Public Health and Violent Crime


It’s almost three years since I wrote an article on the issue of youth violence for the Guardian newspaper. In July of 2008 I called for the adoption of a public health approach to tackling youth violence and it’s now five years since I embarked on a campaign to seek to convince Government, stakeholders and anyone else who would listen that this approach would be a much more effective method of reducing youth violence.

Since then I have been banging on about this approach, meeting after meeting, convinced as I am that adopting a multi agency community led interventionist,prevention, education and enforcement public health approach to tackling violent crime was the only effective way forward.

In my original article I cited the injury surveillance projects based at Accident and Emergency units in Wales and Scotland as clear successful examples where a public health approach worked.

So it is with some sadness (given the number of deaths and injuries that have occurred in the last three years) tinged with relief that I read today in the Independent that the example cited by me three years ago is now to be rolled out across the country. The tragedy is that many lives could have been saved if this approach was adopted earlier.

The projected as cited in my original article is information sharing partnership between health services, police, and local government in Cardiff, Wales. Incidence of violence were captured and shared and then informed policing and other strategies to prevent violence based on information collected from patients treated in emergency departments. These were injuries that were not being reported to the police.

At that time I said:

“Research conducted in three Glasgow hospitals in March 2004 suggests that violent crimes are under-reported by at least 50%, possibly nearer 70%. And 55% of the individuals who came into accident and emergency departments during the period of another recent study stated they would not report their assault to the police. In order to get an accurate assessment of the level of community violence we must start where the action is: at the point of treatment, all violent injuries must be reported to the police. Schools must be champions of the violence-prevention agenda and both must work with community organisations.”

“Injury surveillance pilot projects started by the government are now being run in Wales and Scotland and early indications are that even at the level of simply capturing and sharing data they are effective in reducing and preventing criminality. The government should build on this success.”

A lots of lives could have been saved had this approach been adopted earlier. Politicians have known about the effectiveness of this approach and yet have been reluctant to implement a public health programmed because of the cost implications. The cost to communities of inaction has left whole communities living with the bitter legacy of serious youth violence.

Thousands of young people are presenting themselves for treatment at hospital A&E departments having been involved in a fight or subject to a violent attack - some of them very serious indeed. The majority and I choose my words carefully here; do not make complaints to the police.

The official figures on violent crime do not reflect the true extent of level of violence in our communities. The reality as all communities know is that violent crime is much, much worse than the official figures suggest. The data is known but not shared with the public for fear of what might happen if the true extent of violence was to become public knowledge.

This innovative public health approach over a three year period led to a significant reduction in violent injury in Cardiff compared with similar cities in England and Wales.

Information sharing on serious injuries and use were associated with a substantial and significant reduction in hospital admissions related to violence. In Cardiff rates fell from seven to five a month per 100,000 population compared with an increase from five to eight in comparison cities.

Average rate of woundings recorded by the police changed from 54 to 82 a month per 100, 000 population in Cardiff compared with an increase from 54 to 114 in comparison cities There was a significant increase in less serious assaults recorded by the police, from 15 to 20 a month per 100,000 population in Cardiff

Professor Jonathan Shepherd, who led the Cardiff Violence Prevention Programme, said:

“All this work was built on the shock finding 15 years ago that all violent incidents are not known to the police, mainly because they aren’t reported.

“Even serious injuries, which lead to hospital admissions, such as knife wounds and even shootings in the US aren’t picked up on by the police.

“We’re recording, in A&E, where the violence takes place – the name of the nightclub or the street and where in the street; the name of the park or the school – what type of weapon was involved and the day and time it happened. This information, collected by the A&E receptionist once anonymised, can be shared with the police and is key to targeted prevention.”

The scheme in Cardiff has been developed over the past 15 years and is dependent on the partnerships between the local communities, the police, NHS and local council.

Speaking to WalesonlineProf Shepherd said: “This is very practical, straightforward and doable but it will only translate to other areas if it is well managed, and it needs the local A&E consultant to get hold of it and work with the local police.

“It hasn’t always been easy setting this up but we now have these partnerships throughout Wales and several hospitals are doing this. The UK coalition Government is also committed to making hospitals share information for the purpose of violence reduction.”

A recent evaluation by the British Medical Journalfound “information sharing and use were associated with a substantial and significant reduction in hospital admissions related to violence”.

The study added: “Our findings suggest that communities can achieve substantial reductions in the public health burden of violence through organised data driven partnerships between health, law enforcement agencies, and local government.

“The intervention was associated with an estimated 42% fewer woundings recorded by the police relative to comparison cities four years after implementation.”

Alexander Butchart, of the World Health Organisation(WHO), leading a global campaign on encouraging nations to adopt the public health approach to tackling violence said:

“In light of its large effect on preventing violence, this model will hopefully be emulated by other cities in developing and developed countries.”

Prof Shepherd added: “It’s particularly encouraging WHO has said it wants this model reproduced around the world.

“Because this is such a low-tech idea it means it can be done in those countries where violence levels are very much higher than here but police resources are limited.

Let’s hope there is no further delay by Government and local authorities in implementing this approach. Every day lost comes at an enormous cost and personal tragedy to many communities whose lives are blighted by violence.

Lee Jasper