A public health approach means tackling an issue by preventing it from happening instead of treating it afterwards. Better to design and build safe pavements for people to walk on than fix broken bones from people falling over in the high street! To do this we need to look at the cause of the problem (an uneven pavement next to a busy road?) and may also need to understand what created the cause (a global shortage of tarmac or a company using cheaper materials to meet their budget?) so we can decide how best to address it (increase pavement budgets or close the walkway while we wait for more tarmac?). This gives us an opportunity to offer environmental solutions that work for whole communities and prevent other people from being hurt in future.
Physical, mental and social health are equally important in living a good life(1&2) Violence and health are interlinked but it isn’t possible to say that one causes the other (think chicken and egg!). What is clear is that violence and poor mental and social health co-exist so improving one could improve the other – this is where the NHS has a role in violence prevention through supporting the health of Londoners including young people, children, parents, families, communities, and its own staff.
The population level data collected by OHID about mental health has changed over recent years which makes it difficult to track exactly the same aspects over time,(3) but analyses conducted by the London VRU in 2018, 2019 and 2021 showed that mental health factors and life satisfaction are correlated with young people’s experiences of violence(4). Neighbourhoods where there is a higher risk of early death or disability through poor physical or mental health for everyone are also neighbourhoods where young people are more at risk of violence (as victim and/or offender)(4). Higher rates of emotional, mental health and conduct disorders amongst 5-19yr olds are seen in boroughs with higher levels of violence amongst young people(4) and 71% of children receiving custodial sentences have mental health needs(5)
However, an individual’s mental health is not the only issue – collective social health factors such as financial and food insecurity, levels of alcohol/drug use (amongst adults and young people), risky sexual health and self harm amongst young people, neighbourhood deprivation and lower standards of living are all correlated with young people experiencing violence. In contrast, access to family support in the early years, access to education and employment thorough life stages, affluence, greater community cohesion and higher levels of satisfaction with life are all associated with lower levels of violence amongst young people(4).
We cannot expect young people to thrive in environments that damage their physical and mental health; preventing youth violence requires an approach which supports wellbeing from birth onwards and achieves parity of physical, mental and social health. The NHS is working in partnership with other agencies to try new models of care to support young Londoner’s mental health needs. Despite this we know that there is still more we can do together with other organisations to advocate for the means to achieve this through environments that promote their social wellbeing.
- Fair Society Healthy Lives (The Marmot Review) – IHE (instituteofhealthequity.org)
- Health Equity in England: The Marmot Review 10 Years On – The Health Foundation
- Children and Young People’s Mental Health and Wellbeing – OHID (phe.org.uk)
- Understanding serious violence among young people in London – London Datastore
- Assessing the needs of sentenced children in the Youth Justice System – GOV.UK (www.gov.uk)
London Violence Reduction Public Health Specialist