Preventing crime and violenceBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6988.1198a (Published 06 May 1995) Cite this as: BMJ 1995;310:1198
A population approach is needed
- Shelley Rifkin,
- Anthony Zwi
- Research fellow Senior lecturer Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT
EDITOR,—Violence continues to be a cause of substantial ill health and emerging debate.1 2 The incidence of reported violent crime is increasing1 and results not only in appreciable mortality and morbidity but also psychological and economic costs to the community.
The response to violent crime has traditionally been through the criminal justice system and has focused on retribution and rehabilitation.3 More recently, violence has been recognised as a public health problem, and epidemiological techniques are being used in the development and implementation of preventive strategies.4
In addressing the problem of violence most effort has been focused on a small group of vulnerable people. This approach, termed the high risk approach, aims at reducing levels of violence in those at higher risk. Not only is it difficult to identify accurately those at highest risk, however, but most acts of violence will probably be committed by people outside these high risk groups. Thus if efforts are restricted to the minority, most violent crime will not be prevented.
An alternative approach, the “population strategy,” recognises that extreme violence reflects the range of behaviour and circumstances of society as a whole.5 This approach suggests that there is not a clear demarcation between those who will commit violence and those who will not but a continuum within a society that tends to follow a normal distribution. The extreme tail of the distribution is therefore a function of the society as a whole, and if that society could be shifted to the left the number of extreme incidents would diminish. Conceptualising violence in these terms suggests that societal measures aimed at reducing important influences such as poverty, alcohol consumption, access to weapons, and television violence are likely to reduce these acts.
It would be valuable to develop a measure that would help us describe the distributions of the nature and form of violent behaviour in populations. This would help in exploring the causes of violence, comparing societies, and measuring the success of interventions.
High risk approaches will continue to be necessary to help the most vulnerable people in our society, but to establish enduring change in the culture of violence in societies a broader, population based approach will be needed.