Emergency medicine physician and National Academy of Medicine Member Garen Wintemute’s research points to ways clinicians can intervene in moments of crisis, and why a public health approach to violence is gaining traction.
“It doesn’t matter who you are … you have skin in this game.”
In recent years, the United States has experienced a series of high-profile incidents of political violence, alongside broader concerns about polarization and public safety. While these events have drawn significant attention, they do not tell the whole story.
Garen Wintemute, an emergency medicine physician who has studied firearm violence since the early 1980s, says that public support for political violence remains low. His research points to a less visible but more important insight: the vast majority of Americans reject it, and even among those who do not, many can be influenced to choose a different path.
That idea shapes how Wintemute approaches the issue. If violence is understood as a health problem, then participating in violence can be understood as a health behavior. And health behaviors, he emphasizes, can change.
Wintemute has long framed firearm violence as a public health issue that affects communities across the country. Most Americans, he says, have some personal connection to it, whether through family, friends, or their broader community. Today, firearms are the leading cause of death for children and teens in the United States.
If firearm violence touches nearly everyone, he contends, it is not a niche issue or someone else’s concern. It is a broad public health problem that calls for a public health response.
Investigating Attitudes Toward Political Violence
In recent years, Wintemute has focused his research on politically motivated violence, which in the United States often involves firearms. During the COVID-19 pandemic, he notes, firearm purchases surged. “People buy guns when they’re afraid, and pandemics cause fear,” he says.
What surprised him was what happened next. When he revisited the purchasing data as the pandemic waned in mid-2021, levels had not returned to baseline. At the same time, the country was experiencing episodes of political unrest. That convergence led him to study public attitudes toward political violence more closely.
Wintemute and his colleagues have since conducted a longitudinal survey of more than 8,000 Americans, tracking responses year over year. The findings are consistent: roughly three-quarters of respondents completely reject political violence, and that number has remained stable.
Among the small minority who express some willingness to consider violence, many also say they could be persuaded against it. For Wintemute, that finding reinforces a core principle: behaviors that lead to harm can be influenced, especially in moments of uncertainty or crisis.
Clinicians, already trained to counsel patients on smoking, alcohol use, and other risks, may be well positioned to play a role.
The Public Health Case
For those who question whether violence belongs in the domain of public health, Wintemute points to a straightforward argument once made by former CDC director David Satcher: If violence is not a health problem, why are so many people dying from it?
He also broadens how firearm violence is defined. While public attention often focuses on homicide and assault, the term also includes suicide and self-harm. In fact, firearm suicide accounts for the majority of firearm-related deaths in the United States.
“As an ER doctor, I know from clinical experience that the bullet really doesn’t care whose finger’s on the trigger,” he says.
Recognizing violence as a health problem is only the starting point. The next step is applying what is known about behavior change. Decisions that lead to harm, whether interpersonal or political, can be approached in the same way as other health risks.
“It’s an adverse health behavior like smoking or drinking to excess,” Wintemute says. “And we know a lot about how to change adverse health behaviors.”
Trusted messengers play a key role. Survey findings suggest that among those open to political violence, nearly half say family members could influence them to reconsider.
The Moment of Intervention
Clinicians may have opportunities to intervene at critical moments. In his own practice, Wintemute has developed approaches for navigating these conversations.
He describes sitting with a patient in crisis and intentionally positioning himself alongside them. “My personal approach is to put myself on the same side of the crisis with the patient,” he says.
He prepares patients for sensitive questions before asking them directly. “I might say, ‘Some of what we’re talking about raises concerns about your safety, so I may ask about things like firearms in the home or alcohol use.’” After a pause, he follows through.
The pause matters. It gives patients time to process, making them less likely to feel caught off guard. “Most of the time when I do this, I get an answer,” he says.
These conversations can open the door to practical steps, such as ensuring firearms are stored safely and kept out of reach during periods of crisis. But not all clinicians have been trained to approach these discussions.
Building the Capacity to Act
For years, surveys showed a gap: clinicians recognized the importance of these conversations but often lacked the tools to have them.
“The prevalence of ‘I would really like to do this’ was much higher than ‘I know how to do it,’” Wintemute says.
To address that gap, he and colleagues at the University of California, Davis, developed a clinical guide outlining how to raise the topic, what questions to ask, and how to respond. The work helped launch the BulletPoints Project, which provides training materials, case studies, and curricula now used in medical schools nationwide.
These resources cover a range of topics, from suicide prevention to safe firearm storage. Other organizations have developed similar efforts, contributing to a growing field focused on prevention and clinical response.
What has emerged is a broader effort to equip health professionals with practical tools to address violence as part of patient care.
Wins Worth Building On
Wintemute describes himself as an optimist. His research offers some basis for that outlook.
The challenge, he says, is translating that majority view into action.
“We can minimize harm if the vast majority of us say not me and not in my name,” he says.
As training programs expand, research networks grow, and more clinicians adopt these approaches, the capacity to intervene is increasing. The premise behind the work is straightforward but consequential: if violence can be understood as a behavior, it can also be prevented. changed.
