17 years following the publication of the world report on violence by the World Health Organization (WHO), it is terrific to see that the UK is beginning to catch up. We are now starting to talk about violence, seeing it as a public health approach, and beginning to put in place the foundations for future prevention.
Having attended the Avon and Somerset Serious Violence Summit on 8th May, I am pleased that we are now beginning to see the light. I fear however, that it has come too late. We are facing a much greater challenge undoing the years of unaddressed violence, than if we had listened to the global stage in 2002. In the 17 years since the WHO report I would dread to think how many lives have been lost to violence, my brothers included. It was refreshing to see that schools are being included in this plan as active participants. Universal intervention targeted at all members of society and not just for those deemed ‘at risk’, cannot be achieved without full support from the education sector. That term ‘at risk’ comes up often and is still something we are clinging on to. We are still not talking universal intervention as I would like. Today, it was highlighted that the Violence Reduction Unit in Scotland, start to pick up young people after 5 offences. What they have achieved is terrific, but 1 incident is too many and too late as there have often been significant build up to that offence, where many opportunities to intervene has been missed. We talk about certain young people as being ‘high risk’, for example if they have been excluded, put into pupil referral units, have had adverse events in their lives. I would argue we all have risk and true prevention and early intervention means educating and supporting everyone across the board, no matter your background and no matter your age. That is prevention. Waiting until there is a detectable problem, no matter how small, then becomes reactionary and no longer prevention. This is something we, at Stand Against Violence offer, an evidence based preventative intervention to youth organisations, evaluated to demonstrate statistical benefit to young people.
One concern that still plays on my mind, is that we are still behind the curve. A trend I have noticed in violence over the years is that the age range most affected has changed. In 2005, Liverpool John Moores University found that it was the 15-24 year olds most at risk of being a victim or a perpetrator of violence. In 2013, Cardiff University found that it was the 18-30 year olds and today, we heard that it is the 20-34 year olds. I believe we are witnessing a generation where we got it wrong. Despite these changes, we are continuing to tackle the issue of ‘youth violence’ as a core focus and I believe that once again, this is more media driven than data driven. We should be looking at the present high-risk group and asking what was different about the society they grew up in and the schooling they received amongst other things. Young people are still disproportionately affected by violence and of course to prevent another violent generation emerging, we must intervene proactively with young people. However, are we now getting so focused on prevention and youth violence that we are overlooking the 20-34 year olds who represent the greatest threat of violence? I’m sure the global community has already recognised a generational change in violence. Unfortunately, we in the UK are only just beginning to realise the gravity of the bed we have made. We heard much about the Cardiff Model and the Violence Reduction Unit in Scotland. All terrific work, all based on evidence informed intervention through good data sharing. The Cardiff model evidence was first published in 2011 and demonstrated effective results in Cardiff. It has since been adopted in countries across the globe yet 8 years on, we have been unable to implement nationally in our own country. This is concerning. I am however, hopeful for the future. We are now approaching the starting block for real change, but we have a long way to go before we can start the race. We could save ourselves much time and effort by working with the current evidence base rather than reinventing the wheel.
There are many good people out there dedicated to the eradication of violence; the evidence base exists; it is simply a case of facilitating and supporting these people to take action. Governments are far too hands off and we have paid the price to date. They must grab hold of the reigns and enforce a robust, consistent and evidence-based approach nationally. No one likes the word ‘enforce’ but unless it is then violence will always sit on the back row and other ‘enforced’ targets will be prioritised. How interventions are delivered and managed must be done locally by local partnerships. This is the fundamental principles of public health. Those who understand their local demographics and epidemiology must lead the bespoke intervention. The framework to inform these partnerships however, must be enforced, supported and funded by central government. National data sharing networks and data analysis; collaboration and enablement of professionals to sit at a partnership table; and funding within those partnerships to take local action. These are things that must come from top down. I feel there is much willingness and eagerness to engage but there is no one pulling it together. We all have things to contribute, skills and knowledge to bring to the table, what we lack is a facilitator and enabler with the influence and power. Someone centrally needs to take the parent role and be the guiding strength to help us all through the vast ocean that is tackling the issue of violence. That is what we elect a government to do… to govern and lead our country.
Florence, C. Shepherd, J. Brennan, I. Simon, T. (2011) Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis British Medical Journal (BMJ) Research 342 (3313) McVeigh, C. Hughes, K. Bellis, M. Ashton, J. Syed, Q. Reed, E. (2005) Violent Britain: People, Prevention and Public Health Centre for Public Health, Liverpool John Moores University Sivarajasingam, V. Wells, JP. Moore, S. Page, N. Shepherd, JP. (2013) Violence in England and Wales in 2013 An Accident and Emergency Perspective Violence and Society Research Group, Cardiff University Krug, E. Dahlberg, L. Mercy, J. Zwi, A. Lozano, R. (2002) World report on violence and health World Health Organization, Geneva