A Public Health Overview

Yesterday would have been the 29th birthday of Damilola Taylor, and it was in this honour, that the DTT held it’s annual Memorial Lecture. The theme of the event was to discuss the recently announced Violence Reduce Unit in London and the public health approach to violence. Karyn McCluskey, previous Director of the Scottish VRU delivered the key note speech, but not before Vicky Foxcroft MP, chair of the Youth Violence Commission spoke about their interim report. This was then followed by a panel discussion chaired by Jermaine Jackman including Karyn McClusky, John Carnochan, Niven Reed, Gwenton Sloley, Keir Irwin-Rogers and myself.

A lot was discussed across the event, much of which will take a few days to soak in and digest, there is a lot to think about and reflect on. However, rather than depict the nights events, I thought it might be better to go back to basics and give an overview of terms for those looking to develop knowledge and join the wider discussion.

So here is a VERY BRIEF overview:

The World Health Organisation definition of violence:

When speaking about violence, it is always important to define your meaning, there are many different definitions for violence. This is the one I choose to use the most:

“the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation”

– The World Health Organisation definition of violence, 2002.

The Public Heath Approach:

For those who do not know what is meant by the term public health approach, here is the World Health Organisation’s (WHO) definition:

The principles of public health provide a useful framework for both continuing to investigate and understand the causes and consequences of violence and for preventing violence from occurring through primary prevention programmes, policy interventions and advocacy. The activities of VPA are guided by the scientifically-tested and proven principles and recommendations described in the World report on violence and health. This public health approach to violence prevention 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.

The approach consists of four steps:

1) To define the problem through the systematic collection of information about the magnitude, scope, characteristics and consequences of violence.

2) To establish why violence occurs using research to determine the causes and correlates of violence, the factors that increase or decrease the risk for violence, and the factors that could be modified through interventions.

3) To find out what works to prevent violence by designing, implementing and evaluating interventions.

4) To implement effective and promising interventions in a wide range of settings. The effects of these interventions on risk factors and the target outcome should be monitored, and their impact and cost-effectiveness should be evaluated.

By definition, public health aims to provide the maximum benefit for the largest number of people. Programmes for the primary prevention of violence based on the public health approach are designed to expose a broad segment of a population to prevention measures and to reduce and prevent violence at a population-level.

Link: https://www.who.int/violenceprevention/approach/public_health/en/

The Scottish Violence Reduction Unit

If you want to know more about the Scottish VRU here are their “Pathway to Success: 5 Key Areas” taken from their ten year plan.

  1. Primary Prevention – seeking to prevent the onset of violence, or to change behaviour, so that violence is prevented from developing.
  2. Secondary Prevention – to halt the progression of violence once it is establish -this is achieved by early detection or early diagnosis followed by prompt, effective treatment.
  3. Tertiary Prevention – The rehabilitation of people with established violent behaviour or affected as a victim.
  4. Enforcement and Criminal Justice – Developing innovative criminal justice practices that reduce offending behaviour and recidivism.
  5. Attitudinal Change – changing attitudes and behaviours towards all types of violence at societal, community and personal level.

The London Violence Reduction Unit

Here is also a brief outline of the London VRU (although make sure you read more via the link provided):

In September 2018, the Mayor of London Sadiq Khan announced plans to establish a new Violence Reduction Unit (VRU) of specialists in health, police and local government to lead and deliver a long-term public health approach to tackling the causes of violent crime.

A public health approach treats violence like any other health issue that causes disease or physical harm. First, you work to contain it and stop it spreading, and then you address the causes, to lower the chances of it happening again. Throughout medical history, we have learned to combat infectious diseases by containing the spread and prevent future outbreaks by putting money into designing better public education, sanitation, medical care and housing. The idea is that the same approach used in tackling disease can be deployed to cut knife crime and other forms of violent crime.

In practice, a public health approach means intervening at critical moments in a young person’s life. For example, if a young person has been excluded from school, suffered trauma, experienced a family breakdown or been a victim of violence themselves, it means stepping in to give them the right support at the right time. A troubled upbringing, and specifically the factors listed above, makes it more likely that a young person will commit violence later in life. By addressing these risk factors in young people, it is possible to prevent violent incidents in the future.

Key Points for Critical Analysis/Reflection:

  • The Scottish VRU was police backed but not police-led; the London VRU needs strong leadership either from or backed by the community – it cannot be a separate entity.
  • If the VRU only responds to direct violence, the root causes of violence will not be dealt with, many of the root causes are systemic;- institutional racism and poverty are two examples of this. We must not take our eye off the ball and constantly push for reform on every level.
  • Violence Reduction and Prison Reform go hand-in-hand.
  • The Gangs Matrix still needs to be dismantled and should not be used within the VRU or part of the public health framework. Instead, the Gangs Matrix should be replace with a model of safeguarding.
  • Longer sentencing will not work; there is however, an argument for more accessible and diverse mental health services to support prevention and intervention.
  • The media and police need to stop posting pictures of weapons John Carnochan stated at the event that this is a problem and causes harm. An easy measurement of success, would be to get the police to change their social media policy around this.

Things you can do:

Please note: This is a very brief article to bring together a few key pieces of information, the Key Points at the end are my own opinion based on experience and not based on my own research, although there may be research to give credibility to the points.

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