Approaches to violence

The criminal justice approach sees its main task as enforcing laws that proscribe violence and ensuring that "justice is done". The notions of individual blame, responsibility, guilt, and culpability are central to criminal justice's approach to violence and one of the criminal justice system's main tasks is to "do justice", i.e. to ensure that offenders are properly identified, that the degree of their guilt is as accurately ascertained as possible, and that they are punished appropriately. To prevent and respond to violence, the criminal justice approach relies primarily on deterrence, incarceration and the punishment and rehabilitation of perpetrators.[42] The criminal justice approach, beyond justice and punishment, has traditionally emphasized indicated interventions, aimed at those who have already been involved in violence, either as victims or as perpetrators. One of the main reasons offenders are arrested, prosecuted, and convicted is to prevent further crimes through deterrence (threatening potential offenders with criminal sanctions if they commit crimes), incapacitation (physically preventing offenders from committing further crimes by locking them up) and through rehabilitation (using time spent under state supervision to develop skills or change one's psychological make-up to reduce the likelihood of future offences).[43] In recent decades in many countries in the world, the criminal justice system has taken an increasing interest in preventing violence before it occurs. For instance, much of community and problem-oriented policing aims to reduce crime and violence by altering the conditions that foster it - and not to increase the number of arrests. Indeed, some police leaders have gone so far as to say the police should primarily be a crime prevention agency [Bratton W (with Knobler P). Turnaround: how America's top cop reversed the crime epidemic. New York: Random House, 1998.]. Juvenile justice systems an important component of criminal justice systems are largely based on the belief in rehabilitation and prevention. In the US, the criminal justice system has, for instance, funded school- and community-based initiatives to reduce children's access to guns and teach conflict resolution. In 1974, the US Department of Justice assumed primary responsibility for delinquency prevention programmes and created the Office of Juvenile Justice and Delinquency Prevention, which has supported the "Blueprints for violence prevention" programme at the University of Colorado The public health approach is a science-driven, population-based, interdisciplinary, intersectoral approach based on the ecological model which emphasizes primary prevention.[2] Rather than focusing on individuals, the public health approach aims to provide the maximum benefit for the largest number of people, and to extend better care and safety to entire populations. The public health approach is interdisciplinary, drawing upon knowledge from many disciplines including medicine, epidemiology, sociology, psychology, criminology, education and economics. Because all forms of violence are multi-faceted problems, the public health approach emphasizes a multi-sectoral response. It has been proved time and again that cooperative efforts from such diverse sectors as health, education, social welfare, and criminal justice are often necessary to solve what are usually assumed to be purely "criminal" or "medical" problems. The public health approach considers that violence, rather than being the result of any single factor, is the outcome of multiple risk factors and causes, interacting at four levels of a nested hierarchy (individual, close relationship/family, community and wider society) of the Social ecological model. From a public health perspective, prevention strategies can be classified into three types: Primary prevention approaches that aim to prevent violence before it occurs. Secondary prevention approaches that focus on the more immediate responses to violence, such as pre-hospital care, emergency services or treatment for sexually transmitted infections following a rape. Tertiary prevention approaches that focus on long-term care in the wake of violence, such as rehabilitation and reintegration, and attempt to lessen trauma or reduce long-term disability associated with violence. A public health approach emphasizes the primary prevention of violence, i.e. stopping them from occurring in the first place. Until recently, this approach has been relatively neglected in the field, with the majority of resources directed towards secondary or tertiary prevention. Perhaps the most critical element of a public health approach to prevention is the ability to identify underlying causes rather than focusing upon more visible "symptoms". This allows for the development and testing of effective approaches to address the underlying causes and so improve health. The public health approach is an evidence-based and systematic process involving the following four steps: Defining the problem conceptually and numerically, using statistics that accurately describe the nature and scale of violence, the characteristics of those most affected, the geographical distribution of incidents, and the consequences of exposure to such violence. Investigating why the problem occurs by determining its causes and correlates, the factors that increase or decrease the risk of its occurrence (risk and protective factors) and the factors that might be modifiable through intervention. Exploring ways to prevent the problem by using the above information and designing, monitoring and rigorously assessing the effectiveness of programmes through outcome evaluations. Disseminating information on the effectiveness of programmes and increasing the scale of proven effective programmes. Approaches to prevent violence, whether targeted at individuals or entire communities, must be properly evaluated for their effectiveness and the results shared. This step also includes adapting programmes to local contexts and subjecting them to rigorous re-evaluation to ensure their effectiveness in the new setting. In many countries, violence prevention is still a new or emerging field in public health. The public health community has started only recently to realize the contributions it can make to reducing violence and mitigating its consequences. In 1949, Gordon called for injury prevention efforts to be based on the understanding of causes, in a similar way to prevention efforts for communicable and other diseases.[45] In 1962, Gomez, referring to the WHO definition of health, stated that it is obvious that violence does not contribute to "extending life" or to a "complete state of well-being". He defined violence as an issue that public health experts needed to address and stated that it should not be the primary domain of lawyers, military personnel, or politicians.[46] However, it is only in the last 30 years that public health has begun to address violence, and only in the last fifteen has it done so at the global level.[47] This is a much shorter period of time than public health has been tackling other health problems of comparable magnitude and with similarly severe lifelong consequences. The global public health response to interpersonal violence began in earnest in the mid-1990s. In 1996, the World Health Assembly adopted Resolution WHA49.25[48] which declared violence "a leading worldwide public health problem" and requested that the World Health Organization (WHO) initiate public health activities to (1) document and characterize the burden of violence, (2) assess the effectiveness of programmes, with particular attention to women and children and community-based initiatives, and (3) promote activities to tackle the problem at the international and national levels. The World Health Organization's initial response to this resolution was to create the Department of Violence and Injury Prevention and Disability and to publish the World report on violence and health (2002).[2] The case for the public health sector addressing interpersonal violence rests on four main arguments.[49] First, the significant amount of time health care professionals dedicate to caring for victims and perpetrators of violence has made them familiar with the problem and has led many, particularly in emergency departments, to mobilize to address it. The information, resources, and infrastructures the health care sector has at its disposal are an important asset for research and prevention work. Second, the magnitude of the problem and its potentially severe lifelong consequences and high costs to individuals and wider society call for population-level interventions typical of the public health approach. Third, the criminal justice approach, the other main approach to addressing violence (link to entry above), has traditionally been more geared towards violence that occurs between male youths and adults in the street and other public places which makes up the bulk of homicides in most countries than towards violence occurring in private settings such as child maltreatment, intimate partner violence and elder abuse which makes up the largest share of non-fatal violence. Fourth, evidence is beginning to accumulate that a science-based public health approach is effective at preventing interpersonal violence.