Publication Details

(August 19, 2024)

Policing, as a reflection of the societies it serves, is constantly evolving. In the United Kingdom, various paradigms and their associated change programs come and go, with some gaining more traction than others. These include problem-oriented policing, intelligence-led policing, community-oriented policing, evidenced-based policing, and whole-system approaches, all of which coexist with the traditional command-and-control framework of policing (Ratcliffe, 2022). The command-and-control model is a natural fit given the crisis and operationally oriented nature of many aspects of police work. It sits naturally within policing’s hierarchical structure rather more easily than the newer models. New initiatives in policing come and go, their longevity often dependent on political biases as well as the individual levels of leadership support for the latest approach that has been taught in a recent course or presented at a conference. Policing lurches from crisis to crisis, introducing new ideas but without ever really getting to grips with the issues and solving them at source, such is the cyclical nature of policing initiatives.

At present policing in the United Kingdom is under intense scrutiny regarding its response to violent crime. The public health approach to policing has been acknowledged as a valuable strategy for tackling the complex systems and issues that lie at the intersection of law enforcement and public health domains (Christmas & Srivastava, 2019, Davey et al., 2021). This approach prioritizes the incorporation of public health strategies into policing practices to minimize harm and promote community well-being (Evans et al., 2021). Unlike traditional methods that focus on individuals or specific locations, the public health approach adopts a proactive and reactive strategy that targets population-level groups. This approach involves a comprehensive understanding of data and needs, which encompasses primary, secondary, and tertiary prevention programs. Primary prevention focuses on stopping diseases before they occur, while secondary prevention measures involve early detection, and tertiary treatment targets existing cases (Davey et al., 2021).

To explain how the three-phase public health approach works is a useful to consider it in the context of diabetes, a prevalent chronic disease that affects millions of people worldwide. The first phase of this approach focuses on primary prevention, which includes community-wide education campaigns that promote healthy lifestyle choices such as balanced nutrition and regular physical activity. Additionally, this phase supports screening programs conducted by primary healthcare providers to identify early signs of the disease in individuals who are at risk, such as those with a family history of diabetes or who are overweight. The primary phase also includes policy interventions such as the introduction of sugar taxes or regulations on food labeling, which aim to discourage the consumption of sugary foods and beverages that contribute to the risk of diabetes. In England and Wales, this is exemplified by the Soft Drinks Industry Levy (SDIL), which was Implemented under the Finance Act 2017 and focused on reducing sugar content in soft drinks by imposing a tax based on sugar levels.

At the Secondary Level, early detection and diagnosis are required. This involves the implementation of screening programs and routine health check-ups to identify individuals with prediabetes or early-stage diabetes. In addition, treatment and management are provided by healthcare providers, who offer interventions such as medication, dietary counseling, and lifestyle modifications to manage blood sugar levels and prevent complications. These structured programs provide education, support, and resources to individuals diagnosed with diabetes, empowering them to engage in self-management. An example of such a program is the National Health Services Diabetes Prevention Program (NHSDPP).

At the Tertiary Level, preventing and managing complications associated with diabetes, such as kidney disease, require specialized healthcare services. Rehabilitation programs promote recovery and improve the quality of life for individuals who have experienced complications, such as amputation. Finally, in cases where complications are severe or irreversible, palliative services are provided at this stage to enhance comfort and quality end of life care for individuals with advanced diabetes.

In theory, replicating the diabetes example, the three-tiered public health approach can be applied to roads/traffic policing in the following manner, as shown in Figure 1. The primary level would involve preventive measures, where law enforcement agencies would collaborate with government agencies and non-profit organizations to implement primary prevention strategies, such as public awareness campaigns promoting safe driving practices, seatbelt usage, and adherence to speed limits. Additionally, educational programs could be implemented in primary schools, driving schools, and community centres to teach road safety knowledge and behaviours in children and young adults. Finally, there is a requirement for improvements in the road infrastructure. Collaborating with urban planners and transportation authorities, the police would advocate for infrastructure changes, such as improved signage, road markings, and traffic calming measures to enhance overall road safety.

A Secondary Level would focus on enforcement of traffic laws, and police officers would conduct regular patrols and traffic stops to enforce laws related to speeding, drunk driving, distracted driving, and seatbelt use. Supporting ongoing behavior change, driver education, and rehabilitation would be beneficial for individuals involved in traffic violations or accidents, and secondary interventions may include mandatory education programs and courses to promote safer driving behaviors. Finally, specialist police departments should investigate traffic accidents to determine their causes and identify patterns, enabling targeted interventions to prevent similar incidents in the future.

The Tertiary Level focuses on effective emergency response. Police personnel collaborate with emergency medical services to provide rapid response to road traffic accidents, administer first aid, and facilitate transportation to medical facilities. Victim Support Services could also be provided such as the use of Specialized Family Liaison Officers and charitable agencies such as the Road Victims Trust[1] within law enforcement agencies offering support services to victims and their families affected by serious road traffic accidents, providing emotional support, information, and resources. Finally, post-accident investigations and analyses would entail tertiary interventions involving in-depth investigations of major accidents to identify systemic issues, leading to policy changes, infrastructure improvements, and targeted enforcement efforts to prevent similar incidents in the future. All three levels operate together across policing to provide a comprehensive strategy for prevention and enforcement at individual and population levels within a public health framework.

Figure 1 Public Health Approaches to Diabetes and Roads Policing

A new paradigm for policing recognizes violent crime, as a societal disease rather than a legal infraction. In 2002, the World Health Organization (WHO) published is report on global violence which highlighted the extensive consequences of violence on the well-being and prosperity of individuals and society as a whole. The report emphasized the importance of addressing the underlying causes of crime through a public health approach that targets the root causes of serious violence (Krug et al., 2002). This approach requires an examination of factors that contribute to crime, such as poverty, greed, inequality, opportunity, power, and mental health. By viewing crime as a symptom of multiple underlying causes, rather than focusing solely on the crime itself, it is possible to eliminate or prevent it by addressing the root issues that lead to its occurrence. This approach differs from the traditional method of addressing crimes, which typically involves punishment and incarceration. Instead, it requires a more comprehensive understanding of the factors that contribute to criminal behaviour and a commitment to addressing these factors in a holistic manner. Despite gaining more currency during the Covid-19 pandemic, the public health approach has yet to be incorporated into main stream policing and has mainly been used in relation to domestic abuse, violent crime, and substance abuse policing strategies.

The public health approach has been fundamental to the UK government's policing strategy for tackling serious violence. It focuses on multi-agency data collection, the creation of prevention-focused violence reduction units, alongside the more traditional policing enforcement approach for hotspot policing, stop-and-search, and Achilles heel arrest strategies for prolific offenders. Based on a model operating within Scotland in 2019, the Home Office[2] awarded significant funding (£35 million in the first year of operations) to 18 police forces experiencing significant increases in serious youth violence in order to establish violence reduction units which were to be founded in a public health approach (HM Government, 2018). The Home Office did not set a prescribed structure for the units meaning each of the 18 units had differing operating models designed to meeting local needs and partnership working arrangements. However, to receive the funding each unit had to evidence the collaboration of health, police, local authority and community groups with a mandated public health approach to prevention focused work, tackling the ‘causes of the causes’ of serious violence. Thus far, the approach has been evaluated as successful, with an estimated 49,000 violent crimes prevented in areas where it has been piloted. Furthermore, it appears to provide an effective return on investment of £3.16 for every £1 invested (Home Office 2022; Sebire 2024).

The theoretical stance was evidence-based given that lower crime rates result in reduced fear of crime, contributing to heightened safety for both residents and investors, and cultivating the growth of flourishing communities. However, its practical implementation is not straightforward. Adopting a public health approach is gradual and necessitates extensive data sharing, which policing institutions often hesitate to adopt for legitimate reasons. Furthermore, not all agencies are eager to collaborate with policing because of concerns about how their information may be utilized and the potential for criminalization. This approach calls for patience, time, trust and resources that are not always available in the policing sector, particularly in its conventional command-and-control leadership style.

Whilst there have been other successful public health cases strategies for dealing with serious youth violence such a ‘Ceasefire’ in Chicago (Skogan et al., 2008), ‘Anchor’ in Finland (Aromaa &Takala, 2005) the public health approach has not been widely adopted with policing. Commentators suggest that public health approaches are too narrowly focused on longer-term population-based measures and do not adequately incorporate more immediate situational-based prevention strategies, such as designing out crime plans (Sidebottom & Tilley, 2023). Policing is a hierarchical organisation and command-and-control is a natural and inherent mechanism for its operations. However, the issues it currently faces are far too complex to simply rely on the command protocols of the past, and new thinking by police leaders is required (Grint 2020). 

Despite the various obstacles that may arise, a public health approach has the potential to provide a sustainable solution. Violence Reduction Units demonstrate promise, as evidenced by research conducted on brain trauma and violent crime (Moore, 2014). The Global Law Enforcement and Public Health Association (GLEPHA) is an international organization dedicated to promoting best practices, research, and collaboration through its website, podcasts, and conferences. By adopting this perspective and considering crime and law enforcement as part of a larger system in tandem with the command-and-control incident response approach, law enforcement leaders and government agencies can more effectively and sustainably fulfil their responsibilities to ensure the safety and well-being of citizens.

Further resources

Global Law Enforcement and Public Health Approaches Association Inc. https://glepha.com

References

Aromaa, K., & Takala, J. P. (2005). Recent developments in crime prevention and safety policies in Finland. Canadian Journal of Criminology and Criminal Justice, 47(2), 389-406.

Christmas, H., and Srivastava, J. (2019). Public Health Approaches for Policing. Public Health England and College of Policing.

Davey, P., Bath, R., Staniforth, R., Firmin, C. E., MacFarlane, C., Sebire, J., & Cestaro, D. (2021). Evidence-based approaches to violence reduction: A discussion paper. Contextual Safeguarding Network.

Evans, D., Hawk, S., and Ripkey, C. (2021). Domestic violence in Atlanta, Georgia before and during Covid-19. Violence and Gender, 8(3), 140-147. https://doi.org/10.1089/vio.2020.0061

Grint, K (2020) Clumsy Solutions for Wicked Problems: Decision- Making in Uncertainty and the Role of Systems Leadership. National Leadership Centre. [online]. Available at: https://assets.publishing.service.gov.uk/media/5f881de5d3bf7f632f6be1dd/NLC-thinkpiece-Systems-Leadership-GRINT.pdf (accessed 5 June 2024).

HM Government. 2018. Serious Violence Strategy. Retrieved 5 June 2024 from Home Office – Serious Violence Strategy, April 2018 (publishing.service.gov.uk)

HM Government. Public Health England. 2019. A whole-system multi-agency approach to serious violence prevention. A Resource for local system leaders in England. Retrieved April 2024 from whole-system multi-agency approach to serious violence prevention (publishing.service.gov.uk)

Home Office (2022) Violence Reduction Unit Year Ending March 2021 Evaluation Report. Her Majesty’s Government. [online]. Available at www.gov.uk/government/piblications/violence-reduction-unit-year-ending-march-2021-evaluation-report/violence-reduction-unit-year-ending-march-2021-evaluation-report (accessed 7 March 2024)

Krug, E.G., Mercy, J.A., Dahlberg, L.L. and Zwi, A.B., 2002. The world report on violence and health. The Lancet, 360(9339), pp.1083-1088.

Moore, E., Indig, D., & Haysom, L. (2014). Traumatic brain injury, mental health, substance use, and offending among incarcerated young people. The Journal of head trauma rehabilitation, 29(3), 239-247.

Ratcliffe, J. H. (2022). Evidence-Based Policing: The Basics. Routledge

Sebire, J. (2024). Systems leadership. In Kilgallon M. and Wright M., (Eds) Leadership Behaviours for Effective Policing: The Service Speak. Critical Publishing

Sidebottom, A. and Tilley, N. Broadening the public health approach to policing, Policing: A Journal of Policy and Practice, Volume 17, 2023, paad064, https://doi.org/10.1093/police/paad064

Skogan, W. G., Hartnett, S. M., Bump, N., & Dubois, J. (2008). Evaluation of ceasefire-Chicago. Chicago: Northwestern University, 42(5).

World Health Organization. (2002). World report on violence and health: Summary. World Health Organization.

[1] https://retrust.org.uk

[2] The Home Office is the lead UK government department for policing, immigration, drugs policy, crime, fire and counter-terrorism. https://www.gov.uk/government/organisations/home-office/about

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The views and opinions expressed in the INSIGHTS publication series are those of the individual contributors and do not necessarily reflect the official policy or position of Rabdan Security & Defense Institute, its affiliated organizations, or any government entity. The content published is intended for informational purposes and reflects the personal perspectives of the authors on various security and defence-related topics.