Regular dialogue between hospitals and police drastically lowering violent injuries
As many cities across the world are seeing a worrying rise in violent crime, some are taking a different approach to tackling it, based on a model developed in the UK.
The Cardiff model, which involves hospitals sharing data with local police to help reduce violent injury rates, has been adopted by cities across the US, Australia, South Africa, Canada, Jamaica, Colombia and The Netherlands, where it is dramatically lowering the rates of violence in each and championing a public health approach to violent crime.
It has also been endorsed by the World Health Organization (WHO).
In The BMJ today, Shivali Fulchand talks to the physician who led the development of the model, Professor Jonathan Shepherd at Cardiff University, about its continuing impact.
The model shares anonymous data collected by hospital emergency departments on the locations and times that violence occurs and the types of weapons used with local police so that violence “hotspots” can be identified and targeted.
At its heart are city violence prevention boards. These comprise health, local authority and police executives which, informed by the anonymised data from emergency departments, deploy violence prevention resources.
This collaborative approach (akin to the collaboration in NHS multidisciplinary teams), generates mutual accountability for violence prevention, says Shepherd. “This makes the model especially relevant in the United States and other countries where, as recent killings at the hands of the police illustrate, greater accountability is badly needed.”
Violence is the cause of 1.4 million deaths annually and considered a global health issue by the WHO. Homicide is the leading cause of death in 15-49 year olds in some countries, with deaths from homicide as high as 10%. In hospitals in England and Wales there were 190,747 emergency department attendances related to violent crime in 2017.
After the model was first introduced in the city of Cardiff in 2001, the number of violence related admissions and wounding crimes committed fell substantially and Cardiff was found to be the safest of 14 UK cities studied in 2007.
The model has since been rolled out across other UK cities and continues to deliver success.
An April 2020 report from the Cardiff University Crime and Security Research Institute showed a 45% drop in people treated at emergency departments after a violent crime in England and Wales since 2010. The national cost of violence in the UK has dropped from an estimated £75bn in 2004-05 to £44bn in 2015-16.
But the battle is far from won, argues Shepherd, pointing out that it was only in 2019 that the UK government announced a “public health duty” to tackle serious violence.
Shepherd believes implementation of the Cardiff Model is still one of the most effective ways to prevent the violence epidemic.
Implementation is still patchy, but new multi-agency violence reduction units are now funded by the Home Office, he explains. And, after the improvement in emergency department data collection in England in 2017, he believes that “there is every facility, and every reason, [for NHS trusts] to implement this.”