Public Health Model to reduce youth violence

What is a public health approach?

In the words of the World Health Organisation in a 2002 report, World report on violence and health, a public health approach to criminal justice involves the following:

By definition, public health is not about individual patients. Its focus is on dealing with diseases and with conditions and problems affecting health, and it aims to provide the maximum benefit for the largest number of people. This does not mean that public health ignores the care of individuals. Rather, the concern is to prevent health problems and to extend better care and safety to entire populations. 

The public health approach to any problem is interdisciplinary and science-based. It draws upon knowledge from many disciplines, including medicine, epidemiology, sociology, psychology, criminology, education and economics. This has allowed the field of public health to be innovative and responsive to a wide range of diseases, illnesses and injuries around the world. 

The public health approach also emphasizes collective action. It has proved time and again that cooperative efforts from such diverse sectors as health, education, social services, justice and policy are necessary to solve what are usually assumed to be purely ‘‘medical’’ problems. Each sector has an important role to play in addressing the problem of violence and, collectively, the approaches taken by each have the potential to produce important reductions in violence. 

There are various examples of authorities taking a public health approach to tackling violent crime. In Scotland, the police-led Scottish Violence Reduction Unit (VRU) leads on a public health approach to violent crime:

The Scottish Violence Reduction Unit is a national centre of expertise on violence. Part of Police Scotland the VRU targets violence wherever it occurs whether it’s on the streets, in schools or in our homes. Supported by the Scottish Government the unit has adopted a public health approach, treating violence as an infection which can be cured. The VRU is the only police member of the World Health Organisation’s Violence Prevention Alliance. The VRU believe violence is preventable – not inevitable.

Leslie Evans, the Scottish Government Permanent Secretary, has described the approach as having “changed lives”:

Scotland’s homicide rate has halved (between 2008 and 2018). Over a decade, the number of hospital admissions due to assault with a sharp object has fallen in Glasgow by 62%. In essence, it has changed lives.

Violence remains a chronic problem – domestic abuse and sexual violence are still areas of concern – but, crucially, we are shifting the focus from reacting to the problem of violence to preventing it happening in the first place.

The director of the VRU, Niven Rennie, has said that the “good news story” of the VRU’s impact on recorded crime is only part of the story:

According to official Scottish Government statistics, recorded crime is at its lowest level since the mid-1970s. But the VRU maintains the level of crime in society is not reflected in the figures.

“We’re still at the stage where we see more victims of violence coming to A&E than we do to the police,” Rennie said. “We know the statistics are as accurate as they can be, but there’s a lot of crime going unreported.

”He added: “When someone from government stands up and says crime is at a 43-year low, I always say it’s recorded crime that’s at a low.”

In September 2018 the Mayor of London, Sadiq Khan, announced the launch of a Violence Reduction Unit in London to implement a public health approach for the capital.

What is the Government doing?

The Home Office published the Serious Violence Strategy on 9 April 2018, which it has described as looking at “the root causes of the problem and how to support young people to lead productive lives away from violence” as well as at law enforcement. 

Action in the Strategy is centred on 4 main themes: 

• tackling county lines and misuse of drugs
• early intervention and prevention
• supporting communities and local partnerships
• law enforcement and the criminal justice response

The Government has described the Strategy as taking a “public health approach” to serious violence:

The strategy represents a step change in the way we think and respond to serious violence.

Our approach is not solely focused on law enforcement, very important as that is, but depends also on multi-partnership working and a ‘public health’ approach across a number of sectors such as education, health, social services, housing, youth services, victim services and others.

The Strategy includes a new £11 million Early Intervention Youth Fund to support communities for early intervention and prevention with young people. The Fund was open for bids over the summer of 2018, and successful applicants were announced in November 2018: see Transparency data – Early Intervention Youth Fund: successful bids, 10 November 2018.

Many stakeholders have praised the government for emphasising early intervention. However, others have expressed concerns that there would not be enough funding. 

At the Conservative Party Conference in October 2018, the Home Secretary announced a number of new measures aimed at tackling serious violence. These include:

• taking steps to introduce a statutory duty for all agencies – including health, education, social services, local government and housing, as well as law enforcement – to tackle serious violence.
• launching a £200 million endowment fund, to target young people at risk of starting a life of crime and violence; and
• conducting a major review of the market for illegal drugs.

Further details were set out in a Home Office press release: Home Secretary announces new measures to tackle serious violence, 2 October 2018. 

The bidding process for an organisation to run the £200 million Youth Endowment Fund opened on 10 December: see Home Office press release, Home Secretary opens bidding process for Youth Endowment Fund.