Health Promotion Journal of Australia, 2013, 24, 49–52 http://dx.doi.org/10.1071/HE12907
Public Policy and Systems Thinking
Health promotion and crime prevention: recognising broader synergies Janette Young A,C and Rick Sarre B A
University of South Australia, Health Sciences, GPO Box 2471 Adelaide, SA 5001, Australia University of South Australia, School of Law, GPO Box 2471 Adelaide, SA 5001, Australia. C Corresponding author. Email:
[email protected] B
Abstract Issue addressed: Although health promotion and crime prevention have been brought together to address specific social ills, such as illicit drugs and road trauma, there is little literature that seeks to lift the connections between the fields of health and justice to a more general level. Methods: The present paper explores the synergies between health promotion and crime prevention by considering a range of parallels between them. Results: Health promotion and crime prevention can be shown to have several parallel interests, agendas, systemic locations and shared population foci, indicating a potential for more conscious engagement between each field. Conclusion: There are a range of synergies, parallels and shared interests that crime prevention and health promotion share. These fields could develop more supportive networks with each other. So what? There is scope for those who champion both crime prevention and health promotion to align more readily in activities of public policy, academia and practice. In addition, the two fields and their advocates could be more supportive of each other in progressing agendas of social equity. Health promotion practitioners could consider seeking to extend their employment and opportunities by being aware of projects, employment and relationships outside of health in the field of crime prevention.
Key words: health promotion, crime prevention, prisoners, health, justice. Received 26 June 2012, accepted 2 October 2012, published online 21 March 2013
Introduction Health promotion and crime prevention are conceptually brought together from time to time in relation to areas where health and crime, justice and policing have been identified as intersecting. Most commonly, these are areas such as responses to illicit drugs,1 sex work2 and road trauma.3 However, there is great potential for more collaborative awareness between health promotion and crime prevention. Recognising the broad synergies and parallels of health promotion and crime prevention would lead to more ongoing collaborations, beyond the funding of specific projects, and promote the utilisation of health promotion competencies in partnership building.4 Furthermore, such developments extend the potential for health promotion practitioners to consider employment in the justice field (police, courts and corrections) more generally.
charters, the Ottawa Charter has wide acceptance as a central summative document defining health promotion. Crime prevention does not have such a unified and generally agreed set of broad principles. Rather, statements from governments and key national programs provide a binary or two-dimensional picture of crime prevention approaches.6,7 Although the overt focus of these two dimensions is slightly different, it is possible to see several parallels between these and health promotion. These parallels are significant and are worthy of further exploration.
One of the best known summaries of health promotion principles is the Ottawa Charter.5 Although there are several other international
Essentially, the crime prevention approaches can be divided into two key themes: (1) opportunity reduction (situational responses); and (2) social and/or developmental approaches.7 Opportunity reduction includes things such as building and planning principles that increase natural surveillance and traffic flows, thereby decreasing opportunities for crime, and decreasing the likelihood of vandalism or theft through ‘target hardening’ (i.e. making an item or object too difficult to steal or damage).8 This approach may encompass strategies such as reducing vehicle theft by improving vehicle
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security in the manufacturing process and increasing the number of secure parking spaces.7 It must be said that most of the focus (and the evaluative interest) of crime prevention is directed at this form of crime prevention because it yields more immediate responses (which seems to satisfy political imperatives) and is easier to measure. Opportunity reduction has been highly effective in reducing crime in Australia, especially property crime.9,10 Broadly, this crime prevention approach is consistent with the Ottawa Charter action area of creating supportive environments and healthy public policy.5 That is, advocates of both fields (health policy and crime prevention) are aware of the impact of the physical environment on individual behaviours and have an understanding that changing the environment can impact positively on individual human actions.11 However, an even stronger connection to health promotion can be found in crime prevention’s emphasis on targeting social and developmental aims.6–8 These approaches consist mainly of responses that seek to address broader social agendas, such as increasing local ownership of public spaces and building social capital. By way of example, Currie argues that there is a direct link between child abuse and violent crime, as well as between school failure and crime.12 Wilkinson and Pickett argue that low wages, low social security benefits and low public spending on housing and education all serve to frustrate efforts to reduce crime,13 a theme echoed by Marmot and Wilkinson.14 Manning et al.15 conclude that people are less likely to commit crime if they have been the subject of well-conducted early development programs in adolescence. Finally, researchers from the NSW Bureau of Crime Research and Statistics16 concluded recently that income levels have five times more effect than either the threat of arrest or the threat of imprisonment in preventing violent crime. In relation to property crime, the effect of income levels was more than eight times as strong.16 Crime prevention approaches that strengthen community action and create supportive environments are pursuing the same approach as the Ottawa Charter. For example, crime prevention advocates would be quite content to support the community development and engagement activities undertaken by health promotion workers (e.g. via the use of the Arts in promoting health).17 Social and/or developmental approaches to crime prevention, with their use of lifespan and broad social understandings,7,8 link most overtly to the sorts of projects that health promotion has most readily and often focused upon. Indeed, health promotion experts have played a strong part in promoting a broad range of these projects.1,18,19 As noted previously in this paper, although health promotion has a well-articulated set of principles in the Ottawa Charter, it is not impossible to see the alignment of Ottawa Charter principles in crime prevention principles. For example, the Pathways to Prevention Program20 included a focus on engaging in community development, with nine core principles identified as underpinning such engagement. These principles included empowering individuals and communities, partnering with communities and working towards sustainability.
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Systemic location Health promotion practitioners will be familiar with the critique of ‘health’ responses explored by Ackoff and Pourdehnad,21 namely that health systems are, in fact, illness focused and even illness dependent. Health promotion, with its conception of ill health as potentially a social outcome of social inequities (a social determinants understanding), butts up against the medical model that perceives and addresses health–ill health as an individualised phenomenon. Medical ethics focus on service to individuals and respond to illness as the marker of medical competence.22 This ‘medicalised’ framework of understanding largely guides the allocation of funds within health budgets. Health promotion is an alternative voice to the biomedical system, a system that, by and large, continues to funnel the bulk of health funds towards illness responses.23 In parallel, crime prevention sits on the fringes of the interlocking sectors of police, justice and corrections systems. Policing focuses on the maintenance of order and the detection and arresting of criminals; the justice system focuses on the assessment of guilt and the meting out of penalties to those assessed as guilty. The corrections arm of this state power undertakes the administration of punishments. In this society, notions of rehabilitation and reform are an accepted part of correctional understandings; however, these vie with strong populist agendas, such as ‘tough on crime’.24,25 Such policies commonly call for more police on the streets, longer sentences and more and larger prisons.21 Other commentators, at the same time, lament overcrowded and overwhelmed court systems.25 The marginalisation of both crime prevention and health promotion occurs despite economic arguments for both.26
A shared population: prisoners With a core focus on inequalities and inequities in the health of population groups, health promotion and crime prevention have a shared interest in the well being of marginalised groups in society. To demonstrate this connection it is worth considering the data on prisoner health. Prisoner health is poorer than that of the average population in Australia.27,28 Data on prison entrants reveals that it is not prison itself that engenders this difference. Prison entrants have significantly higher rates of ill health, engage in behaviours that put their health at risk and come from several disadvantaged population groups. Most prisoners are men (86%), whose health is poorer than that of women in Australia.29 In addition, 31% of respondents to the National Prisoner Health Survey27 identified themselves as having a mental health diagnosis in the previous 12 months, compared with 20% in the general population,30 yet only 16% of respondents were taking medication. One in five reported a history of self-harm, 83% were current smokers, 58% reported risky alcohol consumption and 66% used illicit drugs.27 Some of these datasets may seem logical; for example, prisoners may well have been sent to prison for illicit drug activities. However, the
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social determinants information (i.e. the data relating to ‘the conditions in which people are born, grow, live, work and age. . . [leading to]. . .unfair and avoidable differences in health status’31) indicates that prisoners come from populations that experience inequities. Almost 30% of prison entrants have been unemployed for at least 1 month before arriving in prison; 35% had not completed Year 10 and only 15% had completed Year 12.27 This compares with an unemployment rate of 3% and two-thirds of the Australian population having achieved Year 11 or higher.32 Aboriginal and Torres Strait Islander peoples comprise 25% of the prison population at any one time, an overrepresentation of 12 times their population as a percentage of the Australian population.25 Aboriginal respondents’ rates of smoking and risky use of alcohol are higher than the prisoner average.27,28 Awareness of this should prompt policy makers to be active in advocating for prisoner health, recognising that prisoner health issues are, to some extent, a reflection of Indigenous health.
Case study It is not difficult to conclude that social justice is a core component of health promotion. It is reflected in the Australian Health Promotion Association Core Competencies knowledge requirement that practitioners understand ‘. . . inequalities and inequities in health including the concept of the social gradient . . . [and] . . . the determinants of health [biological, behavioural and socioenvironmental]’.4 To highlight the need for a greater awareness of the intersection of health and justice (system) issues, the following case study is offered. In 2011, a school bus driver of intellectually disabled children was accused of sexually abusing some of these children. However, the charges were dropped because the public prosecutor felt that the alleged victims in this case (intellectually disabled children) would not be able to communicate their experiences well enough to fulfil the legal requirements of the legal process.33 Parents of these children were distressed by this decision and expressed grave concerns at the inability of the legal system to provide their children with a voice in regard to their allegations. This may seem to be clearly a justice system issue, yet it has health implications. The connections are complex; however, sexual abuse is strongly linked to future and ongoing poor mental health.34–36 Given that mental health issues account for the highest levels of years of life lost due to disability of all disease and disability causes in Australia,37 to not be vigilant and proactive in preventing sexual abuse is an omission that has significant implications for future demands on the health system. It is imperative that policy makers make the links between justice outcomes and the promotion of health and welfare and act on them accordingly. More generically, the Ottawa Charter identification of peace and social justice as prerequisites for health, the call to health promoting action through the building of healthy and/or just public policy, the supporting and
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strengthening of community action (parents of intellectually disabled children in this scenario) in order to create environments that support health (and deter unhealthy behaviours) all indicate that health promotion professionals who ascribe to the Charter can consider aligning their work to crime prevention.
Conclusion Health promoters should consider working more closely with those in crime prevention and, conversely, crime prevention advocates should be more open to their health promotion counterparts. Both health promotion and crime prevention have a social understanding of human behaviour. Rather than viewing health outcomes, or criminal activity, as entirely the outcome of individual choices, both draw on a broader perspective that see individual choice as enmeshed in the broad social, political and even global environment. Thus, health promotion and crime prevention both share a concern for preventing the negatives their fields identify through upstream, long-sighted understandings. They share concerns for respectful communication with communities, and see community and the members of society as resources in preventing negative outcomes (namely ill health and crime). Health promotion has a clearly expressed awareness of the needs for partnerships in promoting health.4 Raising awareness of practitioners to look beyond what may, at first, seem to be incongruencies between the fields of health promotion and crime prevention has the potential to increase the supportive network of these two fields. After all, both look to the flourishing of people in society as individuals, groups and communities.
References 1.
Wodak A, Liberman J, Moodie R, Fitzgerald J, Sullivan L, Santamaria J. Cigarettes and syringes: which is a better model for drug policy? Health Promot J Austr 2000; 10: 93–126. 2. Schloenhardt A, Cameron L. Happy birthday, brothels! Ten years of prostitution regulation in Queensland. Queensland Lawyer 2009; 29(4): 194–220. 3. Harris A, Hulme A. The potential for collaborative, preventative approaches to reduce road trauma among youth. In Road Safety Research, Policing and Education Conference, 2001, Melbourne. Maroochydore: AHPA; 2001. 4. Australian Health Promotion Association (AHPA). Core competencies for health promotion practitioners. Maroochydor: AHPA; 2009. 5. World Health Organization (WHO). The Ottawa Charter for Health Promotion. In. Proceedings of the First International Conference on Health Promotion, 17–21 November 1986, Ottawa, Canada. Geneva: WHO; 2011. Available from: http://www. who.int/healthpromotion/conferences/previous/ottawa/en/ [Verified 20 June 2012]. 6. Attorney General’s Department. Approaches to community crime prevention. Canberra: Australian Government; 2004. 7. Sutton A, Cherney A, White R. Crime prevention: principles, perspectives and practices. Port Melbourne: Cambridge University Press; 2008. 8. Australian Capital Territory Planning and Land Management. Australian Capital Territory crime prevention and urban design resource manual. Canberra: Sarkissian Associates Planners; 2000. 9. Prenzler T. Preventing burglary in commercial and institutional settings: a place management and partnerships approach. Washington, DC: ASIS Foundation; 2009. 10. Prenzler T. Strike Force Piccadilly: a public–private partnership to stop ATM ram raids. Policing Int J Police Strategies Mgmt 2009; 32(2): 209–25. doi:10.1108/1363 9510910958145 11. Van Dijk J. Closing the doors: Stockholm Prizewinner’s Lecture 2012. Stockholm Criminology Symposium, 11–13 June 2012; Stockholm: Swedish National Council for Crime Prevention; 2012.
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Health Promotion Journal of Australia
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12. Currie E. The roots of danger: violent crime in global perspective. Upper Saddle River, NJ: Prentice Hall; 2008. 13. Wilkinson R, Pickett K. The spirit level: why greater equality makes societies stronger. London: Allen Lane; 2009. 14. Marmot M, Wilkinson R, editors. Social determinants of health, 2nd edn. Oxford: Oxford University Press; 2006. 15. Manning M, Homel R, Smith C. A meta-analysis of the effects of early developmental prevention programs in at-risk populations on non-health outcomes in adolescence. Child Youth Serv Rev 2010; 32: 506–19. doi:10.1016/j.childyouth. 2009.11.003 16. Wan W-Y, Moffatt S, Jones C, Weatherburn D. The effect of arrest and imprisonment on crime. Crime Justice Bull 2012; 158: 1–20. 17. Scanlon C, Mulligan M. Arts, agency and community engagement. Community 2007; 3: 72–80. 18. O’Donnell C. Toward better coordinated initiatives for community health management and crime prevention in Australia. J Allied Health 2005; 34(4): 223–9. 19. Toumbourou JW, Hemphill SA, Tresidder J, Humphreys C, Edwards J, Murray D. Mental health promotion and socio-economic disadvantage: lessons from substance abuse, violence and crime prevention and child health. Health Promot J Austr 2007; 18: 184–90. 20. Homel R, Freiberg K, Lamb C, Leech M, Batchelor S, Carr A. The Pathways to Prevention project: doing developmental prevention in a disadvantaged community. Contract no. 323. Canberra: Australian Institue of Criminology; 2006. 21. Ackoff RL, Pourdehnad J. On misdirected systems. Syst Res Behav Sci 2001; 18: 199–205. doi:10.1002/sres.388 22. Australian Medical Association. AMA code of ethics, revised edition. Barton, ACT: Australian Medical Association Limited; 2006. 23. Young J, McGrath R. Seeking ‘equity’ and ‘social justice’ in Australian healthcare policy and planning documents. Aust J Primary Health 2011; 17(4): 369–77. doi:10.1071/PY11038 24. Andrews DA, Bonta J. Rehabilitating criminal justice policy and practice. Psychol Public Policy Law 2010; 16(1): 39–55. doi:10.1037/a0018362
25. Sarre R. The importance of political will in the imprisonment debate. Curr Issues Criminal Justice 2009; 21(1): 154–61. 26. Sassi F, Cecchini M, Lauer J, Chisholm D. Improving lifestyles, tackling obesity: the health and economic impact of prevention strategies. OECD Health Working Paper No: 48. Paris: OECD; 2009. 27. Australian Institute of Health and Welfare (AIHW). PHE 149: The health of Australia’s prisoners 2010. Canberra: AIHW; 2011. 28. Australian Institute of Health and Welfare (AIHW). PHE 123: The health of Australia’s prisoners 2009. Canberra: AIHW; 2010. 29. Australian Institute of Health and Welfare (AIHW). The health of Australia’s males. Canberra: AIHW; 2011. 30. Australian Bureau of Statistics (ABS). 4326.0: National survey of mental health and wellbeing: summary of results, 2007. Canberra: ABS; 2008. 31. World Health Organization (WHO). The social determinants of health. Commission on Social Determinants of Health. Geneva: WHO; 2012. 32. Australian Bureau of Statistics (ABS). 6227.0: Education and Work, Australia, May 2011. Canberra: ABS, 2011. 33. Haxton N. Bus driver may escape child sex charges. ABC News, 8 December 2011. 34. Bulik CM, Prescott CA, Kendler KS. Features of childhood sexual abuse and the development of psychiatric and substance use disorders. Br J Psychiatry 2001; 179(5): 444–9. doi:10.1192/bjp.179.5.444 35. Mullen PE, Martin JL, Anderson JC, Romans SE, Herbison GP. Childhood sexual abuse and mental health in adult life. Br J Psychiatry 1993; 163(6): 721–32. doi:10.1192/ bjp.163.6.721 36. O’Leary P, Gould N. Men who were sexually abused in childhood and subsequent suicidal ideation: community comparison, explanations and practice implications. Br J Soc Work 2009; 39(5): 950–68. doi:10.1093/bjsw/bcn130 37. Australian Institute of Health and Welfare (AIHW). AUS 122: Australia’s health 2010. Canberra: AIHW; 2010.
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