Riots on the streets
BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5248 (Published 16 August 2011) Cite this as: BMJ 2011;343:d5248
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I seldom read the Daily Mail [1] and I am reluctant to prejudge the
family histories of the variety of persons involved in recent serious
public disorder across English cities, until we have some real data.
However, there is one part of Hayes' letter that evidence supports,
strongly. If we took child public health (and the long term survival of
our species) seriously, then active promotion of 'marriage as a public
health measure' [1] makes sense. Children grow best in stable
environments, with secure longterm parental attachment.[2] Most of the
recent research comes from either North America or Continental Europe, but
not only do children of married couples do better than other young
populations, there are modest benefits from intervening (marriage
education programmes) with the aim of promoting stable and fulfilling
marriages.[3] While the design quality of trials is good, so far the
people who have agreed to take part in 'marriage education' trials have
not represented the whole spectrum of city residents - perhaps a UK public
health experiment could address such health promotion and health
inequalities, together?
Since it seems to be more often "non-involved fathers" (a social work
term) who desert their offspring, rather than biological mothers, we do
need to consider the evidence for what encourages a man to stay with his
child long term. For both black and white fathers in America, the key
parameter is employment - especially if a workless young man has left
education with 'low skills'.[4]
So for adults education, employment and secure family attachments all
appear inter-related. This year the MRC's national survey of health and
development reached its 65 birthday... for those 1946 babies, education,
employment and family attachments have all been inter-related, too.
[1] Hayes SF. What if the Daily Mail is correct? BMJ rapid response
23 August 2011.
[2] Bowlby R. Fifty Years of Attachment Theory. The Donald Winnicott
Memorial Lecture. London: Karnac, 2004.
[3] Reardon-Anderson J, Stagner M, Macomber JE, Murray J. Systematic
Review of the Impact of Marriage and Relationship Programs. Washington DC:
Urban Institute, 2005 (still accessible online at www.urban.org/ 24 August
2011).
[4] Briefing. Decline of the working man. The Economist 2011; 398
(8731) 30 April: 75-77.
Competing interests: In the past, I researched the mental problems of people attending JobCentrePlus and am currently involved in a Work Experience project for unemployed service users (with NHS mental health colleagues).
McKee and Raine call for public health research into the causes of
the recent disturbances which began in London and then spread to other
English cities. However, their use of phrases like 'clearly, deprivation
is a factor' and 'prison is an expensive way of making bad people worse.'
seem to indicate a bias towards certain kinds of answer. Regarding
'deprivation', newspaper reports have by now shown that a number of
wealthy and employed persons took part.
Truly objective research into why some people did not loot, burn, mug
and threaten their fellow citizens might be very helpful. But what if its
conclusions were unacceptable to the prevailing liberal secular humanist
mindset?
I would dearly like to know what proportion of those who engaged in
criminal activity came from fatherless homes, how many use cannabis or
other mind altering drugs (including prescribed), how much time they spend
using violent video games (several participants in the disturbances
compared them to 'like being in a video game') and what their beliefs are
about the entitlement culture versus individual responsibility.
If an objective study comparing looters and non-looting controls
shows that (for example) living in a benefit funded fatherless household
is a key factor, would McKee and Raine support the active promotion of
lifelong monogamous marriage as a public health measure?
Or would that option be unacceptable in case it upset the liberal (as
opposed to the tabloid) press?
PS the use of the term 'riot' has been questioned as there was no
political purpose to the disturbances which were primarily characterised
by violence, theft and arson.
Competing interests: No competing interests
Making the riots a public health issue made for interesting reading
(1). Rioters represent a small number in our society. It may be advisable
to take a simultaneous 'individual' approach to this problem.
We believe there may be a lot more to be gained from qualitative
research in this area. Focus groups with prosecuted rioters may provide
underlying reasons for their decisions. However, this would be difficult
to conduct unless it was made part of their penalty.
There is also a relatively easier group to reach; those that chose
not to join the riots. Their reasons for not joining may be more
beneficial to ascertain in the short term.
Rioting is a far more complex issue than cardiovascular disease and
obesity and deserves a distal to proximal approach to identifying
causation, in conjunction with public health initiatives.
(1) BMJ 2011 343:d5248; doi:10.1136/bmj.d5248
Competing interests: No competing interests
I welcome the Editorial by Professors McKee and Raine on rioting and
public health.
I would like to add some other types of comparisons by using
epidemiological tools, for example adjusted analyses by judicial type of
systems or criminal justice systems as a whole. This could be done in a
similar manner with which we, in public health, use health care systems
when comparing health care in different countries.
For example the Paris vs. London riots. The judicial systems differ
in France (Napoleonic Code) and England. The context of recent riots in
the two capitals was perhaps different. However, one element was common to
both events: the predominance of young male populations.
As a public health physician I subscribe to the fact that human
health and behaviours are closely linked. In public health we almost
always refer to lifestyle behaviours and always quote ubiquitous factors
such as smoking, drinking, eating, physical exercise, etc. Has violence
become a lifestyle factor in some parts of societies, in communities?
There may be an association of violence with health and this
association may have different strengths in diferent judicial systems.
I look forward to reading further views and articles on the topic of
health and its relation to criminal justice systems.
Competing interests: No competing interests
Public anger at recent rioting and looting across England has focused
on young people, identified through compelling media imagery as the
principal perpetrators of criminal activity. However only around 21% of
those who have appeared in court so far are under 18. Moreover, only a
tiny minority of the 6.6 million children and young people aged 10-18
years in the UK are involved in crime and young people are more likely to
be victims of a crime than commit one.(1) Perceptions of young peoples'
involvement in recent civil unrest should also include the many who
volunteered to help clean up their communities and of course those who
were victims of violence themselves. We believe that it is essential that
political and wider responses do not feed into negative generalisations
about young people.
Young people in Britain contribute significantly to wider society.
Adolescents and young adults are more likely to perform regular voluntary
work than any adult age group and contribute significantly as unpaid
carers. Yet evidence tells us that the health status and economic
prospects of our young people are poor. Comparative studies by UNICEF show
that child and adolescent well-being is lower in Britain than in other
wealthy countries (2) and 22% of children live in relative poverty in the
UK, higher than any economically comparable country in Europe.(2) Youth
unemployment is higher than at any other age and has increased most during
the global financial crisis.(3) In 2010, Sir Ian Kennedy wrote "there are
significant shortages of professionals trained to care for young people
with mental health problems at a time when an epidemic of such problems
lies beneath the surface of society" and that a large proportion of young
people in the criminal justice system have a significant need for
healthcare, especially in relation to mental health.
These issues cannot excuse the behaviour of some in recent unrest but
they should inform our responses which should move beyond policing to
address the position of young people in British society. There is strong
evidence from interventional as well as observational studies that factors
such as connection of young people with family, school and community;
consistent and authoritative parenting; and emotional well-being are
highly protective for young people across a range of health behaviours and
violence. (4) Each of these protective factors has declined for British
young people across the past 40 years.
The UNICEF State of the World's Children report in 2011 focused on
adolescence as "The age of opportunity", and emphasised that nations will
reap an economic as well as social dividend if they invest in adolescents
as the future of their nation. (3) The planned UK cross-governmental
statement on services for young people (5) provides a promising but
challenging opportunity to develop positive responses to the recent crisis
to reduce violence and social exclusion whilst promoting healthy social
and economic development.
1. Coleman J, Brooks F. Key Data On Adolescence 2009. Association for
Young People's Health. London, 2009.
2. Layard R, Dunn J. A Good Childhood, Searching for Values in a
Competetive Age. The Children's Society, London, 2009.
3. UNICEF. State of the World's Children 2011: Adolescence, An Age of
Opportunity. United Nation's Children's Fund, 2011.
4. IOM (Institute of Medicine) and NRC (National Research Council).
2011. The Science of Adolescent Risk-Taking: Workshop Report. Committee on
the Science of Adolescence. Washington, DC: The National Academies Press.
5
http://www.education.gov.uk/childrenandyoungpeople/youngpeople/positive%...
-for-youth-discussion-papers
Competing interests: No competing interests
Richard Wilkinson has a rather different, but in my view, more
compelling perspective on the recent riots and the causes of rioting, than
Professors McKee and Raine. Richard Wilkinson, co-author of the Spirit
Level, co-founder of the Equality Trust [1] and professor emeritus of
social epidemiology at the University of Nottingham Medical School etc,
etc, was recently interviewed by American radio talk show host Thom
Hartmann. During the interview, Professor Wilkinson talked of the rioting
and the causes of riots ...
.... "incidents ... groups of young people ... and in a way, what
they're doing is just taking what they think they can get away with ...
helping themselves, and that's very much what we've seen, both amongst the
bankers and CEOs, who are taking these huge bonuses ... but also in
Britain we had a scandal in 2009, a very major scandal, when it was found
that most members of Parliament were claiming expenses way beyond what
they were allowed to claim ... and so they too were helping themselves to
what they could get away with ... and so, you know, when people talk of
about the need for moral examples, the examples that these kids have been
set are pretty poor ... I think that's quite an important element ...
they're not doing something that is quite unlike people at the top end of
society but with much less ... they're doing it with much more
justification in effect." [2]
Britain needs to be more like Sweden, Norway, Finland and Japan, and
less like the US, Singapore and Portugal. The key message is that more
unequal societies have greater health and social problems, more mental
illness, lower life expectancy, more violence as measured by murder rates,
higher rates of teenage pregnancy, and more people in prison. Public
health professionals cannot ignore the message: reducing the levels of
looting and larceny by the top end of society is likely to improve the
level of public wellness ... and reduce the incidence of wider civil
disorder.
[1] The Spirit Level: Why Equality is Better for Everyone. Richard
Wilkinson and Kate Pickett, published in paperback in February 2010.
http://www.equalitytrust.org.uk/resource/the-spirit-level
[2] Thom Hartmann & Prof Wilkinson: London Riots and economic
inequality. YouTube: uploaded 12 August 2011.
http://www.youtube.com/watch?v=CwmrGzDotuo
Competing interests: No competing interests
McKee and Raine [1] have raised important points about the public
health impact of riots, and possible antecedents. By chance, this
afternoon I was in a meeting with the Office for National Statistics, and
informally at the end we discussed the 'crime map' of poverty and rioters'
home addresses in today's Guardian.[2] Impoverished neighbourhoods do have
more residents in trouble with the police, but we agreed that a poor ratio
of trees to people would give similar correlations, as would GCSE exam
success and the case control study implied by the editorial.[1]
Both the live television reports and the subsequent court appearances
show 'rioters' were a fairly heterogenous population, although I was
struck that over the last 30 years I have worked in many of the local
authorities affected. Mobs can include a significant proportion of
suggestable Followers, especially when these are adolescents. Many
adolescents in urban sink schools struggle with poorly managed mental
illness: 30-40% of 14 year olds in the worst East End schools. English
CAMHS services for child and adolescent mental health cannot cope with the
numbers of cases identified, and waiting lists are often long and
unmanageable.... a two year wait for a 14 year old is an infinity of
misery. If we do not want this chronically unhappy population to provide
tinder, every time there is a local conflagration (however much career
criminals are involved in lighting the fire) we must engage seriously with
strengthening CAMHS in just those neighbourhoods with the worst schools,
poverty... and treelessness.
[1] McKee M, Raine R. Riots on the streets. BMJ 2011;343:d5248
[2]Rogers S. Mapping the riots: poverty. The Guardian 2011; 17
August: 6.
Competing interests: Social science member of the statistics users forum, Royal Statistical Society.
Dr Noble says it is time for action and calls for more investment in
public health.
Could he please tell us:
What exactly he wants to be done
What will be done by the "public health service"
What extra staff will be needed by the public health service of the
defined area he is currently serving.
How much the staff costs will be.
What will be the knock-on effects on the other services provided by
his "authority" or "trust"...
In the pre-1974 public health service, the Medical Officer of Health
would have been required to present a report to his Borough Council.
Presumably, the chief officer under whom Dr Noble is training as a
registrar would be preparing such a report (detailing the current
position, the problem to be solved, the plan for action, the staff
required, the time frame for action, the plan for evaluating the outcome).
May I hope that the tax-payers of Dr Noble's patch will, through
their councillors, receive such a report so that they can accept, reject
or accept with amendments, the recommendations of Dr Noble and his
colleagues.
Pre-1974, the Medical Officer of Health would not have received extra
funding simply by saying : "I need so many more thousands for my
service".
JK Anand
Competing interests: Tax-payer
There is undoubtedly a role for public health specialists in tackling
the wider determinants of health, and crime is certainly a key factor.
However, more research, more analysis, inquiries and the like will only
give us more and more eloquent descriptions of problems we already know a
lot about. Now is the time for further investment in the public health
service, and a time to act quickly to apply the evidence based
interventions we already know work to curb the causes of the recent
deplorable rioting.
Competing interests: No competing interests
Research-Based Meditations on Mass Violence
The interchange sparked by this editorial is intriguing. I offer the
following reflections about the most recent riots based on the
considerable literature available on the social psychology of group
aggression and violence.
It is clear from psychological anthropology, evolutionary psychology,
and paleontology research that a considerable foundation of human behavior
in general, and violence in particular, is genotypically grounded: the
human animal has evolved mechanisms meant to adaptively respond to social
problems. The use of violence as a specific strategy for adaptive problem
solving is a cross-cultural and cross-species phenomenon, from simians to
arthropoda. Moreover, empirical behavioral genetic evidence exists that
supports genetic predispositions for human antisocial personality traits.
However, while a genetic predilection for violence might be evident
in the human species, it is imperative that this perspective be tempered
with the awareness that psychological variables and contexts are
critically important causes or mediators of not only individual antisocial
behaviors, but the group aggression witnessed in London.
Strong research suggests that individuals who perceive themselves to
have less economic resources are more likely to believe that they are the
victims of economic inequality, and therefore, view violence as a means of
obtaining the resources they desire. Perceived challenges to status,
reputation, and respect, just as with our simian relatives, provide a
fertile motivation for violent acts.
An interesting assessment developed by Mills and Kroner (2001), the
Measures of Criminal Attitudes and Associates, is a good starting point
for understanding mob-related violence. According to this theory, high
ratings on the following variables are predictive of violence and violent
recidivism: The identification with attitudes that support violence as a
means; perceived entitlement - the right to have and take away; antisocial
intent; and association with those involved in criminal activities.
Furthermore, social psychological research on the role of
deindividuation, (a reduction of self-awareness) and diffusion of
responsibility (a reduction of individual moral responsibility), in-group
/ out-group bias, social identity, and conformity to group norms and
perspectives might have a role in precipitating antisocial activities.
Even though, arguably, most melee-causing mobs are not a tightly-woven
group of similarly-minded ideologues with cohesive relationships (as in
many terrorist groups), the inspiration, if based on an experience of
shared injustices by an out-group, can certainly lead to the formation of
the arousal and attitudes of a new disaffected identity and corresponding
norms that legitimize violent mayhem.
These recent events should prompt clinicians, law enforcement
professionals, and those engaged in public policy to study the panoply of
available research on this topic and to judiciously utilize these insights
from science when implementing strategies to address this social ill.
Stanley M. Giannet, Ph.D.
*Affiliate Assistant Professor of Psychiatry: USF College of
Medicine, Tampa, Florida.
*Provost: Pasco-Hernando Community College, North Campus,
Brooksville, Florida.
References:
Buss, D.M., & Shackelford, T.K. (1997). Human aggression in
evolutionary psychological perspective. Clinical Psychology Review, 17,
605-619.
Mills, J.F., & Kroner, D.G. (2001). Measures of Criminal
Attitudes and Associates (MCAA). User Manual.
Monohan, J. (1981). The clinical prediction of violent behavior.
Rockville, MD: NIMH publication
Russell, G.W. & Arms, R.L. (1998). Toward a social psychological of
would-be rioters. Aggressive Behavior, 24, 219-226.
Wilson, M. & Daly, M. (1997). Life expectancy, economic
inequality, homicide, and reproductive timing in Chicago neighbourhoods.
British Medical Journal, 314, 1271-1274.
Competing interests: No competing interests