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Abstract
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In the United Kingdom escalating incidents of street violence and death from knives in London and other cities has become a major issue over the past 2-3 years. It has in fact become one of the few things to push discussion of Brexit off the newspaper front pages. The response in recent months has been a growing call to adopt what is being called a “Public Health Approach” to the problem. Yet many politicians and commentators remain confused as to what this really means.
In 2002, the World Health Organization (WHO) published its World Review on Violence and Health.1 This was a comprehensive, epidemiologically based study that has set the scene for much of the work that has taken place internationally since. The introduction quoted Nelson Mandela that the twentieth century would be remembered as a century marked by violence; the President of South Africa going on to point out that more widespread than the impact of war was the daily toll of suffering from violence in everyday life. The WHO report made two very important observations: firstly that the prevention of violence was an orphan, for whilst criminal justice systems and health services pick up the consequences of it, there is no clear lead agency for prevention. And secondly that despite pessimism, international and temporal studies indicate that violence is preventable.
Seven categories for prevention emerge from the WHO work: child abuse, youth violence, intimate partner violence, sexual violence, self-directed violence, abuse of the elderly and collective violence. For effective intervention action must be intelligence and evidence-based using epidemiological and sociological analysis with a focus on a partnership approach to the determinants of violence and a harm reduction approach once violence is already occurring.
Efforts at preventing violence using a range of methods have preceded the World Health report. In the 1980's high levels of street violence and disturbance in New York led to what came to be known as the ‘glass windows’ approach in which there was zero tolerance of low level nuisance on the streets.2 This seemingly led to a culture change and lower levels of more serious crime including that of violence. Effective law enforcement together with building trust between citizens and the police is certainly part of the story.
On the other hand, also in the 1980's, in Cali, Colombia, then described as the homicide capital of the world, a classical public health approach led by the Mayor and professor of public health, Rodrigo Guerrero and his colleague, Alberto Concha-Eastman, led to a more than halving of the homicide rate ...
Language: en |