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Four steps to use the public health model to curb crime

By John Carnochan

The first of two blog posts

In 2004-2005, we had 132 homicides in Scotland and violence, by Western European standards, was high. What did we do?

In 2004 we established the Violence Reduction Unit (VRU), a police unit that uses the public health model to develop and apply effective violence reduction tactics, working with education, health, government, housing, social services, charities and communities.

Arthurs_seat_edinburgh2Violence is preventable, but criminal justice solutions alone cannot achieve this. Violence is situated within a complicated and complex landscape of causes, societal conditions, personal circumstances, individual characteristics, attitudes and cultures.

The principal of prevention is gaining increasing currency and the application of a public health model provides a framework of understanding, a clear identification of the components of violence, a means to articulate solutions to a complex multi-sectorial problem and a methodology founded in a robust science based process of evaluation.

Different agencies are already dealing directly with the same people, as victims, offenders, patients, clients, students and tenants; already we can identify the shared agenda. The effective coordination of services that are appropriate, proportionate and timely and focused on positive outcomes is the most viable response. Primary prevention, just as in health interventions, must be at the heart of all our collaborative efforts. Preventing violence through the development of safe, stable and nurturing relationships between children and their caregivers must become a key component of all national strategies.

Thinking about violence as a public health issue provides a more reliable basis with which to frame the problem. There are four components to the public health models that can be applied to violence:

  1. Understand the scale of the problem.

Violence that is reported to the Police does not reflect the true scale or complexity of the violence that occurs in homes and communities. Violence is vastly under-reported. The under-reporting is usually because victims are too afraid to report it or will seek their own revenge or they do not think the Police are capable of dealing with it. All of these reasons confirm the corrosive nature of interpersonal violence.

  1. Identify risk and protective factors.

When we are able to understand a clearer picture of violence it is far easier to identify those circumstances that impact on violence and which in turn will allow the development and application of protective factors. Many of the causal factors of violence are common to communities around the world; they include inequality, alcohol, alienation, drugs and domestic violence.

  1. Develop and evaluate interventions that work.

Interventions that prevent violence are not always delivered by Police or Criminal Justice resources and understanding the causes will help identify those best placed to intervene. Good education will help prevent violence, quality early years experience for children will prevent violence as will robust legislation on the access to alcohol and the access to lethal means. The key is to apply interventions that have been evidenced to work and then evaluate the outcome.

  1. Scale up those programmes and interventions that have been proven to work.

Programmes that can be scaled up to a national level are best. There is always a danger that local communities think the problems they face are unique to them and therefore the solutions must also be unique to them. It is true that there will always be a local relevance but the causes and the solutions are common, no matter where.

Governments around the world rely on the criminal justice model to solve the problem of violence. Despite a wealth of evidence to the contrary some stubbornly persist with the notion that what is needed to reduce or prevent violence is more Police officers, more prisons and harsher punishments.

It will not work.

Violence prevention is a shared agenda and therefore we must develop and work collaboratively to deliver sustainable reductions. No matter the challenge we must apply a process of understanding, diagnosis and evaluation. This offers the best chance to at least make things better. I think too there is room in this for compassion.

Whatever we do we must take action that is informed by evidence and designed to deliver clear meaningful outcomes, our research must be informed by and connected to practice and there must be a clear, consistent, collaborative policy that hits the pavement.

The VRU worked in this collaborative manner and the results were dramatic. In 2012-2013 we had 62 murders and violence in Scotland is at its lowest level in 37 years. In the next blog post I will go into greater detail on how we implemented the health model in Scottland.

John Carnochan is the former Detective Chief Superintendent at the Scottish Violence Reduction Unit. He is currently part of the Public Health Medicine team at the University of St. Andrews in Scotland and continues to work with the VRU.

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