In 2020, the United States experienced an increase of 30% in gun-related homicides, with firearm deaths becoming the leading cause of death for children and adolescents. Four years later, in June 2024, Surgeon General Vivek Murthy, MD, MBA, declared gun violence a public health crisisafter a year during which nearly 47,000 people died from gunshot wounds. The leading causes of gun-related harm – suicide, homicide and unintentional injury – affect people of all ages, races and communities, with significant psychological effects. Among American adults21% have been threatened with a gun and 19% have seen a family member killed by a gun.

In response, the Biden administration increased federal funding for violence reduction. The Department of Justice’s Community Violence Intervention and Prevention Initiative, launched in 2022, has distributed nearly $200 million in grants to support community-based violence interventions (CVI), local governments, research and evaluation efforts and other violence reduction initiatives. Notably, Murthy’s opinion on gun violence calls for increased implementation of CVIs.

As frontline witnesses to the effects of violence, clinicians also play a crucial role in prevention and advocacy.

The impact of interventions against community violence

CVIs encompass a broad range of programs designed to implement evidence-based strategies and disrupt the cycle of violence in communities. These programs have been proven to reduce medical and legal system costs and save lives. For example, hospital-based violence intervention programs (HVIP) have been shown to save $750,000 to $1.5 million in incarceration and medical costs each year, with some programs reducing injury recidivism rates fourfold.

When someone is admitted to the hospital due to violence, an HVIP specialist can conduct a needs assessment, develop a personalized safety plan, and connect the patient to critical resources such as housing, services mental health and vocational training. This ongoing case management ensures patient safety and progress while providing long-term support and regular check-ins. HVIPs, often run by a combination of medical staff and community partners, provide physicians with a direct opportunity to help reduce violence. Other CVIs, such as safe passage programs (which ensure students can move around safely), environmental redesign, and group violence interventions have also seen significant success.

Beyond the federal government, municipal governments have also increased their funding for violence prevention. In 2023, Philadelphia increased its anti-violence investments by $46 million, bringing the total to $184 million for violence prevention. Their plan, Philadelphia Roadmap to Safer Communities, funds various CVIs and allocates funds for summer and school year programs, evening community resource centers, and scholarships. This comprehensive approach has placed Philadelphia second in the rankings. Community Justice Violence Prevention Index for 2023.

Disjointed services

CVIs, by their nature, operate at the community level. However, while federal, state, and municipal funding is vital, the effectiveness of CVIs depends on collaboration among small, effective programs. Unfortunately, these programs often operate independently, leading to diffuse subsidies, competition, and fragmented efforts. Without coordination, inefficient use of funds can lead to redundant services, thereby missing opportunities to maximize their impact.

For example, CVIs often work with the same people. Imagine a 16-year-old who, after being admitted to the hospital, begins working on an HVIP team. The HVIP connects him with essential resources such as medical monitoring, mental health counseling and social assistance in housing or education. They also help him develop a personalized safety plan, give him access to legal support and connect him with job training programs – essential tools for stabilizing his situation and rebuilding after trauma.

When he returns to his community, he could be involved in another conflict. This time, a street outreach program comes into play. While the outreach workers focus on conflict mediation and community engagement, they could also offer services similar to those provided by the HVIP. If the street outreach program is aware of its previous contacts with the HVIP, it can better focus its efforts on navigating the resources it is already connected with, rather than duplicating what has already been done.

By collaborating, CVIs can avoid this overlap and build on existing efforts. This coordinated approach allows each CVI to focus on its strengths — with HVIPs focusing on hospital resources and long-term planning, and street outreach teams excelling in community support and conflict resolution — ultimately improving one’s chances of recovery and reducing the likelihood of future violence.

A coordination model

To meet the coordination challenge, it is essential to consider effective strategies from other Community programs. In Houston, the Coalition for the Homeless (CFTH) is the leader of city programs aimed at ending homelessness. As an umbrella organization, CFTH ensures that more than 100 community programs work together, sharing data and optimizing the allocation of funds. Since 2012it has housed more than 32,000 people, had a 90 percent success rate in local housing programs, and directly coordinated $179 million in state funding for homelessness solutions last fiscal year. CVIs can achieve similar success with coordination in place.

Violence Reduction Councils (VRCs) offer a comparable model to CFTH project coordination. These councils bring together stakeholders, including law enforcement, public health officials, local residents, and IVCs, to coordinate efforts to reduce violence within a community. VRCs focus on identifying the root causes of violence, developing intervention strategies, and promoting partnerships to implement comprehensive, evidence-based solutions.

Currently, the VRC model emphasizes data collection from community stakeholders after a homicidal or nonfatal shooting. Council members then create a list of recommendations for prevention and implementation plans. The first HRV was created in Milwaukee almost 20 years ago and saw a 52% reduction of monthly homicides during the first 2 years. Violence reduction councils can serve as a hub not only for CVIs, but also for other violence prevention agencies within a community. Given their centrality, cities can adapt this guidance to help consolidate programs and better define CVI roles to avoid redundancies. Furthermore, thanks to this coordination, the CVIs can directly adopt the council’s recommendations. To encourage broader adoption, researchers at the Johns Hopkins Bloomberg School of Public Health developed a toolbox for communities interested in forming VRCs.

Physicians, particularly those involved or interested in the management of HVIPs, can play a central role in creating and leading VRCs. Physicians can advocate for the creation of VRCs within their communities, help design and implement data-driven strategies, and ensure that medical and mental health services are fully integrated into broader prevention efforts violence. By participating in or leading these councils, physicians can bridge the gap between health care and community interventions, fostering a more coordinated and comprehensive approach to violence reduction.

CVIs reduce violence within communities, but cities can maximize their impact through better coordination through violence reduction counseling and physician support.

Amélie Mercado is a third-year medical student at Baylor College of Medicine in Houston.