Better Health For All

The fourth international LEPH (Law Enforcement & Public Health) conference was held in October 2018, with an overarching theme of disparities in health and criminal justice. We were delighted to be invited to speak about our work developing a national consensus agreement between policing and health (and not just because the conference was in Toronto!), and humbled by the amount of national and international interest it generated.

Attention to the links between public health and policing is growing at the moment, especially the concept of a “public health approach to…”. The conference showcased both the breadth and depth of work going on in this field internationally. In particular, it demonstrated that “a public health approach” is being applied effectively in law enforcement far beyond violent crime. This blog gives an overview of the different strands of the conference and picks out some highlights for us.

An opening presentation from Dr Eileen de Villa, Toronto’s Medical Officer of Health, set the scene, outlining the health needs of her communities, the inequalities and challenges and her hopes for their future. The crisis of opioid overdose is not at the same scale for us in the UK (and we hope never will be) – but the rest of her words felt very familiar, a reminder of shared values and challenges and the necessity of taking a shared approach to evidence, research and practice in order to meet common goals.

Wellbeing of law enforcement staff was a key theme at the conference, with powerful personal stories and evidence about the impact of trauma on emergency service workers. Work to develop a national emergency services wellbeing service, starting with the National Police Wellbeing Service in England and Wales was highlighted, along with Oscar Kilo (a joint Public Health England and police evidence-based wellbeing initiative). There was a real recognition that this is world-leading, and should be common practice across the international community. Not only is this essential to support and protect the protectors; but it also links to our own understanding of trauma and adversity as a cause of poor health and wellbeing.

The emerging discipline of epidemiological criminology, or ‘epicrim’, was explored. At its most basic this is the study of crime as a form of disease, but also more broadly involves merging the techniques and theories of epidemiology and criminology. Examples of studies were from the US and South Africa focussed mainly on gun crime. Many more examples of innovative inter-disciplinary policing and health research were presented throughout the conference. In particular, we were really excited by the work colleagues in Scotland are doing to develop the law enforcement and public health evidence base, with workstreams around vulnerability, better partnership working, information and data sharing, peer support and organisational wellbeing; and mental health crisis.

Violent crime is of increasing concern in London and other cities in the UK – and there were several sessions discussing public health approaches to violence. The Cure Violence approach began in the USA, and is part of a movement to recast violence as a health issue. Other examples included a data sharing, surveillance and analysis system in Wales enabling targeted early intervention. Traumatic brain injury was highlighted as a vastly under-recognised issue.

Mental health was another theme, with presentations focussing on evidence-based partnership approaches. The question of unintended consequences and fragile intersections between policing and mental health services was also raised many times: for example concerns that efforts to upskill police staff to better support people in mental health distress can lead to a scaling back of mental health services – and/or that scaling back of mental health services leaves police supporting individuals who need crisis treatment. This was a reminder that problems we are struggling with here in the UK are also being experienced internationally.

Colleagues from Public Health Wales presented on their Early Action Together programme which marries an academic and a practical intervention-focussed approach to Adverse Childhood Experiences (ACEs) and trauma informed services. ACEs were discussed in many of the presentations throughout the conference, and there was a strong commitment to early intervention and prevention.

There were many other strands of law enforcement and public health being explored – prison health featured strongly, with presentations ranging from the impact of austerity in English prisons to needle exchange programmes. Other sessions explored the role of public health and law enforcement collaborations to address alcohol; drugs; race; particular needs of indigenous and other marginalised communities; and the role of technology.

The oration was given by Professor Sir Michael Marmot and was a definite highlight of the conference. He spoke with clarity and energy about inequalities in a way that brought together the potentially quite disparate audience of academics and practitioners, from across law enforcement and public health. The intersection of evidence base and passion for social justice is always music to the ears of public health people – but to witness it also being shared equally by a conference hall of law enforcement professionals was a special moment.

Our focus as we presented the work that we’ve done to develop, agree and implement the policing and health consensus is also very upstream, and it was a privilege to be able to share that with colleagues from around the world. One of our main strengths so far in England has been our partnership approach, and we hope that as we collaborate with our colleagues internationally with their strong academic, evaluation and intervention skills we can together grow and embed a holistic approach to public health and policing that will demonstrably improve outcomes for the most vulnerable in society that we are all here to serve. We look forward to sharing our progress at LEPH 2019 in Edinburgh.

Written by Helen Christmas, Specialty Registrar in Public Health at PHE, and Supt Justin Srivastava, Lancashire Constabulary. You can follow Helen on Twitter @helen_christmas and you can follow Justin @SuptSrivastava. If you’re interested in policing and public health, you can also follow @police_health.