by Dr Paul Walker
Image: Health Headlines: Sten Vermund Dean of Yale School of Public Health discusses ways
to address violent crime / Credit: WTNH.com
Crime is a Public Health Problem
What is the relationship between crime and public health? The two themes connect two of The Hub's areas of interest Wellbeing and Prison. In a 1998 publication John Middleton argued Crime is a Public Health Problem, concluding "Health workers should contribute in full to community development" and therefore reduced crime and inter-relatedly improved health.
Abstract: "Crime is a public health issue. It shares common causes with ill health, particularly poverty, and fear of violent crime is itself a major cause of anxiety. Community development in pre‐school education, parental education, and among ethnic minorities, both reduces crime and promotes better health, for example in reducing the effects of alcohol and illicit drugs. Health workers should contribute in full to community development."
More recently, in the US The Healthy People 2020: Social Determinants of Health states: "Crime and violence experienced by individuals living in a community is an important public health issue. People can be exposed to violence in many ways. They may be victimized directly, witness violence or property crimes in their community, or hear about crime and violence from other residents.
Violence can lead to premature death or cause non-fatal injuries. People who survive violent crime endure physical pain and suffering and may also experience mental distress and reduced quality of life. Repeated exposure to crime and violence may be linked to an increase in negative health outcomes. For example, people who fear crime in their communities may engage in less physical activity. As a result, they may report poorer self-rated physical and mental health. One study found that people who perceive their environment to be less safe from crime may also have higher body mass index scores and higher levels of obesity due to reduced physical activity."
In the following article public health specialist Dr Paul Walker argues for "a new nexus" between crime and public health in his column in Bristol-based The Western Mail. The article was first published in September, 2005.
Crime and Public Health: A New Nexus
Image: Maps of Bristol by Life Expectancy, Crime Areas and Socio-Economic Category
In previous pieces I have dealt with the traditional lifestyle issues which we know have a major impact on the public’s health, namely, diet, smoking, alcohol and drug misuse, physical exercise and sexual health. But, you might ask, are these the only factors which are important? The answer may surprise because we now know that most if not all aspects of life affect our health; and probably none more so than education and income. But the one that I am going to focus on today is crime and its large shadow, fear of crime. Both are inevitably very much on all our minds in the aftermath of the events of 7/7 and 21/7.
I have to confess to a long term personal interest in crime both as a regular victim – a mugging at knife point in the US and two burglaries and three attempted car thefts in Bristol; and as a former Magistrate having adjudicated on a wide range of crimes, albeit mostly trivial ones such as poaching and road traffic offences.
So, some years ago, I got myself involved in a landmark study which sought to explore the links between crime and public health and the perceptions on such links among public sector policy makers.
The first thing we did was to survey 1000 organizations involved in health and criminal justice to seek their views. The responses were fascinating. There was, we found, a general understanding that some forms of crime can affect the health of victims and their families; and some sense that they can sometimes affect the health of the perpetrators and their families. And to the extent that some victims would inevitably be healthcare workers it was recognized that crime could also affect the delivery of healthcare to others thus having a wider indirect impact on health. Some respondents saw crime, and the fear of crime, as possible dimensions of health-related quality of life whereas others seemed to accept these as established aspects of public health. One response from a medium sized English city sticks in the mind. It detailed local research which correlated the prevalence of youth unemployment with crime. For every percentage point increase in unemployment there were, it was found, an extra 100 crimes committed each year.
More significant, however, was the common belief that some types of crime and some aspects of ill health were related through having the same underlying causes, notably material deprivation, social exclusion, unemployment and poor education. In this context it is germane that the epidemic of crime of the last three decades has occurred at a time when, as documented in the Black Report, Margaret Whitehead’s Health Divide and the Acheson Report of 1998, the health of the underprivileged in the UK has declined and inequalities in health have grown.
So, the theory goes, just as it is an absolutely certainty that males born into disadvantaged families will suffer more heart disease and cancer than their more advantaged peers, it is also a sure bet that these same males in their teens will have a much higher risk of being involved in criminal behaviour. Or, put another way, adolescent criminal behaviour and heart disease and cancer in middle age are, at least in part, manifestations of the same negative influences in early life.
Parallel with the epidemic of crime there has been a growth of a new societal phenomenon, namely the fear of crime. The notion that the fear of crime is a problem in its own right emerged during the 1970’s from the results of victimization surveys in the US. The British Social Attitudes Survey has from time to time attempted to measure the prevalence of the fear of crime by asking respondents whether worries about crime affected their everyday lives. One third of women and quarter of men answered in the affirmative, with older age groups more fearful than younger ones. Young men were least fearful even though, unsurprisingly, they are the most likely victims of violent crime.
So, the message comes over loud and clear that crime is not just an issue for the Police, the judiciary and the victims. It is very much an issue for all of us concerned with health and wellbeing. Gratifyingly, this truth is now well appreciated and particularly so in Wales where the health, social care and wellbeing agenda provides an innovative framework for tackling the links between crime and public health through partnership working at local level.
by Paul Crawford Walker
Chair, PHA Cymru, the Welsh Public Health Association
Image: The front cover of From Public Health to Wellbeing
Edited by Paul Walker and Marie John / Credit: MacMillan Education
Dr. Paul Walker is an independent public health consultant with 50 years experience of working for the NHS, local government and academe as a public health specialist and manager. He is the co-editor of Public Health Matters and the co-editor of From Public Health to Wellbeing: The New Driver for Policy and Action.
Synopsis for From Public Health to Wellbeing: There has never been more awareness of the public health agenda, as policy-makers stress the importance of 'wellbeing' to the general public. Charting the history and evolution of the public health agenda, this insightful reader argues the place of wellbeing in local and national strategy. It identifies some of the critical events that have influenced the development of public health systems, and looks at the challenges for policymakers and professionals in the formulation and delivery of effective strategies for the future.
This text explores the challenges of defining and promoting wellbeing across the lifespan, from childhood and youth to older age, through a range of approaches, such as town planning and partnership working. It is a valuable resource for students of public health, health promotion, the social sciences and social policy, as well as for any practitioner supporting health promotion within the public, private or voluntary sector.
Dr Walker has previously appeared on The Hub in International Nurses' Day and A Radical GP Practice in Liverpool.