BMJ 2018;361:k1967 doi: 10.1136/bmj.
k1967 (Published 8 May 2018)
Editorials
Preventing violent crime
Partnerships between health, education, social, and police services are essential
John Middleton president, Jonathan Shepherd professor of faciomaxillary surgery
UK Faculty of Public Health,
The recent surge in killings in north London has created public
outcry. The Metropolitan police are investigating 55 murders
in London so far this year. There have been welcome calls for
a “public health approach” to tackling violent crime.1 But what
does that entail?
Public health has a role in identifying risk and protective factors,
monitoring and understanding the changing threat of violence,
and supporting the development of a robust evidence base
around what works for prevention and control.2-4
The public health lexicon describes primary, secondary, and
tertiary prevention. In criminal justice, these translate to
preventing violence happening, controlling or reducing violence
when it happens, and rehabilitating or reconciling individuals
and communities after violence has occurred.4 A life course
approach to violence prevention is also useful—through early
years family support, home visits, training in parenting skills,
and youth support programmes.2 4 5 Adverse childhood
experiences influence criminal behaviour as well as mental and
physical ill health in later life, and are of growing importance
in formulating preventive strategies.6
Multiprofessional, multiagency partnership is critical to
preventing and controlling violence, including sharing data
across agencies, in real time. In Cardiff, a violence prevention
board translates data from emergency health services and the
police into practical prevention measures that have helped reduce
the incidence of violence by 40% since implementation in 2001.7
This model has been adopted by many UK cities and is included
in the UK government’s serious violence strategy.8 Other data
driven partnership interventions include programmes in Cali
(Colombia) and Chicago (US).9 There has been renewed interest
in the partnership work through the Scottish Violence Reduction
Unit10 and the Boston model, “Operation Ceasefire,” from which
it was developed.11 A strong partnership with affected
communities is also important, addressing the needs of victims,
the fears of the community, and the rehabilitation of
offenders.1 10 12
The recent surge in gun and knife crime in England and Wales
is being driven at least partly by important changes in the market
for illicit drugs. The overall prevalence of illicit drug use
remains stable, but we are seeing rapid evolution of new
psychoactive drugs, fentanyl as a newer drug of misuse, and a
2University of Cardiff, Cardiff, UK Correspondence to: J Middleton president@fph.org.uk
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Page 1 of 2
EDITORIALS
rise in the supply, use, and purity of crack cocaine.8 13 Suppliers
are increasingly reaching out beyond their urban bases to hubs
in other towns and rural areas, recruiting young or vulnerable
people to help store and supply drugs or move cash (the “county
lines” distribution).14 A pernicious use of social media is
facilitating this,15 bringing new drugs, new violence, new human
trafficking, and new drug related deaths and harms to places
not previously in the headlines.
Many supportive public services have been lost or reduced;
police service budgets have been cut, as have public health
budgets,16 forcing difficult funding choices around community
programmes and early years and youth services.17
What should happen now?
The government’s recent serious crime strategy8 emphasises
prevention and recognises the need to identify individual and
societal risk factors for violent crime. Effective multiagency
partnerships are needed that link education, policing, local
authority, health, and social services. The National Consensus
for Policing, Health and Social Care demonstrates this resolve.18
Police forces should prioritise disruption of markets and
trafficking.8 People with drug problems need access to good
services with harm reduction, reducing chaotic behaviours, and
normalisation of life as central aims.19 Services for early
intervention with children and families should be reinstated and
expanded along with the public health budgets that help to fund
them.17 20
Finally, we must ensure continuing UK involvement with
agencies such as Europol and the European Monitoring Centre
for Drug and Drug Addiction, to help maintain and develop
international drug and crime surveillance and control.13
Internationally, the World Health Organization’s INSPIRE is a
promising package of evidence based approaches.3 It targets
violence against children through laws to criminalise violence,
reduce alcohol misuse, and control access to arms; strengthening
norms supporting non-violent and equitable relationships;
creating safe environments for young people; supporting parents
and carers to reduce harsh parenting practices and foster positive
attachments; improving families’ economic security and
stability; improving response and support services; and
developing children’s social, emotional, and life skills.
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BMJ 2018;361:k1967 doi: 10.1136/bmj.k1967 (Published 8 May 2018)
The UN sustainable development goals specify violence
prevention targets within a framework that tackles poverty,
inequalities, and the protection of human rights. As violence
increasingly seeps across porous national borders and through
a borderless global internet, tackling these violence drivers in
low and middle income countries must be a priority.3
The primary prevention of violence, as for the prevention of ill
health, requires policies to reduce inequalities in wealth and
opportunity.21 The London killings starkly show how we are
failing young people in the UK. Our neglect has led to young
people becoming susceptible to grooming, sexual exploitation,
radical extremism, and gang membership. The clear call for gun
control by young people in the US has created new energy and
debate around one of the more obvious forms of violence
prevention.21 We need to develop a shared vision of a better
future for, and with, all our young people.
Competing interests: We have read and understood BMJ policy on declaration of
interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.
1 Torjesen I. Can public health strategies tackle London’s rise in fatal violence?BMJ
2018;361:k1578. 10.1136/bmj.k1578 29625963
2 Bellis MA, Hughes K, Perkins C, Bennett AM. Protecting people, promoting health: a
public health approach to violence prevention for England. Department of Health, 2012.
3 Bellis MA, Hardcastle KA, Hughes K, etal . Preventing violence, promoting peace: a policy
toolkit for preventing interpersonal, collective and extremist violence. Commonwealth
Secretariat, 2017.
4 UK Faculty of Public Health. The role of public health in preventing violence. 2016. http:
//www.fph.org.uk/uploads/Violence%20report.pdf
5 O’Connor R, Waddell S. What works to prevent gang involvement, youth violence and
crime. Home Office Early Intervention Foundation, 2015.http://www.eif.org.uk/wp-content/
uploads/2015/11/Final-R2-WW-Prevent-Gang-Youth-Violence-final.pdf.
6 Hughes K, Bellis MA, Hardcastle KA, etal . The effect of multiple adverse childhood
experiences on health: a systematic review and meta-analysis. Lancet Public Health
2017;2:e356-66. 10.1016/S2468-2667(17)30118-4 29253477
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Page 2 of 2
EDITORIALS
7 Florence C, Shepherd J, Brennan I, Simon TR. An economic evaluation of anonymised
information sharing in a partnership between health services, police and local government
for preventing violence-related injury. Inj Prev 2014;20:108-14. .
10.1136/injuryprev-2012-040622 24048916
8 HM Government. Serious violence strategy. HM Government, 2018. https://www.gov.uk/
government/publications/serious-violence-strategy
9 Guerrero Vasco R. Big data are reducing homicides in cities across the Americas. Scientific
American2015 Oct 1. https://www.scientificamerican.com/article/big-data-are-reducing-
homicides-in-cities-across-the-americas/
Younge G, Barr C. How Scotland reduced knife deaths among young people. Guardian,
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2018 Dec 3. https://www.theguardian.com/membership/2017/dec/03/how-scotland-reduced-
knife-deaths-among-young-people
11 Braga AA, Kennedy DM, Waring EJ, Piehl AM. Problem-oriented policing, deterrence,
and youth violence: an evaluation of Boston’s operation ceasefire. J Res Crime Delinq
2001;38:195-22510.1177/0022427801038003001.
12 Braga AA, Weisburd D. The effects of ‘pulling levers’ focused deterrence strategies on
crime. Campbell Collaboration, 2012.10.4073/csr.2012.6 .
13 European Monitoring Centre for Drugs and Drug Addiction, Europol. European drug
markets report: in depth analysis. ECMDDA, 2016. http://www.emcdda.europa.eu/system/
files/publications/2373/TD0216072ENN.PDF
14 National Crime Agency. County lines violence, exploitation and drug supply. 2017. http:/
/www.nationalcrimeagency.gov.uk/publications/832-county-lines-violence-exploitation-
and-drug-supply-2017/file
15 Irwin-Rogers K, Pinkney C. Social media as a trigger for youth violence. University College
Birmingham, 2017. https://www.catch-22.org.uk/wp-content/uploads/2017/01/Social-Media-
as-a-Catalyst-and-Trigger-for-Youth-Violence.pdf
16 Buck D. Local government spending on public health: death by a thousand cuts. King’s
Fund, 2018. https://www.kingsfund.org.uk/blog/2018/01/local-government-spending-public-
health-cuts
17 National Police Chiefs Council. Police, health and social care: working together to protect
and prevent harm to vulnerable people.2018. http://www.npcc.police.uk/Publication/NEW%
20Policing%20Health%20and%20Social%20Care%20consensus%202018.pdf
18 Middleton J, McGrail S, Stringer K. Drug related deaths in England and Wales. BMJ
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19 Local Government Association. Children’s social care at breaking point council leaders
warn. 2017. https://www.local.gov.uk/about/news/childrens-social-care-breaking-point-
council-leaders-warn
20 Middleton J. Time to put health at the heart of all policy making. BMJ
2017;357:j2676.28576819
21 Loder E. Children’s crusade. BMJ 2018;360:k1305. 10.1136/bmj.k1305 29563090
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