In 2020, the US experimented an increase of 30%. in gun-related homicides, with firearm deaths becoming the main cause of mortality for children and teenagers. Four years later, in June 2024, Surgeon General Vivek Murthy, MD, MBA, declared gun violence a public health crisisfollowing a year in which almost 47,000 people died of gunshot wounds. The leading causes of gun injury — suicide, homicide and unintentional injury — affect people of all ages, races and communities, with significant psychological effects. Among US adults21% have been threatened with a firearm and 19% have had a family member killed by a firearm.

In response, the Biden administration increased federal funding to reduce violence. The Department of Justice’s Community Violence Prevention and Intervention Initiative, launched in 2022, distributed nearly $200 million in grants to support community violence interventions (CVI), local governments, research and evaluation efforts, and other violence reduction initiatives. In particular, 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.

Impact of community violence interventions

CVIs encompass a broad spectrum of programs designed to implement evidence-based strategies and disrupt the cycle of violence in communities. These programs are proven to reduce medical costs and legal system fees and save lives. For example, Hospital Violence Intervention Programs (HVIP) have shown to be cost-effective $750,000 to $1.5 million in incarceration and medical costs annually, with some programs reducing recidivism rates by fourfold.

When a person is hospitalized due to violence, an HVIP specialist can conduct a needs assessment, develop a personalized safety plan, and connect the patient to essential resources such as housing, mental health services, and job training . This ongoing case management ensures patient safety and progress while providing long-term support and regular check-ins. HVIPs, often led by a combination of medical staff and community partners, provide clinicians with a direct opportunity to help reduce violence. Other CVIs such as safe crossing programs (which ensure students can commute safely), environmental redesign, and gang violence interventions have also demonstrated significant success.

Beyond just the federal government, municipal governments have also increased 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, the 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 placed Philadelphia second in the Community Justice Violence Prevention Index for 2023.

Disjointed services

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

For example, CVIs often work with the same people. Imagine a 16-year-old who, after being hospitalized, starts working with an HVIP team. HVIP connects him with critical resources such as medical follow-up, mental health counseling and social assistance with housing or education. They also help him develop a personalized safety plan, give him access to legal aid and connect him with vocational training programs – essential tools for stabilizing his situation and rebuilding after the trauma.

As he returns to his community, he may become embroiled in another conflict. This time, a street outreach program intervenes. While outreach workers focus on conflict mediation and community engagement, they could also provide services similar to those provided by HVIP. If the street program is aware of its previous contact with HVIP, they can better focus their efforts on navigating the resources they are already connected with, rather than duplicating what has already been done.

By working together, CVIs can prevent this overlap and instead build on existing efforts. This coordinated approach allows each CVI to hone its strengths — HVIPs focusing on hospital resources and long-term planning and street teams excelling in community support and conflict resolution — ultimately improving their chances of recovery and reducing the likelihood of future violence.

A coordination model

To address the challenge of coordination, it is essential to consider successful strategies from other community programs. In Houston, Coalition for the Homeless (CFTH) serves as leader of the city’s programs to end homelessness. As a single body, CFTH ensures that more than 100 community programs work together, sharing data and optimizing the allocation of funds. Since 2012housed more than 32,000 people, had a 90% success rate in local housing programs, and directly coordinated $179 million in public funding for solutions to homelessness in the previous fiscal year. CVIs can achieve similar success to in-place coordination.

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

Currently, the VRC model emphasizes data collection among community stakeholders after a fatal or nonfatal shooting occurs. Council members then create a list of recommendations for prevention and implementation plans. The first VRC was established in Milwaukee almost 20 years ago and recorded a 52% reduction. in monthly homicides in the first 2 years. Violence reduction councils can serve as a focal point not only for CVI, but also for other violence prevention agencies within a community. Given their centrality, cities can adapt such boards to help bring programs together and better outline the roles of CVIs to prevent redundancy. Furthermore, through this coordination, the CVIs can directly adopt the recommendations of the council. To encourage wider adoption, researchers at the Johns Hopkins Bloomberg School of Public Health did developed a set of tools for communities interested in forming VRCs.

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

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

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