Preventing Crime & Creating Safer Communities
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Crime Prevention Information & News

Why it's worth promoting one to prevent the other

Henry Shaftoe and Paul Walker, World Health Organisation Collaborating Centre for Healthy Cities and Urban Policy, University of the West of England, Bristol

Crime prevention and Health
Since 1950 the annual amount of crime recorded by the police has increased tenfold. Crime is now one of the top worries expressed by citizens. For many years the criminal justice system (police, courts and prison) was seen as the principal crime control mechanism. The theory was that the combination of deterrence and incapacitation would prevent crime. As crime continued to rise, another approach was espoused ì the protection of person and property against victimisation, using barriers, defence and avoidance. Unfortunately, none of these approaches did anything about the motivation to commit crime in the first place - they just raised the stakes a little.

Recently there has been a growing recognition that we are all (potentially) criminals and whether we actually offend or not, has as much to do with our own personal histories and social circumstances, as it does with whether we get an opportunity to steal something or assault someone. This psychological and sociological awareness of the causes of crime means that other actors may be implicated in its prevention. The police and courts cannot do much about people's histories and circumstances but social workers, psychologists and health workers can. It has also become apparent that criminogenic factors are usually part of an interlocking web of other deleterious conditions such as health problems, poverty and unequal opportunities.

The new Crime and Disorder Act for England and Wales partly embraces this broader understanding of the causes of crime, by requiring the Police, Local Authorities and Health Authorities to work in partnership to prevent crime and disorder in their areas.

In many cases the Health Authority has been the reluctant partner. We feel that this may be a result of a lack of understanding about the forceful links between health and crime and no clear articulation of what health professionals could do to prevent crime in the broadest sense. This article sets out to offer the necessary understandings.

Costs of Crime to Health Services
If for no other reason, Health Authorities should be involved in preventing crime because crime is a huge cost to them. A recent Audit Commission Report found that a typical hospital in South Wales was having to spend £100.000 per year on security and many NHS Trusts are losing staff hours as a result of stress and injury from violent incidents in hospitals and health centres. But, of course, the biggest cost to the NHS is the treating of victims of crime - not only victims of violence and drug abuse, but people traumatised and depressed as a result of incidents or threats. Furthermore, people who already have mental health problems or learning difficulties are disproportionately more likely to be victims (and sometimes perpetrators) of offending.

What Health Services can do
This depressing picture of the costs of crime to the NHS shouldn't just lead to a demand for more police and security. It should awaken the recognition that Health professionals can do things to prevent crime by enhancing and focusing work they already do. Many health workers are already involved in crime prevention without explicitly realising it. There are two principal health interventions in this field: harm reduction and primary prevention.

Harm reduction
Harm reduction programmes are being increasingly used to manage people's over-dependence on drugs and alcohol. The link between drug and/or alcohol abuse and crime is irrefutable, so any intervention which can break the link (for example overcoming the need to steal to buy drugs or reducing violent behaviour induced by alcohol intoxication) must be both health beneficial and crime preventative.

Work done by psychologists and therapists to manage anger and violence, will also help to prevent further people becoming victims.

Primary prevention
The most promising point for health interventions to prevent crime is at the early stages of child development, when key behaviour traits are beginning to form. Health Visitors have a key role to play here, not just in the traditional role of watching out for the signs of non-accidental injury, but, most importantly by offering an enabling role in ensuring positive and appropriate parenting. Currently this role appears to be undervalued and under-resourced, as it is often regarded as a "soft" intervention and thus accrues low priority. We would argue, on the contrary that intensive and supportive intervention with parents struggling to bring up infants and young children is immensely important in influencing future prospects for healthy and non-problematic development in later years. Resources invested at this early stage will reap huge financial and humane benefits in later years, in terms of savings to public services, including the criminal justice system. The Home Office recognised this in their recent discussion document entitled "Supporting Families" where they stated: "the expanding role of health visitors would involve a shift of emphasis from dealing with problems to preventing problems from arising in the first place". The government is attracted to the idea of building on the excellent service already provided by health visitors, by formally extending the focus of their work beyond 'health' in a narrow sense to supporting families more generally". The proposal for a new National Family and Parenting Institute and the funding of pilot "Sure Start" schemes represent further government recognition of the importance of early childhood development in the prevention of later personal and social problems.

Health Visitors can carry the flag in the early years, but the other important actors as children grow up are Health Promotion staff, who have a crucial role, particularly in the field of preventing drug and alcohol abuse.

Hawaii Healthy Start
This is a universal parent support programme which explicitly aims to prevent child abuse and future criminal consequences. Home visitors recruited and trained from the local community, visit families weekly for the first 6 to 12 months after birth. Early in the relationship, the home visitor helps parents to develop an individual support plan, specifying the kinds of services they want and need, and the means by which to receive them. This plan will then be implemented over the next five years of the child's development.

Partnerships
It should be clear from all of the above, that no one agency can single-handedly reduce crime and disorder in our communities, but that jointly agreed action between a number of agencies should produce an outcome greater than the sum of the parts. It is also important to note that intervention by one agency may accrue benefits most directly to another agency. (For example, the kind of intensive home visitor support described above would cost the Health Authority considerably but may result in long term savings to schools and penal services.) It is therefore important to get away from traditional 'departmental' thinking and instead progress to integrated planning and action to address the 'wicked issues' of our time, such as crime and social exclusion. This is easier said than done - professional and agency demarcations are usually defended with rigour by vested interests and entrenched working practices, but 'joined-up working' is our only real hope for cracking the multi-facetted problems of crime and insecurity.

Joint working and strategy development in Dyfed/Powys
In Wales the opportunities for active collaboration between health related and criminal justice organisations in developing community safety policy and practice are greater than in England because of the way that the statutory sector is organised. All local authorities are unitary and are coterminous with local health groups - the Welsh equivalent of Primary Care Groups. Further, each local authority has the lead role for promoting health locally through the agency of the Local Health Alliance. This uniquely Welsh structure comprises representatives of relevant local authority departments, of the local health group and the Health Authority, of the local health related voluntary sector and, crucially, of the local Probation Service and the Police. In most local authorities the establishment of local health alliances is still at a very early stage but in a few such as Powys and Pembrokeshire they are well established because de facto alliances have existed for several years. It is interesting to speculate whether the fact that the Dyfed Powys Police Force area has the lowest recorded crime rate in England and Wales is partially the result of long standing effective partnership with its four constituent local authorities and the Health Authority, with which it is coterminous.

Health, Community Safety and Public Policy
Finally it is important that we avoid what some observers have described as the 'criminalisation of social policy'. We shouldn't need to argue for more health visitors or health promotion staff, purely because they will help to prevent crime. The good news is that most social measures to prevent crime (unlike the traditional fortification and deterrence approaches), have wider quality of life benefits too. Also we should also be striving to achieve healthy communities of people, not purely based on absence of disease, but also measured by the degree to which they feel safe, secure and free from fear.

Health Authorities have a central role to play in the prevention of crime and the promotion of community safety. Some of their staff are already engaged in this work, often without realising it. This needs to be recognised, developed and supported, not least because reductions in criminality will, in the long term, save the NHS millions and provide a better quality of life for all.

Henry Shaftoe is a senior lecturer in the School of Housing and Urban Studies at the University of the West of England.

Dr Paul Walker is a Visiting Fellow at the Faculty of Health and Social Care at the University of the West of England.