Violence as a public health problemBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7380.104 (Published 11 January 2003) Cite this as: BMJ 2003;326:104
Combined approach is needed
- Jonathan Shepherd, professor of oral and maxillofacial surgery (Shepherdjp@cardiff.ac.uk)
- University of Wales College of Medicine, Heath Park, Cardiff CF14 4XY
- Elliot Institute, PO Box 7348, Springfield, IL 62791-7348, USA
- Mixenden Stones Surgery, Halifax, HX2 8RQ
- University of Newcastle, Locked Bag 1014, Wallsend, NSW 2287, Australia
EDITOR—Although treating violence as a public health issue is not new,1 the World Health Organization's report on violence and health is an important reminder of the suffering we inflict, intentionally, on each other.2 In the United Kingdom the Crime and Disorder Act 1998 places a statutory obligation on health services to work with the police and local government to tackle crime. So far, however, the police and local authorities in England and Wales have found the NHS difficult to engage, probably because the reasons to contribute are not widely understood.
A great deal of violence that results in treatment is not reported to or recorded by the police. This means that health services have substantial opportunities to collect unique information about the circumstances of violence, which, combined with police data, can be used to target violence prevention resources at particular locations, times, and vulnerable individuals and groups.3 Since most injured people are treated by emergency services, they should be a major focus of preventive effort.
Tackling violence as a problem of intentional injury provides both a rational framework for prevention and existing local expertise, which has much to offer statutory partnerships for reducing local crime.
Injury rates due to assault as provided by emergency departments are proving objective and unique local, regional, and national measures of violence.4 These correlate with measures of unemployment, poverty, and expenditure on alcohol, for example. Data can be collected without extra resource by clerical staff in emergency units and have successfully been used to target local police activity. They also have potential as evidence relevant to alcohol licensing: a recent study found a correlation between capacity of licensed premises and injury sustained in local street violence.5
Heath draws attention to the perspective of human rights.1 Nowhere …