Should political violence be addressed as a threat to public health?

In the middle of the 19th century, garbage of all kinds accumulated in the streets of New York. The land was swampy and lacked proper drainage. Unsanitary conditions allowed contagious diseases to ravage many of the city’s poor neighborhoods. During the summer of 1864, an inspection undertaken by a committee of concerned physicians produced a seventeen-volume report listing the conditions. An inspector noted that in his assigned district, waste was filling gutters, blocking sewer culverts, and emitting “permanent fumes which generate pestiferous diseases.” Another observed that some streets looked more like “dung beetles than the thoroughfares of a civilized city.” In response to this report, state legislators introduced legislation that led to the creation in 1866 of the Metropolitan Board of Health, one of the nation’s first municipal public health authorities. Upon its formation, the board immediately faced a possible cholera epidemic. He established quarantine measures and administered new health orders that helped contain the spread of the disease. Support for the new agency soared, and other cities began organizing similar authorities. The modern public health movement in the United States was born.

An important revelation of the 19th century “Great Health Awakening,” as it became known, was that social and environmental factors could significantly affect people’s health. During the second half of the 20th century, policymakers began to focus their attention on issues such as product and workplace safety in order to save lives. In the mid-1950s, nearly forty thousand people died each year from road accidents. Much of the attention has focused on driver liability, but doctors and engineers have pointed out that most of these deaths could actually be avoided through changes in automobile design. In 1965, Ralph Nader, a young lawyer who later became an activist and perennial presidential candidate, published “Unsafe at Any Speed,” a book examining how automakers had failed to prioritize safety. It became an unlikely non-fiction bestseller, alongside Truman Capote’s “In Cold Blood.” Nader’s reporting led to congressional hearings and the formation of what is now known as the National Highway Traffic Safety Administration. William Haddon, a pioneering public health scientist, became the agency’s first administrator and oversaw the first safety requirements for new cars, including energy-absorbing steering columns, shoulder harnesses and the side door beams. The ratio of motor vehicle deaths to miles driven by drivers in the United States has fallen.

The main goal of public health is prevention. It is mainly inspired by epidemiology, which studies the prevalence of diseases and their determinants to shape control strategies. In the mid-1960s, public health practitioners began integrating these methods into a nascent discipline known as injury science, tackling problems such as children falling out of windows, residential incidents, drug poisonings among children and, beginning in earnest in the 1990s, gun violence. The principle is incredibly simple: use scientific data to identify risk factors and the most vulnerable populations, and adopt multi-pronged solutions to stop problems before they arise. When it comes to gun deaths, for example, public health interventions might include pediatricians asking about the safety of home storage, and the government establishing waiting periods for purchasing firearms. firearms and increasing the legal age to own a firearm. The challenge is to build consensus on the type of community-based solutions that public health requires. This is where public health initiatives have often failed, including with guns.

In recent years, public health researchers have begun to wonder whether a new societal threat deserves their attention: political violence. One of the researchers leading the effort is Garen Wintemute, director of the Violence Prevention Research Program at the University of California, Davis, who has spent more than four decades studying gun violence. Wintemute is a gaunt, bespectacled emergency room doctor. (He still works four or five weekends a month at the UC Davis hospital.) He is seventy-two but speaks with an almost childlike curiosity when discussing research on violent death. Wintemute told me that during the coronavirus pandemic, he and his researchers have tracked an increase in gun purchases nationwide, particularly among new gun owners. Even if the COVIDAs the -19 crisis began to ease in 2021, they noticed that people were still buying guns at unusually high rates. Baffled by the constant demand, he wondered: What is this? He spent a week delving into the available data on political polarization and its link to violence. When it emerged, he concluded that the subject of political violence needed to be urgently studied because people appeared to be “arming themselves” and the result “could reshape the future of the country.” He eventually asked a third of his team of thirty to devote at least part of their time to a new project: studying the possibility that people might resort to violence to achieve their political ends.

As with any public health issue, the first task is to collect reliable data. Wintemute’s team conducted its first large-scale survey in 2022 and found that nearly a third of the population believed violence was usually or always justified to advance at least one of seventeen policy goals , a list that included fighting election fraud, stopping illegal immigration, and returning Donald Trump to the presidency. Nearly one in five people strongly or very strongly agree with the statement that “having a strong leader for America is more important than having a democracy.” Willingness to justify violence was greater among people who identified as “strong Republicans” than among those who identified as “strong Democrats.” Another study by Wintemute’s team found that nearly half of a cohort they described as “MAGA Republicans” – self-identified Republicans who voted for Trump in 2020 and believed the election was stolen – strongly or very strongly agreed with the statement “Our American way of life is disappearing so quickly that we may have to to resort to force to save him. Wintemute also examined the threat posed by right-wing extremists who support racist beliefs and the use of violence to bring about social change, and who express approval of certain militias such as the Proud Boys and the Oath Keepers. Within this small subset – Wintemute estimates it represents less than 2% of the population – he found a strong association with support for political violence and willingness to engage in such violence.

Still, some findings gave Wintemute reason to be optimistic. A survey released last month found that only 6.5 percent of the population strongly or very strongly believe that civil war is imminent, and only 3.6 percent think that “the United States needs ‘a civil war to make things right’. Both figures are roughly similar to the previous year, an unexpected result given that 2024 is a presidential election year and political tensions have heightened. Wintemute also found that, of the 3.7 percent of respondents who said it was very or extremely likely that they would participate as a combatant in a large-scale conflict, more than 44 percent said that it would be “unlikely”. to join if they have been dissuaded by members of their family; more than thirty percent said they might be dissuaded if a respected religious leader urged them not to participate; and just under a quarter said they could be dissuaded by a respected news or social media source. The implication, according to Wintemute, is that “a large percentage say, ‘You can talk me out of it.’ » This paves the way for possible public health interventions, which could include consistent messages from the media, religious leaders and others about rejecting political violence.

The threat of violence looms like a dark cloud during this election period. The specter of the Jan. 6 insurrection at the Capitol remains ever-present, but the two most visible instances of violence during the 2024 campaign have been directed at Trump. On July 13, during a Trump campaign rally in Butler, Pennsylvania, a man on the roof of a warehouse shot the former president eight times. A bullet grazed Trump’s ear; a rally participant, a former volunteer fire chief, was killed; two others were injured. Then, on September 15, while the former president was playing a round of golf at his West Palm Beach club, a Secret Service agent patrolling the grounds spotted the muzzle of a rifle protruding from a bush along a wire fence. The officer opened fire and the shooter fled. After his arrest, authorities discovered he had been monitoring the course for hours. Democrats were also targeted. In Tempe, Arizona, state party officials recently closed a campaign office after it was shot three times in three weeks.

According to tracking by the Bridging Divides Initiative at Princeton University, threats and harassment against local public officials increased in July. Despite this, violence from extremist groups, as reported by another organization, Armed Conflict Location and Event Data, has actually declined this year, likely because law enforcement has arrested dozens of members of these groups for their participation in the Capitol riot. This paints a confusing picture. Whether or not political violence poses an imminent threat to Americans? Political scientists, applying their theoretical frameworks, have long made clear the reasons for their concerns, including how the country’s deepest divisions over race, ethnicity, religion, geography and culture, are now anchored in the politics of the people; the weakening of the safeguards of democracy under the Trump era; and the spread of disinformation.

The promise of public health is to rely on scientific data and propose pragmatic solutions. Treating political violence as a contagion could help preserve the future of American democracy. And yet, the same divides that potentially drive political violence can jeopardize the collaboration needed to address public health crises. They can also lead to the most dangerous symptom of all: a feeling of helplessness. But if we just wait for the disease to strike, it may already be too late. ♦