Early years

Measure what is measurable and make measurable what is not so. - Galileo

As a first-year medical student, Dr. Rodrigo Guerrero learned that becoming a physician would not be enough to save lives on a large scale.

The aspiring physician was asked, “Would you prefer to fish with a line or with a net?” by public health expert Dr. Guy Hayes, then a fellow with the Rockefeller Foundation working in Colombia. “If you practice medicine, you are fishing with a line. But if you really want to help more people, you fish with a net. That’s public health; that’s epidemiology.”

After graduating from medical school at the Universidad del Valle in Cali, Dr. Guerrero earned his PhD in epidemiology at Harvard, where he learned to look beyond patients’ symptoms and use scientific tools to identify the root causes of health problems in society.

Dr. Guerrero spent much of his career teaching epidemiology to undergraduate and graduate students at the Universidad del Valle, where he held positions ranging from Head of the Department of Epidemiology to University President. He also served as Secretary of Health of Cali.

Dr. Guerrero’s drive to improve people’s lives led him to run for mayor of Cali in 1992, and he won easily.

Roots of the problem

When he began his term as mayor, Dr. Guerrero knew that violence was the leading cause of death in the city. Even in Colombia as a whole, violence was the leading cause of early death and disability at that time. Many people believed the violence in Cali stemmed from the drug cartel that dominated the city. Determined to use science to uncover the truth, Dr. Guerrero went in search of data.

He started at the police office. “Tell me, how many homicides have occurred in Cali in the last few months?” he asked. The police gave him a number. Next, Dr. Guerrero went to criminal justice officials and posed the same question. The number they gave him was twice as high as the figure from the police. Upon further investigation, Dr. Guerrero discovered neither the police nor the judicial system was keeping accurate counts of homicides.

To obtain an accurate homicide count, he went back to his academic roots and called on a branch of the Universidad del Valle, Cisalva, devoted to the study of forensic medicine. Dr. Guerrero convened weekly meetings among Cisalva, the police, and the judicial system to identify which cases were truly homicides.

Once he had good data to work with, Dr. Guerrero and his colleagues began to investigate the driving factors behind homicides in Cali. They found most homicides occurred on weekends, holidays, and Fridays coinciding with payday. This information made Dr. Guerrero question the hypothesis about drug traffickers being the main source of the violence. Further investigation revealed that 26% of homicide victims were intoxicated, and 80% of all victims were killed by firearms.

To stem the tide of violence, Dr. Guerrero championed measures to address the key risk factors for homicide – alcohol and firearms. He formed a violence prevention program called Desepaz. He proposed limiting the hours that alcohol could be sold to 1 a.m. on the weekdays and 2 a.m. on the weekends. There was broad, citywide opposition to Dr. Guerrero’s proposal. Before instituting the restrictions, he met with concerned bar owners who doubted the measures would work to curb violence. “Let’s do a three-month observation period,” the mayor proposed. “If it works, I will keep it. If it doesn’t, I will be the first one to celebrate.” When homicide rates began to decrease quickly, the restrictions remained in place for the rest of Dr. Guerrero’s term.

The next step was to tackle the gun problem. Dr. Guerrero negotiated with the army, the main gun vendor in Colombia, to implement temporary gun bans when the risk of homicide was highest, during select weekends and holidays.

The results of the restrictions on alcohol and firearms were dramatic. A study found that, combined, alcohol and tobacco restrictions reduced homicide rates by 33%.

Beyond the mayor's office

When Dr. Guerrero left office, he joined the Pan American Health Organization in Washington, DC, and established its violence prevention program. He succeeded in convincing additional cities in Colombia and other Latin American countries to adopt aspects of the Desepaz model to fight violence.

For the Inter-American Development Bank (IDB), Dr. Guerrero helped Latin American and Caribbean countries adopt violence prevention programs inspired by his experience in Cali. While he was working with IDB in 1998, the Bank provided its first loans for violence prevention to Latin American countries. Since that time, IDB has funded more than 80 projects through its Citizen Security Initiative.

One of the places where Dr. Guerrero’s approach to violence prevention had the most enduring impact was in Colombia’s capitol, Bogotá. In the mid-1990s, Bogotá Mayor Antanas Mockus instituted alcohol and firearm restrictions. These restrictions endured through successive mayors. The homicide rate in Bogotá dropped from 80 per 100,000 in 1993 to 16 per 100,000 in 2012.

Dr. Guerrero’s numerous academic publications and case studies of his work have encouraged leaders in Latin America and the Caribbean to tackle violence. He served on the advisory committee for the landmark World Health Organization report titled World Report on Violence and Health, which provided a comprehensive look at premature death and disability – also known as health loss – due to violence worldwide, as well as recommendations for reducing its toll. Building on the first Global Burden of Disease study published in 1993, Dr. Guerrero co-authored a study that estimated “each Latin American loses the equivalent of three days per year of healthy life due to violence.” The introduction of the burden of disease approach allowed Dr. Guerrero to move beyond the homicide rate to measure years lost to both injuries and death from violence.

In 2012, 15 countries in Latin America and the Caribbean committed to joining an IDB-funded partnership to share and standardize data on crime and violence under the leadership of Cisalva, the academic department Dr. Guerrero appointed to track homicides in Cali 20 years earlier. When the IDB project was announced, Dr. Guerrero commented: “This is a tool that can be exported and become a model for other countries. If we don’t have accurate information, we can’t take action to solve problems. The development of indicators points to the causes of the problems, enabling us to develop cures and provide greater security in our cities.”

Current work

Despite its adoption in many other cities and countries, the Desepaz program was not rigorously promoted by the mayors who followed Dr. Guerrero in Cali. In 2011, after

witnessing a series of mayors who were heavily influenced by the drug cartels, Dr. Guerrero decided to run for the office again and won.

Once again, Mayor Guerrero is implementing firearm and alcohol restrictions in Cali. According to Guerrero, homicide rates in the city have decreased from 80 per 100,000 in 2012 to 56 per 100,000 between August 2013 and August 2014. He has also introduced programs to fight another driver of violence, inequality. Under Dr. Guerrero’s leadership, Cali is investing in the education, health centers, streets, and recreational areas of 27 impoverished neighborhoods. He and his colleagues found that citizens could not enjoy parks in the evenings because of high levels of gang activity. Because gangs can easily conduct criminal activities in parks at night due to lack of lighting, the city of Cali plans to install lights in 1,500 parks by the end of 2014.

In order to translate scientific knowledge into action that improves health, Dr. Guerrero has stepped out of the comforts of the academic world and into the often messy and sometimes dangerous world of politics. In awarding Dr. Guerrero the 2014 Roux Prize, the award committee hopes his work to reduce the impact of violence on public health in the Latin American and Caribbean regions will inspire leaders around the world to use science to identify solutions that save lives. 

About the Roux Prize

The Roux Prize rewards bold action to improve population health through disease burden evidence. The winner, chosen after a worldwide nomination and selection process, receives US$100,000.

Purpose

David and Barbara Roux established the Roux Prize in 2013 to award innovation in the application of Global Burden of Disease (GBD) research. The prize recognizes the person who has used burden of disease data in bold ways to make people healthier.

Mr. Roux is a founding board member of IHME and, over the past decade, he championed IHME’s most ambitious project, the updating of the Global Burden of Disease. And he encouraged IHME, as the coordinating center for researchers around the world, to find ways to make the information more useful, so that it would actually have an impact on the ground.

Since the first GBD publication in 1993, GBD data have been used in a wide variety of ways to inform better policymaking at the local and international levels. Mr. Roux wanted to reward that kind of evidence-based innovation and to encourage even bolder attempts to improve population health through better measurement of disease burden. 

About GBD

The Global Burden of Disease (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors. In 1993, the original GBD study was funded by the World Bank and featured in its landmark World Development Report 1993: Investing in Health. Co-authored by Dr. Christopher Murray, now Director of IHME, this study included estimates for 107 diseases and 483 nonfatal health consequences in eight regions and five age groups.

Now an ongoing enterprise with annual updates, GBD is an international, collaborative effort with more than 1,000 researchers in over 100 countries, led by IHME. Results are regularly published in peer-reviewed journals for more than 300 diseases, injuries, and risk factors, by age, gender, and country. The latest updates through 2013 have been published for tobacco use, maternal and child health, obesity, HIV, tuberculosis, and malaria.  For more information about GBD, visit IHME’s website.