While contending with a global pandemic of a life­time, North Carolina and the United States more broadly have collectively experienced a significant uptick in community gun violence.1,2 Gun violence persists as a leading cause of injury death in the United States, and for the first time is now the leading cause of death among chil­dren, surpassing motor vehicle accidents.3 As we reflect on our current response, we must ask whether we would accept this for any other preventable cause of death. The answer should be a resounding, “NO.” Community gun violence deserves the same level of systems coordination, collaboration, and investment as every other preventable cause of morbidity and mortality. Beyond the direct impact of community gun violence on victims, it extends deep, impacting the physical, economic, and social fabric of entire communities.

Community gun violence is rooted in a complex web of individual, family, community, and structural disadvantage and disinvestment. Gun violence threatens the public’s health, making it a public health crisis that warrants a public health response. What does that mean? No, public health is not replacing the role of law enforcement or proposing to defund the police. The public health framework simply offers guiding principles and an approach for developing collaborative solutions that actually address the individuals, families, communities, and structures at the root cause of the crisis, in a resourced, sustainable way. How can public health ideologies be applied to an issue that has historically been reserved for law enforcement and is so overwhelming that it feels too powerful to halt? This commentary aims to explore one local public health approach to violence pre­vention as an example for others as we work to collectively change the trajectory of gun violence across the state. It is important to acknowledge up front that this work is difficult and, given the role of multisector influencers—including the economy, political landscape, law enforcement, education, and so many more—success will not occur rapidly.

The Public Health Approach to Violence Prevention

The public health approach to violence prevention is rooted in four key steps: 1) define and monitor the problem, 2) identify risk and protective factors, 3) develop and test prevention strategies, 4) assure widespread adoption. More simply, we need quality, accessible data to understand gun violence in our communities; who it impacts, where, and why; and what works and is not working, so that we can implement more of what works, and less of what doesn’t.

Building Mecklenburg County’s Office of Violence Prevention

In 2020, Mecklenburg County Public Health (MCPH) established an Office of Violence Prevention (OVP), the first of its kind in the state of North Carolina positioned within a local health department. The OVP was charged with devel­oping an actionable plan to address community gun violence within Mecklenburg County.

The Way Forward (TWF), Mecklenburg County’s Community Violence Prevention Strategic Plan, is a commu­nity-centered, partner-driven, evidence-informed collective impact approach for reducing violence.4 Notably, con­trary to many traditional government-planning models, TWF is anchored in the priorities and recommendations of com­munities most impacted by violence. Community members most proximal to the issues led the way in all aspects of plan development, and now implementation. The ability to estab­lish and maintain genuine, trusting, and mutually beneficial relationships rooted in shared decision-making and power is critical to progress. MCPH engaged residents using online surveys, focus groups, and interviews to gain perspectives of violence and allow residents to provide practical solutions based on their daily lived experience. Five core areas of focus emerged: Community Engagements and Partnerships, Support for Youth and Families, Economic Opportunities, Intergovernmental Collaborations, and Safer & Healthier Neighborhoods.

TWF further highlights recommended prevention and interventional solutions within each focus area for a vari­ety of stakeholders to implement using a collective impact approach.4 Many of these initiatives concentrate efforts upstream, focused on addressing social determinants, root causes, and other drivers of violence among individuals, families, communities, and structures. Drawing upon the strengths and expertise of agencies, individuals, and groups from various sectors, lessens the burden on any one entity. The implementation strategies outlined in TWF use local data to drive interventions, intentionally engage community members, support community-based organizations, and center youth voices. A few specific key initiatives included in TWF, many adopted from evidence-based best practices throughout the country, are highlighted here.

Early Implementation

The Carolina Violence Prevention Collaborative (CVPC) is a coalition of mostly grassroots community-based orga­nizations and community partners with a vested interest in reducing community violence. The OVP convened the self-governed CVPC in October 2021. The CVPC aims to break the cycle of violence in Mecklenburg County through cre­ative education, advocacy, and collective impact strategies. The coalition’s vision is a “community with less violence and more value”.5 The CVPC has five core values: knowledge sharing, action-driven strategies, collaboration, innovative solutions, and focus on community. In addition to provid­ing resources and fostering opportunities for collaborative action and advocacy, the CVPC will provide opportunities for technical assistance and support for coalition members, including increasing individual organizations’ capacity and infrastructure.

The Violence Prevention Data Collaborative (VPDC) is an example of intergovernmental/interagency collabora­tion. This partnership between local government and non-government agencies began in August 2020 to combine and share data on violent crime in Mecklenburg County. Data from the VPDC is used to inform policies, guide practices, and enhance programs associated with reducing violence. The groups involved include various departments from the City of Charlotte, Mecklenburg County, and community organizations.

The 100 Youth Advisory Council (100YAC) is an initia­tive designed to increase youth engagement in identifying solutions to prevent youth violence and increase neigh­borhood safety. Through a partnership with local schools, other youth services agencies, and OVP, the 100YAC is comprised of three branches: middle school students, high school students, and young people aged 18–24. Members of the 100YAC will advise OVP on best practices for reaching youth, review existing programs in Mecklenburg to identify gaps and opportunities, participate in conversations around neighborhood and school safety, present recommenda­tions to elected officials and community stakeholders, cre­ate opportunities for peer learning and supportive services related to youth violence prevention initiatives, and facilitate conversations around youth violence prevention.

Alternatives to Violence (ATV) is a community violence interruption program that was launched in 2021 through a partnership between Mecklenburg County and the City of Charlotte. Designed as a pilot program, ATV focuses on decreasing shootings and killings in the priority area of Beatties Ford Rd/LaSalle St Corridor. Employing the Cure Violence Global (CVG) model, the program uses data and trusted messengers to resolve conflict and stop violence before it happens. Additionally, this program trains out­reach workers who work with participants to develop and achieve self-identified goals, link participants and families to resources, and provide services that prevent future vio­lence. First-year results show a measurable decline in shoot­ing events in the corridor (unpublished data).

The Way Forward

Community gun violence travels well beyond the path of the bullet. In addition to the many North Carolinians who have lost their lives to gun violence, countless others have survived their injuries with sometimes-permanent disability, trauma, and excessive health care debt, in addition to the potentially multigenerational impact on families grieving loved ones who have succumbed to their injuries. Further, countless neighbors live with the cumulative trauma of wit­nessing an act of gun violence or routinely hearing the sound of gunfire ringing out, as well as the disinvestment in com­munities deemed unsafe.

While violence is concentrated in these communities, it inevitably impacts all of us, and reducing community violence is everyone’s responsibility. This paradigm shift involves changing social norms, dispelling myths about com­munities that are disproportionately impacted by violence, and making intentional social and economic investments in historically underserved and disinvested communities. Community is the core of any successful violence reduction effort. As public health professionals, to realize change we must begin by establishing genuine, mutually beneficial, trusting relationships rooted in shared decision-making and power.

Disclosure of interests

No interests were disclosed.