This document summarizes a presentation given by Professor John Middleton on better evidence for better law enforcement and public health. It discusses the roles of various public health organizations in Europe, such as EUPHA and ASPHER. It provides examples of effective public health interventions including pre-school programs, harm reduction approaches, and healthy urban planning. It emphasizes taking a multidisciplinary, evidence-based approach to issues like crime prevention. The presentation addresses topics like adverse childhood experiences, mental health, climate change, and human rights in relation to public health and law enforcement.

1. Voicing knowledge. Enhancing capacity.
Law Enforcement and Public Health PHDF
preconference workshop
Better evidence for better law enforcement
and public health
Professor John Middleton, President, the Association of
Schools of Public Health in the European Region

2. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
What is EUPHA ?
• An umbrella organisation for public health associations and
institutes in Europe. EUPHA now has 86 members from 47
countries:
• EUPHA is an international, multidisciplinary, scientific
organisation, bringing together around 25’000 public health
experts for professional exchange and collaboration
throughout Europe.
• We encourage a multidisciplinary approach to public health.

3. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
What is ASPHER ?
The Association of Schools of Public Health in the European Region
(ASPHER) is the key independent European organisation dedicated to
strengthening the role of public health by improving education and
training of public health professionals for both practice and research.
We have 120 member schools of public health in Europe and
associates around the globe.
We are part of the WHO Coalition of Partners in European public
health
And we are developing our partnerships with sister public health
organisations in America, Africa, Asia, Australasia and the Arab world

4. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
• Experience of 40 years of working with the police in
public health and safety issues
• Experience of 19 years working with the ‘Safer Sandwell’
crime and disorder partnership
• What works ? And why does it matter
• The Campbell collaboration
• West Midlands Crimegrip ®
• UK Faculty of Public Health: role of public health in
violence prevention
• Knife crime, and the public health approach to preventing
crime
• Policing and public health in the climate breakdown era
• Law, ethics, rights and values

5. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Public health is :
The science and art of promoting health and wellbeing,
preventing disease and prolonging life through the
organised efforts of society
Acheson 1988, after Winslow 1920, WHO 1948

6. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Other relevant definitions for the public’s health:
Sustainable development:
‘protecting resources from one generation to the next’ (Brundtland 1986)
Environmental justice:
‘the pursuit of equal justice and equal protection under the law for all
environmental statutes and regulations without discrimination based on race,
ethnicity, and /or socioeconomic status.’
Security:
freedom from danger, social, military, environmental (UNDP 1994)

7. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Coventry public health and
police work
1. Coventry Health Promotion Committee
Accident prevention
Health of staff in partner agencies
2. Children’s safeguarding
3. Child and adolescent mental health
review

9. Included chapters on all
WHO ‘pre-requisites for
health’ from Health for All
Strategy
including violence –
Peace, ‘being more than
the absence of war’

10. it's not who your
doctor is, it's
who you vote
for, that most
affects your
health

11. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

12. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
International review of best available research
evidence on most effective social and educational
interventions to prevent crime and improve
educational, social and health outcomes
www.campbellcollaboration.org

14. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Research evidence
• 1 Meta-analysis/ systematic reviews
• 2a Single randomised, controlled trial
• 2b Controlled studies
• 3 Observational studies
• 4 Informed opinions

15. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Why evidence based policy?
Things we do can do harm as well as good

16. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

17. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

18. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

19. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
West Midlands Crimegrip
• Early years interventions
• Mild to moderate behaviour disturbance in children
• Peer education and interactive education programmes
of drugs education
• Harm reduction approaches to drug treatment and
rehabilitation
• Cognitive behavioural approaches to offender
rehabilitation
• Streetlighting
• CCTV
• Restorative justice
• Alcohol brief interventions
• Scared straight

20. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Case study 1 Pre-school interventions
Perry Pre-school study

21. 0 10 20 30 40 50 60 70
Did homework at age 15
In program for mental impairment
IQ at 5 90 or more
9th %ile or better in school at 14
Average or better literacy at 19
Data from the High/Scope Perry preschool project. Bars represent percentage in each of the
two groups. The difference in major educational performance findings between program
and non-program children is significant.
Program No program

22. 0 20 40 60 80
5 or more arrests by age 27
Soc.Services ever in previous 10 years
High school graduate
Home owner at age 27
$2000 or more monthly pay
Further data from the High/Scope Perry preschool project. Benefits from the program
continue to be seen in adulthood. Bars represent percentages of each of the groups The
difference between program and non-program children is significant.
Program No program

23. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
In education, Highscope:
‘If it was a drug, it would be
unethical not to use it’

25. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

26. Teenage Conception 1998-2012
Sandwell's reduction since baseline (44%) is higher than England & Wales's
reduction of 40.8%. The West Midlands reduction has also been lower than
Sandwell at 42%. Figure 1, above, show that the gap between Sandwell and
England is reducing further.

27. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Case study 2
Harm reduction and methadone
maintenance

30. Marsch Addiction 1997

31. Domestic burglary Sandwell 2001-2005
Full implementation
drug intervention
project doubling
numbers of drug users
in treatment
1300 fewer
domestic
burglaries
33% fall

34. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Why evidence based policy?
Things we do can do harm as well as good

35. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
West Midlands Crimegrip®
No: ‘Scared straight’
No: didactic drugs education lectures in schools
by uniformed staff eg. ‘DARE’
No: driver education for under 17s
No: CCTV- except for car parks!

37. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

38. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

41. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
The Observer 20th June
2010

44. UK Responsibility deal has
failed to deliver - control of
advertising and marketing to
young people
Been used to delay regulatory
and fiscal actions - increasing
real price of alcohol
Scotland 1 year into Minium
unit price, wales about to
implement
as has been done now in British
Columbia, Saskatchewan and
soon in South Africa

45. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
• ‘Evidence-based crime reduction’: further actions
Home visiting expansion ; FNP national evaluation not so positive
effect size
Environmental designing out crime and the Sandwell Healthy
urban Development Unit
20 mph zones
Domestic violence strategy and investment
Shared protocols for domestic violence, drug and alcohol and
children’s safeguarding
Multiagency safeguarding hub
‘Hotspots policing’- ‘tasking’?

47. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Case study 3
Healthy safer town planning

48. http://www.local.gov.uk/web/guest/health/-
/journal_content/56/10171/3511175/ARTICLE-TEMPLATE

55. Neighbourhood policing :
Real time information
Neighbourhood tasking
Prompt response to
Anti- social behaviour
and
Environmental crime

56. North west Public
Health Observatory,
Liverpool John Moores
University. Mark Bellis
et al

57. The epidemiology of violence
Evidence-based violence prevention: a life course approach
Asset based community development
Primary, secondary &tertiary prevention role of the public health
community as primary preventers of violent conflict, through healthy public
policies and tackling major social inequalities in health; and as early reactors,
mitigaters and responders to violence.
New public mental health approaches
A role for public health in conflict resolution with aid agencies,
political scientists, theologians and international lawyers
A role for public health educational bodies
A leadership and partnership role for public health
www.fph.org.uk/uploads/Violence%20report.pdf
Areas of action for the public health
community in preventing violence

58. Crucial importance of early years, the first 1001 days and
adverse childhood experiences
An evidence based approach – Good systematic reviews re
early years interventions, parenting training, youth
mentoring; good modelling of alcohol pricing, control of
access and enforcement.
A life course approach- new concerns about adverse
childhood experiences (ACES) impacts on violent behaviours,
poor communication and poor mental health in later life
A public mental health approach- linked to ACEs, the
neurobiological hardwiring of young brains in the first 1001
days; Reinforcing positive mental attributes: self-confidence,
self-esteem, self-expression and positive communication
A public health approach to violence prevention
Early Death
Social, Emotional and
Learning Problems
Adopt Health Harming
Behaviours and Crime
Disrupted Nervous, Hormonal
and Immune Development
ACEs Adverse
Childhood Experiences
Non Communicable Disease, Disability,
Social Problems, Low Productivity
LifeCourse
Death
Birth
Adverse Childhood Experiences (ACEs): impacts across
the life course. adapted from Felitti et al, 1998

59. A public health approach to violence
• From problem identification to
effective response
Define the problem:
Data collection,
surveillance
Identify causes:
Risk factor
identification
Develop and test
interventions:
Evaluation research
Implement
interventions,
measure
effectiveness:
Community
intervention,
training, public
awareness
(Adapted from: Mercy et al. 1993)

60. 22/10/2019 60

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63. 6322/10/2019

64. Sandwell last drink survey 2013

65. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

67. A role for our climate
change special
interest group

68. Interconnectedness:
conflict over natural
resources: oil, water

69. Interconnectness:
Climate change
refugees

70. Interconnectness: Loss of agricultural land through global
warming, crop failure, food riots, Arab Spring, Syrian war

71. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Law,
Ethics,
Rights,
Values

72. http://www.un.org/en/uni
versal-declaration-human-
rights/index.html
22/10/2019 72
December 10th 2018: 70th anniversary of
the universal declaration of human
rights

73. Human rights are everyone’s business
“Where, after all, do universal human
rights begin? In small places, close to
home … they are the world of the
individual person; the neighborhood he
lives in; the school or college he
attends; the factory, farm, or office
where he works”
Eleanor Rooseveldt

74. Scotland’s National Action Plan
for Human Rights

75. William Beveridge designed a
welfare state for the UK in the
deepest point of the Second
World War.
‘We should regard want,
idleness , ignorance,
squalor and disease as
enemies of us all. That is
the meaning of a social
conscience; that we refuse
to make our separate peace
with evil.’

76. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Asset based public health
Community assets

77. 77
Asset based public health
Community assets: Community health
network, Youth Cabinet, Ideal for All
Independent Living Centre, Options for
life, Agewell,

78. Where there is no vision the
people suffer
Andrija Stampar,
Yugoslavian Public health
pioneer and WHO founding
father
After Proverbs/29-18.

80. Better evidence for better law enforcement and public health John Middleton, LEPH 2019

81. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Thank you
Professor John Middleton
Wolverhampton University
Chester University
President, Association of Schools of Public Health
in the European Region (ASPHER)
John.middleton@aspher.org

82. Better evidence for better law enforcement and public health John Middleton, LEPH 2019
Acknowledgements , declaration of interests
• John Middleton has been supported in this work by grants from the West Midlands Branch of the Home Office
2001-2005; the National Institute of Health Research through the Collaboration for Leadership in Applied Health
Research and Care (CLARHC) 2008-2014, and through the funding and support of Sandwell primary care trust,
Sandwell Metropolitan Borough Council and West Midlands Police in Safer Sandwell Partnership.
• He has been generously supported in attending and speaking at the LEPH conference by the European Public
Health Association and the Association of Schools of Public Health in the European Region.
• The views expressed are his own.
• Thanks to Prof Richard Lilford, Sir Iain Chalmers, Gavin Butler formerly WM Home Office and all those involved in
Crimegrip, CLARHC and the Safer Sandwell Partnership, Prof Jonathon Shepherd, Cardiff violence reduction
partnership, Professor Mark Bellis, Bangor University and Public Health Wales.

83. Appendix
UK Faculty of public Health Statement on violence
prevention and the role of public health
References

84. The epidemiology of violence
Evidence-based violence prevention: a life course approach
Asset based community development
Primary, secondary &tertiary prevention role of the public health
community as primary preventers of violent conflict, through healthy public
policies and tackling major social inequalities in health; and as early reactors,
mitigaters and responders to violence.
New public mental health approaches
A role for public health in conflict resolution with aid agencies,
political scientists, theologians and international lawyers
A role for public health educational bodies
A leadership and partnership role for public health
www.fph.org.uk/uploads/Violence%20report.pdf
Areas of action for the public health
community in preventing violence

85. Global & local violence-epidemiology and evidence
www.euro.who.int/violenceinjury
www.who.int/violence_injury
www.who.int/gender
◀️Middleton
J, Sidel V.
Terrorism &
public
health. In
Promoting
Public
Health.
Open
University
and Sage,
2007
Global deaths from interpersonal and collective violence,
2005 and 2015
0
100000
200000
300000
400000
500000
600000
2005 2015
Numberofdeaths
Collective violence
Bellis, M.
A.et al.
London:
NHS and
Dept. of
Health,
2012▶️
Source: GBD 2015 Mortality
and Causes of Death
Collaborators, 2016

86. References and resources
Resources :
REWIND http://www.rewind.org.uk
http://www.quilliamfoundation.org/about/
Institute for Strategic Dialogue
http://www.strategicdialogue.org
WAVES Trust
www.wavestrust.org.uk/home.html
Parent Infant Partnership
http://www.pipuk.org.uk
ECPAT http://www.ecpat.org.uk
TASC http://tascwheel.com
Centre for Nonviolent Communication
www.cnvc.org
Medical peace work. Online course work,
course part Health professionals, conflicts
and peace. Berlin: Medical Peace Work,
2015.
http://www.medicalpeacework.org/teaching-
resources/mpw-presentations.html
References
Bellis, M. A., Hughes, K., Perkins, C., Bennett, A. M.,
Protecting people, promoting health: a public health
approach to violence prevention for England. London:
NHS. and Department of Health, 2012.
World Health Organization. (2014). Global status report on
violence prevention 2014.
http://www.who.int/violence_injury_prevention/violence/status_
report/2014/en/ update on WHO (2002). World report on
violence and health. Geneva, WHO
Galtung J (1996). Peace by peaceful means: peace and
conflict, development and civilisation. London, Prio/Sage.
Mercy J et al. (1993). Public health policy for preventing
violence. Health Affairs. Winter:7-29.
Rosenberg M (2003). Nonviolent communication: a
language of life. Encinitas, CA, Puddle Dancer Press.
Santa Barbara J, MacQueen G (2004). Peace through health:
key concepts. The Lancet 364:384-5.