Douglas Noble on the riots

douglas nobleThe recent riots in London and across the UK have been an awakening for many to realise the deep seated social problems in post modern British society.  The right look for thugs to be prosecuted, while the left demand further description and analysis of the complex “causes of the causes.” Both approaches are polarised and neither is satisfactory. 

A current BMJ editorial poses the idea that the riots and the ensuing societal implications are also the business of public health. They go on to argue that from the perspective of loss of life, casualties, and psychological trauma, that crime and its underlying causes should not be left out of any discussion on the wider determinants of health. Despite having created the perfect platform for a discussion about the interventions to tackle the underlying causes of the riots (not the immediate control) the authors diverge into a discussion about different research techniques that could be used to explain this threat to public health. Setting up a case control trial at this point in time to better understand the “causes of the causes” seems unnecessary. This will only play to the classical criticism of public health – we describe eloquently, but fail to act. 

There comes a time to stop describing and start intervening. We already know many of the complex causes of the riots. The big causes are uncomfortable to the right and left – stark income disparities, deprivation, and health inequalities, to suggest but a few. The right object because it damages the prospect of blaming “the thugs,” the left because they failed in 13 years of government from 1997 to seriously do anything about them. 

The “causes of the causes” spiral in endless further complexities – joblessness, illiteracy, absent parents, etc. All have multiple underlying contributors, but we are aware of many of these as well – from being advised by the job centre not to take employment because it pays marginally less than benefits, to educational techniques that have so valued learner driven objectives and scorned rigorous assessment, that in some parts of London a third of children own no books and 20% leave school unable to confidently read and write. As for the destruction of community spirit, life, and values – which might protect against rebellious and anarchist elements looting and rioting – with lifetime risk of divorce estimated at 45%, the chances of long term stable families and communities are slim.

These are only some of the examples of deep social problems intrinsically linked to health and wellbeing that we know only too well.  So please let’s not use the riots as an excuse for endless research, inquiries, and paralysis by analysis. Now is the time to act.

Douglas Noble has worked in surgery, emergency medicine, public health and for WHO. From 2006 to 2008 he was clinical adviser to the chief medical officer for England. You can follow him on twitter @douglasnobleMD