Letters Public health and knife crime

Tackling the knife violence epidemic requires a radical upgrade in public health investment

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2116 (Published 16 May 2018) Cite this as: BMJ 2018;361:k2116
  1. Laura Cattermole, foundation doctor in public health,
  2. Padmanabhan Badrinath, consultant in public health medicine,
  3. Abdul Razaq, director of public health and protection
  1. Public Health Suffolk, Endeavour House, Suffolk County Council, Ipswich IP1 2BX, UK
  1. p.badrinath{at}suffolk.gov.uk

Torjeson asks whether public health strategies can tackle London’s rise in fatal violence.1 Violence costs the NHS £2.9bn (€3.3bn; $3.9bn) annually. It also affects mental wellbeing and freedom to use outdoor spaces and increases the risks of obesity, cancer, and heart disease.2

A recent BBC news article said that making “a direct link between the number of killings and the number of Bobbies on the beat” was too simplistic, emphasising that the underlying causes of violence are multifactorial.3 For example, violence related emergency admissions are five times higher in deprived communities than in wealthy ones.2

Public health’s role is to enhance wellbeing, reduce inequalities, and prevent disease by tackling the wider determinants of health such as poverty and mental illness. Violence is strongly associated with wider determinants and hugely influences society’s welfare, so it cannot be denied that violence is a public health issue.

Torjeson says that “the principles of treating knife crime like an epidemic of disease should apply.” The World Health Organization4 states that “violence can be prevented, and its impact reduced, in the same way that public health efforts have prevented and reduced infectious diseases.”

Many examples2 show the positive effects of prevention strategies, such as parenting programmes and restricting alcohol sales times, on violence. Through law enforcement and early intervention, Scotland is seeing violent crime at its lowest level for 41 years.5

Unfortunately, England’s public health budget has been cut by £200m and is predicted to fall by another £331m by 2021,6 despite evidence that interventions are cost effective.7

Focusing on primary prevention and population-wide interventions in alliance with law enforcement gives us the best hope of tackling violence. This strategy is not compatible with the cuts to public health resources.


  • Competing interests: The authors of this letter currently work in public health.

  • Disclaimer: This article reflects the personal opinions of its authors and does not in any way represent the views of Suffolk County Council or West Suffolk NHS Foundation Trust.

  • Full response at: https://www.bmj.com/content/361/bmj.k1578/rr-0.


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