Elsevier

The Lancet

Volume 358, Issue 9294, 17 November 2001, Pages 1717-1722
The Lancet

Public Health
Criminal deterrence as a public health strategy

https://doi.org/10.1016/S0140-6736(01)06716-2Get rights and content

Summary

Deterrence is an established theme in criminal justice, but its role in prevention of assault has been treated with ambivalence and even hostility in medicine. The extent to which offenders can be persuaded, through knowledge of criminal and health risks, not to injure others is emerging from studies of the health effects of firearm and other crime legislation, and from macro-level studies and controlled experiments of police interventions. There is convincing evidence that motorists can be deterred from alcohol-impaired driving, and recognition that specific, targeted, and visible police work and increasing certainty of punishment are effective interventions. By contrast, duration of imprisonment and generic police initiatives such as blanket increases in police numbers seem to have little effect on deterrence, at least in the context of the decline in US homicide rates since 1991, to which demographic and economic factors seem to have contributed little. Together with established and cost-effective preschool education and early family support, targeted policing and increasing rates of conviction should be integrated into strategies for injury prevention.

Section snippets

Criminal deterrence in medicine

Research on criminal deterrence indexed in Medline in the past 10 years is sparse and has focused on the extent to which people can be deterred from causing injury through alcohol-impaired driving. Various measures have been assessed, including law reform, new criminal laws, law enforcement (especially in relation to lowering the legal limit for driving), and various naming and shaming techniques for people convicted of alcohol-impaired driving.6 This research has shown that women and men are

Criminal laws

An interesting development in medicine has been the study of the effectiveness of criminal laws by epidemiologists. The introduction of laws requiring gun owners to keep firearms locked away was associated with reductions in accidental deaths of children.17 Evaluation of state laws that restrict handgun purchases has shown reductions in violent offences.18 Improved law enforcement has also been the basis of prevention of alcohol-related violence in Australia.19 The findings of these

Police response

Although increases in the likelihood of conviction probably reduce overall rates of injury from assault, the manner of police response to certain types of violent offences is important. Indeed, some police responses to domestic violence can increase risk of injury for victims. For example, if offenders are present when the police arrive, or if offenders are unemployed, or live in urban areas of concentrated poverty, the chance of repeat assault by the perpetrator after an arrest can be

Human rights issues

Deterrent measures can threaten or infringe human rights and impose substantial burdens in some circumstances.30, 31 Repressive regimes and illegal paramilitary organisations are often characterised by brutal attempts to deter. This fact emphasises the need to deter only in the context of a sound legal and ethical framework that safeguards the rights of citizens, families, and detainees.

Demographic factors

Demographic forecasts of US violent crime rates from 1975 to 2000 anticipated the peak in 1980 and the fall in the early 1980s, but did not predict the sharp decline in homicides since 1991.33 Overall, black males aged 14–24 years contributed disproportionately to homicide offence rates (figure 3): during 1988–98 they represented about 1% of the population but constituted 9% and 17% of victims and perpetrators, respectively, in 1988, and 17% of victims and 30% of perpetrators in 1998.33

Economic factors

Economic explanations, in particular, market wages, for reduction in homicides in the USA are also potentially relevant. Importantly, however, whereas youth wages first started rising in 1993, after an almost continuous fall from 1979, homicide rates peaked in 1991, and the 4% rise in wages to 1997 was not large enough to explain the overall reduction in homicide. At best, rising wages could have had a supporting role.36 This conclusion is consistent with the findings of a cohort study of

Police work

Increases in the number of police in the USA do not seem to have had an independent or consistent role in reducing violence.38 Further, although police-community partnerships can reduce violence, these were neither prevalent nor effective enough to explain reductions in US homicide.38 Assessments of generic zero-tolerance (strict enforcement) policing have been hampered by simultaneous implementation of other police interventions, but, overall, evidence of effectiveness is equivocal.38

By

Imprisonment

A potential contributor to decreasing offence rates has been the quadrupling in imprisonment rates in the USA since 1980, at an increased yearly cost of more than US·20 billion. In this case at least, estimates of the contribution of incapacitation to overall declines in crime rates have been calculated. Incarceration could affect crime rates through deterrence, isolation of offenders, and reductions in number of victims, since offenders are especially vulnerable to injury.46, 47 In accordance

Conclusion

The wider public-health agenda acknowledges the contributions of economic conditions, housing, education, transport, and crime reduction to health.48 It is harder, perhaps, to think of police and other criminal justice services as equally important as these factors, though evidence relevant to this agenda includes a recent analysis of criminal deterrence and sentence severity.24 A main aim of recent public-health research strategies in the UK has been to make the best use of current knowledge,49

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