Culture and Disease Model – The Glasgow Experience

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The Home Secretary, Sajid Javid, says he may adopt a ‘public health’ model to tackle violent crime. What does he mean?

He is espousing the notion that violent behaviour is a kind of epidemic that spreads from person to person, infecting and reproducing itself. It has long been apparent that this is indeed how behaviours spread, whether in schools, prisons or on oil rigs. ‘Cultures’ or endemic behaviours do spread like disease and people ‘infect’ each other, or communities.

A US epidemiologist mapped the spread of disease in East Africa and found unmistakable parallels with the spread of violent behaviours in his native Chicago. Contact is the main factor needed for transmission and, as with HIV or cholera, the main mode of stopping spread is interrupting this transmission by contact. The culture in schools, or in a company, is the same. Often there is talk of one individual or group ‘infecting’ others. The cure seemed to be less about blaming the culprit/s than changing group norms.

An Unlikely Pioneer

In 2005 The World Health Organisation published figures showing that Glasgow was the ‘murder capital’ of Europe and it was not being improved by the traditional blame and punishment model. So, Strathclyde Police decided to do something different.  Its advisers concluded that many of the factors underlying violence – poverty, alcohol use, family breakdown, and ‘toxic’ masculinity – were outside the boundaries of policing, but they were indicators, causal factors, nevertheless. Therefore, in 2005, the VRU (Violence Reduction Unit) was formed. This Scottish police force became the first in the world to adopt the public health model of policing. It involved addressing the ‘causal factors’ underlying violent manifestations and behaviours. It involved breaking the links, eliminating the infection. And it involved bringing in other agencies to tackle these individual contributors. 

This strategy worked. Since the VRU was formed in 2005, the murder rate has dropped by half across Scotland and by 60 per cent in Glasgow itself. Conversely, the number of violent assaults and murders in London has increased sharply in recent years. It has been argued that London (and other large conurbations) has different and unique issues. But John Carnochan, co-founder of Glasgow’s VRU, disagrees. Violence in London, and elsewhere, he says, derives from “poor education, addictions, bad role models, absent fathers, mums with different partners – exactly the same as in Glasgow”.

In Scotland, the public health approach has worked. Blaming social conditions for violent offending, it has been said, risks removing any notion of individual culpability deserving of punishment, an abrogation of criminal responsibility for criminal actions. However, dealing with the underlying causes really seems to deliver. Though it is more expensive, spreading the load wide and involving other agencies and resources, it is a great deal cheaper than sending people to prison or mopping up the social costs of murder and endemic violence.

It is notable how seldom learning happens across sectors, or how difficult it is to convince people that blame or punishment do not help to eradicate negative behaviours. In A & E departments, schools, oil rigs, railways, or anywhere else, behaviours can be seen spreading, especially where there is discontent or where there are factions that spread ‘attitudes’. And there will be indicators that point to the dysfunctional culture – not necessarily major, but issues that create an atmosphere that means all is not well. And it is then, when things ‘happen’, that exploration or investigation is needed to uncover the ‘causal factors’ of the incidents or unhealthy outcomes.

Good leadership, as in Police Scotland, can uncover, through effective investigation, the causes to be dealt with. And that will take time. Each of the causal factors does not in itself potentially result in seriously dysfunctional outcomes but, dealt with together or selectively, after a thorough Root Cause Analysis, they can be remedied and learnt from so as to obviate further incidents or deviant behaviours. Left to themselves to fester, they will continue to infect their environment and the people in it, the ‘culture’, how things are done. Dealt with systematically and with imagination, though, a culture can be changed incrementally in whatever sector. Or whatever city!

Interestingly, public health and infection was little understood until not much over a century ago. But once it was understood, it became remarkably tractable. By having the same approach to dealing with the spread of maladaptive and at times violent behaviours, similar successes are being experienced. Mindless blame does not help; in-depth understanding and creative action does.