You are a trauma surgeon,
working in the midnight shift in an inner city emergency room.
A young man is wheeled in before you,
lying unconscious on a gurney.
He's been shot in the leg and is bleeding profusely.
Judging from the entry and exit wounds,
as well as the amount of hemorrhaging,
the bullet most likely clipped the femoral artery,
one of the largest blood vessels in the body.
As the young man's doctor, what should you do?
Or more precisely, what should you do first?
You look at the young man's clothes, which seem old and worn.
He may be jobless, homeless,
lacking a decent education.
Do you start treatment by finding him a job,
getting him an apartment
or helping him earn his GED?
On the other hand,
this young man has been involved in some sort of conflict
and may be dangerous.
Before he wakes up,
do you place him in restraints,
alert hospital security or call 911?
Most of us wouldn't do any of these things.
And instead, we would take the only sensible
and humane course of action available at the time.
First, we would stop the bleeding.
Because unless we stop the bleeding,
nothing else matters.
What's true in the emergency room is true for cities all around the country.
When it comes to urban violence, the first priority is to save lives.
Treating that violence with the same urgency
that we would treat a gunshot wound in the ER.
What are we talking about when we say "urban violence"?
Urban violence is the lethal or potentially lethal violence
that happens on the streets of our cities.
It goes by many names:
street violence, youth violence,
gang violence, gun violence.
Urban violence happens
among the most disadvantaged and disenfranchised among us.
Mostly young men,
without a lot of options or much hope.
I have spent hundreds of hours with these young men.
I've taught them at a high school in Washington DC,
where one of my students was murdered.
I've stood across form them in courtrooms in New York City,
where I worked as a prosecutor.
And finally,
I've gone from city to city as a policymaker and as a researcher,
meeting with these young men
and exchanging ideas on how to make our communities safer.
Why should we care about these young men?
Why does urban violence matter?
Urban violence matters,
because it causes more deaths here in the United States
than any other form of violence.
Urban violence also matters
because we can actually do something about it.
Controlling it is not the impossible, intractable challenge
that many believe it to be.
In fact, there are a number of solutions available today
that are proven to work.
And what these solutions have in common is one key ingredient.
They all recognize that urban violence is sticky,
meaning that it clusters together
among a surprisingly small number of people and places.
In New Orleans, for instance,
a network of fewer than 700 individuals
accounts for the majority of the city's lethal violence.
Some call these individuals "hot people."
Here in Boston,
70 percent of shootings
are concentrated on blocks and corners covering just five percent of the city.
These locations are often known as "hot spots."
In city after city,
a small number of hot people and hot spots
account for the clear majority of lethal violence.
In fact, this finding has been replicated so many times
that researchers now call this phenomenon the law of crime concentration.
When we look at the science, we see that sticky solutions work best.
To put it bluntly,
you can't stop shootings if you won't deal with shooters.
And you can't stop killings if you won't go where people get killed.
Four years ago,
my colleagues and I performed a systematic meta-review
of antiviolence strategies,
summarizing the results of over 1,400 individual impact evaluations.
What we found, again and again,
was that the strategies that were the most focused,
the most targeted,
the stickiest strategies,
were the most successful.
We saw this in criminology,
in studies of policing, gang prevention and reentry.
But we also saw this in public health,
where targeted tertiary and secondary prevention
performed better than more generalized primary prevention.
When policymakers focus on the most dangerous people and places,
they get better results.
What about replacement and displacement, you might ask.
Research shows that when drug dealers are locked up,
new dealers step right in, replacing those that came before.
Some worry that when police focus on certain locations,
crime will be displaced,
moving down the street or around the corner.
Fortunately, we know now that because of the stickiness phenomenon,
the replacement and displacement effects associated with these sticky strategies
are minimal.
It takes a lifetime of trauma to create a shooter
and decades of disinvestment to create a hot spot.
So these people and places don't move around easily.
What about root causes?
Isn't addressing poverty or inequality or lack of opportunity
the best way to prevent violence?
Well, according to the science,
yes and no.
Yes, in that high rates of violence are clearly associated
with various forms of social and economic disadvantage.
But no, in that changes in these factors
do not necessarily result in changes in violence,
especially not in the short run.
Take poverty, for instance.
Meaningful progress on poverty will take decades to achieve,
while poor people need and deserve relief from violence right now.
Root causes also can't explain the stickiness phenomenon.
If poverty always drove violence,
then we would expect to see violence among all poor people.
But we don't see that.
Instead, we can empirically observe that poverty concentrates,
crime concentrates further still
and violence concentrates most of all.
That is why sticky solutions work.
They work, because they deal with first things first.
And this is important,
because while poverty may lead to violence,
strong evidence shows that violence actually perpetuates poverty.
Here's just one example of how.
As documented by Patrick Sharkey,
a sociologist --
he showed that when poor children are exposed to violence,
it traumatizes them.
It impacts their ability to sleep,
to pay attention, to behave and to learn.
And if poor children can't learn,
then they can't do well in school.
And that ultimately impacts their ability to earn a paycheck later in life
that is large enough to escape poverty.
And unfortunately, in a series of landmark studies
by economist Raj Chetty,
that is exactly what we've seen.
Poor children exposed to violence have lower income mobility
than poor children who grow up peacefully.
Violence literally traps poor kids in poverty.
That is why it is so important to focus relentlessly on urban violence.
Here are two examples of how.
Here in Boston, in the 1990s,
a partnership between cops and community members
achieved a stunning 63 percent reduction in youth homicide.
In Oakland, that same strategy
recently reduced nonfatal gun assaults by 55 percent.
In Cincinnati, Indianapolis and New Haven,
it cut gun violence by more than a third.
At its simplest,
this strategy simply identifies those who are most likely to shoot
or be shot,
and then confronts them with a double message
of empathy and accountability.
"We know it's you that's doing the shooting.
It must stop.
If you let us, we will help you.
If you make us, we will stop you."
Those willing to change are offered services and support.
Those who persist in their violent behavior
are brought to justice via targeted law enforcement action.
In Chicago, another program uses cognitive behavioral therapy
to help teenage boys
manage difficult thoughts and emotions,
by teaching them how to avoid or mitigate conflicts.
This program reduced violent crime arrests among participants
by half.
Similar strategies have reduced criminal reoffending
by 25 to 50 percent.
Now Chicago has launched a new effort,
using these same techniques,
but with those at the highest risk for gun violence.
And the program is showing promising results.
What's more,
because these strategies are so focused, so targeted,
they tend not to cost much in absolute terms.
And they work with the laws already on the books today.
So that's the good news.
We can have peace in our cities,
right now,
without big budgets
and without new laws.
So why hasn't this happened yet?
Why are these solutions still limited to a small number of cities,
and why do they struggle, even when successful,
to maintain support?
Well, that's the bad news.
The truth is, we have not been very good at organizing our efforts
around this phenomenon of stickiness.
There are at least three reasons why we don't follow the evidence
when it comes to urban violence reduction.
And the first, as you might expect,
is politics.
Most sticky solutions don't conform to one political platform or another.
Instead, they offer both carrots and sticks,
balancing the promise of treatment with the threat of arrest,
combining place-based investment with hot-spots policing.
In other words,
these solutions are both soft and tough
at the same time.
Because they don't line up neatly
with the typical talking points of either the Left or the Right,
politicians won't gravitate to these ideas without some education,
and maybe even a little pressure.
It won't be easy,
but we can change the politics around these issues
by reframing violence as a problem to be solved,
not an argument to be won.
We should emphasize evidence over ideology
and what works versus what sounds good.
The second reason why we don't always follow the evidence
is the somewhat complicated nature of these solutions.
There is an irony here.
What are the simplest ways to reduce violence?
More cops.
More jobs.
Fewer guns.
These are easy to spell out,
but they tend not to work as well in practice.
While on the other hand,
research-based solutions are harder to explain,
but get better results.
Right now, we have a lot of professors
writing about violence in academic journals.
And we have a lot of people keeping us safe out on the street.
But what we don't have
is a lot of communication between these two groups.
We don't have a strong bridge between research and practice.
And when research actually does inform practice,
that bridge is not built by accident.
It happens when someone takes the time
to carefully explain what the research means,
why it's important
and how it can actually make a difference in the field.
We spend plenty of time creating research,
but not enough breaking it down into bite-sized bits
that a busy cop or social worker can easily digest.
It may be difficult to acknowledge or accept,
but race is the third and final reason
why more has not been done to reduce violence.
Urban violence concentrates among poor communities of color.
That makes it easy for those of us who don't live in those communities
to ignore the problem or pretend it's not ours to solve.
That is wrong, of course.
Urban violence is everyone's problem.
Directly or indirectly,
we all pay a price for the shootings and killings
that happen on the streets of our cities.
That is why we need to find new ways to motivate more people
to cross class and color lines to join this struggle.
Because these strategies are not resource-intensive,
we don't need to motivate many new allies --
we just need a few.
And we just need them to be loud.
If we can overcome these challenges
and spread these sticky solutions to the neighborhoods that need them,
we could save thousands of lives.
If the strategies I've discussed here today
were implemented right now in the nation's 40 most violent cities,
we could save over 12,000 souls
over the next eight years.
How much would it cost?
About 100 million per year.
That might sound like a lot,
but in fact, that figure represents less than one percent
of one percent of the annual federal budget.
The Defense Department spends about that much
for a single F-35 fighter jet.
Metaphorically, the treatment is the same,
whether it's a young man suffering from a gunshot wound,
a community riddled with such wounds,
or a nation filled with such communities.
In each case, the treatment, first and foremost,
is to stop the bleeding.
I know this can work.
I know it, because I've seen it.
I've seen shooters put down their guns
and devote their lives to getting others to do the same.
I've walked through housing projects that were notorious for gunfire
and witnessed children playing outside.
I've sat with cops and community members
who used to hate one another, but now work together.
And I've seen people from all walks of life,
people like you,
finally decide to get involved in this struggle.
And that's why I know that together,
we can and we will end this senseless slaughter.
Thank you.
(Applause)