0:00:01.254,0:00:03.912
You are a trauma surgeon,

0:00:03.936,0:00:07.334
working in the midnight shift[br]in an inner city emergency room.

0:00:08.109,0:00:10.204
A young man is wheeled in before you,

0:00:10.228,0:00:12.418
lying unconscious on a gurney.

0:00:12.442,0:00:15.488
He's been shot in the leg[br]and is bleeding profusely.

0:00:15.925,0:00:17.822
Judging from the entry and exit wounds,

0:00:17.846,0:00:19.656
as well as the amount of hemorrhaging,

0:00:19.680,0:00:22.053
the bullet most likely[br]clipped the femoral artery,

0:00:22.077,0:00:24.672
one of the largest[br]blood vessels in the body.

0:00:24.696,0:00:27.998
As the young man's doctor,[br]what should you do?

0:00:28.022,0:00:31.114
Or more precisely,[br]what should you do first?

0:00:32.169,0:00:35.621
You look at the young man's clothes,[br]which seem old and worn.

0:00:35.645,0:00:37.423
He may be jobless, homeless,

0:00:37.447,0:00:39.447
lacking a decent education.

0:00:40.015,0:00:42.658
Do you start treatment[br]by finding him a job,

0:00:42.682,0:00:43.944
getting him an apartment,

0:00:43.968,0:00:45.968
or helping him earn his GED?

0:00:46.856,0:00:48.038
On the other hand,

0:00:48.062,0:00:50.777
this young man has been involved[br]in some sort of conflict

0:00:50.801,0:00:52.045
and may be dangerous.

0:00:52.069,0:00:53.696
Before he wakes up,

0:00:53.720,0:00:55.379
do you place him in restraints,

0:00:55.403,0:00:58.299
alert hospital security or call 911?

0:00:59.868,0:01:02.661
Most of us wouldn't do[br]any of these things.

0:01:02.685,0:01:05.407
And instead, we would take[br]the only sensible

0:01:05.431,0:01:08.147
and humane course of action[br]available at the time.

0:01:08.753,0:01:11.253
First, we would stop the bleeding.

0:01:11.277,0:01:13.380
Because unless we stop the bleeding,

0:01:13.404,0:01:15.555
nothing else matters.

0:01:16.957,0:01:20.576
What's true in the emergency room[br]is true for cities all around the country.

0:01:20.949,0:01:26.164
When it comes to urban violence,[br]the first priority is to save lives.

0:01:26.188,0:01:28.546
Treating that violence[br]with the same urgency

0:01:28.570,0:01:31.410
that we would treat[br]a gunshot wound in the ER.

0:01:32.137,0:01:35.700
What are we talking about[br]when we say "urban violence"?

0:01:36.217,0:01:39.259
Urban violence is the lethal[br]or potentially lethal violence

0:01:39.283,0:01:41.283
that happens on the streets of our cities.

0:01:41.633,0:01:43.093
It goes by many names:

0:01:43.117,0:01:45.201
street violence, youth violence,

0:01:45.225,0:01:47.225
gang violence, gun violence.

0:01:48.019,0:01:49.796
Urban violence happens

0:01:49.820,0:01:53.744
among the most disadvantaged[br]and disenfranchised among us.

0:01:53.768,0:01:55.364
Mostly young men,

0:01:55.388,0:01:57.633
without a lot of options or much hope.

0:01:59.328,0:02:02.368
I have spent hundreds of hours[br]with these young men.

0:02:02.392,0:02:04.976
I've taught them at a high school[br]in Washington DC,

0:02:05.000,0:02:07.077
where one of my students was murdered.

0:02:07.101,0:02:09.896
I've stood across form them[br]in courtrooms in New York City,

0:02:09.920,0:02:11.626
where I worked as a prosecutor.

0:02:12.087,0:02:13.269
And finally,

0:02:13.293,0:02:17.109
I've gone from city to city[br]as a policymaker and as a researcher,

0:02:17.133,0:02:18.617
meeting with these young men,

0:02:18.641,0:02:21.964
and exchanging ideas[br]on how to make our communities safer.

0:02:24.923,0:02:26.925
Why should we care about these young men?

0:02:27.942,0:02:29.942
Why does urban violence matter?

0:02:30.791,0:02:32.165
Urban violence matters

0:02:32.189,0:02:35.236
because it causes more deaths[br]here in the United States

0:02:35.260,0:02:37.716
than any other form of violence.

0:02:38.598,0:02:39.899
Urban violence also matters

0:02:39.923,0:02:42.526
because we can actually do[br]something about it.

0:02:42.868,0:02:45.864
Controlling it is not the impossible,[br]intractable challenge

0:02:45.888,0:02:47.700
that many believe it to be.

0:02:48.084,0:02:51.592
In fact, there are a number[br]of solutions available today

0:02:51.616,0:02:53.410
that are proven to work.

0:02:53.879,0:02:58.058
And what these solutions have in common[br]is one key ingredient.

0:02:58.514,0:03:02.033
They all recognize[br]that urban violence is sticky,

0:03:02.490,0:03:04.451
meaning that it clusters together

0:03:04.475,0:03:08.299
among a surprisingly small number[br]of people and places.

0:03:08.967,0:03:10.637
In New Orleans, for instance,

0:03:10.661,0:03:13.199
a network of fewer than 700 individuals

0:03:13.223,0:03:16.620
accounts for the majority[br]of the city's lethal violence.

0:03:16.644,0:03:19.233
Some call these individuals "hot people."

0:03:19.807,0:03:20.982
Here in Boston,

0:03:21.006,0:03:22.356
70 percent of shootings

0:03:22.380,0:03:26.942
are concentrated on blocks and corners[br]covering just five percent of the city.

0:03:27.688,0:03:30.648
These locations[br]are often known as hot spots.

0:03:31.292,0:03:32.834
In city after city,

0:03:32.858,0:03:35.831
a small number of hot people and hot spots

0:03:35.855,0:03:38.701
account for the clear majority[br]of lethal violence.

0:03:39.169,0:03:42.479
In fact, this finding[br]has been replicated so many times

0:03:42.503,0:03:46.876
that researchers now call this phenomenon[br]the law of crime concentration.

0:03:47.365,0:03:52.000
When we look at the science,[br]we see that sticky solutions work best.

0:03:52.539,0:03:54.444
To put it bluntly,

0:03:54.468,0:03:57.995
you can't stop shootings[br]if you won't deal with shooters.

0:03:58.577,0:04:02.482
And you can't stop killings[br]if you won't go where people get killed.

0:04:03.522,0:04:04.697
Four years ago,

0:04:04.721,0:04:07.355
my colleagues and I performed[br]a systematic metareview

0:04:07.379,0:04:09.225
of antiviolence strategies,

0:04:09.249,0:04:15.177
summarizing the results of over 1,400[br]individual impact evaluations.

0:04:15.717,0:04:17.993
What we found, again and again,

0:04:18.017,0:04:20.636
was that the strategies[br]that were the most focused,

0:04:20.660,0:04:22.001
the most targeted,

0:04:22.025,0:04:23.993
the stickiest strategies,

0:04:24.017,0:04:25.533
were the most successful.

0:04:25.927,0:04:27.276
We saw this in criminology,

0:04:27.300,0:04:30.831
in studies of policing,[br]gang prevention, and reentry.

0:04:31.177,0:04:33.749
But we also saw this in public health,

0:04:33.773,0:04:36.870
where targeted tertiary[br]and secondary prevention

0:04:36.894,0:04:40.367
performed better than more generalized[br]primary prevention.

0:04:41.150,0:04:44.801
When policymakers focus[br]on the most dangerous people and places,

0:04:44.825,0:04:46.705
they get better results.

0:04:48.046,0:04:51.624
What about replacement[br]and displacement, you might ask.

0:04:52.466,0:04:54.998
Research shows that when[br]drug dealers are locked up,

0:04:55.022,0:04:58.617
new dealers step right in,[br]replacing those that came before.

0:04:59.165,0:05:02.536
Some worry that when police focus[br]on certain locations,

0:05:02.560,0:05:04.226
crime will be displaced,

0:05:04.250,0:05:06.733
moving down the street[br]or around the corner.

0:05:07.496,0:05:11.723
Fortunately, we know now[br]that because of the stickiness phenomenon,

0:05:11.747,0:05:16.131
the replacement and displacement effects[br]associated with these sticky strategies

0:05:16.155,0:05:17.467
are minimal.

0:05:17.870,0:05:21.193
It takes a lifetime of trauma[br]to create a shooter,

0:05:21.217,0:05:24.407
and decades of disinvestment[br]to create a hot spot.

0:05:24.780,0:05:28.105
So these people and places[br]don't move around easily.

0:05:31.582,0:05:33.114
What about root causes?

0:05:33.519,0:05:37.228
Isn't addressing poverty or inequality[br]or lack of opportunity

0:05:37.252,0:05:39.252
the best way to prevent violence?

0:05:39.768,0:05:41.323
Well, according to the science,

0:05:41.347,0:05:42.649
yes and no.

0:05:42.673,0:05:46.455
Yes, in that high rates of violence[br]are clearly associated

0:05:46.479,0:05:49.653
with various forms of social[br]and economic disadvantage.

0:05:49.677,0:05:51.883
But no, in that changes in these factors

0:05:51.907,0:05:54.783
do not necessarily result[br]in changes in violence,

0:05:54.807,0:05:56.553
especially not in the short run.

0:05:57.188,0:05:59.114
Take poverty, for instance.

0:05:59.138,0:06:02.796
Meaningful progress on poverty[br]will take decades to achieve,

0:06:02.820,0:06:06.967
while poor people need and deserve[br]relief from violence right now.

0:06:07.339,0:06:10.664
Root causes also can't explain[br]the stickiness phenomenon.

0:06:10.974,0:06:13.026
If poverty always drove violence,

0:06:13.050,0:06:16.193
then we would expect to see violence[br]among all poor people.

0:06:16.534,0:06:18.000
But we don't see that.

0:06:18.471,0:06:23.561
Instead, we can empirically observe[br]that poverty concentrates,

0:06:23.585,0:06:25.823
crime concentrates further still,

0:06:25.847,0:06:28.251
and violence concentrates most of all.

0:06:29.085,0:06:31.367
That is why sticky solutions work.

0:06:31.947,0:06:35.256
They work because they deal[br]with first things first.

0:06:35.812,0:06:37.003
And this is important,

0:06:37.027,0:06:39.387
because while poverty[br]may lead to violence,

0:06:39.411,0:06:43.632
strong evidence shows that violence[br]actually perpetuates poverty.

0:06:44.585,0:06:46.233
Here's just one example of how.

0:06:46.257,0:06:48.582
As documented by Patrick Sharkey,

0:06:48.606,0:06:50.455
a sociologist --

0:06:50.479,0:06:54.612
he showed that when poor children[br]are exposed to violence,

0:06:54.636,0:06:55.898
it traumatizes them.

0:06:55.922,0:06:58.644
It impacts their ability to sleep,

0:06:58.668,0:07:01.842
to pay attention, to behave and to learn.

0:07:02.387,0:07:04.323
And if poor children can't learn,

0:07:04.347,0:07:06.220
then they can't do well in school.

0:07:06.244,0:07:11.006
And that ultimately impacts their ability[br]to earn a paycheck later in life

0:07:11.030,0:07:12.900
that is large enough to escape poverty.

0:07:13.371,0:07:16.054
And unfortunately,[br]in a series of landmark studies

0:07:16.078,0:07:18.220
by economist Raj Chetty,

0:07:18.244,0:07:20.244
that is exactly what we've seen.

0:07:20.839,0:07:24.871
Poor children exposed to violence[br]have lower income mobility

0:07:24.895,0:07:26.895
than poor children who grow up peacefully.

0:07:27.553,0:07:30.947
Violence literally traps[br]poor kids in poverty.

0:07:31.273,0:07:36.550
That is why it is so important[br]to focus relentlessly on urban violence.

0:07:36.574,0:07:38.574
Here are two examples of how.

0:07:39.087,0:07:41.849
Here in Boston, in the 1990s,

0:07:41.873,0:07:44.325
a partnership between cops[br]and community members

0:07:44.349,0:07:48.410
achieved a stunning 63 percent[br]reduction in youth homicide.

0:07:48.434,0:07:50.815
In Oakland, that same strategy

0:07:50.839,0:07:54.529
recently reduced nonfatal[br]gun assaults by 55 percent.

0:07:54.919,0:07:58.576
In Cincinnati, Indianapolis[br]and New Heaven,

0:07:58.600,0:08:01.028
it cut gun violence by more than a third.

0:08:01.496,0:08:03.394
At its simplest,

0:08:03.418,0:08:07.926
this strategy simply identifies[br]those who are most likely to shoot

0:08:07.950,0:08:09.410
or be shot,

0:08:09.434,0:08:11.693
and then confronts them[br]with a double message

0:08:11.717,0:08:13.717
of empathy and accountability.

0:08:14.431,0:08:16.875
"We know it's you[br]that's doing the shooting.

0:08:17.217,0:08:18.633
It must stop.

0:08:19.034,0:08:21.034
If you let us, we will help you.

0:08:21.574,0:08:23.748
If you make us, we will stop you."

0:08:24.550,0:08:27.788
Those willing to change[br]are offered services and support.

0:08:28.746,0:08:30.747
Those who persist[br]in their violent behavior

0:08:30.771,0:08:34.023
are brought to justice[br]via targeted law enforcement action.

0:08:34.864,0:08:39.585
In Chicago, another program[br]uses cognitive behavioral therapy

0:08:39.609,0:08:41.323
to help teenage boys

0:08:41.347,0:08:43.617
manage difficult thoughts and emotions,

0:08:43.641,0:08:47.220
by teaching them how to avoid[br]or mitigate conflicts.

0:08:47.244,0:08:50.443
This program reduced violent[br]crime arrests among participants

0:08:50.467,0:08:51.895
by half.

0:08:51.919,0:08:54.506
Similar strategies have reduced[br]criminal reoffending

0:08:54.530,0:08:56.530
by 25 to 50 percent.

0:08:57.236,0:08:59.283
Now Chicago has launched a new effort,

0:08:59.307,0:09:00.743
using these same techniques,

0:09:00.767,0:09:03.434
but with those at the highest risk[br]for gun violence.

0:09:03.458,0:09:06.100
And the program is showing[br]promising results.

0:09:07.169,0:09:08.876
What's more,

0:09:08.900,0:09:11.847
because these strategies[br]are so focused, so targeted,

0:09:11.871,0:09:14.259
they tend not to cost much[br]in absolute terms.

0:09:14.561,0:09:17.474
And they work with the laws[br]already on the books today.

0:09:18.550,0:09:20.333
So that's the good news.

0:09:20.947,0:09:23.161
We can have peace in our cities,

0:09:23.185,0:09:24.526
right now,

0:09:24.550,0:09:26.355
without big budgets

0:09:26.379,0:09:28.148
and without new laws.

0:09:30.411,0:09:32.411
So why hasn't this happened yet?

0:09:32.934,0:09:36.459
Why are these solutions still limited[br]to a small number of cities,

0:09:36.483,0:09:39.656
and why do they struggle,[br]even when successful,

0:09:39.680,0:09:41.378
to maintain support?

0:09:42.133,0:09:43.831
Well, that's the bad news.

0:09:43.855,0:09:47.395
The truth is, we have not been very good[br]at organizing our efforts

0:09:47.419,0:09:49.558
around this phenomenon of stickiness.

0:09:50.249,0:09:53.344
There are at least three reasons[br]why we don't follow the evidence

0:09:53.368,0:09:55.400
when it comes to urban violence reduction.

0:09:55.424,0:09:57.553
And the first, as you might expect,

0:09:57.577,0:09:58.933
is politics.

0:09:59.799,0:10:04.045
Most sticky solutions don't conform[br]to one political platform or another.

0:10:04.395,0:10:08.041
Instead, they offer[br]both carrots and sticks,

0:10:08.065,0:10:10.955
balancing the promise of treatment[br]with the threat of arrest,

0:10:10.979,0:10:13.933
combining place-based investment[br]with hot-spots policing.

0:10:14.487,0:10:16.087
In other words,

0:10:16.111,0:10:19.261
these solutions are both soft and tough

0:10:19.285,0:10:20.825
at the same time.

0:10:21.509,0:10:23.117
Because they don't line up neatly

0:10:23.141,0:10:27.188
with the typical talking points[br]of either the Left or the Right,

0:10:27.212,0:10:31.491
politicians won't gravitate to these ideas[br]without some education,

0:10:31.515,0:10:33.339
and maybe even a little pressure.

0:10:33.950,0:10:35.125
It won't be easy,

0:10:35.149,0:10:37.672
but we can change the politics[br]around these issues

0:10:37.696,0:10:42.114
by reframing violence[br]as a problem to be solved,

0:10:42.138,0:10:44.502
not an argument to be won.

0:10:44.900,0:10:47.455
We should emphasize evidence[br]over ideology,

0:10:47.479,0:10:49.843
and what works versus what sounds good.

0:10:50.987,0:10:53.693
The second reason why we don't[br]always follow the evidence

0:10:53.717,0:10:57.098
is the somewhat complicated nature[br]of these solutions.

0:10:57.122,0:10:58.614
There is an irony here.

0:10:59.030,0:11:01.815
What are the simplest ways[br]to reduce violence?

0:11:02.712,0:11:03.950
More cops.

0:11:04.268,0:11:05.586
More jobs.

0:11:05.610,0:11:07.014
Fewer guns.

0:11:08.498,0:11:09.855
These are easy to spell out,

0:11:09.879,0:11:12.506
but they tend not to work[br]as well in practice.

0:11:12.530,0:11:13.744
While on the other hand,

0:11:13.768,0:11:17.022
research-based solutions[br]are harder to explain,

0:11:17.046,0:11:18.800
but get better results.

0:11:19.504,0:11:21.766
Right now, we have a lot of professors

0:11:21.790,0:11:24.155
writing about violence[br]in academic journals.

0:11:24.179,0:11:27.313
And we have a lot of people[br]keeping us safe out on the street.

0:11:27.680,0:11:28.839
But what we don't have

0:11:28.863,0:11:31.291
is a lot of communication[br]between these two groups.

0:11:31.315,0:11:34.553
We don't have a strong bridge[br]between research and practice.

0:11:35.688,0:11:38.122
And when research[br]actually does inform practice,

0:11:38.146,0:11:40.050
that bridge is not built by accident.

0:11:40.074,0:11:42.828
It happens when someone takes the time

0:11:42.852,0:11:45.177
to carefully explain[br]what the research means,

0:11:45.201,0:11:46.379
why it's important,

0:11:46.403,0:11:49.132
and how it can actually[br]make a difference in the field.

0:11:49.974,0:11:52.220
We spend plenty of time creating research,

0:11:52.244,0:11:55.752
but not enough breaking it down[br]into bite-sized bits

0:11:55.776,0:11:59.712
that a busy cop or social worker[br]can easily digest.

0:12:02.749,0:12:05.090
It may be difficult[br]to acknowledge or accept,

0:12:05.114,0:12:07.876
but race is the third and final reason

0:12:07.900,0:12:11.429
why more has not been done[br]to reduce violence.

0:12:12.795,0:12:16.414
Urban violence concentrates[br]among poor communities of color.

0:12:17.152,0:12:20.807
That makes it easy for those of us[br]who don't live in those communities

0:12:20.831,0:12:24.015
to ignore the problem[br]or pretend it's not ours to solve.

0:12:24.744,0:12:26.728
That is wrong, of course.

0:12:26.752,0:12:29.553
Urban violence is everyone's problem.

0:12:29.577,0:12:31.291
Directly or indirectly,

0:12:31.315,0:12:33.814
we all pay a price[br]for the shootings and killings

0:12:33.838,0:12:35.838
that happen on the streets of our cities.

0:12:36.417,0:12:39.671
That is why we need to find new ways[br]to motivate more people

0:12:39.695,0:12:42.667
to cross class and color lines[br]to join this struggle.

0:12:43.822,0:12:46.861
Because these strategies[br]are not resource-intensive,

0:12:46.885,0:12:49.496
we don't need to motivate[br]many new allies --

0:12:49.520,0:12:51.145
we just need a few.

0:12:51.169,0:12:53.169
And we just need them to be loud.

0:12:54.747,0:12:56.899
If we can overcome these challenges

0:12:56.923,0:13:00.363
and spread these sticky solutions[br]to the neighborhoods that need them,

0:13:00.387,0:13:02.387
we could save thousands of lives.

0:13:03.752,0:13:05.776
If the strategies[br]I've discussed here today

0:13:05.800,0:13:10.720
were implemented right now[br]in the nation's 40 most violent cities,

0:13:10.744,0:13:13.466
we could save over 12,000 souls

0:13:13.490,0:13:15.259
over the next eight years.

0:13:16.514,0:13:18.114
How much would it cost?

0:13:18.138,0:13:20.138
About 100 million per year.

0:13:20.582,0:13:23.542
That might sound like a lot,

0:13:23.566,0:13:26.410
but in fact, that figure represents[br]less than one percent

0:13:26.434,0:13:29.434
of one percent[br]of the annual federal budget.

0:13:29.458,0:13:31.768
The Defense Department[br]spends about that much

0:13:31.792,0:13:34.291
for a single F-35 fighter jet.

0:13:35.363,0:13:38.340
Metaphorically, the treatment is the same,

0:13:38.364,0:13:41.220
whether it's a young man[br]suffering from a gunshot wound,

0:13:41.244,0:13:43.688
a community riddled with such wounds,

0:13:43.712,0:13:46.045
or a nation filled with such communities.

0:13:46.355,0:13:49.688
In each case, the treatment,[br]first and foremost,

0:13:49.712,0:13:51.616
is to stop the bleeding.

0:13:55.582,0:13:57.433
I know this can work.

0:13:58.217,0:14:00.217
I know it because I've seen it.

0:14:01.158,0:14:03.539
I've seen shooters put down their guns

0:14:03.563,0:14:07.229
and devote their lives[br]to getting others to do the same.

0:14:07.253,0:14:10.721
I've walked through housing projects[br]that were notorious for gunfire

0:14:10.745,0:14:12.942
and witnessed children playing outside.

0:14:12.966,0:14:15.149
I've sat with cops and community members

0:14:15.173,0:14:18.514
who used to hate one another,[br]but now work together.

0:14:18.538,0:14:21.410
And I've seen people[br]from all walks of life,

0:14:21.434,0:14:23.123
people like you,

0:14:23.147,0:14:25.686
finally decide to get involved[br]in this struggle.

0:14:26.004,0:14:27.997
And that's why I know that together,

0:14:28.021,0:14:32.129
we can and we will[br]end this senseless slaughter.

0:14:33.063,0:14:34.262
Thank you.

0:14:34.286,0:14:38.603
(Applause)