Reflection from the LEPH Conference in Edinburgh, October 2019

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Dr Mattea Clarke, Specialist Registrar in Public Health
Last week I attended the Fifth International Conference on Law Enforcement and Public Health, on the theme of collaborative leadership.  This was impeccable timing from a personal standpoint because I have only just begun working in this field and therefore the conference provided a perfect opportunity to become immersed in the current thinking, evidence and work going on in this space.  Below is my personal reflection from the conference.
 
The speakers were excellent and inspiring, and their passion and commitment was palpable.  The talks were full of examples of work going on around the world which demonstrates the impact of collaboration between law enforcement and public health, some of which I will mention below.  But ultimately, I have taken from the conference a renewed and deeper understanding of a key principle that was a consistent message across the presentations – public health and law enforcement are inseparable.  Public health, as a discipline, very often defines itself by its focus on reducing health inequalities which, ultimately, result from wider socioeconomic inequalities.  No one attending the conference could be in any doubt about the role of inequalities in the lives of people in contact with criminal justice.  Socioeconomic and health inequalities increase the chances of someone being justice-involved (either as a victim or perpetrator).  At the same time, involvement with the criminal justice system increases the chances that someone will go on to experience socioeconomic and health inequalities, for example through impacts on mental health or employment opportunities.  The relevance for public health is undeniable.  The societal drivers and impacts of crime are too complex not to view as a public health issue.  The tasks of law enforcement agencies in preventing and responding to crime are too complex not to take a ‘public health approach’.  Law enforcement alone, without action to address the causes of crime, cannot lead to change.
 
One speaker said something that particularly resonated with me.  He said that taking a public health approach to reducing crime requires two things.  One is an understanding that there are environmental and societal factors which increase the likelihood of someone being justice-involved, and the other is a belief that this can be changed, that change is possible.  Without these we can’t begin to change the narrative in our respective professions, or for young people at risk of being involved in criminal activity, that a different future is possible.
 
Not surprisingly, the majority of presentations I listened to made at least one reference to the role of Adverse Childhood Experiences (ACE).  It is now widely accepted that ACEs are hugely significant in contributing to a person’s likelihood of becoming justice-involved, and there is a broad evidence base to support this.  Within the confines of the conference, it is easy to assume that this understanding is held in all sectors of society.  However, being relatively new to this area, my reflection is that there is lot more work to be done to disperse this understanding both across professional arenas and into society as a whole. 
 
The content of sessions spanned a huge breadth of subject areas, and my only regret is not being able to be in three places at once so that I could go to all of them.  A few of those which made a particular impression for me included presentations on police practices in relation to a supervised injecting site in Vancouver, expanding access to medication assisted treatment in Cuyahoga County Corrections Centre, the journey to smoke-free prisons in Scotland, and the work of the Lucy Faithfull Foundation to prevent child sexual abuse through the Stop It Now! Programme.  The variety of these examples just goes to show the complexity of the challenge.  In addition, there were a number of sessions where speakers presented their work on defining what a public health approach is, and how it can be applied in different settings.  I found these hugely valuable to my learning and in helping me to understand the broader concepts and their historical context.  Indeed, one of these sessions included a talk by Dr Eamonn O’Moore who presented the newly-published resource entitled ‘A whole-system multi-agency approach to serious violence prevention’*.  This document aims to propose a practical approach that will facilitate understanding and response to serious violence, and advocates for a whole system multi-agency approach that is place-based and incorporates public health principles.  As part of my work with the Public Health England Health & Justice team over the next few months, I will be supporting local system leaders to utilise this resource to inform the work of Violence Reduction Units and beyond.
 
Improving the health of those in contact with the criminal justice system, be that through provision of better support for victims and perpetrators once that contact has occurred, or through upstream action to prevent people from becoming justice-involved, the benefits for individuals and society are clear.  Collaborative leadership from law enforcement, public health, and beyond is vital for this to be achieved. 
*The resource is now available online and can be accessed through the following link:  https://www.gov.uk/government/publications/preventing-serious-violence-a-multi-agency-approach/preventing-serious-violence-summary