The Public Health Approach to Prevention

Hate, intolerance, and polarization are pulling people apart from each other, rupturing relationships and communities.

By Seth M. Limmer

Seeing the news is usually dispiriting: there seems to be little we can do about the daily cadence of government officials threatened with physical harm, the regularity of mass shootings, or the alarming rise in hate crimes. These stories we encounter every day illustrate what research evidence has also demonstrated. We face a national crisis of violence, namely targeted violence, often racially or ideologically attacks directed at specific individuals and groups.

Hate, intolerance, and polarization are pulling people apart from each other, rupturing relationships and communities. America is not healthy right now. Physical assaults of politicians are one symptom of this societal sickness. Unending cycles of school shootings are another. Armed Nazi marches in major cities are a third. Grievance homicides of executives are a fourth. The list feels endless. On any given day, a suspect is arraigned or a conviction is secured, but more violence erupts in a terrifying version of Whac-A-Mole™. It is easy to feel helpless and disempowered in the face of this overwhelming and constant violence.

However, there is something we can do to stem this tide. We can, as individuals and a society, rise in response.

The first step is realizing that this societal sickness is just that: an epidemic. Targeted violence—specifically violence aimed at minorities, targeting elected officials, attacking genders and gender identities—is a disease destroying America. Knowing that this is true, seeing reality from this important angle, we can create and implement not just a response but a remedy. The societal epidemic of targeted violence requires a public health solution. Such solutions have proved effective against epidemics of tuberculosis, lung cancer, even highway safety. A public health approach can likewise prove effective in reducing the targeted violence caused by hate and polarization that proliferates today.

There is a growing body of evidence about what works to intervene in pathways to targeted violence. These methods equip the public with tools that shore up their capacity and resilience, following the tried and true stages of a public health approach: defining and monitoring the problem, identifying risk and protection factors, developing and testing prevention strategies, and ensuring widespread adoption. Importantly, they also protect the right to free speech and reduce the need for security-based responses (which overwhelmingly only serve to punish perpetrators after violence occurs and do little to prevent violence before it happens).

Just as anti-smoking campaigns made our country healthier, a similar approach can be effective for our epidemic of violence. Public school curricula on the non-partisan topic of internet safety will not only protect children from sextortion and a host of on-line harms, but it also will help kids be less susceptible to people trying to radicalize them with mis-, dis-, or mal-information. Campaigns to recruit and train veterans to serve as poll workers can help restore faith in fair, democratic elections. Workshops for parents, coaches, clergy, and mental health professionals on the best strategies for recognizing and responding to signs of potential violent activity will greatly reduce the risk posed by people showing those signs. These evidence-based, thoroughly tested interventions are individual pieces of a larger puzzle of what a public health approach to prevention can look like.

The public health approach aims big: The goal is to treat the entirety of society. Therefore, even while there are efforts underway to develop and test interventions, including many here at our lab at PERIL, the crucial aspect of all public health work is the last stage: ensuring widespread adoption. Currently, upstream efforts to prevent targeted violence are mostly hyper-local or in pilot phases. Only now are conversations beginning on any larger scale—particularly in states like Washington and Illinois—to address more holistically the problems of mass violence and hate crimes. [This is especially important because the current administration effectively shuttered the federal agency tasked with preventing targeted violence.] What will be required to address America’s epidemic of violence will be a whole-of-society public health approach that ensures widespread adoption of democratic norms. Such a broad approach has been underway for decades in Germany, with hundreds of millions of Euros in annual funding and nationally funded efforts such as “Demokratie leben!” A similar approach, sustained by state and federal commitments, can be equally effective in America.

A public health approach to prevention requires the active participation of, well, the public. That is why everyone, from private citizens to elected officials, from state workers to federal appointees, needs to work together to establish programs that protect against risk factors and sustain efforts to build resistance to those conflict entrepreneurs who stoke violence. This will take a coordinated effort of advocacy and activism, a sustained push not only to put programs into place but also to ensure their continuation.

The task before us is massive; but so is the societal disease of targeted violence. Instead of throwing up our hands and wondering what it is that we can do, we can join hands—at the local level, in our state houses, and even in the halls of Congress—to bring the public health work of violence prevention here to America.

Rabbi Seth M. Limmer is director of public affairs for PERIL, bringing the powerful work of countering extremism and polarization to a strategically crucial region.

---