CHERI keynote addresses intentional violence as public health issue

Viewing intentional violence as a public health issue has led Robert Gore, MD ’02, down an interesting path, both personally and professionally.

That path recently led Gore back to Buffalo, the city of his birth, to give the keynote address at UB’s Community Health Equity Research Institute’s second annual research day.

Gore grew up in Brooklyn, attended Morehouse College in Atlanta as an undergraduate and received his medical degree from the Jacobs School of Medicine and Biomedical Sciences. He did his residency and chief residency in emergency medicine at Cook County Hospital in Chicago and then returned downstate to work as an attending physician and clinical associate professor of emergency medicine at Kings County Hospital — SUNY Downstate Medical Center.

In 2009, he founded KAVI (Kings Against Violence Initiative), an in-school, hospital and community nonprofit program that teaches young people how to resolve conflicts peacefully.

Gore was named a 2018 Top 10 CNN Hero, a global honor that celebrates everyday people changing the world. He was also a member of the 2018 Class of Presidential Leadership Scholars.

Gore, who received UB’s Distinguished Medal Alumni Award earlier this year, credited mentors in the Jacobs School’s Department of Emergency Medicine, such as E. Brooke Lerner, professor and vice chair for research, and Ronald M. Moscati, clinical associate professor, with introducing him to emergency medicine-based research.

“I wanted to do research that was tied to the community, and they told me about a project involving intimate partner violence,” he said. “It gave me my first opportunity to really look at violence from this public health frame and incorporate education as a way to achieve health equity.”

As a resident physician in Chicago, Gore further delved into the issue.

He recalled a day in August 2005 when he was on a 24-hour trauma call rotation. One of the other residents expressed that he was bored and “hoped something exciting comes into the ER.”

“A lot of people chimed in because herd mentality being what it was, because exciting means trauma and excitement means you get to go to the operating room,” he said. “But excitement also means mostly likely that a young Black or Hispanic male coming in as a victim of violence.

“And I looked around the room and the only people of color in the entire room were me and one of the clerks.

“I started thinking, what if I am in the wrong place at the wrong time on the west side of Chicago,” Gore added. “Are people going to be looking at me as something exciting, as some sort of science experiment? That really got me to thinking. I didn’t want to become a patient.”

He started exploring the work of other physicians who were the first to talk about intentional violence as a public health issue.

“What if we created a space where people didn’t have to become patients? That’s a noble thought,” Gore said, noting the concept of working to save youth from violence before they ever become ER patients.

“I began going on this path of looking at violence as a public health issue, mainly so that if you understand the risk factors and intervene, you could potentially change the course of these risk factors and have a direct impact on patients’ lives, our lives, my life,” he said. “I was definitely being selfish because according to the Centers for Disease Control and Prevention, homicide was the number one cause of death of Black males ages 1 to 44.”

Gore moved back to Brooklyn upon completing his residency training.

“I am very fortunate that I get to practice emergency medicine across the street from the elementary school I attended. I live a couple of miles away. I grew up a couple of miles away. The patients that I take care of are people that I know,” he explained. “They are friends, my colleagues, former classmates, neighbors. They are even family.”

But Gore said the concept of intentional violence as a public health issue kept playing in the back of his mind.

“As a physician you see things up close and personal that completely change your perspective,” he said. “Sometimes on the research side and on the administrative side, we think about projects and engagement purely as work, not really realizing that people’s lives are being impacted by it.

“I kept seeing young men who were victims and survivors of intentional violence. Things look a little differently when it hits close to home,” Gore added. “These aren’t neighborhoods I just transiently pass through. This is home. I’ve admitted people from families I have known. I have admitted a friend of mine because he got shot in the face around the corner from where I live.”

Gore estimated the direct and indirect cost of intentional violence — hospital bills, lost wages, property values that are impacted — is costing people in the United States $30 billion a year.

“Not to mention the fact that when someone comes into the emergency room, the likelihood of them coming back is pretty high, so this is a problem,” he said.

Since 2008, Gore has been involved with global medicine outreach trips to Haiti and he estimated he has visited the country 14 or 15 times.

He said after a few trips, he realized the work being done in Haiti could translate to the youth he wanted to reach in the U.S. KAVI started out as a grassroots organization run by volunteers but has since secured funding in the form of several grants.

The school/community program works with more than 200 kids in and around the central Brooklyn area.

“Some of the work we have done on school campuses includes an entire curriculum focusing on mediation, conflict resolution and restorative justice practices like understanding power and oppression, and really creating a circle for people to be able to process as it relates to the trauma going on in their communities,” Gore said.

He noted that many of the youth the program works with are gang members or gang-affiliated.

“Depending on where you grow up, you’re going to have an affiliation,” he said. “I joined a gang when I was 14 years old. I was valedictorian of my high school, but I carried razor blades on and off between the ages of 11 and 18 because I grew up in pre-gentrified Brooklyn.

“You have a lot of kids who are smart and are well performing, but because of where they live, they have to process violence in a very different way.”

Gore explained that KAVI’s hospital program is a bit different in that it works with people who are patients — victims and survivors of violence.

“We want to make sure there is no retaliation, and we also want to make sure the patients have advocates,” he said. “We want to make sure they have services that are going to help make them stay alive — and help them tackle the social determinants of health — everything from health care access to education and safety.

“If you don’t have food, clothing, shelter and security, the odds you are going to be engaging in interpersonal violence once you get back out in the community are a lot higher.”

Gore said UB and the Community Health Equity Research Institute is fortunate to have access to the university’s different schools, where faculty and staff have their own unique interests and areas of expertise.

“These multidisciplinary teams can conduct community-based research and create powerful projects,” he said. “Do not be afraid to fail. It is just part of the process.”