Determinants Public Health

The Home Office and a public health approach to knife crime



Signs are Home Office going to take knife crime via a a PH approach

Does this mean we will cut fund for the services that go into it & at the same time largely ignore the root causes of the things that lead to the problem in first place.

Quick thoughts


1. Language proving important – Public health approach to vs public health issue.

There’s some tricky stuff re upstream risk exposure prevalence vs actual violent crime.

the phrase “public health approach” can lead to some interesting discussions. This is an issue that massively impacts on a relatively small number of individuals, as does lung cancer.

But the risks that lead to it, or contribute to the wider picture are far more widespread. Does this make knife crime a public health issue.

Lung cancer is a clinical issue, smoking is a public health issue. How many agencies involved and focal point. Violence is seen as a police issue, but no more a police issue than “health” is a “NHS issue”. Health ≠ “NHS” just as violence ≠ “police”. Violent crime could be seen as an outcome that is a result of positive or negative stuff that happened upstream.

Lots also argue with the notion of “taking a PH approach to”…. say over medicalises it (depends if  you see PH as a medical sort of thing or not…..those on this list don’t, obviously)


2. Intervention.

Previous blogs had covered a PH approach to knife crime and specifically some links to files on evidence base

a. how far upstream??

So not only a focus on arresting those at the tip of the triangle, but preventive and divertive stuff across the whole continuum etc. And also upstream in age terms. ACE primary prevention vs trauma informed practice. Public Health and Safety: The Social Determinants of Health and Criminal Behaviour is worth a read.

Understanding and acting on determinants is an important consideration. Knowledge about the determinants changes little. This applies to the Policy and strategy and also operational response.

What is the ask of national agencies – regulators, Home Office, other govt depts. These really hold the keys.

The ask of local agencies is obviously important, but it can’t only be local.

Be good to see something on interaction between police and criminal justice policy and operation

Police is one part of CJ sytem. How does the model interface with other parts. What’s the ask on sentencing, prison, bail, probation policy and operation??


b. What needs to be different to now. Being claer on that and how do systems and processes the police operate on will be different (not criminalising when avoidable etc, focused on aspiration etc, addressing ACE agenda and all that)

How operationally is the response of frontline different, the frontline copper etc.

ACE informed systems – how does the various systems involved (schools, police, criminal justice, courts, etc etc….) move towards ACE informed – both operational response and broader policy / SOP . practical eg = Sentencing policy – getting balance between punishment, rehab, protecting society not further harming the life chances have done something bad etc. tricky.

c. How is our response community and people oriented, not crime oriented.

Crime led response versus child or community / place led response.

Focus on whole of risk continuum not just those at the peak – victims of / perpetrators of violent crime.

d. Get the design principles right

Complex set of interacting issues and interventions

Can’t specify in the grounds what the answer will be principles-based approach

Principles for the city not one agency

A small number of big things, a 1, 5 and 10 year approach

e. The VRU gets a lot of attention as basic model for delivery

Obviously no panacea, and not for straightforward import without contetualisation. Bones of approach are:

Got to be truly multi agency

Change culture upstream say around carrying and the like

Navigators, focused on A&E and revolving door people, practical emotional and psychological support to exit violence.

School, peer mentoring ACE informed and resilience approach

Training and mentoring.

Skills training, nothing stops a bullet like a job.

tagging as an exit from crime with a badge of honour

I think it was well funded.

Would be interested to see some good evaluation of the VRU – both of independent interventions and (more importantly) complex system as a whole. This LSE blog highlights two key problems. Firstly, the lack of systematic long term analysis of crime trends and their causes; and secondly, the paucity of evaluation data for initiatives like the VRU. The blog cautions on overcalling the results of the VRU

3. Resourcing

how is the response PROPERLY embedded in communities (neighbourhood policing seems a good start, but must be way beyond only neighbourhood policing alone)

We know there’s been a massive asset stripping of young people early intervention and prevention services – obviously the elephant in the room.

We all know where we are  funding wise in our local places.

Need to be careful that we don’t end in a position where police – who are considered lead agency, maybe appropriately so – don’t have to single handedly sort al, the prevention, equality all other local agencies are just as asset stripped as the police. Everyone wants more prevention, as long as someone else is investing

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