntly,

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you can't stop shootings
if you won't deal with shooters.

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And you can't stop killings
if you won't go where people get killed.

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Four years ago,

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my colleagues and I performed
a systematic meta-review

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of antiviolence strategies,

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summarizing the results of over 1,400
individual impact evaluations.

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What we found, again and again,

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was that the strategies
that were the most focused,

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the most targeted,

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the stickiest strategies,

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were the most successful.

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We saw this in criminology,

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in studies of policing,
gang prevention and reentry.

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But we also saw this in public health,

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where targeted tertiary
and secondary prevention

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performed better than more generalized
primary prevention.

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When policymakers focus
on the most dangerous people and places,

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they get better results.

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What about replacement
and displacement, you might ask.

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Research shows that when
drug dealers are locked up,

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new dealers step right in,
replacing those that came before.

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Some worry that when police focus
on certain locations,

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crime will be displaced,

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moving down the street
or around the corner.

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Fortunately, we know now
that because of the stickiness phenomenon,

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the replacement and displacement effects
associated with these sticky strategies

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are minimal.

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It takes a lifetime of trauma
to create a shooter

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and decades of disinvestment
to create a hot spot.

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So these people and places
don't move around easily.

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What about root causes?

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Isn't addressing poverty or inequality
or lack of opportunity

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the best way to prevent violence?

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Well, according to the science,

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yes and no.

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Yes, in that high rates of violence
are clearly associated

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with various forms of social
and economic disadvantage.

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But no, in that changes in these factors

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do not necessarily result
in changes in violence,

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especially not in the short run.

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Take poverty, for instance.

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Meaningful progress on poverty
will take decades to achieve,

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while poor people need and deserve
relief from violence right now.

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Root causes also can't explain
the stickiness phenomenon.

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If poverty always drove violence,

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then we would expect to see violence
among all poor people.

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But we don't see that.

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Instead, we can empirically observe
that poverty concentrates,

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crime concentrates further still

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and violence concentrates most of all.

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That is why sticky solutions work.

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They work, because they deal
with first things first.

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And this is important,

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because while poverty
may lead to violence,

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strong evidence shows that violence
actually perpetuates poverty.

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Here's just one example of how.

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As documented by Patrick Sharkey,

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a sociologist --

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he showed that when poor children
are exposed to violence,

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it traumatizes them.

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It impacts their ability to sleep,

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to pay attention, to behave and to learn.

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And if poor children can't learn,

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then they can't do well in school.

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And that ultimately impacts their ability
to earn a paycheck later in life

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that is large enough to escape poverty.

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And unfortunately,
in a series of landmark studies

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by economist Raj Chetty,

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that is exactly what we've seen.

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Poor children exposed to violence
have lower income mobility

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than poor children who grow up peacefully.

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Violence literally traps
poor kids in poverty.

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That is why it is so important
to focus relentlessly on urban violence.

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Here are two examples of how.

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Here in Boston, in the 1990s,

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a partnership between cops
and community members

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achieved a stunning 63 percent
reduction in youth homicide.

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In Oakland, that same strategy

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recently reduced nonfatal
gun assaults by 55 percent.

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In Cincinnati, Indianapolis
and New Haven,

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it cut gun violence by more than a third.

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At its simplest,

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this strategy simply identifies
those who are most likely to shoot

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or be shot,

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and then confronts them
with a double message

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of empathy and accountability.

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"We know it's you
that's doing the shooting.

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It must stop.

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If you let us, we will help you.

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If you make us, we will stop you."

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Those willing to change
are offered services and support.

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Those who persist
in their violent behavior

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are brought to justice
via targeted law enforcement action.

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In Chicago, another program
uses cognitive behavioral therapy

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to help teenage boys

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manage difficult thoughts and emotions,

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by teaching them how to avoid
or mitigate conflicts.

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This program reduced violent
crime arrests among participants

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by half.

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Similar strategies have reduced
criminal reoffending

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by 25 to 50 percent.

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Now Chicago has launched a new effort,

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using these same techniques,

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but with those at the highest risk
for gun violence.

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And the program is showing
promising results.

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What's more,

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because these strategies
are so focused, so targeted,

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they tend not to cost much
in absolute terms.

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And they work with the laws
already on the books today.

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So that's the good news.

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We can have peace in our cities,

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right now,

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without big budgets

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and without new laws.

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So why hasn't this happened yet?

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Why are these solutions still limited
to a small number of cities,

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and why do they struggle,
even when successful,

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to maintain support?

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Well, that's the bad news.

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The truth is, we have not been very good
at organizing our efforts

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around this phenomenon of stickiness.

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There are at least three reasons
why we don't follow the evidence

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when it comes to urban violence reduction.

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And the first, as you might expect,

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is politics.

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Most sticky solutions don't conform
to one political platform or another.

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00:10:04,395 --> 00:10:08,041
Instead, they offer
both carrots and sticks,

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00:10:08,065 --> 00:10:10,955
balancing the promise of treatment
with the threat of arrest,

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00:10:10,979 --> 00:10:13,933
combining place-based investment
with hot-spots policing.

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00:10:14,487 --> 00:10:16,087
In other words,

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00:10:16,111 --> 00:10:19,261
these solutions are both soft and tough

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00:10:19,285 --> 00:10:20,825
at the same time.

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00:10:21,509 --> 00:10:23,117
Because they don't line up neatly

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00:10:23,141 --> 00:10:27,188
with the typical talking points
of either the Left or the Right,

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00:10:27,212 --> 00:10:31,491
politicians won't gravitate to these ideas
without some education,

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and maybe even a little pressure.

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00:10:33,950 --> 00:10:35,125
It won't be easy,

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00:10:35,149 --> 00:10:37,672
but we can change the politics
around these issues

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00:10:37,696 --> 00:10:42,114
by reframing violence
as a problem to be solved,

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00:10:42,138 --> 00:10:44,502
not an argument to be won.

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00:10:44,900 --> 00:10:47,455
We should emphasize evidence
over ideology

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00:10:47,479 --> 00:10:49,843
and what works versus what sounds good.

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00:10:50,987 --> 00:10:53,693
The second reason why we don't
always follow the evidence

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is the somewhat complicated nature
of these solutions.

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There is an irony here.

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What are the simplest ways
to reduce violence?

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00:11:02,712 --> 00:11:03,950
More cops.

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00:11:04,268 --> 00:11:05,586
More jobs.

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00:11:05,610 --> 00:11:07,014
Fewer guns.

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These are easy to spell out,

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00:11:09,879 --> 00:11:12,506
but they tend not to work
as well in practice.

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00:11:12,530 --> 00:11:13,744
While on the other hand,

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00:11:13,768 --> 00:11:17,022
research-based solutions
are harder to explain,

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00:11:17,046 --> 00:11:18,800
but get better results.

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00:11:19,504 --> 00:11:21,766
Right now, we have a lot of professors

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00:11:21,790 --> 00:11:24,155
writing about violence
in academic journals.

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00:11:24,179 --> 00:11:27,313
And we have a lot of people
keeping us safe out on the street.

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00:11:27,680 --> 00:11:28,839
But what we don't have

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00:11:28,863 --> 00:11:31,291
is a lot of communication
between these two groups.

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00:11:31,315 --> 00:11:34,553
We don't have a strong bridge
between research and practice.

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00:11:35,688 --> 00:11:38,122
And when research
actually does inform practice,

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00:11:38,146 --> 00:11:40,050
that bridge is not built by accident.

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00:11:40,074 --> 00:11:42,828
It happens when someone takes the time

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00:11:42,852 --> 00:11:45,177
to carefully explain
what the research means,

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00:11:45,201 --> 00:11:46,379
why it's important

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00:11:46,403 --> 00:11:49,132
and how it can actually
make a difference in the field.

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00:11:49,974 --> 00:11:52,220
We spend plenty of time creating research,

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00:11:52,244 --> 00:11:55,752
but not enough breaking it down
into bite-sized bits

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00:11:55,776 --> 00:11:59,712
that a busy cop or social worker
can easily digest.

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00:12:02,749 --> 00:12:05,090
It may be difficult
to acknowledge or accept,

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00:12:05,114 --> 00:12:07,876
but race is the third and final reason

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00:12:07,900 --> 00:12:11,429
why more has not been done
to reduce violence.

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00:12:12,795 --> 00:12:16,414
Urban violence concentrates
among poor communities of color.

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00:12:17,152 --> 00:12:20,807
That makes it easy for those of us
who don't live in those communities

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00:12:20,831 --> 00:12:24,015
to ignore the problem
or pretend it's not ours to solve.

258
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That is wrong, of course.

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Urban violence is everyone's problem.

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Directly or indirectly,

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we all pay a price
for the shootings and killings

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that happen on the streets of our cities.

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That is why we need to find new ways
to motivate more people

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to cross class and color lines
to join this struggle.

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Because these strategies
are not resource-intensive,

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we don't need to motivate
many new allies --

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we just need a few.

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And we just need them to be loud.

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If we can overcome these challenges

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and spread these sticky solutions
to the neighborhoods that need them,

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we could save thousands of lives.

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If the strategies
I've discussed here today

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were implemented right now
in the nation's 40 most violent cities,

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we could save over 12,000 souls

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over the next eight years.

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How much would it cost?

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About 100 million per year.

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That might sound like a lot,

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but in fact, that figure represents
less than one percent

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of one percent
of the annual federal budget.

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The Defense Department
spends about that much

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for a single F-35 fighter jet.

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Metaphorically, the treatment is the same,

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whether it's a young man
suffering from a gunshot wound,

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a community riddled with such wounds,

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or a nation filled with such communities.

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In each case, the treatment,
first and foremost,

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is to stop the bleeding.

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I know this can work.

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I know it, because I've seen it.

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I've seen shooters put down their guns

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and devote their lives
to getting others to do the same.

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I've walked through housing projects
that were notorious for gunfire

294
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and witnessed children playing outside.

295
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I've sat with cops and community members

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who used to hate one another,
but now work together.

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And I've seen people
from all walks of life,

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people like you,

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finally decide to get involved
in this struggle.

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And that's why I know that together,

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we can and we will
end this senseless slaughter.

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Thank you.

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(Applause)