He always knew that epidemiology and criminology were a perfect fit, but it wasn’t until 2009 that the phrase he was looking for was coined.
That was the year that Dr. Ali Rowhani-Rahbar of UW Medicine and the School of Public Health encountered “epicrim.”
While the portmanteau of “epidemiology” and “criminology” is a hip term and the field was only recently formalized, the concept is “nothing new,” according to Rowhani-Rahbar. There has always been a clear link between health and criminal justice, he said, but the primary text on epicrim served to formalize the field and allowed for integration of methods, theories, and practices from many disciplines.
In February, Rowhani-Rahbar and other researchers at the UW put these ideas into practice with the publication of their article on the disease-like firearm use in Seattle in the Annals of Internal Medicine. The initial research was conducted with a grant from the Seattle City Council. Rowhani-Rahbar further expanded on these findings with the help of a grant from the UW Royalty Research Fund.
The study analyzed hospitalizations, death records, and criminal records over a 10-year period, looking for data both five years before and after a firearm-related incident.
The data are widely considered “revealing,” in the words of Councilmember Tim Burgess, shedding light on some of the most inscrutable aspects of gun violence; their evidence shows that criminal activity involving firearms is limited to a very small percentage of Seattle’s population, but this tiny group has a large impact.
But what’s more revealing, Rowhani-Rahbar said, is that there appears to be a circle of violence among young men already involved in crime when it comes to firearms: Those who are the victim of a crime involving a firearm are also more likely to commit a crime with a firearm themselves, and the opposite is also true. In other words, it appears those who are shot are more likely to shoot, and those who shoot are more likely to be shot.
In this way, the team of doctors and epidemiologists, aided by legal and criminal justice experts, were able to show that the use of firearms is infectious, much like a virus.
The paper also served to further deconstruct a popular myth that mental illness and gun violence are intimately related. The team’s research showed that previous criminal activity, not mental illness, make someone more likely to commit a crime in the future. The only link between mental illness and firearm activity was violence against self, not others.
The authors argue that this is one of the paper’s most crucial findings. By illustrating how criminal activity, and not mental illness, breeds further crime, they hope to encourage the public to reduce the stigma against the mentally ill and governments to provide additional resources to those who are at risk of self-harm.
Though the research paper yielded powerful insights on its own, according to Rowhani-Rahbar, the addition of a policy statement from eight health professional organizations and the American Bar Association (ABA) dramatically increased the impact of the data.
Together, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Emergency Physicians, American Congress of Obstetricians and Gynecologists, American College of Physicians, American College of Surgeons, American Psychiatric Association, the American Public Health Association, and the ABA detailed a list of necessary measures to reduce both the health and public health consequences of firearms.
Their recommendations included universal background checks, the restriction of both manufacture and sale of military-style assault weapons, and continued research of these pressing issues.
“This is one of the first times they came together,” Rowhani-Rahbar said of the organizations involved in the policy paper. “The power of this approach was that it solidified all these isolated voices.”
Mary Fan, the Henry M. Jackson Professor of Law at the University of Washington School of Law, agrees.
For many years, the use of federal funds in firearm-related research has all but disappeared due to the power of the gun lobby in the United States. According to Fan, this has left government officials, academics, social workers, and others without data and without the forum for conversation. Despite these political challenges, the organizations decided to unite and address these important issues.
“These organizations have been struggling with this silence, with this deprivation of information and deprivation of informed conversation,” Fan said. “You’re seeing these diverse organizations uniting on the more neutral ground of, ‘How do we have this right exist while preventing crime perpetration, preventing death?’”
Fortunately for Rowhani-Rahbar and his team, they were able to circumvent these federal obstacles with the help of the Seattle City Council.
Burgess was one of the figures who led the charge on securing funding for this research in King County.
“There is not much research on this topic because of the block at the federal level —— the NRA being able to block research on gun violence —— so we did it locally,” Burgess said.
According to Burgess, the study was the first municipally-funded research on gun violence conducted. He has hope both for the changes this research can affect in King County, and for the way this study can further promote research on this topic.
“We’re at this interesting moment and we don’t know what’s going to happen,” Fan said of the renewed pursuits in gun violence research.
Rowhani-Rahbar and his team hope to conduct randomized trials for gun violence interventions in order to prove or disprove the efficacy of certain programs.
There is some evidence that case managers, education, and other interventions aid in rehabilitating those with a criminal history, but the UW team wants hard data on what works and what doesn’t.
They are hopeful that successful interventions can be crafted. The data revealed that those who end up in the hospital for firearm-related activities are likely to end up there again, so there is a potential to intervene after the first incident and stop recurrence.
“By the time cases have reached criminal prosecution, the harm has been done,” Fan said. “And so the big goal is to prevent injury and violence before it happens. That’s why the insights into prevention are so important.”
There is also evidence from past interventions. According to Burgess, more than a decade ago, the UW pioneered hospital-based interventions among patients at Harborview Medical Center who sustained alcohol-related injuries.
“This team would visit them explaining to them that the likelihood of being admitted is high and they should change their behavior,” Burgess said of the alcohol intervention team. “That is now standard procedure in trauma hospitals around the country, and we hope to do that again with gun violence.”
In addition to studying the outcomes of intervention programs, the researchers also hope to expand beyond firearms and into other topics pertinent to “epicrim,” including human trafficking, gang violence, and police shootings.
Reach News Editor Eleanor Cummins at firstname.lastname@example.org. Twitter: @elliepses