Should Political Violence Be Addressed Like a Threat to Public Health?

In the middle of the nineteenth century, filth of every kind accumulated on the streets of New York. The land was boggy and lacked proper drainage. The unsanitary conditions allowed contagious diseases to ravage many of the city's impoverished neighborhoods. In the summer of 1864, an inspection undertaken by a committee of concerned physicians yielded a seventeen-volume report that catalogued the conditions. One inspector noted that, in his assigned district, refuse filled gutters, blocked sewage culverts, and sent forth "perennial emanations which generate pestiferous disease." Another observed that certain streets better resembled "dung-hills rather than the thoroughfares in a civilized city." In response to the report, state lawmakers introduced legislation that led to the establishment, in 1866, of the Metropolitan Board of Health, one of the country's first municipal public-health authorities. Upon its formation, the board immediately confronted a potential cholera outbreak. It established quarantine measures and administered new health ordinances that helped to contain the spread of the disease. Support for the new agency soared, and other cities began organizing similar authorities. The modern-day public-health movement in the United States was born.

An important revelation from the "great sanitary awakening" of the nineteenth century, as it became known, was that social and environmental factors could significantly affect people's health. During the second half of the twentieth century, policymakers began turning their attention to issues such as product and workplace safety as a way to save lives. In the mid-nineteen-fifties, nearly forty thousand people were dying every year from motor-vehicle accidents. Attention was primarily focussed on the responsibility of drivers, but physicians and engineers pointed out that most of these deaths were, in fact, preventable through changes in automobile design. In 1965, Ralph Nader , a young lawyer who later became an activist and a perpetual Presidential candidate, published "Unsafe at Any Speed," a book examining the ways in which automakers had failed to prioritize safety. It became an unlikely nonfiction best-seller, alongside Truman Capote 's " In Cold Blood ." Nader's reporting prompted 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 side-door beams. The ratio of motor-vehicle deaths to miles travelled by drivers in the United States plummeted.

The principal aim of public health is prevention. It takes its scientific cues primarily from epidemiology, which studies the prevalence of diseases and their determinants to shape control strategies. In the mid-nineteen-sixties, public-health practitioners began to incorporate these methods into a nascent discipline known as injury science, taking on problems such as children falling from windows, residential fires, childhood drug poisonings, and, beginning in earnest in the nineteen-nineties, gun violence. The premise is tantalizingly straightforward: utilize scientific data to identify risk factors and the most vulnerable populations, and adopt multipronged solutions to stop problems before they arise. When it comes to gun deaths, for instance, public-health interventions might include pediatricians inquiring about safe storage at home, and the government establishing waiting periods for the purchase of firearms and raising the legal age for gun ownership. The challenge comes in marshalling consensus for the kind of community-wide solutions that public health demands. This is where public-health initiatives have often floundered, including with guns.

In recent years, public-health researchers have begun to consider whether a new societal threat deserves their scrutiny: political violence. One of the researchers leading this effort is Garen Wintemute, the director of the Violence Prevention Research Program at the University of California at Davis, who has spent more than four decades studying firearm violence. Wintemute is a gaunt, bespectacled emergency physician. (He still works four or five weekend shifts a month at U.C. Davis's hospital.) He is seventy-two years old but speaks with an almost childlike inquisitiveness when discussing research into violent death. Wintemute told me that, during the coronavirus pandemic , he and his researchers tracked a nationwide surge in firearms purchases, particularly among first-time gun owners. Even as the COVID-19 crisis began to subside in 2021, they noticed that people were still purchasing guns at unusually high rates. Baffled by the ongoing demand, he wondered, What the hell is this? He spent a week immersing himself in the available data on political polarization and its connection to violence. When he emerged, he concluded that the subject of political violence urgently needed study, because people seemed to be "arming up" and the result "could reshape the future of the country." He eventually directed a third of his thirty-person team to spend at least some of their time on a new project: researching the possibility that people might resort to violence to achieve their political ends.

As with any public-health problem, the first task was to collect reliable data. Wintemute's team conducted their first broad-based survey in 2022 and found that nearly a third of the population believed that violence was usually or always justified to advance at least one of seventeen political objectives—a list that included curbing voter fraud, stopping illegal immigration, and returning Donald Trump to the Presidency. Nearly one in five agreed strongly or very strongly with the statement that "having a strong leader for America is more important than having a democracy." The willingness to justify violence was greater among people who identified as "strong Republicans" than those who identified as "strong Democrats." Another study by Wintemute's team found that nearly half of a cohort that they labelled "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 fast that we may have to use force to save it." Wintemute also examined the threat posed by right-wing extremists who endorse racist beliefs and the use of violence to effect social change, and who express approval of certain militia groups such as the Proud Boys and the Oath Keepers. Within this small subset—Wintemute estimates it to be less than two per cent of the population—he found strong association with support for political violence and the willingness to engage in such violence.

Yet certain findings offered Wintemute reason for optimism. A survey published last month found that only 6.5 per cent of the population believes strongly or very strongly that a civil war is coming, and just 3.6 per cent that the "United States needs a civil war to set things right." Both figures are roughly similar to the previous year's findings, an unexpected result, given that 2024 is a Presidential-election year and political tensions have ratcheted upward. Wintemute also found that, of the 3.7 per cent of respondents who said they considered it very or extremely likely they'd participate as a combatant in a large-scale conflict, more than forty-four per cent said they would be "not likely" to join if they were dissuaded by family members; more than thirty per cent said they could be deterred 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 "a large percentage are saying, 'You can talk me out of it.' " That points the way to potential public-health interventions, which might include consistent messaging from the media, religious leaders, and others about rejecting political violence.

The threat of violence has hovered like a nimbus cloud over this election season. The spectre of the January 6th insurrection at the Capitol remains omnipresent, but the two most visible instances of violence during the 2024 campaign have been directed at Trump. On July 13th, during a Trump campaign rally in Butler, Pennsylvania, a man on a warehouse roof fired eight times at the former President. A bullet grazed Trump's ear ; one rallygoer, a former volunteer fire chief, was killed; two others were injured. Then, on September 15th, as the former President was playing a round of golf at his club in West Palm Beach, a Secret Service agent patrolling the grounds spotted the muzzle of a rifle poking out of the shrubbery along a chain-link fence. The agent opened fire and the gunman fled. After the authorities arrested him, they discovered that he had been staking out the course for hours. Democrats have also been targeted. In Tempe, Arizona, state Party officials recently closed a campaign field office after it was shot at three times in three weeks.

According to tracking by the Bridging Divides Initiative, at Princeton University, threats and harassment of local public officials surged in July . Despite this, violence by extremist groups, as reported by a different organization, the Armed Conflict Location and Event Data, has actually ebbed this year , likely because law enforcement has arrested dozens of members of these groups for their participation in the Capitol riot. It makes for a perplexing picture. Is political violence an imminent threat to Americans or not? Political scientists, applying their theoretical frameworks, have long made clear the reasons for concern, including the way the country's deepest cleavages, over race, ethnicity, religion, geography, and culture, are now embedded in people's politics; the weakening of democracy's guardrails during the Trump era; and the spread of misinformation.

The promise of public health is that it rests on scientific data and offers pragmatic solutions. Treating political violence like a contagion could help safeguard the future of American democracy. And yet the same fractures that potentially drive political violence can imperil the collaboration needed to address public-health crises. They can also lead to the most dangerous symptom of all: a sense of helplessness. But, if we simply wait for the disease to strike, it may already be too late.