Creating More Peaceful Societies --- Global Strategies to Reduce Interpersonal Violence Plenary Talk, 19 September 2016 World Conference on Injury Prevention and Safety PromotionTampere, 18-23 September 2016 Prof Manuel EisnerDirector, Violence Research Centre

INSTITUTE OF CRIMINOLOGY

The Biggest Question of All

The Biggest Question of AllAssume you could spend $ 1 per person in the world (i.e. $ 8 Billion) per year on measures to achieve the SDG goals related to violence against children, human trafficking, violence against women, violence against men, violence against the elderly, etc. by 2030 …..

Where would your money go?

Where would you expect the biggest return?

Why?

The Progress Made1. Growth in Available Data

E.g. Violence Against Children surveys, IPV meta-analyses, Homicide Monitor

2. More Evaluation Studies outside Europe and USAE.g. Children and Violence Challenge Fund

3. Development of Global Information SystemsE.g. v-info, global violence prevention information system

4. Diffusion of Public Health ApproachWhat’s the problem – What’s the cause – What works – How do you do

it?

-> A growing toolbox of prevention strategies.

Home Visiting Programmes

Parenting Programmes

Life Skills Development Programmes

Anti-Bullying Programmes

Academic Enrichment Programmes

Hotspots Policing Programmes

Educational Sports Programmes

Antigang programmes

Microcredit programmes

Victim Protection programmes

Offender rehabilitation Programmes

Urban Upgrading Programmes

Dating Violence Prevention programmes

Awareness Building Programmes

What do we have in our toolbox?

DoWeneedWiderSystemChange?

Do we know what works?The Knowledge Gap

We know increasingly what kinds of programmes have desirable effects in trials

We are beginning to learn how to scale them up

We are beginning to have relevant evidence in LMIC countries

The SDGs expect us to achieve population-level sustainable declines in violence

We know close to nothing about how to achieve population level change

We know very little about the system changes that support macro-level declines in violence

Some population level success stories in cities and countries

What Brings Levels of Violence Down?

Bogotá and Medellín(-80%)

Sao Paulo, Rio de Janeiro and Recife(- 70%)

Southern Italy(-78%)

Cardiff and United Kingdom(-55%)

Singapore and Hong Kong(-90%)

United States(-50%)

Estonia(-83%)

Example I The US Crime Decline

1985 1990 1995 2000 2005 2010 2015 20200

20

40

60

80

100

120

Child Physical Abuse

Child Sexual Abuse

Homicide

Violence at schools

Violent Victimization, Total Pop.

Inde

x, 1

993

= 10

0

Source: Eisner et al (2016, in print), Achieving Population-level Violence Declines: Implications of the International Crime Drop for Prevention Programming, Journal of Public Health Policy.

Why

• Demographics• Imprisonment and net widening• More effective policing & more police

officers• Change in attitudes and norms to

violence incl. feminization• Medication for mental health

problems• Abortion and Lead• End of Crack epidemic/ street drug

markets

There is continued disagreement about the relative weight of each of these factors.

Example 2 SingaporeHomicides Singapore 12 cases

Caracas 3500 cases ( approx. same pop.)

Robberies Decline by 90% since 1990s50x lower than London

IPV Lowest in IVAWS Survey (9% v. 52% in USA, UN Women, 2013)

1980 1985 1990 1995 2000 2005 2010 20150

0.5

1

1.5

2

2.5

3

0

500

1000

1500

2000

2500

Homicide Rate

Crime Rate

Why?• High economic growth, poverty declined

(inequality went up)

• Demographic change, fewer young people

• Harsh punishment and imprisonment(“Disneyland with the Death Penalty” William Gibson)

• Improved policing based on Kobane system

• Meritocratic public administration based on rule of law.

• National Crime Prevention Council since 1981

• Housing policy that limits segregation

• Effective public health system

Population-Level Violence Declines• There exist examples in all parts of the world of

successful violence reductions.

• Understanding why they happen would be highly relevant for achieving the SDG goals, but our understanding is currently very limited.

• Individual programmes rarely seem to be involved.

• Genuine policy effects are likely, but usually systemic und multifaceted.

Four proposals for strategies that can generate systemic support.

Proposal 1

Address Cross-Cutting Mechanisms that Affect Multiple SDG Outcomes

What mechanism affects all these outcomes?

Low Self Control

Crime

Violence

Nicotine

Alcohol

Obesity

Teenage Pregnancy Truancy

School Exclusion

Bullying

Low Income

Unstable work

Divorce

Unsafe sex

Moffitt, Terrie E., et al. "A gradient of childhood self-control predicts health, wealth, and public safety." Proceedings of the National Academy of Sciences 108.7 (2011): 2693-2698.

Self-control as a cross-cutting mechanism

• Self-control is a cross-cutting psychological mechanism that has positive effects on health, wealth, and crime.

• It is malleable and can be promoted across settings and systems in families, schools leisure time, work places etc.

• Focusing efforts on a small number of general mechanisms that affect many outcomes may be a promising systemic strategy.

Proposal 2

Bridge the Gap between Criminal Justice and Public Health Systems

16.2 End all forms of violence against children16.3 Promote the rule of law

These two SDG targets belong together!

Prevention/Public health

Repression, control, punishment

Why is the CJ system important for a public health approach?1. It is often the first point of contact for victims.

In the US, law enforcement agencies are by far the most important source of substantiated child maltreatment cases (32%), NCANDS (2013).

2. Where the state fails to provide protection, others will step in.

In Honduras and El Salvador only 2-3% of all homicide cases result in a conviction. Eisner (2015) How to reduce Homicide, http://homicide.igarape.org.br/

3. The CJ system is the most likely access for interventions for serious and repeat offendersMost serious violent adult offenders had contact with the CJ system as adolescents.

4. Violence prevention requires that people see a good reason to comply with the law.

Fair and effective enforcement of existing laws is the basis for any sustainable delivery of violence prevention.

Inter-systemic integration

• Across all systems, but CJ --- public health possibly most difficult and most important.

• CJ system support essential for effective prevention.

• Convincing national advocacy coalitions need a strong anchor in public health, education, and criminal justice.

• Capacity building (e.g. training of professionals) needs to promote mutual understanding and support.

• Interagency cooperation needs strengthening.

Proposal 3

Build Violence Prevention into Modern Technologies and Infrastructures

Why?• Changing people is often more difficult and more costly than

changing situations.

• There is substantial evidence suggesting that change in daily routines affects crime and violence.

• Simple design changes can have considerable effects– E.g. toughened glass, Jonathan Shepherd.

• Partnerships with private sector are important.

• Build systemic violence prevention into …– Nutrition (SDG 2), Health (SDG 3), Education (SDG 4), Gender

Equality (SSG 5), Infrastructure (SDG 9), Urban planning (SDG 11) etc.

Proposal 4

Build cutting-edge research into national decision-making processes

Why?

• Because while we have learnt a lot, we don’t know the answers to some very fundamental questions relevant for achieving the SD-Goals related to violence.

Why?

Because while we have learnt a lot, we don’t know the answers to some very fundamental questions relevant for achieving the SD-Goals related to violence.

Here is one:If Caracas has 200 times more homicides than Singapore, in what period of human development do the causally relevant risk factors emerge? Infancy, childhood, adolescence?

The Biggest Question of AllAssume you could spend $ 1 per person in the world (i.e. $ 8 Billion) per year on measures to achieve the SDG goals related to violence against children, human trafficking, violence against women, violence against men, violence against the elderly, etc. by 2030 …..

Where would your money go?

Where would you expect the biggest return?

Why?

ConclusionsAssume you could spend $ 1 per person in the world (i.e. $ 8 Billion) per year on measures to achieve the SDG goals related to violence against children, human trafficking, violence against women, violence against men, violence against the elderly, etc. by 2030 …..

Where would your money go?

Where would you expect the biggest return?

Why?

Conclusions

1. Invest into inserting violence-prevention into other systems.

2. Foster broad coalitions across systems.

3. Invest into general and well-researched mechanisms with multiple outcomes.

4. Use the opportunity for advancing cutting-edge basic research that can support the SD-Goals.

• end

Public Health• Child development• Early prevention• Social skills

Justice and Governance• Better policing• Fight corruption• Better justice• Offender treatment

Civil Society• Sectarian violence• Minorities, ethnic tensions• Transitional justice• Political violence

Public Health• Child development• Early Prevention• Social Skills

Justice and Governance• Better policing• Fight corruption• Better justice• Offender treatment

Civil Society• Sectarian violence• Minorities, ethnic tensions• Transitional justice• Political violence

• End

(UN Women, 2013).

16.1 Significantly reduce all forms of violence and related death rates everywhere

16.2 End abuse, exploitation, trafficking and all forms of violence against and torture of children

16.3 Promote the rule of law at the national and international levels and ensure equal access to justice for all

16.4 By 2030, significantly reduce illicit financial and arms flows, strengthen the recovery and return of stolen assets and combat all forms of organized crime

16.5 Substantially reduce corruption and bribery in all their forms16.6 Develop effective, accountable and transparent institutions at all levels [….]

Background

1996 World Health Assembly declares the prevention of violence a public health priority

2014 World Health Assembly mandates WHO to develop a global plan of action to address violence through the public health system.

2015 SDGs prioritize violence reduction in several targets, especially 5.3, 16.1 and 16.2.

2016 Global Partnership to End Violence against Children officially launched

2016 Global Partnership and WHO present INSPIRE: a framework of seven strategies for ending violence against children.

What do we want to achive?

• Today

What we currently know

Much• Efficacy in RCTs (but almost all in the US and Europe)• Short-term effects in well-controlled efficacy trials• Relatively much knowledge about branded programs

Less• Large-scale dissemination of programmes• Integration of programmes into services

Nothing• Achieving a long-term population-level decline in

violence.

Thinking about Violence Declines

Map of the World by Homicides

(WHO recorded homicides 2002, www.worldmapper.org)

Map of the World by Research Output

(Published papers in 2001www.worldmapper.org)

What do we know?

16.1 Significantly reduce all forms of violence

The example of homicideWhat do we know about periods of declining interpersonal violence in the past?

The Victorians had a theory of change

Promote hard work, self-reliance, responsibility, sobriety, respect, frugality, and good manners.

-> Rational Recreation-> Comprehensive schooling-> eliminate unhealthy living conditions-> Better parenting-> Control of alcohol consumption-> a Trusted and effective police-> Functioning

How much do we know about whether evidence-based prevention or intervention policy can affect trends in violence?

Example I The US Crime Decline

1985 1990 1995 2000 2005 2010 2015 20200

20

40

60

80

100

120

Child Physical Abuse

Child Sexual Abuse

Homicide

Violence at schools

Violent Victimization, Total Pop.

Inde

x, 1

993

= 10

0

Source: Eisner et al (2016, in print), Achieving Population-level Violence Declines: Implications of the International Crime Drop for Prevention Programming, Journal of Public Health Policy.

To have a population effect on violence we need to understand what drives violence trends.

There are many examples of declines over decades with annual rates of decline of 2-9 % per year. If we understood how they did it, we could learn how to do it.

• Slide with World Map and three examples of activities.

The Core Message The SDG 2015-2030 Agenda expects us to achieve population-

level reductions in violence in the coming 15 years.

Increasing number of RCTs and recommendation lists on violence prevention. Call for ‘going to scale’ using ‘translational science’. International actors (e.g. WHO, CDC, UNICEF) recommend evidence-based policy (EBP) as the strategic focus.

Population-wide effects of EBP on reducing violence are unknown. One reason is lack of data on the dissemination of EBP.

We need high-resolution indicators on the diffusion of EBP across policy systems (public health, education, social services, urban planning) over the 2030 SDG period.

Evidence-based suite of Parent Training

programmes

Replication of the ‘Cardiff-Modell’ of Violence Prevention in Mexico

: A&E emergency wards share data with police on violence incidents

allowing police to intervene earlier and in the right places.

Correlated Behaviors

Violence Substance Use

Reproductive Health

School Failure

Prevention and Intervention Systems

Schools

Child Protection

Sports Clubs

GPs/Hospitals

Police

Mul

tiage

ncy

Coop

erati

on

Multi-Symptom Integration

Linking Criminal Justice and Public Health is Essential

Reason 1Why should most people comply with the law?

• Several classes of psychiatric medication linked to less violence, e.g. antidepressants, stimulants (against ADHD), antipsychotics.

• Their increased use coincides with the decline in violence levels.

• FINKELHOR, D. & JOHNSON, M. (2015), 'Has psychiatric medication reduced crime and delinquency?'. Trauma, Violence, & Abuse, 1524838015620817.

Bringing the Criminal Justice System and the Public Health System Together

16.2End all forms of violence against children16.3 Promote the rule of law

Prevention/Public health

Repression, control, punishment

An accountable, legitimate, effective and fair criminal justice system is a necessary partner of a public health approach focused on prevention and treatment.

What does this mean in practice?

• Multi-agency Partnerships– Cardiff Modell

• Police Training– Train police officers and in child

protection, early prevention

Why?

• Without a rule of law somebody else will step in, sell protection, and take revenge.

• Rotberg (2003) When States Fail.• Trust that the state and it’s agencies provide

justice is an important reason for compliance with the law.

Tyler (1990). Why People Comply with the Law.• Many interventions for victims and for

perpetrators of violence require co-operation with the criminal justice system.

• Many forms of violence are linked to flourishing organized crime and illegal markets

• What is the most effective way for police officers to respond to domestic abuse?

• How much repression is necessary to have a deterrent effect?

• How can prisons be made less violent?• When are alternative sanctions such as

restorative justice better?• Do treatments work for serious and repeat

offenders?• Can CCTV cameras in hotspots reduce crime?

0 20 40 60 80 100 1200

2

4

6

8

10

12

14

16

Homicide Rate per 100,000

Odd

s of I

mpu

nity

(not

conv

icte

d/co

nvic

ted)

The link between impunity and homicide rates in Mexico

Public Health• Child development• Early prevention• Social skills

Justice and Governance• Better policing• Fight corruption• Better justice• Offender treatment

Civil Society• Sectarian violence• Minorities, ethnic tensions• Transitional justice• Political violence

Public Health• Child development• Early Prevention• Social Skills

Justice and Governance• Better policing• Fight corruption• Better justice• Offender treatment

Civil Society• Sectarian violence• Minorities, ethnic tensions• Transitional justice• Political violence

The Core Message The SDG 2015-2030 Agenda expects us to achieve population-

level reductions in violence in the coming 15 years.

Increasing number of RCTs and recommendation lists on violence prevention. Call for ‘going to scale’ using ‘translational science’. International actors (e.g. WHO, CDC, UNICEF) recommend evidence-based policy (EBP) as the strategic focus.

Population-wide effects of EBP on reducing violence are unknown. One reason is lack of data on the dissemination of EBP.

We need high-resolution indicators on the diffusion of EBP across policy systems (public health, education, social services, urban planning) over the 2030 SDG period.

ConclusionsA reduction of homicide rates by 70% over 30-40 years is possible. It has many historical predecessors.We lack a good understanding of the universal mechanisms associated with declining violence.The present analyses suggest that across many societies, in many different time periods, in many different places extended periods of declining homicide appear to be associated with similar cultural and structural dynamics.• They include:

– An effective state monopoly of power– The pacification of the political elites– An increasing legitimacy of the state– Effective state functioning including the rule of law and lack of corruption– ‘Social Disciplining’ and increasing emphasis on self-constraint, civility,

conscience, respect and inner-directedness.Such processes are likely to play a major role in any attempt to achieve a macro-level long-term decline in violence.

Conclusion

• Prevent or reduce violence

The Perpetrators: Five Principles1. Mostly male

– Exceptions: Child maltreatment, infanticide, verbal and indirect aggression, verbal partner violence

2. Age Curve– Severe violence starts in early adolescence, peaks around age 20,

declines thereafter.

3. 70-25-5 Rule– 70% of the population commit 5% of the violence– 5% of the population commit 70% of the violence

4. Little specializationPerpetrators of violence against women and children also tend to have been bullies at school, have had fights with peers, be involved in youth gangs

5. Comorbity- High violence correlated with CD, ODD, ADHD, substance abuse, truancy, unstable partnerships, poor health, low education outcomes

The Health System: One of several state actors

Public Health System

Criminal Justice System

Urban Planning

Education System

Also:Non-state actors including- Religious Organizations- Voluntary Organizations- Philanthropic Organizations- Business leaders

Why the Health System?Reputation– Highly trusted in population– Low corruption – Not political

Access– Access to target populations in critical periods and relevant

situations (pregnancy, infancy, injuries, health problems).– Often a decisive resource in fragile situations

Expertise– Mandate to promote health and prevent harm– Trained personnel– Know-how from anti-smoking, HIV, road safety etc.

campaigns