The importance of considering political contributors to violence in public health research

Over the past few decades, the World Health Organization (WHO) has led the way in approaching violence as a public health problem that we can prevent through research and scholarship rather than merely respond to as a criminal justice or security issue (Krug et al. 2002). Since then, we have made great advances in moving away from the conceptualization of violence as a purely individual issue to considering the wider ecology. This has led to identifying multi-level approaches to preventing violence through the consideration of social, cultural, and economic factors. What has not yet entered into discussion is the political environment’s contribution to violent death rates.

We propose that it is about time that we do: the United Nations (UN) has included violence prevention in its 2030 Agenda for Sustainable Development as a central charge to governments for bolstering sustainability and development (UN 2015). The political environment plays a role in the emergence and interaction of different types of violence. While the sheer complexity of patterns of governance throughout the world has hampered research on global trends (Duit and Galaz 2008), violent death rates might serve as a useful measure for assessing a society’s general state of health.

For example, as more societies have moved toward democracy, we have anticipated a decrease in levels of violence, especially with the reduction of autocracies to almost a quarter of the numbers from 40 years ago. The prevailing theory was, once transitional democracies overcome their initial increase in violence through the phase of instability (compared to strong democracies or strong autocracies), democratic countries experience less interstate conflict and may eventually see a reduction in violence rates (Karstedt 2006).

One reason political systems are important is the growing recognition of economic influences on violent behavior, including suicide and homicide. The unequal distribution of economic income is one of the greatest predictors of violent death rates, as we have seen in forty countries over 46 years (Lee et al. 2014). Oligarchies or autocracies shape inequality; economic growth, higher income levels, respect for human rights, and the abolition of the death penalty are all associated with lower homicide rates (Nivette 2011). It would be useful to discover what effects regime types have, in relation to and independently from the economy; in some cases, for example, an oligarchical economy may undermine a nominal democracy.

Structural violence refers to the increased rate of death and disability that the disadvantaged suffer within societies characterized by inequality, such as large disparities in wealth or other resources (Galtung 1969). While specific economic policies and social welfare systems point to the importance of governmental structures, these are not sufficient to encompass all the societal changes that a political structure might impact, and these would be important to explore.

Globally, inequality, ethnocentrism, gender disparities, and so on, can be potent causes of violent behavior. Democracies with substantial political rights and civil liberties for their citizens generally have lower rates of violent crime, whereas autocracies have a higher incidence (Neumayer 2003). Others argue that autocracies can also suppress unwanted social behavior, including violent crime. However, challenges to autocracy can arise in the form of mass insurrections, demonstrations, and coups d’état (Hayden 2015), and most studies do not consider state violence. Direct or indirect forms of state violence—as in the form of political persecution or coercion—become potent causes of violent behavior when the suppression ceases through democratization, for example.

Transitional democracies, in fact, have the highest violent crime rates of any regime type (Lafree and Tseloni 2006), especially as they undergo the intermediate state of no longer having a strong autocracy but without a strong democracy, either. Such intermediate states must manage conditions such as high unemployment, military occupation, weak rule of law, and the after-effects of previous autocracy and suppression. Such states are ripe for the formation of violent regimes. Whether political democracies, in turn, are working to improve general levels of societal health, through the provision of greater employment, education, justice, and healthcare, may as a whole be measurable through their levels of violence. Furthermore, is there any evidence of what is happening to societies that transition from democracies to autocracies, as we are increasingly seeing? More research is needed to answer these important questions.

This commentary is therefore a call to action for public health scientists to apply innovative and rigorous research methodologies from psychology, econometrics, and political science to understand how governmental factors influence rates of violence. One method might be panel data research with two-way fixed effects to see how time-varying political factors shape rates of violence. Given the importance and scale of the problem we are considering, it is imperative to investigate the role of political factors in shaping rates of violent death at national and cross-national levels.