When Nakita Lovelady matriculated to the graduate program at the University of Arkansas, her evenings were spent studying by the dim light in her Little Rock apartment, where she scribbled down notes, analyses, and comparisons of public health research and policy. One night during her first year, she came across a term that explained how a person’s environment affects their overall health: the “all-around-me” approach. It was that night, she said, that a neighbor who she knew only in passing was fatally shot.
Lovelady was already familiar with gun violence. She grew up near Helena-West Helena, in Phillips County, which snakes along the Mississippi River through the heart of the Arkansas Delta. The rural community, where crops like soybeans and cotton have sustained the agricultural economy for generations, is vast, and Lovelady’s memories are of its close-knit people and its beauty. But in the past decade, poverty, inaccessibility to social services, and a lack of commerce and public transportation have all contributed to a little-known but alarming spike in gun deaths across the county. From 2018 to 2022, according to the Centers for Disease Control and Prevention, Phillips had the highest per capita firearm homicide rate of any other county in the United States, rural or urban.
Gun violence was part of life growing up, Lovelady recalled, but it’s worse now. “If I don’t know the person who was shot,” she said, “I went to the school with one of the relatives.”
In 2012, Arkansas was among the top 10 states with the highest firearm mortality rates in the country, where it remains. That was the year Lovelady graduated with her master’s in public health and went to work as a community health specialist, before returning to the university to receive her doctorate. In 2019, Lovelady successfully defended her thesis on the effects of gun violence and graduated the same year that Congress pledged millions of dollars for gun violence research, a pivotal shift for a long-politicized issue.
Still, funding for gun violence research would take time to trickle down, which worried her. “But in my first year as a student, I did a set of qualitative interviews with 10 young Black males,” she said, “and across the board, gun violence was mentioned. I knew I couldn’t turn away from this work.”
When 2020 hit with the converging public health crises of COVID-19 and a spike in shootings, Lovelady was analyzing her research on health disparities in Black communities and trying to identify some ways to stem the violence. She was thinking of her upbringing, she said, her weekends spent running through the fields of her parent’s farm with her cousins and neighbors, and marveling at the annual King Biscuit Blues Festival on Cherry Street, where shootings are now wracking the community and threatening a quiet way of life. She knew Arkansas needed a public health program that could provide crucial help not only in Little Rock, but across the state.
“We are Arkansas, and we are in a unique situation… things look different here,” said Lovelady. “A third of our state’s gunshot wounds are coming from rural communities that are low-resourced.”
In 2023, years into her academic research and grappling with the new reality, Lovelady established Arkansas’s first hospital-based violence intervention program, Project Heal, one of the first of its kind in the country to be housed in an urban center but extend its services to rural communities throughout the state. Some of the initial funding for Project Heal came from the American Rescue Plan Act, which was part of a federal stimulus package to help states and localities recover from the pandemic and its economic impacts. Additional funding came from the university and the Arkansas Center for Health Disparities, which is supported by the National Institutes of Health.
Hospital-based violence intervention programs (HVIP) like Project Heal are a form of community violence intervention that provides holistic, rehabilitative treatment to patients suffering from gunshot wounds while mitigating reinjury or potential retaliation. The medical staff connects shooting victims to violence intervention specialists from their communities, who provide emotional support to address trauma and help them navigate available resources as they adjust back to daily life.
“If I had a program like Project Heal, it would’ve made all the difference in my life,” said Caleb Glason, a gun violence survivor who has been with the program since it began and serves as a community health worker. In 2007, when he was 19, Glason was in a street fight with rival gang members and was shot once through the jaw. Now, as a minister and Project Heal peer specialist, his day-to-day activities range from motivational speaking engagements to meeting prospective patients in the emergency room. “I now get to be that person that I needed, and do things like take the victims out to eat, take them to the doctor, just be there for them, you know, just treat them like a human being.”
Arkansas’s statewide population hovers just over three million; 41 percent of its residents live in rural areas, compared to 14 percent of the rest of the country. As in many cities, the homicide rate in Little Rock, its capital, reached record highs in the late 1980s through the mid-1990s, then steadily declined until the COVID-19 pandemic. That’s when the state’s lone Level 1 Trauma Center was overwhelmed by pandemic patients and gun violence victims, and Arkansas’s lack of social services and medical infrastructure became acute.
Historically associated with urban problems, gun violence has recently surged across Southern states and rural communities. Nationally, emergency hospitalizations because of firearm injuries increased by 37 percent between 2019 to 2020; 36 percent the following year; and 20 percent in 2022. For people in communities like the one Lovelady is from, which is about 118 miles away from the capital, getting to urgent medical care can take two hours.
Project Heal is currently providing services to the Greater Little Rock area, with hopes to be servicing eight counties by next summer. Lovelady and her staff of five are holding listening sessions throughout the state and speaking to residents about the community effects of shootings. It’s a drop of relief in the South, where gun violence services have not been focused, despite high rates of firearm injuries over the past decade.
“There has been growth in many areas in what this work looks like, but it has been uneven,” said Dr. Kyle Fischer, an emergency physician in Maryland and the policy director for the Health Alliance for Violence Intervention. He has been doing hospital-based violence intervention work for more than a decade. “A lot of the growth has been related to the funding and who has it. You’ll see states like California, New York, and Pennsylvania that have made really big state investments. In the South, we haven’t seen that; it has been more locally driven.”
For those at the forefront of this work, like Lovelady and Fischer, the 30-year-old HVIP method has proven its need for more investment. The first national hospital-based violence intervention program, Youth ALIVE!, was developed in 1994 in Oakland, California, and similar programs gradually spread throughout the country, largely concentrated in urban areas in the Northeast, Midwest, or West. It wasn’t until 2007 that a program established in Virginia brought the method to the South.
Initially, a lot of the Project Heal staff spent their time learning about the unique needs in Arkansas and planning how best to implement the HVIP in the most equitable way, taking lessons from other programs but applying them to the different circumstances — and history — of their state.
“We have the core pieces of what leads to success with HVIPs as a whole,” said Lovelady, “but how do we do that in different places, and what are the local contexts needed to adopt those interventions?”
The issues facing counties like Phillips, for example, are steeped in a history of segregation. In 1919, it saw one of the nation’s deadliest racist massacres, when Black farmers organizing for better work conditions were attacked by a white mob and nearly 240 Black residents were killed, many by gunshot or lynching. The Elaine Massacre worsened the racial divide for decades to come, contributing to severe challenges in establishing Black-owned agricultural businesses and worsening disparities for generations. Today, 30 percent of Phillips County lives in poverty, according to 2022 census data; 60 percent of the deeply rural community is Black, and nearly 40 percent of residents are over the age of 65.
Now, Lovelady and her colleagues are implementing a method to address the needs of communities like Phillips County. They hope the approach can serve as an example to other states with large rural populations, particularly in the South, where a handful of emerging HVIPs are rising up, including in Birmingham and Mobile, Alabama; Charleston, South Carolina; Atlanta; and Memphis.
“From a public health perspective, we should know by now that the meat of HVIPs work,” said Lovelady, noting how long such programs have existed. “There is a ton of literature about having a community health worker who connects people with support and helps them navigate the health system. We know that works.”
But she emphasized there is no single solution. Regionally comparative studies that examine how to implement HVIPs differently in different communities are sorely needed. “Our program,” she said, “represents part of a larger movement.”
