• Carlos Munoz Burgos

Frameworks: The Public Health Methodology

The Public Health Methodology is a framework that has been used to address violence, as it encompasses some of the ideas about violence that I have covered in this blog so far. First, considering that violence is multifaceted, it uses the ecological model to understand the interrelationship between risk factors. Second, it states that there is no causal relationship between risk factors and outcomes; that is, risk factors neither cause violence nor make it inevitable. Risk factors influence the likelihood that individuals and communities will engage in violence. Third, single or specific risk factors are not predictive of an individual's engagement in violence. A combination of at least two risk factors is present in individuals who engage in violence. Additionally, the relative weight or importance of individual risk factors, or combination of risk factors, varies depending on the context. As such, this methodology is very useful to understand violence and identify interventions to prevent.

The public health methodology, also known as the epidemiological approach, focuses on the safety and wellbeing of entire populations. This methodology sees violence and crime as a contagious disease that, if left untreated, can spread like any other disease. Healthcare professionals apply the public health model to prevent medical issues and focus on primary, secondary, and tertiary prevention interventions.

For instance, primary prevention for heart disease includes information and education about healthy eating habits, encouraging regular exercise, and discouraging a sedentary life and smoking for the general population. Secondary prevention identifies individuals at risk with high blood pressure, family history of heart disease, and previous heart attacks or strokes. The recommended actions for this population are a stricter diet, exercise, and medication. Tertiary prevention is for those individuals diagnosed with heart disease, and recommends tailored stroke or cardiac rehabilitation programs to manage related long-term health issues.

As stated above, the public health methodology sees violence as a disease, and as such, proposes interventions to prevent the disease from spreading (primary prevention), to treat those who carry the disease (secondary prevention), and to create the conditions required for a full recovery after the disease has been treated (tertiary prevention). The following describes primary, secondary, and tertiary interventions in more detail.

Primary prevention: Primary prevention is a broad approach directed toward the general population and addressing general socioeconomic risk factors leading to violence, such as citizens’ lack of trust in institutions, the erosion of the social fabric, and a high tolerance for crime and violence. Activities in primary prevention include education, health services, social engagement, cultural awareness, and personal development programs that seek to address sociopolitical, group, and community factors for violent radicalization. Activities may also include public education campaigns that are aimed at changing societal norms that tolerate and normalize violence. This level of prevention is effective because its holistic approach has a low risk of stigmatizing communities since it avoids targeting specific groups of people. Success at this level mitigates the root causes of violence before groups or individuals become at-risk, often through implementing programs that address basic human needs.

Sample primary prevention interventions

Secondary prevention: Secondary prevention focuses on individuals or groups considered at the greatest risk of becoming perpetrators of violence. This population may include victims of domestic violence, members of dysfunctional families, school dropouts, drug addicts and alcoholics, unemployed individuals living in communities with violent extremist recruiters, etc. Secondary prevention interventions reach fewer individuals in a more targeted manner than primary prevention does. These types of interventions require identifying the population or populations at risk and targeting interventions to them. Some examples of secondary prevention activities include programs for youth leadership, remedial education, drug and alcohol rehabilitation, skills training, anger management, and behavioral change.

Sample secondary prevention interventions

Tertiary prevention: This is an approach targeted to individuals who have already engaged in criminal or violent behavior. In the CVE context, these include individuals who have already radicalized or groups who may be actively committing, planning, or recruiting for a violent extremist cause. In the gang context, these include youth in conflict with the law or former gang members. The purpose of this type of interventions is to prevent individuals from reoffending and to reduce recidivism by rehabilitating those who have been prosecuted and incarcerated. In the CVE context, some individuals who have radicalized may no longer be susceptible to CVE interventions. For this population, counterterrorism approaches may be more applicable. Tertiary prevention reaches fewer individuals than either primary or secondary prevention and requires the most specialized rehabilitation and therapeutic services. Tertiary prevention interventions include disengagement, de-radicalization, isolation, redirection, and reinsertion. Given that risks and costs are high at this level, emphasizing primary and secondary prevention interventions before individuals reach the tertiary level is most effective.

Sample tertiary prevention interventions

The public health methodology provides a comprehensive model to address violence in different contexts, and that is why it has been the framework of choice by many governmental and nongovernmental organizations around the world. The examples provided above for each type of intervention level should not be taken as something prescriptive. Instead, the local implementation context should be analyzed first to determine the best type of intervention.

Conflict theories of violence will be presented in upcoming posts to explain why youth engage in violence.