If public safety officials choose to frame a security problem as a public health problem, does that improve the odds of success? Would such a shift affect public health’s mandate to advance population health and well-being? These questions are being tested as Canadian officials responsible for countering violent extremism rethink both the nature of the problem and whose expertise should be called on to address it.
In 2022, when Public Safety Canada released its National Strategy on Countering Radicalization to Violence, it viewed the problem primarily as the spread of ideologies – often within definable groups and networks – leading individuals to commit violent acts. Consistent with prevailing international approaches, the strategy emphasized security and social-service interventions aimed at individuals either radicalized or at risk of radicalization, alongside messaging intended to counter extremist narratives.
More recently, however, the range of extremisms has expanded beyond political ideologies to include nihilistic, misogynistic, hate-fuelled and sexually exploitative forms. Their growth has been linked to broader patterns of social polarization and alienation, worsening mental health and toxic online ecosystems characterized by disinformation and algorithmic amplification. These developments have weakened confidence in an ideology-centric approach focused on intervening with at-risk individuals and communities, which risks stigmatization, intervenes too late in the radicalization process and cannot keep pace with an evolving threat environment.
As a result, Canadian and foreign governments have broadened their focus to include preventing extremism before it takes hold as well as treating it once it takes root. Public Safety Canada’s Canada Centre for Community Engagement and Prevention of Violence now supports early prevention through awareness-raising and capacity-building across the health, education, social service and nonprofit sectors. In 2024, the RCMP called for a “whole of society response” involving “government agencies, the education sector, mental health and social wellbeing services, communities and technology companies as part of a collective effort to identify and counter radicalisation of minors to violent extremism.”
Within this shift, public health is identified as a relevant actor in preventing violent extremism. Its inclusion may seem obvious given that proponents of multi-sector upstream prevention often describe violent extremism as a “public health problem” requiring a “public health approach” that follows standard public health practice: identifying risk and protective factors and upstream determinants; designing interventions to reduce vulnerabilities and strengthen protective factors; and evaluating those interventions with the goal of scaling what works.
Shaping social environments, resources and attitudes before harms escalate aligns closely with public health’s core commitments. Interventions framed around health and well-being are also more likely to be acceptable – and effective – than those casting individuals as security threats. An approach that “envisions building thriving communities and individuals resilient to violence – and by extension, violent extremism” sits squarely within public health’s health promotion mandate. Public health has longstanding experience addressing population-level drivers of violence that affect a wide range of population groups. It also has a strong stake in promoting digital literacy and confronting the under-regulated online ecosystems that foster health mis- and disinformation alongside toxic cultures of hate.
The specific contribution public health can make in this area, however, warrants sober assessment. Its expertise in providing relevant evidence is of course an asset. As one U.S. researcher notes, “[t]he use of a comprehensive public health surveillance system could increase the available evidence within the targeted violence field on the nature, scope, and circumstances of targeted violence to inform prevention efforts.” Public health also brings decades of experience designing evidence-based interventions to influence attitudes and behaviours related to substance use, sexual health and other domains.
Public health systems already struggle to scale mental health and social-connectedness interventions to meet existing population needs.
However, steep challenges remain. Measuring and evaluating impact is particularly difficult. A 2021 systematic review by the Canadian Practitioners Network for the Prevention of Radicalization and Extremist Violence cautions that even where prevention programs improve personal, interpersonal or psychosocial characteristics thought to be protective, these intermediate outcomes cannot be assumed to reduce violent radicalization.
Scaling up promising interventions presents an additional obstacle. A fully realized program of upstream interventions addressing economic, social and emotional protective factors would be immensely resource-intensive. Public health systems already struggle to scale mental health and social-connectedness interventions to meet existing population needs. Contrary to some wishful thinking, simply “joining up” current initiatives is unlikely to deliver effective population-wide prevention strategies tailored to violent extremism.
Public health’s own history offers further reason for caution. Decades of experience show how difficult it is to secure sustained governmental commitment to large-scale prevention efforts. As policy researchers have shown, failure to sustain prevention initiatives is the rule rather than the exception: “[r]eviews of global progress towards preventive health strategies highlight bursts of enthusiasm then disenchantment.” Even when the economic case for prevention is compelling, these failures are rooted in systemic dynamics of public administration that lead prevention efforts to lose focus and fizzle out amid competing policy and fiscal agendas and political priorities.
None of this diminishes public health’s interest in preventing violent extremism or its responsibility to contribute where it can. Bolstering the evidence base through population health surveillance, risk assessment, program design and evaluation is well within public health’s expertise. Recent federal commitments, including the plan to launch a strategy on boys’ and men’s health, may create opportunities for sustained investment in mental health and social risk factors relevant to violent extremism. Public health should also play an important role in advocacy, particularly in coalitions calling for digital literacy initiatives and stronger regulation of hate, extremism and disinformation across social media and gaming platforms.
It would be unrealistic to expect that a turn toward a public health approach centred on upstream prevention will produce rapid or dramatic reductions in extremist violence. Nonetheless, this shift remains valuable.
The challenge is to pursue it with clear vision – grounded in evidence, realistic about capacity and honest about what public health, alongside other sectors, can reasonably be expected to deliver.
This is a timely thought in the theatre of Prevention and Countering of Violent Extremism (P/CVE). Heathcare organizations have diversities of stakeholders across which use of relevant P/CVE approaches can identify push,pull, and vulnerability factors. In particular, key actors within the psychological dimensions at both the clunical and non-clinical departments. This places these organizations at pivotal points to promptly identify macro, meso, and even micro push factors towards violent extremism. Equally, using a whole -of-organization approach, such dedicated actors are able to map resilience factors across the diverse identities of the stakeholders. This helps develop context-soecfic P/CVE strategies for health care as a strategic approach towards reinforcing existing quality safecare health standards. For example, by having effective workplace prevention strategies, push factors emanating from toxic behaviours against employees are mitigated. Similarly, push factors based on perceived or real discrimination in remuneration, relative to doversities of identity, will be addressed proactively. Including employees whose voices are rarely heard in the clinical areas, despite their critical contributions towards quality care, further serve as approaches towards increasing ownership across all spaces. This enhances high indices of trust, thus building resilience against vulnerabilities and exposure to both push and pull factors.
Finally, integrating P/CVE within emergency response plans is key towards quality safe healthcare. This drives the culture of preparedness planning. At the core of preparedness planning is the practice of hazard and threat identification with relevant contextualisation of violent extremism hazards and threats. Across these approaches, hospitals have unique opportunities to play a critical P/CVE role distinct from the mainly applied security-centric approach. .