Medical scientists are crucial, reveals Jonathan Shepherd

A great deal of violence which results in medical treatment never comes to the attention of the police. Since the mid 1980s, medical science, with its focus on injury, epidemiology and risk factors, has made increasing contributions not just to understanding violence, but also to reducing it. 

Traditionally, understanding and tackling violence has been the responsibility of social scientists, lawyers and criminal justice agencies – the police, the courts and the prison service, for example.

Pooling for prevention

Studies in Bristol, Swansea and Cardiff have shown that, overall, only a quarter of violence which results in treatment appears in official police records. Evidence from National Crime Surveys in the UK and other countries shows that this lack of police knowledge extends across national boundaries.

These findings have resulted in the formation of more than 350 crime and disorder reduction partnerships across the UK, in which data about violence and other crime from hospitals, police and other sources can be pooled to give a much more accurate picture of violence in particular cities and regions. Accident and emergency (A&E) and other NHS consultants can make influential contributions to these partnerships. Evaluations have established that this partnership approach results in more prevention than is achieved from police working on their own. These partnerships are now statutory under the provisions of the UK 1998 Crime and Disorder Act and the 2002 Police Reform Act.

Practical measures

Evaluations, including a randomised experiment in an A&E department, show that the best way to collect evidence in health settings is electronically, by hospital reception staff. Following this, data are anonymised and shared with crime analysts who produce summaries of violence hotspot locations, trends and other characteristics of violence which are essential for targeting police resources.

A systematic review shows that targeted police patrols reduce violence more effectively than other police strategies. A&E data can identify violence hotspot nightclubs and streets, previously not identifiable by the police. This combination of A&E and police data have prompted changes in the routes of police patrols to include them. It can also target overt and covert operations at violence hotspots, and reallocate police resources from the suburbs into town and city centres where violence is most likely. In other strategies, it can pedestrianise entertainment thoroughfares and relocate fast food outlets, to reduce the chances of drinkers colliding with each other and with vehicles. 

The crucial contributions of the health sector are intelligence about the locations of violence, and participation of medical consultants in partnerships. This research has also resulted in reforms to General Medical Council ethical guidance to doctors on prompt police reporting in the public interest where the victim or others remain at risk. 

International dimensions

This new, epidemiological approach to violence prompted the publication of the World Health Organisation (WHO) report on Violence and Health in 2002.(1) WHO prevention activity is being developed globally in the WHO Violence Prevention Alliance (VPA).2 VPA Partners include the Centres for Disease Control and Prevention in the United States, the Medical Research Council of South Africa and the Public Health Agency of Canada. Previously, the health sector contributed passive audits of violence-related morbidity and mortality, however it has not been realised until recently how powerful public health interventions to prevent violence can be.

These new, unique contributions of medical science stem from UK research and are helping to put the victim at the centre of criminal justice systems around the world.

Clarifying statistics

This science-based approach is also bringing clarity to crime trends in the context that government crime statistics have often produced conflicting and confusing messages. In the UK for example, this new injury measure has confirmed that violence has decreased since 2000, and that apparent increases identified from police records simply represent greater ascertainment rather than any true increase.

Here, a controlled study of closed circuit television in city centres found that greater surveillance increased ascertainment from the police standpoint, but decreased numbers of victims going to hospital for treatment of their injuries as a result of prompt police intervention. Clearly, police records are not a reliable measure of violence, even in a developed country like the UK. 

Furthermore, increased detection of violent offences by the police, far from signalling an increase in violence, is essential if violence is to be prevented. These findings are influencing national violence strategy in the UK: there is now much greater emphasis on violence resulting in injury.

The science of violence was discussed at a recent symposium organised by the Academy of Medical Sciences

References

1. 2002 World Health Organisation (WHO) report on Violence and Health

2. WHO ISBN 92 4 159313 X 2005; view PDF document here

Click here for the University of Cardiff Violence and Society Research Group website.

Jonathan Shepherd FMedSci is Professor of Oral and Maxillofacial Surgery at Cardiff University, and Chairman of the Violent Crime Task Group of the WHO Violence Prevention Alliance