A consortium of researchers dedicated to improving the understanding of the human causes and consequences of terrorism

How Public Health Can Improve Initiatives to Counter Violent Extremism

The following is part of a series of thought pieces authored by members of the START Consortium. These editorial columns reflect the opinions of the author(s), and not necessarily the opinions of the START Consortium. This series is penned by scholars who have grappled with complicated and often politicized topics, and our hope is that they will foster thoughtful reflection and discussion by professionals and students alike.

Although current countering violent extremist (CVE) efforts were conceived as an attempt to move to a more proactive and positive paradigm to address violent extremism through non-coercive means in the pre-criminal space, they are still tainted by their association with counterterrorism efforts.

Dr. Stevan Weine David Eisenman
Stevan Weine David Eisenman

A growing consensus agrees that preventing terrorist acts cannot be left only to traditional law enforcement and prosecutorial approaches.  We should also draw from public health, a discipline responsible for preventing diseases and injuries, protecting against environmental hazards, and promoting healthy behaviors and environments. Adopting a public health approach to the issue may be the best way to realize the intent of CVE.

Public health uses approaches that are commonly divided into primary prevention, secondary prevention and tertiary prevention. Primary prevention aims to prevent injury and disease before it occurs by preventing exposure to the causes and promoters of injury and disease---think healthful eating and exercise to prevent diabetes. Secondary prevention detects and treats the “pre-clinical” changes that occur before disease manifests and progresses, an example being screening people for pre-diabetes and encouraging those who have it to lose weight.  Tertiary prevention occurs once disease occurs and the goal is to reduce its impact on longevity or quality of life.

In addressing violent extremism, primary prevention may include community-level strategies that mitigate modifiable risk (e.g., availability of extremist media) and leverage protective factors (e.g., parenting support and education) that are empirically or theoretically associated with violent extremism. Secondary prevention may include strategies directed at individuals who have been identified as having some characteristics that render them at elevated-risk for violent extremism, such as exposure to extremist ideologies or proximity to a radical social network.  Strategies for secondary prevention may include counseling and mentoring. Tertiary prevention may be strategies directed at individuals who have already adopted extremist ideologies or are in contact with violent extremists, but are not engaged in planning or carrying out acts of violence, such as psychotherapy and intensive case management.

Studies of school shooters and terrorists have shown that most perpetrators “leak” information that something is wrong beforehand, but not necessarily in a way that would be obvious to law enforcement. Their family and friends frequently do not act on that information because they fear going to law enforcement, and do not know of other good options to get help. This is an obstacle that other areas of injury prevention research and services, such as domestic violence and gang violence, have worked to overcome, and it is one reason why these approaches should be applied to violent extremism. For example, decades of community education, public messaging, and health and social service provider training on domestic violence has reduced the barriers victims once had to seeking protection ongoing abuse. With respect to their concerns about violent extremism, what if family and friends could access trained professionals at trusted community agencies (social service providers, immigration service providers) to get help with their concerns? This would be an example of a secondary prevention provided to an “at-risk” person.

A second reason is that, if left to law enforcement alone, communities will likely resent the securitization of their relationship with the state. Additionally, law enforcement may leave too heavy a footprint in communities.  This can have the unintended consequence of provoking perceptions of discrimination and victimization which can diminish community members’ cooperation with law enforcement.

A third reason is that there are significant numbers of persons who are involved with hateful ideologies but have not yet committed a crime, and who could possibly be diverted from the path towards criminality with alternative approaches to arrest and imprisonment, through secondary or tertiary prevention.

The U.S. Department of Homeland Security (DHS) recently funded two teams of public health scholars (our team from the University of Illinois at Chicago and UCLA, and another team from Harvard University) to formally evaluate the Los Angeles and Boston CVE programs.  It’s no coincidence that DHS chose public health scholars who have the methods to further develop and then evaluate these programs. What does public health have that could help CVE?

Public health providers recognize their responsibility to reduce violence in general, and CVE can be seen as one part of their efforts, which also includes other issues of targeted violence, such as school shootings, workplace violence, and bias-motivated hate crimes.

Public health also teaches not to add to the stigmatization or fear that communities already feel in response to discriminatory approaches focused on identity or on fear-based messaging.  These approaches bring out strong negative emotions and do not to lead to the desired behaviors or outcomes.

Public health teaches instead to identify feasible and positive protective actions that are contextually tailored and appropriate to manage potential threats that persons can identify in their daily lives.

When someone gets carried away by hateful ideology on the Internet, or gets approached by a recruiter who wants them to take violent action, they often do not seek or receive help before it is too late.  They may not seek help because they are told, “You can be a hero,” and the empowerment being offered them is attractive. They may not receive help because communities are concerned over becoming entangled in the criminal justice system.

By comparison, we believe a public health approach may enable this:  that a friend, family member, teacher, or clergy member who knows that person would notice something was wrong and reach out to an advocate or helping professional in their community. This person would know to connect them with a specialized community-based team. That team could assess whether they present an immediate threat requiring law enforcement involvement, or whether they could benefit from mental health or social services. If so, the team could then connect him or her with the help needed, be that individual or family therapy, counseling, mentoring, school or job assistance. 

This seems necessary and appropriate given that many of the individuals involved in violent extremism have in common profound isolation from sources of support or guidance, some have mental health issues, and others have suffered a personal crisis. The hope is that giving them what they are otherwise missing could help to decrease their vulnerability to acting on a hateful ideology that seeks to fill the same void. 

This is an example of the kind of life saving help that public health can potentially provide for some persons on a path to violent extremism.  What is needed to build on this recognition is funding for community-based public health programs focused on violent extremism alongside other issues of targeted violence. 

Stevan Weine is Professor of Psychiatry at the University of Illinois at Chicago and David Eisenman is Associate Professor of Medicine and Public Health at the David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health.