This workshop acknowledged many challenges in countering violent extremism, but it also identified potential solutions by applying public health and medical health practices. Wynia drew an analogy likening the relationship between the current CVE endeavors and traditional counterterrorism to the relationship between public health and traditional medical care. CVE and public health have origins of “heroic” interventions that many feel were too often ineffective and counterproductive. He explained that, just as the resources available to CVE remain modest compared to those available to more traditional counterterrorism tools (i.e., military and law enforcement), public health also remains underresourced compared to traditional medical care. Furthermore, he suggested that when public health approaches are poorly implemented, like community engagement efforts in CVE, they can yield negative unintended consequences. He contended that the focus in the CVE sphere on “conditions in society that may create an environment in which individuals can become more easily radicalized” is a direct analogue to public health work on social determinants of health, with both arenas facing challenges in defining and delimiting their respective fields and in defining their foundational concepts and objectives. Finally, he cautioned that hubris in using the tools of public health has led to the worst ethical failures in the history of medicine, which underscores the consequences of using positive versus negative approaches to public health.
Wynia outlined a set of five potentially useful lessons from public health and medicine that could contribute to CVE efforts. The first is to move upstream, because prevention is more efficient and effective the further upstream to the event you can go. However, he noted that this gives rise to
ethical dilemmas about performing interventions on people at incrementally lower risks of committing violent acts. His second lesson is not to underestimate the social determinants and the role of such socioenvironmental factors as very strong drivers of individual behaviors. He remarked that this may be at odds with the prevailing tendency in medicine, and in society in general, to construe individuals’ behaviors as though they always reflect voluntary, rational choices, uninfluenced by the environments in which they live. The third lesson he offered is to seek small shifts in large populations, rather than large shifts in small populations; he argued that there are tremendous benefits in moving a bell-shaped distribution curve of behavior even slightly. Fourth, he recommended using a clear “conceptual model” that can guide decisions about resource allocation and the development and evaluation of interventions, as well as forcing careful consideration about the assumptions that underlie them. Finally, he warned that utilitarian thinking can backfire. He suggested that in some cases—and perhaps in many various facets of CVE—the best way to achieve an objective is not to aim at it directly: “Nudges might work better than mandates.”
Based on her observations during the workshop, Runnels offered the following set of challenges and needs pertaining to health approaches to CVE:
- Weigh the benefits, challenges, and drawbacks of applying public health, mental health, and health care models to the prevention of extremist violence.
- Explore what it means for public services to be engaged in the CVE space.
- Learn how to use data appropriately, without segmenting and targeting specific populations.
- Foster effective and inclusive partnerships that engage the relevant stakeholders from multiple domains (e.g., community members, community-based organizations, law enforcement, policy makers, health providers, nonclinical providers, public health expertise), and mitigate “turf” issues moving forward.
- Maintain ethical standards at all levels and between all levels of program design and implementation.
- Address the issues of fear and mistrust, including the negative perspective of government as a tool of oppression and marginalization.
- Consider the lack of an evidence base for the threat of violence motivated by extremist ideology.
While many challenges involved in CVE remain, this workshop demonstrated that there is also a great deal of interest in continuing to modify and improve these efforts so they will help communities to become more
resilient as they provide nonviolent avenues for individuals to express their grievances. Many of the speakers and participants at this workshop expressed their belief that a public health approach to countering violent extremism would give communities strategies for how to engage and educate at-risk individuals. Furthermore, it was suggested that studying and establishing best practices could result in stronger, healthier, and safer communities that also counter extreme violent behavior.
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