Safety means different things to different people. In Europe, the safe-communities movement has mainly focused on preventing unintentional injury (so-called “accidents”).
But in the U.S., and to a large degree in Canada, it has focused more on prevention of intentional injury, even though this is much less common than unintentional injury.
There are two main forms of intentional injury: deliberate injury to oneself (suicide and attempted suicide) and deliberate injury of others (homicide and assault). The latter are often what people have in mind when they think about a safe community, although homicide and assault are much less common than suicide and attempted suicide.
A 2015 report from the B.C. Injury Research and Prevention Unit found that between 2010 and 2014, suicide accounted for almost one-quarter of all injury deaths in B.C., while homicide represented only two per cent. Similarly, while attempted suicide and self-harm accounted for 5.5 per cent of hospitalization for injury, assault was just 2.7 per cent.
The prevention unit also reported that unintentional injury resulted in more than 1,400 deaths, 30,000 hospitalizations and 435,000 ER visits in 2010, while intentional injury accounted for more than 560 deaths (more than 500 were from suicide) but only 4,000 hospitalizations and 17,000 ER visits. Nonetheless, the total cost of violence in B.C. that year was $157 million, including $84 million in health-care costs.
But the health impact of violence does not come from just physical assault and injury; it also includes mental and emotional harm, and the costs are not just in health care but in emotional trauma and disrupted lives and communities, effects that can last decades, lifetimes, even generations. Violence can take many forms, including bullying, harassment, abuse and neglect, and can occur in many settings and affect many groups, but several categories stand out.
First comes domestic violence, which includes child and elder abuse and neglect as well as spousal and intimate partner violence. Harassment, bullying and sometimes violence are found among young people in schools and among adults in workplaces, while elder abuse and neglect can be seen in care facilities. Finally, there is violence in the community, everything from online abuse and harassment to road rage, sexual assault and random or targeted assaults, including racist and Islamophobic violence and abuse.
In all these settings, certain groups are more vulnerable and/or more targeted, including women, children, the elderly, Indigenous people, LGBTQ people and various ethno-racial or religious groups — and clearly, people can be members of several of these groups. But what this tells us is that much violence is deeply rooted in cultural and social values that have to do with power, on the one hand, and fear and hatred on the other. So violence prevention will take significant social and cultural change.
I have always been impressed by the work of Irvin Waller, a criminologist at the University of Ottawa and a world expert on prevention of violence. He is clear that this is much more than simply a matter of law and order, policing and punishment.
Just as public-health workers advocate for upstream interventions to keep people healthy, rather than downstream interventions to fix them when they are sick, Waller provides the evidence that “reductions in violence against women, street violence and homicides by 50 per cent are all achievable within a five- to 10-year period by investments in early prevention” — and observes that this is a cheaper approach to reducing crime.
He points to “investments in people such as youth outreach, positive parenting programming and social interventions in emergency rooms.” And he adds there is evidence that “modifications in school curricula to make achievement in life skills and healthy relationship skills stop violence.” So, he asks: “Why not make them as important and measured as writing, reading and arithmetic?”
This approach — what Waller calls “compassionate community safety” — was epitomized recently by Ted Upshaw, the public safety adviser for Halifax and a former RCMP inspector. In a session on healthy communities at the Canadian Public Health Association conference this year, he discussed the importance of social justice, respect, good-quality housing and neighbourhoods, access to parks and other social and community benefits if we are to create safe and healthy communities. It makes sense to me.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.