The Public Health Approach
When the Home Office allocated funding to 18 areas of the UK to establish Violence Reduction Unit’s, the core requirement was to take a Public Health Approach.
The first thing that we did in South Yorkshire was to define what we mean when we say that we are taking a Public Health Approach.
This video explains more;
We are working to prevent and reduce violence within South Yorkshire while applying the public health approach. This video explains the public health approach to violence, and how this approach looks at the causes of violence and, the causes of causes.
This video shows what it means to start with the needs of the population and how we are slightly different to health care and the police force;
This video explains the Violence Reduction Unit’s approach to violent crime;
Violence reduction units bring together many organisations; the police, local government, health, community leaders operating locally to coordinate a response in tackling violent crime through understanding its route causes.
The public health approach to violence can support both long-term, medium-term and short-term solutions.
One of the five elements of our public health approach is prevention:
Primary prevention, stopping violence before it starts;
Secondary prevention, providing intervention when violent behaviour starts, and some risk factors start to be displayed;
Early intervention can also be called secondary prevention, by providing support early;
Everything that follows has been explained in the above videos. This section is here for those who prefer to read.
By far the best document that we have come across that explains ‘a public health approach to…’ is this: Public Health Approaches in Policing. You can replace the ‘policing’ with just about anything. This document outlines five elements to a Public Health approach that we have adopted in South Yorkshire.
- Taking a population approach – it is important to understand the needs of the whole population, in order to better focus resources. Key point = need does not equal demand, and those most able to access resources are often those that need them least (and vice versa).
- Causes of the causes – understanding the determinants of violence. These are largely the same as the determinants of health, and there is a famous diagram that depicts them nicely (Dahlgren and Whitehead). As well as the social determinants, there are Adverse Childhood Experiences (ACEs), adverse community environments (together known as “the pair of ACEs”) and trauma – both in childhood and adulthood.
- Data and evidence base – understanding the issue is key, as is developing and strengthening the evidence base. Evidence is good at individual level, but poor at relationship, community and societal level – strengthening this is hugely important. Our area profiles are seeking to understand local issues – but these need to be continuous processes, not static documents. In South Yorkshire we are working to build a dashboard of data that can be interrogated with various questions that we want to answer (although this is a much longer term aim).
- Partnership – another requirement from the Home Office and also another incredibly important element. There is no one agency that operates across the whole system. A key role for Violence Reduction Units is to coordinate and align organisations across the system.
- Prevention – the core of a public health approach. There are three types of prevention: primary, secondary and tertiary. We are often very good at tertiary prevention – working to provide an alternative or a way out for people entrenched in violence. Sometimes we think that because we are doing tertiary prevention activities, we are “covering” prevention. Or because we do secondary prevention well (things like early help or early intervention, where we aim to stop progression of issues), we are doing well at prevention. The thing we do least of is the thing we need most: primary prevention. This is where we work to prevent violence happening right back before it was even a possibility. This is investment in young people. Investment in communities. In services. In the welfare system. In families. This is investment in all people – believing that all people have the same rights to a minimum standard of living.
Steps to the World Health Organisation’s (WHO) Violence prevention alliance approach:
- Surveillance – what is the problem – find this out through systematic data collection defining the violence problem.
- Identify risk and protective factors – what the causes are, this can be determined by research around why violence occurs and who it affects
- Develop and evaluate interventions – find out what works and who for,, this can be done by designing and evaluating interventions.
- Implementation – scaling up effective policy and programmes by evaluating their impact and cost-effectiveness.
The WHO ecological framework views interpersonal violence as the outcome of many factors at four levels:
Individual level – Personal history and biological factors increase probability of becoming a perpetrator or victim of violence.
Personal relationships – Family, friends, intimate partners, and peers may influence the risks of becoming a victim or perpetrator of violence.
Community – The context in which social relationships occur, like schools, neighbourhoods and that also influence violence. Risk factors may include level of unemployment or existence of local drug trade.
Societal factors – economic and social policies that maintain socioeconomic inequalities between people, these influence whether violence is encouraged or prohibited.