Partners in prevention: the role of health systems in the prevention of youth violence in post-conflict Northern Ireland

Crime Prevention and Community Safety (2022) 24:369–386 https://doi.org/10.1057/s41300-022-00159-9 ORIGINAL ARTICLE Partners in prevention: the role of health systems in the prevention of youth violence in post‑conflict Northern Ireland Colm Walsh1 · Ryan Smyth2 Accepted: 24 August 2022 / Published online: 9 September 2022 © The Author(s), under exclusive licence to Springer Nature Limited 2022 Abstract Interpersonal violence is a wicked and complex issue with youth disproportionately affected. Its effects are multifaceted, placing an additional burden across systems. Despite this, there continues to be an exclusive focus on police recorded crime data in the context of post-conflict Northern Ireland. Given the enduring issue around police legitimacy, it is likely that police-related crime data are limited in its capacity to estimate incidences and trends of youth violence. Leveraging insights from other sources of data can add significant value in the prevention of youth violence. For example, there is significant utility in the use of health-related data in the prevention of higher-harm violence; however, in the context of Northern Ireland this has been under-evaluated. This retrospective cohort study sought to illustrate what could be gleaned using a novel approach to Emergency Department (ED) data. Routinely collected data captured from youth aged 12–25 attending an ED trauma centre for violence-related injuries between August 2020 and August 2021 were collated, coded and analysed. We found that young men were most likely to present to ED with violence-related injuries; incidences were temporally clustered across several months of the year (i.e. Summer); and younger aged youth were at greater risk of violencerelated injuries during the afternoon and early evening. These findings illustrate the utility of health data for violence prevention and the potential for integrating administrative datasets in the design of prevention policy. Limitations and implications for practice are discussed. Keywords Youth violence · Public health · Prevention * Colm Walsh 1 School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK 2 Western Health and Social Care Trust, Londonderry, Northern Ireland Vol.:(0123456789) 370 C. Walsh, R. Smyth Violence is a significant youth issue Despite significant reductions during the late 1990s, there have been growing concerns about the increasing frequency and intensity of interpersonal violence. Globally, there are an estimated 500,000 people murdered each year, and this appears to be increasing at an annual rate of 2% (Mitis and Sethi 2015). Youth violence has received particular policy attention, with academic research consistently demonstrating that young people, particularly young males, are at elevated risk of violence-related harms (WHO 2011; Malik et al. 2020). Globally, five hundred young people die each day as a result of violence (Baxendale et al. 2012) and the scale is so vast that it may even be the said that most violence is youth violence. Administrative data suggest that interpersonal violence is the second leading cause of death for those aged 10–19 (WHO, 2016; UNICEF, 2017). In the USA, violence-related injuries are the leading cause of mortality for adolescents and account for elevated pressure on the health system (Hankin et al. 2014). For every fatality, there are approximately twenty other victims who require medical attention (UNODC 2019). In the UK, researchers have noted the rising trajectory of more serious injuries, including those caused by knives and sharps (Vulliamy et al. 2018; Wortley and Hagell 2020) with predictions that the public health implications associated with the Covid-19 era, and wider socio-economic impact could contribute to increased rates of violence (Ellis et al. 2021; Reid and Baglivio 2022). The impact of violence extends beyond the physical impact to also include bio-psychological morbidities (Junger et al. 2001), an indicator of the long arm of harm associated with violence. In the most recent Global Burden of Disease (GBD) report, both self-directed and interpersonal violence were among the top five causes of global Disability Adjusted Life Years (DALYS), and were the leading causes of mortality for individuals in the 10–24 age group (GBD 2020). This represented a rise in global DALYS between 1990 and 2019. But not all youth appear to be at the same risk. It seems that those in areas of higher deprivation (Hughes et al. 2014) and young males are at elevated risk of violent injury. In Northern Ireland (NI), there is growing evidence that violence continues to affect young people in a myriad of ways, and despite the transition towards peace, violence is highly clustered in areas where young people are exposed in the home, in the community and among peers, all of which take place in the context of ongoing paramilitary violence (Walsh and Gray 2021; Walsh 2022). Indeed, violence is the single most commonly experienced trauma among young people in Northern Ireland (Bunting et al. 2020). The benefits of leveraging health‑related data for violence reduction From both a policy and practice perspective, violence prevention efforts have been traditionally perceived as residing in the realm of justice, with greater focus placed on the deterrent effects of prosecuting perpetrators. This has presented several challenges. Firstly, this siloed approach ignores the impact on victims, Partners in prevention: the role of health systems in the… 371 the connections between victimisation and perpetration, and the wealth of data available that exists across other sectors that could increase preventative insights (Widom 1989; Lee et al. 2017; Hibdon et al. 2021). In contrast to the criminal justice focus on punitive responses, a public health framework places greater emphasis upon an upstream–downstream model (McKinaly, 1979), seeking to understand the needs of those most vulnerable to violence and its harms based upon known risk and protective factors. By understanding these more comprehensively, both victims and perpetrators can be supported at the earliest possible stage to prevent violence and interrupt pathways of harm. From a public health perspective, understanding incidences and trends of violence-related harm can help to provide a framework for a tiered response (Lee 2017). To achieve this however, triangulation of data is preferable to a reliance on single sector data. For example, medical records, such as those obtained by Emergency Department (ED), have been shown to add value to those insights already established from police-recorded crime data (Hibdon et al. 2021; Sutherland et al. 2021a, b). While one could reasonably assume an overlap between health and police data, studies have found that despite some overlap, police data do not fully, or accurately capture the extent of violence in the community (Hibdon et al. 2021). With only a partial view, both op (...truncated)