10 November 2019
Medical approaches to violence prevention are progressively being adopted by various governmental and non-governmental actors around the globe. For example, the World Health Organization has made violence ‘a public health priority’ and centered its global strategy for violence prevention around the public health model; the World Bank pronounces the public health approach the most effective form of violence intervention; UNICEF made the public health model a high-priority strategy to reduce violence against children and in the UK Mayor of London, Sadiq Khan, and home secretary Sajid Javid, have both endorsed public health approaches to address the so-called ‘knife crime epidemic’. Violence is therefore increasingly framed as a public health problem in need of intervention by health care professionals.
On the back of the perceived success of the public health approach attempts are being made to extend it to the broader field of conflict resolution. In our forthcoming publication in Peace Review: A Journal of Social Justice, titled ‘The Perils of Public Health based approaches to Conflict Resolution,’ we critically examine the application of the public health approach to conflict resolution and engage with the possible risks and limitations of its extension to the domain of violent conflict. We argue that a health-based approach to conflict resolution carries the risk of underplaying the structural factors of violence, which in turn risks de-politicizing the way in which we understand and approach conflict resolution. This carries the risk of undermining the establishment of positive peace in a post-conflict environment.
To develop this claim, we first illustrate the methodological and epistemological assumptions of public health-based approaches to violence, using the example of the North American based NGO ‘Cure Violence’. This NGO, devised by infectious disease physician Gary Slutkin, argues “That violence is an epidemic is not a metaphor; it is a scientific fact” and operates on the premise that epidemiological methods and strategies that are applied in infectious disease control are effective in controlling and containing violence. The NGO, which was founded in the Chicago area in 2000, has inspired offshoots in various US cities and has also expanded internationally. In 2019, Cure Violence Global was launched in an effort to further internationalize its epidemiological approach to violence prevention and to extend it into new areas such as conflict resolution.
In our analysis we claim that two critical elements underpin this model. First, through its focus on behavioral change it is firmly centered around the individual as both cause of and remedy to violence and conflict. Second, it relies on an epidemiological approach that produces a specific epistemology of conflict. Our analysis illustrates that each of these have serious implications for the understanding and practice of conflict resolution and peace building.
“A health-based approach to conflict resolution carries the risk of underplaying the structural factors of violence.”
The Cure Violence approach suggests that violent behavior itself is an epidemic that spreads from person to person. As such, although the public health approach to violence prevention is framed as a population-centered approach, its node of intervention is the individual, whose behaviors need to be altered to prevent violent conflict. By emphasizing behavioral change, the approach focusses on individual agency as both pathogen and remedy to violence. It is therefore tightly connected to the philosophical tradition of methodological individualism, that promotes an agent-centered perspective on social phenomena: that social outcomes are the aggregate result of individual behaviors, actions, attitudes and choices. Approaching violent conflict through such lenses has the important implication that structural factors are overlooked in favor of an approach mainly focused on the individualized agent. For this reason, such an approach is predisposed to overemphasize the responsibility of individuals over structural factors that co-determine complex patterns of violence and conflict (e.g. historical legacies of colonialism, uneven economic development, relative deprivation). This focus on the individual is reinforced and sustained by a specific epistemology of conflict, embedded within such a public health model.
With its grounding in methodological individualism, the epidemiological model of public health is deeply rooted in positivist science. The Cure Violence project, for example, bases its model predominantly on the quantitative analysis of statistical evidence. The success of its identification, interruption, and change model depends on the constant stream of quantitatively assessible data. The project furthermore argues that prior assessments of violence have failed because they were based “on moralistic or sociological diagnosis” and not “on proven scientific findings”. Hence, as Malte Riemann argues in relation to Cure Violence’s approach to the prevention of violent crime, the model’s medical language effectively marginalizes the contributions made by other fields such as criminology and sociology. Such criticism is transferrable to this model’s potential for disqualifying alternative forms of knowledge to understand conflict. The public health model differs therefore from other approaches to conflict analysis, which increasingly highlight the centrality of intersectionality and the role of class, race, and gender in shaping the mutual production of structural and agential drivers of conflict. By marginalizing these aspects, a public health approach reduces conflict analysis to a single model explanation geared towards a progressive and linear accumulation of knowledge in the form of ‘scientific evidence’, and the de-valuation of alternative paradigms and approaches.
When conflict is institutionalized as a health problem, both the methodological individualism and the narrow epistemological paradigm it enforces have the potential to depoliticize how we think about conflict resolution. Three means by which this occurs stand out. First, addressing conflict through these specific medical lenses severely underestimates structural factors of conflict, since by placing the focus of analysis almost exclusively on the individual, this approach shifts the responsibility for conflict resolution (or failure thereof) onto the individual. Second, as Vijay Kumar Yadavendu has pointed out, epidemiological approaches have depoliticizing effects because their understanding of agency is reduced to a notion in which “the individual is completely robbed of his collective identity.” Finally, by framing violent conflict as disease, it becomes a biological condition alone. In doing so, the public health model institutionalizes a specific form of knowledge that delegitimizes alternative existing knowledge regimes which offer a contrary explanation, such as those based on ‘sociological diagnosis’. By moving conflict resolution into the realm of health, conflict resolution becomes abstracted from broader structural socio-political conditions. This carries the risk of replacing political solutions, addressing root causes, with a medical diagnosis and treatment model that is aimed at curing symptoms.
Malte Riemann is a Senior Lecturer in the Department of Defence and International Affairs at the Royal Military Academy Sandhurst
Norma Rossi is a Senior Lecturer in the Department of Defence and International Affairs at the Royal Military Academy Sandhurst