Homicides in the United States, which peaked in 2022 amid the coronavirus pandemic, have dropped an astounding 46% over the past four years.
Many theories attempt to explain this historic decline. But in a new report, gun policy expert Daniel Webster identifies an overlooked reason: programs and strategies informed by public health principles in communities at risk of gun violence.
A Bloomberg Professor of American Health at the Johns Hopkins Bloomberg School of Public Health, Webster shared his report publicly for the first time at the 2026 Bloomberg American Health Initiative Summit on Oct. 20 at the Baltimore Marriott Waterfront hotel, where the news stirred excitement in the packed ballroom.
Established in 2016 with a $300 million gift from Bloomberg Philanthropies, the Bloomberg American Health Initiative focuses on five major health challenges in the U.S.: violence, addiction and overdose, food systems, environmental challenges, and adolescent health. Over the past decade, it has supported graduate fellowships in public health for more than 500 professionals who have worked, or continue to work, on the frontlines of U.S. communities, from teachers and librarians to police officers, health workers, and overdose outreach staff.
"Over the past 10 years, you've taken on some of the biggest, most complex threats to public health," Michael R. Bloomberg, WHO Global Ambassador for Noncommunicable Diseases and Injuries, founder of Bloomberg L.P. and Bloomberg Philanthropies, and a Johns Hopkins alum, said in his opening remarks. "You've pushed forward through political attacks on science and public health, through historic cuts to federal spending, and through the deadliest pandemic in a century." He noted that their collective efforts have helped to improve life expectancy in the U.S., once in decline, to a record-high of 79 years, adding that more progress needs to be made.
Many of the 500-plus Bloomberg Fellows sat in the audience as Webster talked through his findings in a panel discussion moderated by Vann R. Newkirk II, senior editor at The Atlantic. For his report, "Understanding the Great Decline in Homicide Deaths in the United States," Webster combed through data from law enforcement, healthcare, education, and economics. Among his discoveries: The federal government's investment in a public health approach known as community violence intervention, or CVI, contributed to the historic drop in fatal shootings nationwide. In addition, federal policies enacted to curb gun access and ban some firearms (including "ghost guns" made from kits and untraceable by law enforcement), along with changes in police procedures and arrests, also played key roles in reducing fatalities.
"The downward slope we're seeing has never happened before, and it didn't happen by chance," Webster told the crowd. Law enforcement got better at identifying violent individuals and bringing them to justice, but another reason homicide rates fell so drastically involves the "specific public policies put in place with ARPA funds to actually support people in their communities," he explained, referencing the federal stimulus package enacted in 2021, the American Rescue Plan Act, to help the country recover from COVID-19.
Public health approaches to violence reduction differ significantly from punitive pathways to combat gun violence, such as large numbers of arrests. It takes a community-driven approach, with practitioners seeking out and training trusted community members to form and lead groups in their own neighborhoods. The groups aim to strengthen social ties, resolve conflicts, teach safe gun storage, and connect residents to mental health counseling and educational and employment opportunities.
In Baltimore, a CVI program known as Safe Streets has been associated with a 42% reduction citywide in gun-related deaths involving 15- to 24-year-olds, according to a study published in May by the Johns Hopkins Center for Gun Violence Solutions. Overall, Baltimore's public health-driven approach to violence reduction has resulted in a drop of more than 60% in the city's homicide rate from its peak in 2019.
"When I first announced a five-year plan that said we were going to reduce homicides and shootings by 15% in this public health-centered way, it wasn't very popular," Baltimore Mayor Brandon Scott said at the summit. "I wasn't on a lot of stages talking about it back then. People literally laughed. ... [But] the approach that we've had is what makes Baltimore now the model that other cities want to look at for violence reduction."
Image caption: Baltimore Mayor Brandon Scott (right) with journalist Jonathan Capehart.
Image credit: Larry Canner for Johns Hopkins University
With these gains, however, Webster's report issues a stark warning, noting that the historic decline in homicides will not persist without the programs and policies that enabled it to happen in the first place.
"Federal funding for community violence intervention has virtually been eliminated," Webster writes in the report. These funding cuts put pressure on local governments to fill the funding gap at a time when those governments face fiscal challenges of their own, he explains. State and local lawmakers and agencies, private philanthropy, community-based nonprofits, and civic organizations will need to step in to sustain the progress, Webster continues.
Given that evidence-based solutions exist, this isn't the time "to be complacent," he told the crowd. "We have to be committed."
Drug addiction and overdose
Nabarun Dasgupta, a senior scientist and Gillings Innovation Fellow at the University of North Carolina, Chapel Hill, spoke about a parallel success story related to drug overdoses, with overdose deaths in the U.S. declining 40% from their peak in the summer of 2023.
"Our work is not done," Dasgupta said, "but we're seeing these declines because of the work that so many of you do every single day."
Dasgupta shared a report he created with funding from the initiative, "Understanding the Recent Rise and Decline of Overdose Deaths in the United States," also released for the first time at the summit. There, he argues that sustaining the steep drop in overdoses will require ongoing investment in public health services. This will involve continued efforts to make naloxone (sold under the brand name Narcan) accessible to people who use drugs, families, and first responders; to provide outreach and access to treatment to people who use drugs; to understand and monitor supplies for fentanyl and other adulterants; and to develop policies tailored to local conditions.
For example, it's easy to dismiss members of Generation Z, who fall between 14 and 29 years old, Dasgupta notes in the report. Only 8.6% of overdose deaths occurred within this age group, whose "drug tastes have changed from potent synthetic opioids, and towards less immediately lethal substances: cannabis, ketamine, MDMA, kratom, and psilocybin," the report says.
Dasgupta's study cautions public health experts to pay particular attention to younger members of Gen Z, or those born from 2005 to 2011, because they've had more overdose deaths than older members of the cohort. "These young people experienced pandemic disruptions during formative periods of adolescence," his report reads. "This cohort may become a harbinger of future opioid cycles if their needs are not addressed directly."
During the summit, Bloomberg announced a new $150 million commitment to Bloomberg Philanthropies' Overdose Prevention Initiative, expanding efforts to combat the overdose crisis in hard-hit U.S. states. Overdoses are the leading cause of death for adult Americans under age 45. The investment brings Bloomberg Philanthropies' total commitment to its Overdose Prevention Initiative, launched in 2018, to $335 million.
"Even one death from an overdose is too many," Bloomberg said. "The overdose epidemic continues to be one of the hardest public health crises our nation faces. Now is the time to accelerate this hard-fought progress, expand access to treatment, and save more lives."
Gender-based violence
The summit also included an announcement that the initiative is leading the implementation of a national plan to reduce gender-based violence, including sexual assault.
"A gender-based violence plan was created by the previous [federal] administration," said initiative Director Joshua Sharfstein, speaking about the extensive National Plan to End Gender-Based Violence released by the Biden administration in 2023. "The new administration came in, took it down ..., fired everyone in the office, and the Bloomberg American Health Initiative is helping to stand it back up."
Image caption: From left: Michelle Spencer, deputy director of the Bloomberg American Health Initiative; Josh Sharfstein, the initiative's director; and journalist Meredith Cohn.
Image credit: Larry Canner for Johns Hopkins University
Sharfstein underscored the importance of the project—and the leadership of Michele Decker, a professor with joint appointments in the Bloomberg School and JHU's School of Nursing who specializes in gender-based violence prevention and response, in addition to the work of many Bloomberg Fellows, in revitalizing the national plan.
The project's website explains the stakes: "1 in 3 women experience intimate partner violence in their lifetime, and nearly half (45%) experience contact sexual violence," which can involve rape and coercion. "The negative physical, emotional, economic, and social impacts on survivors ripple outward to impact family members, social networks, and communities."
The revitalized plan offers "an evidence-based roadmap for prevention, response, and systemic change," including "vital direction for communities" to help keep women safe.
Digital media and youth
From cell-phone bans in schools to statewide warning labels on social media platforms, efforts are underway to protect adolescents and teens from the seemingly endless, often harmful digital content at their fingertips. Now, the initiative is taking up the mantle, launching a project to investigate and safeguard youth from areas that include excessive screen time, algorithmic feeds that can fuel addiction, inappropriate content, and harmful advice from chatbots.
"Exposure to the digital environment is a public health issue," said Pamela Collins, chair of the Department of Mental Health at the Bloomberg School. "Around 36% of young people say they use social media constantly, and the concern is that excessive use, or use that appears to be addictive, displaces other healthy activities, including one of the most important: sleep."
Studies also show that about 10% of adolescents and teens get exposed to unwanted sexual content, self-harming behaviors, and acts of violence when they use social media excessively, Collins said, and many experience cyberbullying. Teen girls in particular can develop negative body image and eating disorders with prolonged social media use.
Through its new program, the initiative will work to expand the science and data on how the digital environment affects kids and teens while using what it learns to develop interventions and inform public policy to protect young people.
