How do we put the ‘Public Health’ into Violence Reduction?

Matt Hopkins – Associate Professor and Violence Hub Lead, Centre for Hate Studies

Public health approaches to violence reduction are very much in vogue. Although the notion of taking a public health approach to tackling violence is nothing new, it has only fairy recently been spoken about within British crime prevention circles. Credit for this largely sits with the government serious violence strategy published in 2018. While critics raised eyebrows at the need for a new strategy when violence had been falling in England and Wales since 1993, it was welcomed by most. The strategy focused on crime problems that were clearly causing harms in many communities – gang violence, knife crime, county lines drug dealing – but also led to the creation of Violence Reduction Units (VRUs) tasked with reducing serious violence in the 18 police areas deemed to be most affected by violence.

…

While the strategy yielded a new dawn in violence reduction, the resultant paradigm shift towards public health approaches has been refreshing. The World Health Organization defines a public health approach to reducing violence as one that: ‘Seeks to improve the health and safety of all individuals by addressing underlying risk factors that increase the likelihood that an individual will become a victim or a perpetrator of violence’. This holistic approach emphasises the need to address individual, relationship, community, and societal risk factors. For VRUs, this has led to careful analysis of violence problems within their communities and the implementation of interventions aimed to address risk factors. Indeed, the plethora of intervention activity is heartening to see. The Youth Endowment Fund intervention toolkit gives a useful overview of the types of interventions currently being implemented – these range from A&E navigators working in hospitals, after school programmes, bystander approaches in communities, to cognitive behavioural therapy and trauma based approaches, focused deterrence and knife crime education programmes.

…

It is clear the current activity heralds an opportunity to build a substantial evidence base of what works (and what doesn’t) in relation to public health focused violence reduction. However, some words of caution need to be expressed. First, while the public health model is holistic, from a crime prevention point of view, it is very ambitious. In accordance with the ecological model of public health, it appears that current preventative activity might reach the individual and impact on relationships with people around them, but it might be limited in affecting communities or wider society in the way the model intends. Ideally, a ‘public health’ approach requires that community factors (such as poverty and employment) and societal factors (such as cultural norms and economic inequality) are tackled. It is evident longitudinal spatial concentrations of much violence is found within communities with high indices of deprivation that require long-term structural change to address. Due to funding constraints, such long-term change might be beyond the VRUs in their current formation, and it is questionable whether the present (or any future) political administration will have the desire to address these structural factors. Second, public health approaches to violence reduction not only require sustained effort and investment, but also systematic evaluation of interventions. Our research suggests that the constraints of short term politically driven funding will mean evaluations (where they are completed) may not be scientifically rigorous and of value in developing knowledge about efficacy of interventions.

…

Finally, it might be wise heed some warnings from history. Between 1999 and 2002 it was intended to invest £400m in the national Crime Reduction Programme (CRP).  Although heralded as a new dawn in learning around ‘what works’, reflections on that programme are often damning. Maguire (2004) notes how the CRP faced challenges as it was overly-optimistic in what could be achieved, faced issues with multi-agency delivery, eventually led to much implementation failure and lack of robust evaluation. Funding was eventually withdrawn in 2002 against a backdrop of disappointing results and a changing political climate, where the ‘threat focus’ moved from domestic crime prevention towards international terrorism.  This is not to suggest that the current VRU project will go the same way. Indeed, the early signs around implementation are encouraging, but there are some warning signs.  Research by Hopkins & Floyd (2022) points to some tensions around multi-agency working, confusion over data sharing across agencies and a general lack of knowledge about evaluation. Further to this, the Youth Endowment Fund intervention toolkit notes that, of the 28 interventions they have currently reviewed, only seven have a high-quality evidence base.  With this in mind, one might be forgiven for thinking the world of crime prevention has been here before. However, we need to be mindful that this is still relatively early days for VRUs and the public health approach. A plethora of implementation and evaluation activity is currently happening that should (hopefully) yield more encouraging findings then were observed in the CRP. This is obviously crucial as the move to imbed the public health does represent a major positive paradigm shift for violence reduction. For the sake of victims of violence, our communities, and offenders, we can’t afford to make the same mistakes again.