Youth violence

Youth violence impacts individuals, families, communities and society. Public health approaches to tackling violence have reduced rates of physical injury in parts of the UK.

Youth violence - 103 deaths from sharp objects (under 24 year olds) in England and Wales 2017/18

Background

  • Youth violence is understood as violence either against or committed by a child or adolescent, which can impact on individuals, families, communities and society.
  • Youth violence should be considered a matter of public health concern, as young people’s health and social outcomes are worsened through increased exposure to violence. There are resource implications across the system, both in the short term to deal with injuries, but also the long-term implications for an individual’s physical and mental health, given that exposure to violence increases the risk of substance abuse, obesity and illnesses (eg cancer and heart disease)1.
  • Causes of youth violence are complex, and risk of committing or being affected by young violence is associated with: adverse childhood experiences, access and availability of youth support and / or mental health services, and socioeconomic deprivation.2, 3
  • This indicator measures physical violence, calculated using weighted contributions from surveys and other routine statistics including emergency admissions to hospital, using physical violence as a measure for youth violence. This covers all aspects of violent assault (e.g. assault by bodily force or by use of an object or substance). Injuries incurred by sharp object are compared with physical injuries sustained by all other means.4
  • Statistics for physical violence among young people may both under- and over-estimate true prevalence. Stigma or fear may mean that the true reasons for sustaining injury are not disclosed (and therefore recorded), either to police, healthcare staff or in survey data. It is important to acknowledge, too, that the increase in awareness, especially around knife crime, may result in an increase in reporting of incidents that involve violence.

Last year there were loads of terrorist attacks - no one knew what to do and still got hurt.

Young person speaking to RCPCH &Us

Key findings

  • Rates of physical violence among young people are broadly similar across the four nations, however England is the only country in which rates are increasing for all age groups.
    • In Wales, Scotland and Northern Ireland, physical violence among young people aged 10-24 shows an overall downward or stable trend from 2012-2017.
    • In England, there has been an increase over the same period for all age groups – most notably for 20-24 year olds, which increased from 297.7 to 315.5 per 100,000 from 2012 to 2017.
    • England also has appreciably higher rates of physical violence among children aged 10-14 years than the other UK nations.
  • The rate of young people sustaining injury from sharp objects, while lower than injuries sustained from other forms of violence, is increasing.
    • From 2012 to 2017, the incidence is rising in England aged 15-19 (35.3 to 38.3 per 100,000) and aged 20-24 (44.4 to 49.9 per 100,000) and in Wales aged 20-24 (46.9 to 48.8 per 100,000).
    • Trends are stable or decreasing for the same age groups in Scotland and Northern Ireland. Positive trends in Scotland may be attributed to the longer-term effects of the public health approach that Scotland adopted in 2005 to tackle youth violence.5
  • Older age groups are more likely to engage in physical violence (including by sharp object), and young men aged 20-24 in particular.
    • In the UK, young people aged 20-24 are more than three times as likely than those aged 10-14 to suffer injury by sharp object.
  • Death recorded as homicides by a sharp instrument remain uncommon among those aged 0-17 years. It is much higher among young people aged 18-24 years, and shows recent increase.
    • In England and Wales, there were 23 homicides by sharp instrument recorded in 2018/19 among 0-17 year olds. For 18-24 year olds, the figure was 60 – a reduction from the record high of 82 recorded the previous year.
  • Prevalence of serious youth violence is most common within urban areas, although it is also rising within smaller towns and rural regions.6, 7

Data sourced from the Global Burden of Disease database using the following selections: Measure: Incidence, age bands 10-14, 15-19 and 20-24, years 2012-2017, Context: Cause, Cause: C.3.2.2 Physical violence by sharp object and C.3.2.4 Physical violence by other means, Location: England, Wales, Scotland, Northern Ireland, Sex: Both, Male, Female, Metric: Rate.8

Data sourced from the Global Burden of Disease database using the following selections: Measure: Incidence, age bands 10-14, 15-19 and 20-24, years 2012-2017, Context: Cause, Cause: C.3.2.2 Physical violence by sharp object and C.3.2.4 Physical violence by other means, Location: England, Wales, Scotland, Northern Ireland, Sex: Both, Male, Female, Metric: Rate.8

Data sourced from the Global Burden of Disease database using the following selections: Measure: Incidence, age bands 10-14, 15-19 and 20-24, years 2012-2017, Context: Cause, Cause: C.3.2.2 Physical violence by sharp object and C.3.2.4 Physical violence by other means, Location: England, Wales, Scotland, Northern Ireland, Sex: Both, Male, Female, Metric: Rate.8

Data sourced from the Global Burden of Disease database using the following selections: Measure: Incidence, age bands 10-14, 15-19 and 20-24, years 2012-2017, Context: Cause, Cause: C.3.2.2 Physical violence by sharp object and C.3.2.4 Physical violence by other means, Location: England, Wales, Scotland, Northern Ireland, Sex: Both, Male, Female, Metric: Rate.8

What does good look like?

Obtaining a clear understanding of the size of the problem. In order to address the rise in serious youth violence, we need robust data on the factors that predispose young people to serious violence, in order to appropriately target preventative interventions and funding for the most vulnerable young people.

Adopting a public health approach to youth violence. A whole system, public health approach is needed to prevent youth violence and ensure young people have adequate access to support.9 A public health approach entails investment to minimise social risk factors, early identification and intervention in those at risk, and requires a coordinated approach across public and social services including health, policing, social care and youth services. This approach has proven successful in Scotland, where youth violence in 20 to 24 year olds has decreased following introduction of the Violence Reduction Unit in 2005,10 and is an approach that has now been adopted in England’s Serious Violence Strategy.11

Reducing poverty and inequalities. There is strong evidence linking deprivation and vulnerability to knife crime,12 alongside links between school exclusion and knife crime and serious violence. This evidence points towards adopting a broad population wide approach focussing on addressing the social determinants of health, with enhanced interventions to support the communities most at risk. In particular, engaging those young people who have had involvement with the justice system (whether themselves or their families) provides an opportunity to influence the trajectory of the most vulnerable young people.13

Increased access to effective youth support services for young people. Over the past five years there has been cuts to universal youth services and youth clubs,14 which provide safe places for vulnerable young people to spend time.

Maintain focus on a life course approach to the root causes of youth violence. The foundations for youth violence are often laid in adverse childhood experiences, and it is important that a whole system approach to reducing youth violence recognises the impact of events much earlier in the life course. This must include upstream interventions, early years investment, family support and contextual safeguarding (which focuses on safeguarding children and young people from extra-familial factors which feature violence and abuse).

Policy recommendations

  • UK Government should adopt a preventative, multi-agency public health approach to tackling youth violence in England. A public health approach should incorporate: exposure to available services, prevention of youth violence, reducing risk factors which make young people vulnerable to violence, and increased work with communities. The approach should draw on comparable schemes (e.g. Violence Reduction Unit Scotland and Violence Reduction Unit London).
  • We welcome the UK Government’s £500m commitment to provide a Youth Investment Fund to deliver new youth centres and mobile facilities alongside refurbishment of existing centres; which should be provided in full. Youth services should provide multidisciplinary services (eg healthcare, mental health services, youth workers and police) and be prioritised in areas with high levels of deprivation.
  • Scottish Government should continue to resource and fund the Scottish Violence Reduction Unit, which provides a preventative, multi-agency public health approach to tackling youth violence.
  • Local Authorities should be provided with additional funding for youth services.
    • Youth services should provide multidisciplinary services (eg healthcare, mental health services, youth workers and police) and be prioritised in areas with high levels of deprivation.
  • Welsh Government should adopt a preventative, multi-agency public health approach to tackling youth violence. A public health approach should incorporate: exposure to available services, prevention of youth violence, reducing risk factors which make young people vulnerable to violence, and increased work with communities. The approach should draw on comparable schemes (e.g. Violence Reduction Unit Scotland).
  • Local Authorities should be provided with additional funding for youth services. Youth services should provide multi-disciplinary services (eg healthcare, mental health services, youth workers and police) and be prioritised in areas with high levels of deprivation.
  • Northern Ireland Executive should adopt a preventative, multi-agency public health approach to tackling youth violence. A public health approach should incorporate: exposure to available services, prevention of youth violence, reducing risk factors which make young people vulnerable to violence.
  • Northern Ireland Executive should ensure funding for the Department of Education to provide youth services across Northern Ireland.
    • Agencies should collaborate to provide youth services in local areas (eg healthcare, youth workers, police and third sector organisations).
    • Youth outreach workers and community youth projects should be prioritised in urban areas and supported with mental health provision.

What can health professionals do about this?

  • Child protection and contextual safeguarding. Keep in mind that youth violence may be a symptom of child abuse, both within the context of the family or trusted adults, but also the societal context in which the young person lives.
  • Make every contact count: Children and young people who suffer violence-related injuries may present to healthcare settings, often at a time when they are vulnerable or afraid. They may also discuss issues beyond their immediate, physical complaint with a trusted health professional. These “teachable moments” may represent a psychologically salient opportunity to signpost them to further support and to positively influence their future behaviours, either by professionals themselves, or sometimes by embedded youth workers trained specifically to engage with young people who encounter violence.15

Contributing authors

  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor

Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

References

(1)

Department of Health (2012) Protecting People, Promoting Health: A public health approach to violence prevention for England. Centre for Public Health: WHO Collaborating Centre for Violence Prevention.

(2)

HM Government (2018) Serious Violence Strategy.

(3)

GLA Strategic Crime Analysis Team CIU (2019) A Public Health Approach to Serious Youth Violence: Supporting Evidence.

(4)

It should be acknowledged that not all young people who have experienced physical violence will present to hospital, and so the data presented here does not provide a wholly accurate rate of physical violence incidence.

(5)

Violence Reduction Unit (2009) Scottish Violence Reduction Unit: 10 year strategic plan.

(6)

Allen, G., Audickas, L., Loft, P. & Bellis, A. (2019) Knife crime in England and Wales. House of Commons Library: Briefing Paper. SN4304: 30 September 2019.

(7)

National Crime Agency (2019) Intelligence Assessment: County lines drug supply, vulnerability and harm 2018. NAC(19)095: January 2019.

(8)

Global Burden of Disease Study 2017. IHME Data, GBD Results Tool. Available at: GHDX (accessed January 2020)

(9)

Public Health England (2019) Whole system, multi-agency approaches to serious violence prevention – a resource for system leaders

(10)

Violence Reduction Unit (2009) Scottish Violence Reduction Unit: 10 year strategic plan.

(12)

MOPAC: Mayor of London (2018) Review of the Metropolitan Police Gangs Matrix

(13)

Public Health England (2019). Collaborative Approaches to Preventing Reoffending in Children (CAPRICORN): A resource for health & justice system leaders to support collaborative working for children and young people with complex needs

(14)

Department for Education (2018) Expenditure by Local Authorities and Schools on Education, Children’s and Young People’s Services in England, 2017-18.

(15)

Seal M, Harris P (2016). Responding to youth violence through youth work. Policy Press, UK.