What exactly is a public health approach to crime and disorder reduction?


Many years ago (ok 2000-2004 to be precise) I worked in community safety and crime reduction.  Among work like supporting and auditing local crime and disorder partnerships and spending time with the Home Office I produced or co-authored a range of tools like guides to crime auditing. Mine was the scintillating , nay riveting research which found its way onto the streets as “security without the spikes” a guide to making streets and houses and public realms safer without throwing gates and bars and fences in everywhere (still available to download and still curing insomnia in, at least double figures of readership by now.)  I enjoyed my time in community safety. I got to do some exciting work on drugs and public health, for example looking at supply of crack cocaine in Lambeth and how to disrupt it.

This last week several things have landed on my desk which make me feel we need to think a little more deeply about what a “public health” approach to crime and disorder is.

First,  the debate and noise created by the Government’s announcement this week of a fund for crime reduction in young people and a public health approach, following the announcement earlier this year that Directors of Public Health in England should play a role in the serious crime strategy, and the recent launch by the Mayor of London of a “public health” approach to this..

Second, lots of interest in the Glasgow “public health” approach to knife crime and whether local areas need to replicate it

Third, we are doing various mapping exercises locally on Adverse Childhood Experiences, all of which tell us that ACE’s are important to address as part of the “upstream” public health approach to crime and violence. Don’t stigmatise people who offend, prevent it arising.

Fourth, the Association of Directors of Public Health have endorsed the about to be released new edition of the Royal College of Psychiatrists guidance on public mental health. When I reviewed this on behalf of ADPH, the importance of public mental health approaches (improving mental wellbeing, improving resilience, reducing risk and impact of mental ill-health) for crime reduction, for preventing offending and victimization, and for rehabilitating people who offend, struck me very strongly.  The impact of discrimination and inequality remains writ large behind the scenes of both being a victim and being an offender, and is stark and apparent in mental health. The 1999 survey of psychiatric morbidity in prisoners suggested 97% of their sample had clinical levels of mental ill-health. That level does not seem, ever, to have decreased since.

Finally, I got asked to be a judge on the Tilley Awards for problem solving and demand reduction.  Introduced by the Home Office way back in 1999, they went into abeyance and are now back, managed by South Yorkshire Police and now they celebrate problem orientated projects that have achieved measurable success in resolving issues faced by the police, partners and/or the community. Applications are now open. Hint.

The opportunity here is to define what a “public health” approach to crime reduction is.  The risk is we end up producing an approach which focuses on trying to change behavior by just giving information. Which doesn’t work. That’s not a public health approach.

A Public Health approach has been around a bit – a brief survey

First, before we all get carried away, a  “public health” approach to crime reduction is not new. It may be fashionable, it may indeed bring benefits. But it is not new.  Evidence-based policing, which is one bit of a public health approach, has been around for years. Problem solving approaches (about which more below), similarly.  We must not take a deficit approach to what everyone already has. Rather we understand what each partner has to bring, and is already doing. And there is much.

A sadly much under-applied 2012 report on a public health approach to violence hoped that the changes in public health structures in England would bring benefits in crime reduction. And indeed in some places they have. A useful paper of the same time in the American Journal of Public Health summarized the links and synergies between criminology, epidemiology and public health.

The Cardiff approach to violence has been around for some considerable time, and while it deals with one facet of crime is a strong public health approach.

An extremely useful book on Epidemiological Criminology remains a book I would have loved to write, had better authors not got there first.  If you want a fast definition Epidemiological Criminology is taking epidemiology (the study of the distribution of risk and disease in space and time) and turning it into the study of variables, vectors and factors that affect distribution of crime and risk. Those variables include upstream ones like the physical environment, opportunity for offending, and circumstances that lead people to offending rather than non-offending; as well as downstream ones like rehabilitation to reduce recidivism.

The World Health Organization has been working on this topic for some years.  Finally, The Campbell Collaboration applied the principles of the Cochrane Collaboration to social justice and crime, being just one of the drivers for evidence-informed crime reduction practice.  Some of the best work on hate crime took a public health approach without ever particularly calling it that.

To complete the brief reprise through history, in 2002 I helped write Better Health, Lower Crime which tried to set out some of the work and knowledge around at that time.

You begin to get the gist. This is not totally novel.  It has also not aways been systematic or population focused as rigorously as it always could have been.

What is different this time is that there is a level of engagement with the issue that is going deeper than rhetoric and deeper than some of the limited – successful and unsuccessful – approaches tried elsewhere. The Cardiff model is one obvious example . The recent multi agency concordat between police and criminal justice agencies and public health agencies should give us impetus to look at what we already have (actually quite a lot) and what we could do (systematize and formalize it rather than build it piecemeal as we sometimes have done.)

What works versus nothing works

For another place there is a debate about the long standing critique of the “what works” movement in crime and disorder and the “nothing works” movement in criminology. I’m not going to deal with that here.

Some early signs of benefit – Drug testing on arrest

There are growing number of areas seeing real benefits from drug testing on arrest, and this is a fast developing application of public health approaches to crime. (I describe drug testing on arrest as case finding of vulnerable people who have offended, are likely to offend or re-offend who need support on drug issues and the criminal justice setting is a way of picking them up through testing. While there are criminal justice system issues here, there are also health and care and rehabilitaton and diversion from crime and rehabilitation opportunities. You get the gist.)

So, what’s in a name?

I want to suggest that just as there is, strictly, no one way of doing public health in general there is no one single way of doing a public health approach to crime. Challenges as diverse as contaminated land and reducing smoking in pregnancy may require some common methods – epidemiology and evidence assessment – but usually require a diversity of methods and insights). What is common is the mindset. The tools vary.

The Mindset

The first thing to realize about a public health approach to crime is that it is a mindset.  Not a science (despite what many hold), but a mindset. And it is a mindset which takes a range of sciences and perspectives to understand the trends in crime and disorder in a population, and provide benefit to society. It is a mindset of serving people by improving and protecting their health and wellbeing. In its widest sense, safety from crime is a health issue. I pointed that out in  Better Health, Lower Crime in 2002.

A crucial thing to say here is that a public health approach does not take a reductionist “interventions to, for or imposed on” individuals. And it does not stigmatise offenders. (When I first started working in hate crime, working on domestic abuse, lgbt hate crime and disability hate crime, victims were often stigmatized too.

A public health approach seeks to understand how crime, risk of crime, impact of crime and outcomes operate in complex dynamics. And where to intervene to shift that. This is a systems approach. I tried to set out something like this to our local community safety board in 2013 and then did something similar with the LGA and APCC.

Guiding Principles for a Public Health Mindset in Crime and Disorder

The Public Health mindset has several guiding principles which I want to set out here, alongside some tools which are already in use. The words in bold below are my watchwords for a Public Health approach.

  1. It seeks to understand what is going on in a defined population, and its sub-populations. The distribution and inequalities in risk, crime, and impact.
    1. Some places use epidemiology.
    2. Some people use intelligence led policing models. The real trick is to combine a range of methods to gain insight and information. Some crime needs assessments are very sophisticated and provide real insight.
  2. It seeks to look back in order to look forward. It is essentially prospective, understanding past trends to look at future, and seeks to understand how to reduce risk of being victimized and the number of incidents
  3. It seeks to use models and tools intelligently
    1. So for example the problem solving approach or problem analysis triangle are examples of models and tools already in use. There are many more. Both from policing and from Public Health (spatial density analysis of victimization, for example.)
    2. Public Health can bring a range of tools such as strategic population needs assessment, equity auditing, evidence assessment and prioritization and apply them to crime and disorder.
  4. It seeks to be Preventive – preventing crime in the first place (primary prevention) and preventing people who have offended from re-offending or people who have been victimized from being repeat victims (secondary and tertiary prevention)
  5. It seeks to be Protective – protecting individuals, communities and populations from the impact of victimization and crime
  6. Once it understands what is going on in a population, it seeks to understand what prioritized interventions may bring about better outcomes for citizens
    1. It seeks to use evidence from a range of sources to understand what these interventions might be
    2. It seeks to systematically apply these for best effect given resources
    3. It seeks to use monitoring, evaluation and research to understand the impact of the process so far
  7. It works not only with indivduals but with populations. Strengthening individuals to resist crime when the key challenge may be changing the public realm, for example, is a mistake that one hopes a good public health approach will not make.
  8. It does this in a systematic and iterative way
  9. It uses a range of disciplines to elucidate a problem
  10. It uses a social and systems approach to understanding the drivers, vectors and impacts of crime on populations
  11. A public health approach takes seriously the prevention of offenders from ever becoming so or from repeating, takes seriously the social determinants as well as individual factors (and does not just blame individuals) and the recovery (rehabilitation) of offenders as much as preventing people becoming victims and responding effectively for them when they do.

I’m a fan of a public health approach to crime and disorder. I have seen the impact in my own area.  The elephant in the room of course is the more government cuts bite into local government, the more difficult this becomes to do and the more likely costs will be displaced disproportionately onto the downstream police response.

Nice words from ministers and policy documents about a public health approach are meaningless if the fiscal regime forces us downstream into police response being all we have left, and of itself increasingly stretched.

What next?

The key thing is to pick a topic in an area and try this approach out, working in dialogue between public health and partners. Each field has tools to bring, and gaps in knowledge.  In its broadest sense, good policing, good prevention of crime, good care of victims and good care of people who offend is an intervention which will improve the public’s health.  The important thing is not to feel deskilled by the term “public health approaches” or feel “it’s not for me, it’s for boffins from Public Health Teams.”  Public Health as a mindset is something everyone can have, and everyone can contribute to.

It’s also important to make government see that further cuts to local authorities are not only a false economy, but a direct driver of avoidable displaced cost.


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