U.S. Surgeon General Vivek H. Murthy recently declared gun violence a public-health crisis and advocated taking a public-health approach to address it. It was the latest call to apply public-health methodologies to a growing number of challenges outside of the traditional health field. The goal of such efforts generally is to use public-health models, evidence, and research to devise effective policies and practices that can reduce and prevent injury, disease, and death.
The motivation for this growing trend has been driven in large part by policymakers, practitioners, and researchers who believe that addressing upstream factors — such as low social connection, lack of family support, and exposure to violence and hate — could reduce multiple forms of violence. Another tragedy in Winder, Georgia this week, in which a 14-year-old is charged with using an assault-style rifle to kill two students and two teachers at a high school, punctuates the urgency of finding better solutions.
In theory, applying a public-health approach to reduce risk and to enhance protective factors common to various types of violence should result in more effective, efficient, and sustainable ways of preventing violence. However, the tendency to think about or respond to the different forms of violence in silos, rather than identifying and addressing the common causes, has impeded the practical application of widespread prevention efforts. This delineation happens particularly when it comes to terrorism, ideologically motivated attacks, and other forms of targeted violence. That is, violence spurred by hate, extremism, political ideology, or serious mental illness tends to be treated separately from other types of violence in communities because of the frequent links to ostensibly separate national security issues.
Four Decades of Public-Health Approaches to Preventing Violence
The idea of applying public-health principles and concepts to violence prevention dates back more than four decades. Since the 1980s, the U.S. surgeon general and what is today the Centers for Disease Control and Prevention (CDC) have been applying the public-health approach to address issues such as youth violence, intimate partner violence (IPV), and school shootings. In each of these contexts, the purpose has been to deploy more than traditional criminal-justice approaches to prevent violence and its harmful impacts on individuals, communities, and society more broadly. This means looking beyond the police and emergency responders and relying more on mental- and other health professionals, teachers, community leaders, peers, and family members to identify early signs of trouble in individuals and communities and to take preventive actions that increase the likelihood of stopping violence long before it starts.
The call from law enforcement and other government officials, as well as researchers, for a public-health approach to reduce the risk of targeted violence was sparked by a series of horrific, high-profile attacks that preceded the Winder, Georgia, shooting — in cities including Pittsburgh, Pennsylvania in October 2018; Dayton, Ohio and El Paso, Texas in August 2019; Buffalo, New York and Uvalde, Texas, in May 2022; Highland Park, Illinois, in July 2022; Lewiston, Maine, in October 2023; and Burlington, Vermont, the following month. The appeal followed years of frustration with a security-dominated approach that was bearing little fruit, and was informed by lessons from whole-of-society prevention efforts in western Europe.
As in earlier situations, the aim of the public-health approach to preventing targeted violence, promoted by the Department of Homeland Security’s Center for Prevention Programs and Partnerships, is to bring together institutions and experts across disciplines in a common effort to develop and implement effective prevention strategies that work by modifying known risk and protective factors to mitigate the risk of violence. (Disclosure: The authors have received grants managed by the center.)
More specifically, according to Bill Braniff, the center’s director, this framework involves tapping proactively into “individuals [e.g., mental health professionals, behavioral health professionals, social workers, school counselors] who already do violence prevention work… such as suicide prevention, prevention of violence against children, and intimate partner violence prevention.” The goal is to lower the number of people who ever reach a point “where they see violence as an attractive way to solve a particular problem, address a grievance, or advance a goal.”
The results so far from the DHS-funded projects (totaling some $90 million) over the past few years aimed at advancing this approach have included the elaboration of state-level targeted-violence and terrorism-prevention frameworks in a small but growing number of states, and the creation of more than 35 behavioral threat assessment and management teams, including in K-12 schools. The number of such teams around the country has risen steadily, an increase that has already saved lives as well as taxpayer money, according to Braniff.
Public Engagement in Safety
Interestingly, this shift towards a public-health approach for this kind of violence has occurred roughly at the same time as another major transformation in the approach to public safety — so-called “reimagining public safety” initiatives — largely developed in the wake of George Floyd’s murder in Minneapolis in 2020. The idea of such efforts (this and these, for example) is to have meaningful, transparent, and ongoing engagement with communities in the design, implementation, and oversight of new strategies to enhance public safety — or, as Ras Baraka, the Mayor of Newark, NJ, has said, it is about putting the “public” back into the concept of “public safety.”
Yet these two lines of efforts, which are and should be mutually reinforcing, developed in silos, often with different funding streams, different champions, and different communities of practice.
Reimagining public safety emerged as a response to the national movement demanding extensive police reforms, an end to systemic racism, and more investment in community solutions for public safety. Meanwhile, community activists have long demanded an expansion of civic engagement programs that involve the public in enhancing community safety and wellness.
Since then, a growing number of American cities, supported by hundreds of millions of dollars in grant funding from the U.S. Department of Justice and other federal agencies, are exploring alternative approaches to traditional law enforcement mechanisms that promote the “co-production” of public safety – a key ingredient of efforts to “reimagine” it – while minimizing harm to communities and ensuring accountability.
This effort has inspired a number of initiatives in cities around the country, including ones focused on community co-responders and hospital-based and community-based violence-intervention strategies. Common themes across all these efforts — and similar to what underpins much of the growing body of public health-oriented initiatives to prevent targeted violence — are the focus on involving institutions and practitioners outside of traditional law enforcement and criminal justice actors and the related emphasis on involving local communities’ voices in program design and implementation.
In short, both reimagining public safety and the public health-driven approach to preventing targeted violence are inspired by a recognition by community leaders and police officers that “we rely too much on the police” to solve societal problems and that over-reliance on law enforcement has inhibited investments and innovations in other public-safety and community well-being tools — e.g., mental health workers or community-based violence interventionists.
In a growing number of cases, reimagining public safety efforts have been institutionalized through the creation of city-level offices of violence prevention, which work with the police and communities. For example, in Newark, the Office of Violence Prevention and Trauma Recovery was created to, among other things, “improve the quality of life for all residents of Newark through reimagining public safety and public health as tools to address the underlying causes of violence, not only its consequences.” According to Baraka, the collective efforts of Newark’s “ecosystem of public safety” has led to an unprecedented 60-year low in violent crime, drawing on “the widest range of skills and expertise in public safety, public health, and mental and social well-being, as well as social justice and criminal justice reform.” In 2022, the Center for American Progress cited Newark’s reform efforts as a successful example of a city implementing a comprehensive approach to public safety “focused not only on stopping violent crime but also on prioritizing community-driven and public health-focused innovations that break the cycle of violence.” (One of us, Alejandro, is co-director of the Newark Public Safety Collaborative, which helped develop the data-informed community engagement model for crime prevention that the city of Newark uses.)
This ecosystem of community-based organizations and other local stakeholders is rooted in the communities most affected by crime and provides such organizations with an opportunity to fully participate in public-safety discussions. Albuquerque, Austin, Columbus, New York City, Rochester, St. Louis, and Tacoma are just a few of the cities around the country that have followed a similar path in recent years.
National Security-Linked Violence Viewed Differently
Yet, these and other reimagining public safety efforts were inspired by different events and catalyzed by different communities than those pushing for a public-health-oriented approach to preventing targeted violence. Thus, they have proceeded without regard to targeted violence threats or concerns in those very same cities where the goal is public-safety reform. In short, targeted violence, with its association with extremism and terrorism and national security threats more broadly, is still too often “exceptionalized” and viewed as a “violence apart” from the more regular forms of violence that fall within the traditional public-safety construct.
Among the practical implications of this are that targeted violence-prevention initiatives are generally unable to benefit from the ability to leverage the responses of community-based organizations and other public-safety reform innovations, resources, structures, and partnerships that could help ensure their effectiveness and sustainability. This is especially true with respect to the behavioral threat assessment and management teams because they can’t do their work alone.
To be effective, such teams require full attention to building the upstream and downstream resources, awareness, and practices that enable the teams to identify, assess, and manage persons at risk for violence. These teams need active and intentional community involvement, such as community awareness and education, conducting primary prevention, encouraging bystander reporting, and of course, community participation. Much of this will be easier to achieve if two important steps are taken in parallel: those involved in developing and implementing such teams can take full advantage of the relevant public-safety reform efforts and those involved in reimagining public safety efforts include targeted violence among the forms of violence their reforms are meant to address.
The silos between reimagining public safety and public-health-oriented approaches to preventing targeted violence need to be broken down, given that these historically disparate fields are, in many respects, two sides of the same coin. The sooner efforts to reimagine public safety integrate behavioral threat assessment and management teams and other targeted-violence prevention efforts, and the sooner the latter leverage reimagining public safety and public-health-based violence-prevention innovations, the more likely that lives will be saved in all communities.