Memorandum submitted by Professor Dr John
R Ashton CBE
Please find my submission as requested on the
topic of injury and violence prevention. This has been proposed
in association with my colleagues at Liverpool John Moores University
under the direction of Professor Mark Bellis OBE. Liverpool John
Moores University is a World Health Organisation Collaborating
Centre for work on the evidence base for injury and violence prevention.
I would especially draw the committee's attention
to the section on reducing access to lethal means as well as to
that on victim identification, care and support programmes although
all sections are relevant to a public health approach to reducing
levels and injury and violence at a population level and should
be viewed in the current policy context of active citizenship
and rebuilding community resilience.
During the present recovery phase in Cumbria,
tertiary prevention ie. reducing the long term harm to bystanders
and witnesses of the mass killings is now the priority and is
the focus of the multi agency recovery group which I chair. Extensive
arrangements have been put in place to identify those at risk
and ensure that support is readily available to them in a non-obtrusive
way. our concern has also turned to the responsible role of the
media in performing its public function without sensationalising
recent events in ways which might sow the seeds for contagion
and the next mass shooting event somewhere else—an occurrence
for which there is an evidence base to believe is all too sadly
likely to occur in the absence of media restraint.
7 December 2010
APPENDIX 1
There is a developing evidence base identifying
a range of measures that can prevent violence from occurring,
reduce violence in individuals who are already involved in violence,
and identify and support victims of violence to limit its long
term effects. The following sections summarise a selection of
the key strategies for preventing violence identified by the World
Health Organization. Further information on all measures is available
through the Prevent Violence: The Evidence series produced
by the WHO and Liverpool John Moores University.
DEVELOPING SAFE,
STABLE AND
NURTURING RELATIONSHIPS
BETWEEN CHILDREN
AND THEIR
PARENTS AND
CAREGIVERS
Early relationships are central to a child's
social, emotional and intellectual development. There is good
evidence that interventions that encourage safe, stable and nurturing
relationships between parents or caregivers and children in their
early years can reduce childhood aggression and prevent violence
in adolescence and early adulthood. Such measures can also prevent
child maltreatment and consequently its life-long negative impacts
on mental and physical health and social functioning. Examples
of programmes that have been proven effective in preventing violence
include the Nurse Family Partnership home-visiting programme and
the Positive Parenting Programme (Triple P). In home visiting
programmes, trained personnel visit parents and children in their
homes and provide health advice, support, child development education
and life coaching for parents to improve child health and foster
parental care-giving abilities. Parenting education programmes,
such as the Triple P, are usually centre-based and delivered in
groups and work to improve parents' child-rearing skills, increase
their knowledge of child development and encourage positive child
management strategies. Evidence also suggests that parent and
child programmes—which typically incorporate parenting education
along with child education, social support and other services—can
prevent child maltreatment and youth violence later in life.
DEVELOPING LIFE
SKILLS IN
CHILDREN AND
ADOLESCENTS
Interventions to develop life skills in children
and adolescents address some of the key risk factors for violence,
such as poor social competence, low self-esteem and low academic
achievement. Preschool enrichment programmes, that provide children
with academic and social skills at an early age and prepare them
for formal education, have been shown to reduce both aggression
in childhood and later violent offending. By involving parents,
they can also reduce child maltreatment. The effects of these
programmes are most pronounced in children from poor families
and neighbourhoods. In formal school settings, social development
programmes that build social, emotional and behavioural competencies
(eg self-esteem, problem solving, empathy, relationship skills
and critical thinking) have also been shown to prevent youth violence.
Programmes that target children early in life can also boost educational
achievement and improve job prospects, providing long lasting
benefits. They have been found to be cost effective.
REDUCING THE
AVAILABILITY AND
HARMFUL USE
OF ALCOHOL
There are strong relationships between alcohol
use and violent behaviour. Measures that reduce the availability
and harmful use of alcohol can be important strategies in violence
prevention. Alcohol availability can be regulated by restricting
the hours or days it can be sold, reducing the number of alcohol
retail outlets and raising the price of alcohol. Reduced sales
hours have generally been found to be associated with reduced
violence and higher outlet densities with higher levels of violence.
Economic modelling strongly suggests that raising alcohol prices
can lower consumption and, hence, reduce violence. Brief interventions
and longer-term treatment for problem drinkers—using, for
instance, cognitive behavioural therapy—have been shown
to reduce various forms of violence such as child maltreatment,
intimate partner violence and suicide. There is also some evidence
to support interventions in and around drinking establishments
that target factors such as crowding, comfort levels, physical
design, staff training and access to late night transport.
REDUCING ACCESS
TO LETHAL
MEANS
The use of weapons such as firearms and knives
increases the lethality of violence. Limiting access to such lethal
means can prevent homicides, suicides and injuries and reduce
the costs of these forms of violence to society. In general, jurisdictions
with restrictive firearms legislation and lower firearms ownership
tend to have lower levels of gun violence. Strengthened firearms
legislation to control the sale, purchase and use of firearms
has been associated with reduced suicides and homicides in several
countries, including Australia, Austria, Brazil and New Zealand.
Restrictions imposed can include bans, licensing schemes, minimum
purchase ages, background checks, limits on quantities purchased
and safe storage regulations. Legislation that prevents high risk
individuals (eg perpetrators of domestic violence) from possessing
firearms has also shown positive effects. Measures that increase
the enforcement of firearms legislation (targeting traffickers,
retailers and users) and provide social support to violent gang
members (eg with employment) have also shown benefits in reducing
the supply of firearms and firearms violence. Given the widespread
availability of knives and a lack of research, there is currently
little evidence available on the impact of measures to reduce
access to knives on violence. Knife amnesties have been associated
with reductions in violence immediately following their implementation,
but their effects are short lived.
CHANGING CULTURAL
AND SOCIAL
NORMS THAT
SUPPORT VIOLENCE
Rules or expectations of behaviour—norms—within
a cultural or social group can encourage violence (eg gender norms
supportive of male dominance over women) and prevent individuals
from seeking help when needed (eg with depression and mental health
problems). Interventions that challenge cultural and social norms
that are supportive of violence can prevent violence and have
been widely used, but the evidence base for their effectiveness
is currently weak. The effectiveness of interventions addressing
dating violence and sexual abuse among teenagers and young adults
by challenging social and cultural norms related to gender is
supported by some evidence. Other interventions appear promising,
including those targeting youth violence and education through
entertainment ("edutainment") aimed at reducing intimate
partner violence.
VICTIM IDENTIFICATION,
CARE AND
SUPPORT PROGRAMMES
Interventions to identify victims of interpersonal
violence and provide effective care and support are critical for
protecting health and breaking the cycles that spread violence
from one generation to the next. Evidence of effectiveness is
emerging for the following interventions: screening tools to identify
victims of intimate partner violence and refer them to appropriate
services; psychosocial interventions—such as trauma-focused
cognitive behavioural therapy—to reduce mental health problems
associated with violence, including post-traumatic stress disorder;
and protection orders, which prohibit a perpetrator from contacting
the victim, to reduce repeat victimization among victims of intimate
partner violence. Several trials have shown that advocacy support
programmes—which offer services such as advice, counselling,
safety planning and referral to other agencies—increase
victims' safety behaviours and reduce further harm.
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