Elsevier

The Lancet

Volume 393, Issue 10168, 19–25 January 2019, Pages 287-294
The Lancet

Series
Law enforcement and public health: recognition and enhancement of joined-up solutions

https://doi.org/10.1016/S0140-6736(18)32839-3Get rights and content

Summary

Public security and law enforcement have a crucial but often largely unacknowledged role in protecting and promoting public health. Although the security sector is a key partner in many specific public health programmes, its identity as an important part of the public health endeavour is rarely recognised. This absence of recognition has resulted in a generally inadequate approach to research and investigation of ways in which law enforcement, especially police at both operational and strategic levels, can be effectively engaged to actively promote and protect public health as part of a broader multisectoral public health effort. However, the challenge remains to engage police to consider their role as one that serves a public health function. The challenge consists of overcoming the continuous and competitive demand for police to do so-called policing, rather than serve a broader public health function—often derogatively referred to as social work. This Series paper explores the intersect between law enforcement and public health at the global and local levels and argues that public health is an integral aspect of public safety and security. Recognition of this role of public health is the first step towards encouraging a joined-up approach to dealing with entrenched social, security, and health issues.

Introduction

The health of the public requires and is dependent on the safety and security of the individual; therefore, public health as a discipline promotes safety and security. The law exists to promote safety and security and the enforcement of law is part of the same endeavour. The public health and law enforcement sectors should work together with overlapping goals and collaboration to achieve safety and security for populations. The fact that they are often unable to achieve, or inadequately achieve efficient collaboration, even when dealing with the same populations or issues, is to the detriment of both sectors.

Although the past few decades have shown an unprecedented growth in collaboration between these sectors, especially in welfare states in developed countries, the collaboration has not led to a unified political agenda. Consequently, there is a permanent and real risk of returning, perhaps temporarily (but at great cost), to the specialisation perspective of the industrial era, especially considering the trends of austerity and neo-liberal ideology in many developed countries. Increased worries about state security, encompassing mass migration, terrorism, and economic insecurity, could lead to a return to a siloed approach in dealing with problems, emphasising the importance of forging structural collaborations on the basis of interdisciplinary evidence. In this Series paper we focus on high-income countries specifically. However, developing countries, with their surfeit of complex social problems magnified by the complications of democratic fragility, have even more to gain from a coherent understanding and complementarity coordination of law enforcement and public health efforts.

Section snippets

At the boundaries of established fields

The global population is faced with complex social issues that have an effect on health and criminal justice, including social and economic inequalities; vulnerability to violence, especially gender-based violence in domestic settings; mental health crises; alcohol and drug dependence and related harms such as HIV infection; dementia and expected increases in calls for assistance; and modern slavery and human trafficking. Recognition of the multidimensional character of such issues is

An emerging agenda

Public health and law enforcement are products of the process of modernisation, intimately related to the state and to urbanisation. In (hypothetical) small communities in which all individuals know about the condition and behaviour of others, separate institutionalised and professional law enforcement and public health would be absent. Therefore, modern public health and law enforcement replicate the support provided by kin in small communities that has been lost in the rise of modern life and

Areas of common ground for law enforcement and public health

Substantive themes for the International Conference on Law Enforcement and Public Health (LEPH) 2016—reflecting the priorities assigned by the burgeoning law enforcement and public health community—were mental health (many aspects), violence (especially gender-based), trauma (especially road and occupational), crises and catastrophes, infectious diseases, and alcohol and other drugs. However, the range of topics that was covered 2 years later at LEPH 2018 was even wider than in 2016, and

The challenge of meaningful collaboration

An analysis of health and welfare service provision to individuals with complex needs found that combining medical and social models was very difficult, because they have different financial and regulatory systems, roles and responsibilities, and organisational and professional cultures.45 The analysis did not include collaborations with law enforcement. Although societal problems are at the centre of the endeavours of both law enforcement and public health, the organisation principles and

What could the relationship look like?

The fact that law enforcement and public health address the same or related problems in the same communities does not automatically lead to cooperation; they are distinct in culture and methods. Two levels of linkage are needed to support effective cooperation. One consists of a conceptual interface between the fields, at which they can achieve a shared understanding of their respective contributions to each other's mission; a simple model of health and policing that shows how police activities

Conclusion

The emerging agenda regarding the intersectoral field of law enforcement and public health is that a holistic approach will generate the best results, but it seems very hard to achieve this approach in practice. The gap is increasing between knowledge of actions necessary to deal with complex social problems—both in law enforcement and public health—and what can be achieved, which is related to the mismatch between classic institutions and the increased demands for security and health. The

Acknowledgments

We are grateful to Maurice Punch who reviewed an early version of the manuscript.

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