{"id":45598,"date":"2019-09-13T14:47:17","date_gmt":"2019-09-13T13:47:17","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45598"},"modified":"2019-09-13T17:38:09","modified_gmt":"2019-09-13T16:38:09","slug":"john-ashton-and-zara-quigg-the-public-health-approach-to-violence-prevention-beyond-the-rhetoric","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/09\/13\/john-ashton-and-zara-quigg-the-public-health-approach-to-violence-prevention-beyond-the-rhetoric\/","title":{"rendered":"John Ashton and Zara Quigg: The public health approach to violence prevention\u2014beyond the rhetoric"},"content":{"rendered":"

At a time of Brexit induced policy paralysis, it seems that only one matter can break through the news headlines. Daily reports of murders and injuries caused by rising knife crime in London and the other cities in the UK have galvanised a call for <\/span>action against violence on the nation\u2019s streets<\/span><\/a>. [1] The media have called for us to adopt a public health approach to solve the crisis. Many column inches of print and characters on social media have been expended, but there is still confusion about what the \u201cpublic health approach\u201d means in practice.\u00a0<\/span>\u00a0\u00a0<\/span><\/p>\n

It is now 17 years since the World Health Organization (WHO) published its <\/span>Global report on Violence and Health<\/span><\/i>\u2060<\/span><\/i><\/a>\u2014<\/span><\/i>a document that remains the key reference point for subsequent work. [2] In the foreword Nelson Mandela stated that the twentieth century would be remembered as a century marked by violence with its burden of mass destruction and violence never seen, or possible, before in human history. But as Mandela pointed out \u201cLess visible, but even more widespread is the legacy of day to day individual suffering. It is the pain of children abused by people who should protect them, women injured or humiliated by violent partners, elderly persons maltreated by their caregivers, youths who are bullied by other youths, and people who inflict violence on themselves.\u201d The current focus on knife crime and other street violence is the latest manifestation of the dark side of human nature, in which the most dangerous place for a woman is in the home and for a young man on the street.<\/span><\/p>\n

The WHO report based on global epidemiological analysis identified seven types of violence that need to be addressed: child abuse, youth violence, intimate partner violence, sexual violence, self-directed violence, abuse of the elderly and collective violence (including gangs, terrorism and war). [2] In calling for action the WHO drew attention to the orphan nature of violence prevention with criminal justice systems and health services picking up the pieces, but nobody being responsible for prevention. It also asserted, based on comparisons at a population level and the evidence of interventions, that fatalistic acceptance of the status quo is an error; that violence can indeed be prevented, but to do so requires concerted action and a whole systems approach which is intelligence led and in which all parties of society recognise their roles and responsibilities. This lies at the heart of the public health approach.<\/span>\u00a0 \u00a0 \u00a0 \u00a0\u00a0<\/span><\/p>\n

Case studies of effective action have been accumulating from as far afield as New York, Cali, Glasgow and Cardiff:<\/span><\/p>\n